Female patient satisfaction with health care in the in vitro fertilization procedure

Uvod: Poznavanje pacientovih izkušenj z zdravstveno obravnavo predstavlja bistveno komponento pri ocenjevanju zdravstvene kakovosti. Na področju zdravljenja neplodnosti je to še posebej pomembno, saj ena tretjina neplodnih parov po zaključku zdravljenja ne rodi otroka. Poleg indikatorjev izidov zdravljenja so posledično zelo pomembni procesni indikatorji, kot je zadovoljstvo pacientov. Namen: Ugotoviti, kakšno je zadovoljstvo pacientk z zdravstveno obravnavo v postopku zunajtelesne oploditve v Sloveniji ter na katerih področjih zdravstvene obravnave je zadovoljstvo pacientk najnižje. Metode dela: Uporabili smo deskriptivno metodo raziskovanja. Oblikovali smo anketni vprašalnik in polstrukturirani intervju. Anketni vprašalnik je bil oblikovan s pomočjo odprtokodne spletne aplikacije 1Ka, v njem je sodelovalo 1010 žensk. Izpeljali smo tudi 13 intervjujev. Rezultati: Kvantitativni rezultati so pokazali splošno visoko zadovoljstvo z zdravstveno obravnavo. Najvišje zadovoljstvo so anketiranke izrazile s fizičnim vidikom zdravstvene obravnave (xŻ = 3.33, s = 0.890) ter z načinom komunikacije (xŻ = 2.89, s = 0.927) in informativno podporo (xŻ = 3.00, s = 1.006). Najnižje zadovoljstvo pa je bilo mogoče opaziti s celostnim pristopom k obravnavi (xŻ = 2.69, s = 1.021), čustveno podporo (xŻ = 2.67, s = 1.012) in organizacijskim vidikom zdravstvene obravnave (xŻ = 2.76, s = 0.949). Medtem pa so v kvalitativnih rezultatih prevladovali opisi negativnih izkušenj z zdravstveno obravnavo in predlogi za izboljšave. Razprava in zaključek: Pacientke so izrazile izredno pozitiven odnos v povezavi s kliničnem okoljem, opremo in higienskim standardom ter z lajšanjem bolečine med in po punkciji jajčnikov. Prav tako so bile mnenja, da je osebje nudilo zadostno količino informacij in tekom celotne obravnave ohranjalo ustrezno obliko komunikacije z uporabo razumljivih izrazov. Negativen odnos pa se je izpostavil v povezavi s čakalnimi dobami in organizacijo dela. Udeleženke raziskave so izrazile občutke izključenosti iz lastne zdravstvene obravnave, nezmožnosti soodločanja, pomanjkanja individualnega pristopa k obravnavi, pomanjkanje ustreznega in točnega informiranja, kontinuirane obravnave s strani zdravnika ter pomanjkanje ustrezne čustvene in psihološke podpore. Raziskava poziva k ponovni oceni zdravstvenih pristopov in k premiku paradigme k celostni skrbi osredotočeni v pacienta. S spodbujanjem individualizirane obravnave in celovitejšega sodelovanja s pacienti je mogoče pot skozi zdravljenje neplodnosti osvetliti s sočutjem in razumevanjem.Introduction: Patient experience with health care presents an essential component in assessing health care quality. This is particularly important in the field of infertility treatment and assisted reproductive techniques, as one third of infertile couples do not give birth to a child after completing treatment. In addition to treatment outcome indicators, process indicators such as patient satisfaction are consequently very important. Purpose: The purpose of this study was to find out the level of satisfaction of female patients with health care in the in-vitro procedure in Slovenia and to highlight areas of health care where patient satisfaction is lowest. Methods: We used descriptive methodology in order to carry out the research. We designed a survey questionnaire and a semi-structured interview. The questionnaire was created with the help of the open-source web application 1Ka. 1010 women participated in it. We also conducted 13 interviews. Results: Quantitative results showed an overall high level of satisfaction with health care. Respondents expressed the highest satisfaction with the physical aspect of health care (x̅ = 3.33, s = 0.890) as well as with communication (x̅ = 2.89, s = 0.927) and informational support (x̅ = 3.00, s = 1.006). The lowest level of satisfaction was observed in regard to the holistic, patient-centered approach to treatment (x̅ = 2.69, s = 1.021), emotional support (x̅ = 2.67, s = 1.012) and the organizational aspect of medical treatment (x̅ = 2.76, s = 0.949). Meanwhile, the qualitative results were dominated by descriptions of negative experiences with health care and suggestions for improvement. Discussion and conclusion: Patients expressed an extremely positive attitude in relation to the clinical environment, use of technologically advanced medical equipment and hygiene standards, as well as in regard to pain relief during and after ovarian puncture. They were also of the opinion that the staff provided a sufficient amount of information and maintained an appropriate form of communication throughout the treatment, using understandable terms. The lowest level of satisfaction was found in regard to integrated, patient-centered approach to health care and also emotional and psychological support that was provided, as well as the organizational aspect of medical treatment, with an emphasis on excessively long waiting times and poor work organization. Research participants expressed feelings of exclusion from their own treatment, inability to co-decide, lack of individual approach to treatment, lack of adequate and accurate information, lack of continuous treatment by the attending physician and lack of adequate emotional and psychological support. The research calls for a re-evaluation of healthcare approaches and a paradigm shift towards holistic, patient-centered care. By encouraging individualized treatment and a more comprehensive collaboration with patients, the path through infertility treatment can be illuminated with compassion and understanding