P-544 Staff and patients’ views of the impact of staff doing fertiShare- a sharing bad news eLearning course – on patients, staff, and the clinic

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Abstract Study question What are staff and patients’ views of the impact of staff doing fertiShare on patient, staff, and clinic outcomes? Summary answer Staff think fertiShare improves SBN performance, but patients report variable experiences, with better performance being associated with ability to make informed decisions about future care. What is known already Sharing bad news (SBN) is a challenging task for fertility staff but little guidance exists to support them. fertiShare is a 2-hour bespoke eLearning course to support staff in SBN with patients. Meta-analytic evidence shows that SBN training that imparts knowledge and models good practice improves staff performance, but how training impacts on patients’ experience of SBN encounters and valued outcomes for patients, staff and clinics is still unknown. This study investigated patients’ and staff views of the impact of fertiShare on their experiences of receiving and sharing news and associated outcomes, and how these are shaped by context. Study design, size, duration Multi-informant qualitative realist evaluation to test fertiShare’s Programme Theory, composed of 27 hypotheses about how fertiShare’s active components (Mechanisms) interact with Context to trigger (or not) desired (or other) staff, patient and clinic Outcomes (CMO chains). Eligible staff were those working at UK and European-clinics and spending 10%-week time sharing bad news (SBN). Eligible patients had received news from participating staff. 12 staff and 12 patients were purposively recruited from European (staff only) and UK-clinics. Participants/materials, setting, methods CMOs were presented to a stakeholder group for feedback and revised accordingly. Consenting staff were invited to do fertiShare and apply it in practice. Staff and patients were independently interviewed using semi-structured interview topic-guides designed to elicit views and experiences of the hypothesized CMOs. Interviews were transcribed verbatim and data coded deductively (against CMO chains) and inductively (emerging themes) to reach conclusions about if, how, and why fertiShare creates impacts for staff, patients and clinics. Main results and the role of chance Based on stakeholders’ feedback, 2 CMOs were changed and 3 added. Interview data addressed 28 of the 30 revised CMOs, with 15 (50%) reaching data saturation. Seven patients reported staff shared news optimally, 3 sub-optimally, 1 could not remember. Patients reported (staff applying) fertiShare-recommended practices helped them understand their situation, make informed decisions about future care, and feel respected, supported and reassured [Mechanisms], resulting in satisfaction with care and trust in the clinic [Outcomes]. Perceptions of SBN encounters were shaped by the broader care Context, via comparing and contrasting with other SBN (and other) interactions with staff, and general views of what is good communication. Patients viewed optimal SBN as an important but insufficient factor for continuing treatment at the clinic [Outcome], with other (clinical, financial, motivational) factors influencing this decision. Staff evaluated fertiShare’s activities (video-lectures, case-studies, quizzes) positively and thought these triggered better SBN performance [Outcome] via reflection on how to improve behaviours, greater consideration of patients’ perspective (e.g., when providing information), emotional resonance, and team support [Mechanims]. Engagement with fertiShare is shaped by staff’s learning preferences and clinic’s organisational (e.g., time, staffing) and cultural context. Ability to apply recommendations is hindered by poor organisation and low resources [Context]. Limitations, reasons for caution Staff worked at different clinics across Europe but patients had treatment in same clinic and responses may be shaped by their specific care context. Low staff and patient pairing and percentage of CMOs with data saturation hindered ability to reach conclusions about some causal chains linking fertiShare implementation to outcomes. Wider implications of the findings fertiShare can catalyse good SBN practice at fertility clinics but needs to be implemented as a team effort so that good practices permeate all patient-staff interactions. Optimal SBN promotes trust in clinic and informed decision-making about future care but will not necessarily lead to uptake of more treatment. Trial registration number No

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