The end of Assisted Reproductive Technologies Treatment: A qualitative study

Introduction: End of treatment is one of the most complex phases of the ART process. In the ART setting, there is no clearly defined biological endpoint; the end of ART treatment occurs or should occur when probabilities of success are so low that it is in the couple’s best interest to stop any further attempt. Patients may experience the end of treatment as an existential failure, as they gain awareness that the desired biological pregnancy will not be achieved. In the doctor-patient relationship, the decision to end treatment is one of the most challenging bad news to break because it drastically and negatively changes patients’ expectation and future perspective. This contribution aims to delineate the end of ART treatment, as health professionals devise it. Methods: A grounded theory approach was used to explore healthcare professionals' perspectives on the end of ART treatment. Data were collected through two focus group interviews with physicians, biologists, and psychologists working in public and private Italian medically assisted procreation centers. The focus group interviews were audiotaped and transcribed verbatim. Content analysis was conducted to identify areas and sub-areas related to the end of ART treatment. Results: A total of 16 health care professionals were involved in the focus groups. The findings provide an illustration of the attributes and components at the end of the ART. The resulting coding system considers seven areas: patients' clinical conditions and probabilities of treatment success; patients' and physicians' roles in decision-making; ethical issues, affective and emotional experiences; physicians' personal attitudes; physician-patient relationship; communication strategies and difficulties. Discussion: The results not only describe the complex process based on expertise and experience leading to the clinical decision to discontinue treatment but also outline the ethical and emotional aspects of this complex phase. Our considerations highlight physicians’ perceptions and attitudes in the doctor-patient relationship, some of which are specific to the ART context and treatment discontinuation.