Understanding the psychological impact of diagnostic uncertainty in early pregnancy
File(s)
Author(s)
Lawson, Kim
Type
Thesis
Abstract
Background
Pregnancy of uncertain viability (PUV) is an ultrasound diagnosis requiring women to wait up to 14-days before the early pregnancy outcome (viable or miscarriage) is known. This diagnostic uncertainty is highly anxiety inducing. Models to predict PUV outcomes are available to healthcare professionals (HCP) but rarely provided to patients. This thesis intends to gain a more sophisticated understanding of the patient’s emotional and psychological needs through exploration of their experiences of both the waiting period and receiving a prediction model.
Methods
To better understand the psychological impact associated with an enforced waiting period, a systematic review of early pregnancy and reproductive medicine waiting periods was conducted. The healthcare professional’s interpretation of PUV findings was assessed using a survey. The psychological impact of providing a prediction of viability to patients with PUV was assessed in a prospective, randomised controlled trial (RCT). In-depth interviews with RCT women explored their views on receiving the prediction model and their waiting period experience.
Results
Women found the prediction model to be helpful (69%) and would use again (88%) however, an objective improvement in psychological well-being was not shown when compared to controls. Those with high baseline anxiety who received the model showed mild improvement in anxiety scores, but not statistically significant. Qualitative themes related to use of the prediction model include credibility, setting expectations, sharing, reflection and risks. Qualitative themes regarding the waiting period experience include emotional journey, impact on life, information provision and surviving the waiting period.
Conclusion
The psychological impact of the waiting period with a PUV has received little attention and is reportedly underestimated by HCP’s. This thesis demonstrates that provision of individualised information to patients can be improved through education of HCP’s and additional tools, such as prediction models.
Pregnancy of uncertain viability (PUV) is an ultrasound diagnosis requiring women to wait up to 14-days before the early pregnancy outcome (viable or miscarriage) is known. This diagnostic uncertainty is highly anxiety inducing. Models to predict PUV outcomes are available to healthcare professionals (HCP) but rarely provided to patients. This thesis intends to gain a more sophisticated understanding of the patient’s emotional and psychological needs through exploration of their experiences of both the waiting period and receiving a prediction model.
Methods
To better understand the psychological impact associated with an enforced waiting period, a systematic review of early pregnancy and reproductive medicine waiting periods was conducted. The healthcare professional’s interpretation of PUV findings was assessed using a survey. The psychological impact of providing a prediction of viability to patients with PUV was assessed in a prospective, randomised controlled trial (RCT). In-depth interviews with RCT women explored their views on receiving the prediction model and their waiting period experience.
Results
Women found the prediction model to be helpful (69%) and would use again (88%) however, an objective improvement in psychological well-being was not shown when compared to controls. Those with high baseline anxiety who received the model showed mild improvement in anxiety scores, but not statistically significant. Qualitative themes related to use of the prediction model include credibility, setting expectations, sharing, reflection and risks. Qualitative themes regarding the waiting period experience include emotional journey, impact on life, information provision and surviving the waiting period.
Conclusion
The psychological impact of the waiting period with a PUV has received little attention and is reportedly underestimated by HCP’s. This thesis demonstrates that provision of individualised information to patients can be improved through education of HCP’s and additional tools, such as prediction models.
Version
Open Access
Date Issued
2024-01-24
Date Awarded
2024-09-01
Copyright Statement
Attribution-Non Commercial-No Derivatives 4.0 International Licence (CC BY-NC-ND)
Advisor
Bourne, Tom
Bennett, Phillip
Bottomley, Cecilia
Publisher Department
Department of Metabolism, Digestion and Reproduction
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Medicine (Research) MD (Res)