You've seen your patient struggle
with one unsuccessful in vitro fertilization (IVF) treatment
after another. She's been counselled, medicated, harvested
and implanted. To no avail. It's taking its toll on
her mental health, her marriage and her bank balance.
You know it's time to advise her she should move on
and explore other options. But how?
"It's delicate," says Janet Takefman,
PhD, Director of Psychological Services at the McGill
Reproductive Centre. Dr Takefman presented a talk on
this very quandary at the 14th World Congress on IVF
in Montreal on September 19.
"A patient-centred approach is
optimal for this type of consult," she says. Keep in
mind you'll need to deliver mind and body counselling
in this situation, so speak and listen with empathy,
Dr Takefman recommends. "Speak from an emotional point
of view. Be compassionate and respectful of their emotions."
Here are Dr Takefman's nine tips
to help you tackle this often painful task.
1 Set limits from the start
"Doctors usually base the decision to stop IVF based
on the probability of success and medical risk factors,"
says Dr Takefman. But the patient has a whole host of
other reasons, she points out, including financial or
emotional. At the outset, have them set a limit in terms
of the number of IVF cycles. This gives patients time
to prepare mentally and accept when it's time to move
on.
2 Don't rush it "Take however
long this consult needs," says Dr Takefman. "Tell the
patient what you think. Say 'we've tried this and had
that result' and guide them to the logical conclusion."
This could take several sessions with the patient.
3 Take away the guilt factor
Patients sometimes feel guilty about stopping treatment,
believing they haven't tried hard enough. "Help the
patient reflect on all they've done," says Dr Takefman.
"Make sure they realize they've done all they could
within their means — 'You took the medication,
you did acupuncture, you couldn't have done any more.'"
4 Find the silver lining
It's no surprise women feel a great deal of stress during
IVF treatments. The experience is an emotional rollercoaster
that many are happy to leave behind — though they
may not feel that way at the time. You can help by pointing
out the positive aspects of ending this, says Dr Takefman.
"They don't have to come to the hospital every week,
for instance. They can drink alcohol again."
5 Allow for sadness "Let
the patient digest the fact that they're not going to
have their own biological child," says Dr Takefman.
"Let them feel whatever they need to feel, don't interrupt
their emotions."
6 Choose an approach that suits
them Your patient's coping style will cue you on
how to proceed with the rest of the consult. Some people
will want you to give it to them straight. They want
all the facts and info. Others may close up and prefer
limited information.
7 Don't rush other options
Whatever option is open to your patient, it will either
involve someone else's gametes or adoption, or not having
children at all. It's not going to be their idealized
version, says Dr Takefman. "They may feel it's second-best
and get angry if you tell them, 'It's going to be OK,
you're going to love your adopted kid.'"
8 Refer them to a fertility
counsellor Health Canada has mandated that every
IVF patient should see a psychological counsellor. Normalize
this transition for them, Dr Takefman recommends. "Tell
them, 'It's normal to see a shrink. It's a difficult
time for anybody and a lot of feelings come up. Fertility
counsellors are specially trained to help you through
this,'" she says.
9 Don't abandon your patient
"Don't let them feel this is their last consult," says
Dr Takefman. Many patients feel let down by the final
consult and welcome another appointment — a chance
to absorb the information and come back for further
discussion. It's important to be perceptive to your
patient's needs and available to them, adds Dr Takefman.
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