• Jacky Boivin, Laura Bunting, Emily Koert, Chin Ieng U, and Christianne Verhaak.
• Cardiff Fertility Studies Research Group, School of Psychology, Cardiff University, Tower Building, Park Place, Cardiff CF10 3AT, UK boivin@cardiff.ac.uk.
• Hum. Reprod. 2017 Feb 1; 32 (2): 403-408.

Study QuestionWhat are some of the challenges of working in a fertility clinic?Summary AnswerThe most frequently mentioned challenges were workload (e.g. high time pressure) and patient-related sources (e.g. unrealistic expectations).What Is Known AlreadyOne study showed a too high workload, worry about handling human material and low success rates were main stressors in fertility clinics.Study Design, Size, DurationAn online open-ended survey inviting participants to respond to seven questions was distributed to 5902 members of the European Society for Human Reproduction and Embryology (ESHRE, October 2010). Questions asked participants to describe the top three factors that made (i) their work stressful (hereafter 'Work stressors') and (ii) working with patients difficult (hereafter 'Perceived sources of difficulties'), and (iii) to choose from these factors which top three issues they would be willing to attend a workshop to resolve (hereafter 'Workshops'). A qualitative content analysis using inductive coding for each question was used to extract meaningful themes from the text replies, at three levels of increasing abstraction (lower and higher categories, general themes).Participants/Materials, Setting, MethodsThe final sample comprised 526 respondents (8.9% participation rate). Respondents were predominantly clinicians (41.3%, n = 216) or embryologists (35.5%, n = 186) from European countries (73.0%, n = 386).Main Results And The Role Of ChanceThe number of text replies generated for each question was 1421, 1208 and 907 for the 'Work Stressors', 'Perceived sources of difficulties' and 'Workshop' questions, respectively. The most often reported higher-order categories of Work Stressors were 'Time and Workload' (61.6%, e.g. time pressure), 'Organisation, Team and management issues' (60.4%, e.g. team conflicts) and 'Job content and work environment' (50.3%, e.g. burdensome administration). For 'Perceived sources of difficulties' these were 'Patient-related sources' (66.7%, e.g. unrealistic expectations), 'Communication and Counselling with patients' (33.7%, e.g. strained information giving) and 'Misinformation and lack of knowledge' (27.8%, e.g. Dr Google). Finally, the topics participants would be willing to address in Workshops were 'Communicating and Counselling with Patients' (24.9%), 'Dealing with Patient-related sources' (19.6%) and 'Clinical topics' (19.6%). Three general themes emerged. First, a theme of 'time and time trade-offs' expressed the oft-mentioned need to trade-off time spent on one activity (e.g. managing patient demands) against another activity (e.g. clinical workload, administration) with stress level dependent on the efficacy of trading-off. Second, the theme of 'multifactorial causes' of challenging patient interactions that embodied the many sources of difficulties working with patients. What staff would be willing to address in workshops was indicated by the final general theme of 'a little of everything', which linked to the need for multiple workshops addressing the multifactorial nature of challenges in fertility clinics.Limitations, Reasons For CautionOnly about 10% of members receiving the survey participated. The work was limited to the stressful and difficult aspects of working in fertility clinics, which may give a more negative impression than if questions about the rewards and benefits had also been included.Wider Implications Of The FindingsThe nature of stressors and difficulties of working in a fertility clinic are consistent with models of occupational stress and patient complexity. Specialized psychologists, management consultants and other occupational experts could assist fertility teams in overcoming many of the challenges. More research is required on the effect of encountered work stressors and perceived sources of difficulties in working with patients on staff and patient outcomes.Study Funding/Competing InterestsNone declared.© The Author 2017. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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