Patients were heartbroken by fertility clinic shutdowns due to the COVID-19 Pandemic. People who have waited for possibly years for their chance to start or continue to build their family had their hopes dashed when they learned their treatment would be delayed for an indefinite amount of time. But how did clinics handle the communication with their patients? And are patients ready to come back with the threat of the disease still looming?
To help answer those questions, RESOLVE, the National Infertility Association, conducted a survey asking over 500 patients directly impacted by the shutdowns to share their experiences.
On this live episode of Inside Reproductive Health, Griffin spoke to Barbara Collura, President and CEO of RESOLVE. She walked us through the survey's results and what your clinic can do with the results to make a better experience for your patients who had to stall their fertility treatments, as well as those coming in during these unknown times.
Link to full survey results: https://resolve.org/covid-19-and-infertility-patient-experience/
This episode was recorded during a live webinar. As the COVID-19 Pandemic continues and new issues arise, we are putting out new information to help you and your fertility business. Follow us on social media for updates on upcoming webinars and how to join them live. Find this information helpful? We’d love it if you’d share with a friend or colleague in the fertility space.
To get started on a marketing plan for your company, complete the Goal and Competitive Diagnostic at FertilityBridge.com.
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Welcome to Inside Reproductive Health, the shoptalk of the fertility field. Here, you'll hear authentic and unscripted conversations about practice management, patient relations, and business development from the most forward-thinking experts in our field.
Wall Street and Silicon Valley both want your patients, but there is a plan if you're willing to take action. Visit fertilitybridge.com to learn about the first piece of building a Fertility Marketing System--The Goal and Competitive Diagnostic. Now, here's the founder of Fertility Bridge and the host of Inside Reproductive Health, Griffin Jones.
GRIFFIN JONES 1:01
I wanted to have Barbara Collura back on to Inside Reproductive Health. Many of you know Barb because she's the President and CEO of RESOLVE. She is one of the most outspoken patient advocates in our field. She's been on the show before. We've been friends for a number of years that we met via Twitter--or her lack of Twitter. And RESOLVE has some really cool new findings that came from patient attitudes during the crux of the COVID shutdown. And we're going to go over what those mean for clinics that have reopened, whether this happens again or whether it doesn't what the evergreen findings are. So Mrs. Collura, Barb, welcome back to Inside Reproductive Health.
BARBARA COLLURA 1:49
It is great to be back and it's also great to see you. You look great and I'm hoping that all as well in your corner of the world during this crazy time.
JONES 2:01
So far so good in Western New York. So far, so good with Fertility Bridge. And we, I think--I think we got to see a lot of who was who was for real and who wasn't the last three months based on how quiet people got or how helpful they were. One of the helpful things that you did was amast this pretty substantial, having over 500 respondents. And so talk to us about the study. What was it? And maybe even before that, what was it that you were setting out to do with it?
COLLURA 2:37
Well, you know, we are always doing surveys at RESOLVE of our community and our constituents. Gosh, I've been at RESOLVE for many years, and we do several surveys a year on a variety of things. And so we had started thinking about this, I would say the beginning of April, Griff, and we were starting to realize that there was a lot of a disconnect between the providers and patients. Patients were emotionally in a whole new space. We also started hearing from some of our trusted partners, Hey, you know, maybe a survey would be good because people will respond if RESOLVE does it. But there's, there's maybe some things that we could learn and some good information that we could put together. So we put this survey together. And it was at this particular time, which was in April, we were really looking at how patients were doing who were impacted by the clinic shut down or partial shut down for some clinics. So that was the specific audience. We wanted to know, how are they doing emotionally? Where are they getting information? How are they getting support? You know, it was really about how are they feeling? You know RESOLVE well, but a lot of people know us for our advocacy work or awareness work. But we're also big into Patient Support. In fact, we have support groups all over the country that, prior to this, were meeting in person. And so we wanted to know, were patients getting support? Where were they getting it? Just really, how are they feeling? So we fielded the survey, it went out April 21st and we closed it on May 13th. So if you think about that timeframe, clinics were closed, and then boom, during that May 13th, beginning of May, maybe some of those clinics even started opening. But again, it wasn't about the opening and how you feel about your clinic being open, because it wasn't really during that time frame when we drafted this. So let me just tell you a little bit about the demographics and then we'll go into--we can talk about some of the findings. But you're right. We had 576 people fill this out. 99% of them identified as female. 97% identified as either married or partnered. These women hailed from 33 states, so I think it's fair to say it was a nationwide survey. And the ages--the two biggest age groups, the largest was at 35%, so a little over a third, were between the ages of 30 and 33 years old, and then about 30%, so about another third, were between 34 and 37. And then it breaks down from there, the next largest was 17%, being 38 to 41, and then down from there, but if you think about it, so 65% were between 30 and 37, women, married and all from all over the country. So that's where we start.
JONES 5:58
Your age is pretty representative of the US patient population. Of those--it's 99% women, most of whom are married or partner, did you stratify for those that were same sex couples, same sex relationships or not?
COLLURA 6:16
We asked all of those questions in terms of where they might be in terms of marital status. And we actually have the full survey results available from our website. So you can see how many identified or chosen to not answer those particular questions. So we, you know, we asked a lot of questions about how they were feeling and how they were doing. And we, we even had a list of different emotions and we asked them, you know, how often have you felt these emotions and they weren't all negative emotions, some of them were happy or hopeful and those kinds of things. But really what hit us when we looked at the findings in terms of how they felt. It's no surprise and honestly, this is how most of the country probably was feeling as well, but we asked them, How often are you feeling nervous? 56% they're feeling nervous frequently, all the time. Sad, 68% are saying they feel sad frequently or all the time. Discouraged, 67% they felt discouraged frequently or all the time. And then worried, 65% said they felt worried frequently or all the time. So that's this group of people who are nervous, sad, discouraged, worried and again, that's a lot of emotions that that many of us were feeling, but I think you'd have to kind of level set and say, Okay, this is this group of people. This is how they were feeling at this point in time. Now, where do we go from here? And what else did they tell us?
JONES 8:06
So, RESOLVE does a lot of surveys, you’re known for doing a lot of surveys. Can you give us an idea of what this is against baseline? You know, we’ve got 81% saying that the clinic closure was stressful on them. 68% saying they felt sad frequently or all the time. What is this relative to infertility patients in non-COVID times?
COLLURA 8:30
Well, this certainly was a little bit off the charts in terms of their emotional strain and you've got patients at this point in time, maybe not certain when their clinic is going to open. We're now ,you know, at 4+ weeks into the closure, if you think that the closure started around March 17, or that week, and this survey started on April 21st. So you're having a group of people who are now in this, Griff, have been in this for a few weeks now and I think we started to see some of that anxiety increase as the clinic closures hung on. Now we also wanted to know kind of where they were in their family building. And by the way, we didn't let anybody fill out the survey, unless they had been in process with a clinic in the prior 30 days from, I think we did March 1. So even if you had started with a clinic back in January or February and you were done, you couldn't fill out this survey. This was really aimed at that group of people caught in the clinic closure who were in process so
JONES 9:51
So anywhere in process could have been--
COLLURA 9:53
Like I was getting ready to do an IUI, I was getting ready to do IVF. So 23% said that at that point in time when the clinic closed, they were preparing for a fresh or frozen embryo transfer in the next 30 days. And then 26% were planning to do IVF but hadn't yet started. So you've got, you've got a big chunk of people who filled this out, like, ready to go. And that's what we were looking for. We were looking for Who are those people that are ready to go. And what are they telling us? So yeah, you know, you mentioned the clinic closure being stressful to them--we had 52% express concern that the treatment delay will diminish their chance of having a baby. So think about that--this is slightly more than half are saying this closure is concerning to me because it's going to cause a delay, and it may impact my ability to have a baby. So whether that's true or not, I don't know, given their personal diagnosis and everything else, but that's that's how they were feeling at that point in time. So, you know, again, no surprise, the clinic closure for the people who filled this out, the clinic closure was stressful 81% and 79% said it is going to have a negative impact on that. Might be interesting--I just had this thought of getting, you know, people asking the same questions now looking back, you know, after your clinic has now reopened, has this had a negative impact on you? You know, that's something for a future survey, because they're going to have some time to be able to look back and say, Hmm, was it really negative or not? Or was it just how I felt in that moment of time?
JONES 11:46
Do you have plans for follow up? Because one of the things that I think, as you said, I think, would you said 23 something percent of folks we're planning on doing an FET or retrieval in the next 30 days?
COLLURA 12:00
Yeah.
JONES 12:01
And so I would be interested in seeing those who actually did in the next 30-60 days since.
COLLURA 12:09
Yeah! Well, it would be not only interesting to ask them that, but no, I hadn't really thought about the follow up survey until I'm sitting here talking to you about it! Because, you know, it's a moment in time and sometimes you want to get a perspective of people and as you know, just because you heard it from patients during this time, you heard it from your clients, high, high, high anxiety, and we don't know what patients--what the reality was of this actually impacting their future ability to have a baby. But yeah, there was some some findings that I'd also love to share about their communication with their practices, because we wanted to get a sense of how were they communicating, who was communicating with them. And Griff, we honed in on those questions because anecdotally, we were hearing from patients during the clinic closures that they were only finding out about what was going on through the clinic’s Facebook page. One, you know, one group of patients we talked to just had, like on their calendar at regular intervals, they were reaching out and calling their clinic because they weren't hearing things. And so they were like, okay, it's Tuesday. I'm going to call my clinic again. And also the clinic closure, you know, wasn't something that clinics had planned for. And thinking about just the mechanics in their practices of how do you contact everyone? I mean, we found this out when we had the clinics that have the tank failures, just getting phone trees and patients’ phone numbers and being able to sit down and call potentially hundreds of people, it's an undertaking. So we were curious about who they were talking to, you know how those communications went. So I want to share some of that with you.
JONES 14:05
They also didn't all shut down at the same time too, which made things interesting and the information that people were getting to be different. It was all happening so fast, right? We had to--we have a monthly reporting document for all of our clients and we had to add an extra tab just for COVID-19 updates so that we could keep track of what our clients were doing. We had questions like, are you allowing the partner at consults? Are you still--are you still doing retrievals? Are you still doing transfers? Are you only doing virtual consults now? And that was changing for people so rapidly, and you could never look at one person's and have it be the exact same as another clinic. Every clinic was doing something completely different, oftentimes in the same state--and we've got people from New Jersey on right now in California, those were two of the earlier states to shut down--and there were still people that were doing things much differently from each other, even in states like those.
COLLURA 15:16
So we really wanted to know--and if you look at the full survey results, you can see all the different questions because we asked like, who were you in contact with? We asked questions about when you called, did somebody actually answer the phone? And at the time, we thought that these would be really kind of interesting questions. Some of them at the end of the day maybe aren't so interesting. But no surprise here, 80% of those that actually had contact with their clinic, had been in contact with a nurse. And, and so again, that's not surprising. We hear that all the time, about, you know, who they were in contact with. We had the ability in most of our questions for people to put in like open text if perhaps what we offered wasn't the answer. The link to the survey that you're going to post doesn't show all of those because there could be identifying information personally identifying information, but a lot of people wrote in there that they were in contact with the finance, the financial counselors, and that sort of thing. There's also a lot of practices that have a patient liaison, that's the title of the person, and so it's not a nurse, and it's not, you know, office staff. And a lot of people wrote that in and we didn't have that as one of the options.So for those who said, Yeah, I have, 80% said to the nurse. But then we, you know, we asked a bunch of questions about that. That was the communication with the clinic, did it didn't meet your needs? Was this helpful to you? Was that communication meeting your needs? And 30%, a third, said n.o When we said that, you know, did the communication meet your needs, and they disagreed. They either disagreed or strongly disagreed. So, you know, a third of the people that filled this out, we're not totally in love with the communication that they had from their clinic.
JONES 17:19
So what about, if I’m playing devil's advocate, the counter or just the point of well, 33% might be insatiable, or there might be some segment that is insatiable in terms of the communication that we could provide, whether it's 33% is higher above baseline or by how much, But there might be a segment of the population that we just can't ease... What do you think of that with respect to someone?
COLLURA 17:53
I mean, this is a sampling of 576 women and you know, you're not going to walk away with let's change everything. And this is--we didn't ask them what clinic. We asked them what state--California, Illinois, New York, Massachusetts, Texas, Colorado, Michigan, all of those had, you know, a fair amount of people who filled out the survey, but it still doesn't necessarily give you enough information. I mean, from my perspective, whenever you look at this, there's always bias of the sample size you're looking at at a very niche period of time. But I still think there's opportunities. The way I like to look at it is, great if let's level test this against our own patient population, why don't you survey your own patients? You and I, I’m not going to name names, but we know people at clinics who are surveying their patients on a regular basis and constantly using that information to improve their patient experience. This might be something that you want to pick up on, Gee, are we that third? Or is this representative of the patients that we serve? And I think from my perspective, when I look at a lot of these responses, that's what I would take away is I would say, I'm not, you know, I don't know who these clinics are and I think a lot of clinics did a phenomenal job. We know that. But are we satisfied that a third of the people who filled out this survey didn't feel like they had good communication? You know, there's some other things I'll go over in here that I'm not satisfied that that's how patients were feeling.
JONES 19:36
Well, I think that a third could be a normal baseline number of the communication and maybe I'm on the right--that this contact with my healthcare team has met my needs. I think that the number of people that strongly agree or disagree with that same you could easily be a third, it could easily be a third at baseline. And I think that it’s one of the things that we try to consult groups on is managing that expectation from the beginning because we are a generation of patients that have and staff members that have had everything available to them immediately, whether it's Netflix or Uber or Instacart or Doordash. And that comes into a much more complex delivery model such as healthcare. And so one of the things that needs to be done immediately is to correct that expectation. This is what people are coming in with. And there's a number of different ways to be able to do that. But this is one of the things that I strongly recommend is for groups to share from the beginning, both outwardly in their marketing, their public image, their social media, and then inside when people are on the one to one level, when they're actually in the patient experience, inside the practice, resetting that expectation. You have to reset it early and often, and it's one of the problems I have when groups are too centered on, here's the baby, here's the baby, this is what you're looking for, because it doesn't allow for people to reset their expectations. And I understand the temptation to say, here's the baby and have people only think about that. The problem is that there can be dissatisfaction with expectations down the line to the extent you say, we're here to help you pursue a baby. But first we're here to get you answers. First, we're here to help you with some other things. And to properly set expectations and the communication the frequency of contact is one of the things that needs to be reset from the beginning or else people are generally dissatisfied.
COLLURA 21:56
One of the things I would also say that I've learned just in this crisis and managing our staff and in just human nature, your anxiety is high. And so you want so much information. Even you want people to tell you what they don't know, which is so counter intuitive. We are, we are--when you make a presentation, you make a presentation, you don't then say, oh, and here's all the things I don't know. But that's where we are. And I think you're sensing this too from some of the survey responses in that, you know, is it realistic for patients to expect to have this one on one personal level of communication? Or, you know, or not, but the way that was worded was, did it meet your needs, and everybody's needs are different. So here's here's an interesting one, we, as you know, RESOLVE is very big into into support and we really encourage people facing an infertility diagnosis and going down this journey to get the support they need, whether that's through friends and family through a mental health provider, whether that's your support group is to care for yourself. And so no surprise here, we asked questions about that. You know, we asked if their health care team had provided them with mental health resources. A lot of people, a lot of clinics that I've talked to, they did that. And a lot of them have mental health professionals on their team. So gosh, you and I know tons of psychologists and so forth those people were working night and day. I mean, they were doing telehealth night and day and talking to patients. So we asked, Have you been provided with mental health resources? Only 24% agreed or strongly agreed and 58% disagreed or strongly disagreed. So that really jumped out at me. And I thought, Wow, you have 58%who don't feel like they got mental health resources from their practices. And I'm not, you know, we didn't go into specifics--like a Mental Health Resource can be as simple as here's some resources, right? It could be that there's a mental health professional on staff or that there's a referral or that there's opportunities to, you know, have a support group or talk to people. So I think this is a really great lesson learned for clinics is to look at that and to say, you know, how are we doing in providing resources to our patients? And if you're a practice that doesn't have i- house mental health professionals, you know, reach out to us. Reach out to me and we're happy to work with you on what a list of resources looks like and how that can be provided to your patients because you may not know of all of those. And if you hadn't already had this in place, Griff, there's a lot going on, putting this list of resources together for your patients may not have been your top priority. But um, but we know based on how these people were feeling, but this--
JONES 25:28
But this list of resources should exist already. I put one of these together in 2015 as a start. Everyone should have, at the very least, one of these things.
COLLURA 25:44
And I think it's making sure there's there's the, hey, we have this poster on our website, or we put a link on Facebook on you know, March 18 to patients knowing it's there and being you know, caught like constantly reaching out because, you know, there may have been people at the beginning of this closure who were like, I'm good, I got it. And then like three or four weeks in, we're like, I'm freaking out. I need some help now, where do I go? And so you have to kind of remember that reminding this group on a regular basis. But yeah, I mean, I think that was really for me something that really stuck out. And then, Griff, I was on a few of your webinars during this closure. I was on a lot that other organizations and ASRM were putting on and one of the mes-- and we did some, too--one of the messages we kept hearing from from health care providers, as a message to patients was look, use this time to take care of yourself, you know, exercise, eat well, meditate. I mean, we did a webinar like how to survive this and we had some great feedback and advice and there was a lot of really great specific things that patients could do to take care of themselves so that when clinics were open, you know, they'd be ready to go. So we asked them about that. We asked if their healthcare team had provided them with ways to stay healthy during the clinic closure. 53% disagreed or strongly disagreed. So a little more than half again, didn't feel that they were given ways to stay healthy during this. So, you know, again, this isn't all the clinics, this is a small sampling. So those are kind of two easy things probably that you could put together a mental health resources sheet and then, you know, what are ways that people--even today, Griff, we know there's people who are afraid to go out of their homes, let alone into a IVF clinic. They probably still could use some advice on how to stay healthy, so that they're when they feel ready to go, they're in a good place.
JONES 27:58
These things are relative--they can be relatively easy to do. To your point, there's a range of things that people could do from having a one sheet of available resources and saying, here's where to find it versus here's a direct referral to a mental health professional, or having a mental health professional on staff and having one free 15 minute visit, or there's a whole range that people could do. But to the extent that one manages expectations in the beginning, you can often meet those expectations based on different points of that spectrum. And it's extremely important to do because otherwise, then the only thing we're helping people do is to have a baby. And we're not doing that for what 30% of the people that we're going to see. And we're also not doing that for people before they go through a lot of hard aspects of treatment. And so if that is the only thing that we allow ourselves to be in the patient's eyes--or the perspective patients’ eyes--then by nature, that many people are going to be dissatisfied with their experience. But if we correct the expectation from the beginning and said, this is long, this is hard, we're here to help you with this. Some of the things that you'll need help with aren't in our wheelhouse, we're going to do our best to direct them, here are a few of the things that you might want to consider. And the hurdle to doing that very often can be just people are inundated right from the beginning--you're trying to tell someone what's going to be in--that they're going to have to do in their testing, you're going to talk about in their follow up, and they can barely wrap their heads around that sometimes because there's so much going on, and that's fine. But this is where content comes in that you can direct people to at different times or send to them outbound. And we should all have a content chain of things like this so that we can one, manage expectations and then two, get people to resources so that the only thing that they're not making everything about our clinics is having a baby at the end.
COLLURA 30:10
Yeah and I think just again, lesson learned from this process, just in life this whole COVID-19 process is that just doing it one time may not be enough. You know, if you say well it was in the new patient kit, you know, we got, those kinds of things could be helpful to different people at different places in their journey. And so just a reminder, they may be your patient for a year and a half and forget where that new patient packet even is. And now they're like freaking out and they need some help. So something to keep in mind. But you know, I think those are two--those are two things right there: the mental health, staying healthy, I was surprised I thought actually that we would just see patients in a lot better place. You know, no surprise here when we asked them where you were getting help and resources, social media was the top place, 71% were connecting with others on social media. Number two place where they were getting support was through other people, peers who had gone through this. It didn't specifically say a support group but from peers, 57% said that. We know there are in person support groups. There are online support groups or Facebook communities. There's online support communities that are all peer. And so we certainly saw people utilizing all of those available resources.
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COLLURA 33:39
So, you know, I want to talk a little bit, too, about what they were told by their clinic about the closure. That was the other thing that we were really curious about, Griff, like, you know, I mean, stuff was happening, you know, governors were shutting down medical treatments. We saw ASRM recommendations impacting clinics. And it was just kind of all over the place. I mean, some places it didn't matter what the ASRM recommendations were, their governor said, you know, no, you can't go get any kind of medical treatment. So we asked about, you know, what was their understanding? And 52% said they were told by their clinic that the reason for the clinic closing was ASRM recommendations, followed by state or local governments but only at 28%. So the patients were told by their clinic, we're going to be closed, 52% the reason being ASRM, 28% state or local guidance. So then we asked them, What are you being told about how you're going to reopen? This is the other thing, we had so many patients who were like, when are they going to open? And how are they going to make the decisions? And, you know, I don't think these clinics knew, I don't think anybody knew. And so again, you've got patients wanting information that nobody really knew or had. So, we asked them, What are you being told about reopening decisions? You know, how are those going to be made? And again, we had more we're saying that those decisions were going to be based on ASRM recommendations rather than government orders. So the ASRM recommendations were not hidden. They certainly were known to patients and were what was being communicated by clinics to their patients as to why they were A) closed and B) when they would reopen. So knowing that now, I now know why patients were waiting, literally with bated breath every few weeks for the latest updates to those ASRM recommendations. It was almost like I was kind of like, how do they even know these existed and where they find them? Well, they were very clearly being, you know, told that by their practices.
JONES 36:13
Well, that was part of a number of things that came from that right was because I think for a while people didn't feel like they had anything to go off but ASRM guidance, even though it was only guidance, I think people felt like well, many people felt like I at least need to do some version of what else everyone else is doing and I at least need to incorporate some of these guidelines and then the Fertility Providers Alliance had their own guidelines. But would you have done something different?
COLLURA 36:52
No, I mean, I think it was the truth. I think that practices were looking at those ASRM recommendations and they were reviewing those and then for a lot of them, state guidance came in and state orders came in. You know, I'm here in the Mid-Atlantic and we were shut down by governors and honestly, if ASRM had said, Open today! I mean, they wouldn't have been able to. I think what we are getting from this is what the practices were doing, and they were getting questions from their patients and this was a truthful answer. We're looking at the ASRM recommendations, and we'll be basing our decision making on what those recommendations are. So I am not really saying that I'm super surprised by this, but I thought that like the governor orders and the government orders would have been, like, more closely tied to it because then it became so many states that they couldn't do anything because of the governor's orders. And in fact, we started reaching out to governors and we had several hundred people send letters to their Governors saying please open fertility clinics. So I wasn't sure going into the survey how strongly the ASRM recommendations were going to be what patients had heard, but they definitely were told. And then, you know, we asked them questions about the clinic opening. [On page 31] We asked them your biggest concern, you know, resulting from the closure of your clinic, we talked about that the clinic delay is going to impact their ability to have a child and then we asked them about, what's your biggest concern if your clinic is still open or in the process of reopening? So this is, remember, we did this at the end of April beginning of May, so this could actually be happening. And so, you know, we put things in this survey that they could choose, like, you know, what are you worried about? I might be exposed to COVID-19, the clinic staff may be exposed, you know, this may put my baby at risk, maybe the treatment is going to need to be suspended once it starts, maybe safety precautions taken may not guarantee my safety. So it was a lot about clinic safety, COVID-19, would they have enough personal protective equipment? Because we kept hearing that, that that maybe these clinics shouldn't be opening because there wasn't enough PPE. So we had all of those choices, and then the top choice was, I am aware of the risks and willing to decide with my doctor how to proceed. That was like almost 33%! The next closest was my treatment may need to be suspended after it starts at 20%. So I was really shocked at this, Griff, because I thought I thought we'd have a lot more people saying COVID-19 is going to put my pregnancy or my baby at risk, or I'm afraid to get COVID-19 from the clinic. When I saw that, it was like, Hey, I know the risks. And let me and my doctor decide. I was like, Wow, okay, that was surprising. It may not be surprising to you, but it was surprising to me because we talked so much about, you know, safety and making sure that the patients feel safe and that you know, it's okay to come back and you've got this group of people who filled this out survey saying, Let me get in there, talk to my doctor. I know the risks. And this is, I think, you know, one of the things that you see today. Here we are in June, and people are like, should I get on an airplane? Should I go to a restaurant? You know, what are the risks? What do I know? And what am I comfortable doing? And I think the people that filled up this survey, at least those the 33%, were saying, let me decide,
JONES 41:16
Yeah, the exposure to COVID-19 is very low here, which is interesting. Many of us, like, we would have thought that that would be higher. And this is folks that had—so they were—this entire group, they've been to an REI within—they had been to an REI within the 30 days prior to closures that right?
COLLURA 41:36
Absolutely, they've already had their consult there. They're in process.
JONES 41:42
So these are folks that they're in momentum and something came in and derailed their momentum or something. So it could be different for prospective patients going forward. Their concerns could be higher in other areas, but I think this is really interesting. I'm still—can you help me a little bit with the phrasing of it I'm aware of the risks unwilling to decide with my doctor how to proceed. I'm not understanding exactly what the concern is there? Is this like, you know, the we're were going to go skydiving and we had bad weather before we had clouds and thunder and now the storm has passed, what is your biggest concern? And it's no longer most people are not saying clouds and thunder but that they're actually going to jump out of the plane. Is that what this is?
COLLURA 42:29
Yeah, well, when you look at the—
JONES 42:31
The concern is if I'm actually going to go through with it?
COLLURA 42:33
No the concern is like, I actually don't have any concerns. So you know, when we put this together, we listed like, Oh, my clinic won’t have enough PPE, somebody at the clinic might have COVID, of course, the big one we kept hearing, you know, will my future pregnancy baby be impacted? This is what we were hearing why patients may not want to walk back in the door, right? So and then as you go through it, you're like, you know, there may be people who don't have any concerns. So we better put that one as an option. And it turned out that's what the majority of the people chose, like, I know the risks, I don't have any concerns, it's between my doctor and I. So, it's a little bit what we heard when people were going to their governors and saying, Hey, open up my state, let the doctor and the patient make the decision on whether care should be given or not. And this is you know, Griff, this is a patient population that wants that personal autonomy, wants to be able to be very engaged and involved in their treatment, and I'm not saying you know, they know best or they don't know best, but they're generally a vocal patient population who, like you say they have, they have a goal in mind. And this is telling me that I actually know the risks and I'm willing to go for it.
JONES 43:57
And another fifth didn't didn't answer it, another fifth said that or said not applicable, and then another fifth said their biggest concern is their treatment might need to be suspended after it starts, right?
COLLURA 44:13
Yeah!
JONES 44:15
This is a largely, the only thing that I'm worried about is not being able to do it.
COLLURA 44:16
Right and again, let me and my doctor decide. Like this could this could have been, you know, that could have been partly aimed at at government intervention and saying, Hey, you know, let me decide. So, you know, you get to this point where you're in the door—I mean, I was telling a reporter, I said, this isn't just about, Oh, you got to wait a few weeks, you might have to wait a couple months. They've already been through so much just to get to this point. And now, there's a pause and and they don't understand it. And and that's where these people are at.
JONES 45:02
And the answer for the folks that their concern is about the process of reopening. I also found these other concerns to be very interesting, which was during the closure of the clinic, and the majority of those folks—just over half—said that it will will delay their their chances of of having a baby. And so there was only small numbers that said things like that their insurance won't be available after the fact or that they won't have the money to pay after the fact or that it's not safe to pursue treatment or safe to become pregnant. Those were pretty small numbers.
COLLURA 45:49
Yeah, I was surprised at that too. Because anecdotally, we were hearing that from people that you know, this is going to be so much harder because my insurance is gonna be cut off. And, you know, we were hearing from people I'm so glad, I'm relieved because I am scared to go right now and knowing that I don't even have to make that decision is such a relief. We absolutely heard that from people. But certainly that particular question again, this sample size, I'm not saying this is every clinic or every patient, this is this sample size. And so again, when you look at the results, you know, look at are there opportunities to test this against your own patient population? Are there opportunities to look at your own procedures, and also to see if there's some places where you might be able to just, you know, bring it up a notch, or again, learn from your own patient population and then see where those gaps may be.
JONES 46:59
So Barb, what would you like to conclude with our audience about what they can take away from this data and how they would benefit from implementing some of it?
COLLURA 47:10
Yeah, I mean, I think, you know, while it was 576, it's still a smallish sample size, I would maybe look at some of the questions and and pose them to your own patient population. I mean, you can do this on Survey Monkey, it's pretty easy and test it. You know, one of the things you and I are used to hearing, when there are surveys like this, is we're used to hearing clinic say, Oh, I know we did a great job, or you get some who are saying it was rough and we didn't we honestly we're just just trying to keep the lights on. And maybe there's some opportunities here, considerations that that clinics have to look at their own processes. God help us that this never happens again. Having said that, I think even in normal times, this is a patient population that needs, as you said, expectations, communication, support. And we still have, you know, we don't have clinics open at 100% patient volume, you know that even if they're open, they may only be seeing a small volume of what they saw in January in February. And so they're still going to be patients who are waiting. And perhaps any mental health resources, perhaps need ways to stay healthy, perhaps need ways to just stay in touch and so I would look at what are your internal processes for that, and how are you doing? But again, there's a lot we don't know Griff, certainly from this survey, and it will be kind of cool to re-survey some of these folks and say, Okay, you thought that your biggest concern was going to be the delay, that it would impact your ability to get pregnant, was that even true or valid ? And some of these people may just put it behind them and never want to revisit.
JONES 49:09
Well I'm glad you could come on and brainstorm. That's what people come on the show for it just to have me as a sense of clairvoyance, a sounding board and brilliant ideas will come.
COLLURA 49:21
Well I, you know, I thought this was would be great to brainstorm with you because you're advising and working with clinics and then we're on the side of what the patients are, right? Where the patients are. So you know, you have clinics have a do things to achieve a certain result, but if the patients don't feel that then maybe we need to revisit how that's being implemented and being done. So I love that you have this for your own business and your own needs, but also we opened the survey results up to the whole world because if there's even just a small little nugget, that that somebody can learn from it, or that helps them, that’s awesome!
JONES 50:11
I appreciate you doing that because I can already tell from going over it with you how helpful this information is to us and to challenged some of the assumptions that we had. And that's true for everyone else. So thank you for making it available to everyone and thank you for coming back on Inside Reproductive Health. Barbara Collura, President of RESOLVE, it has been a pleasure to have you back.
COLLURA 50:35
It's been great. Great to see you.
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You’ve been listening to the Inside Reproductive Health Podcast with Griffin Jones. If you're ready to take action to make sure that your practice drives beyond the revolutionary changes that are happening in our field and in society, visit fertiltybridge.com to begin the first piece of the Fertility Marketing System, the Goal and Competitive Diagnostic. Thank you for listening to Inside Reproductive Health.