The impact of healthcare communication on medical decision-making

This study has two intervention arms and one control arm (so 3 arms in total), administered online using the Qualtrics survey software. The interventions will be delivered with paragraphs of text (hypothetical scenarios). The study will take approximately 15-20 minutes to complete. Interventional materials: a hypothetical scenario of a visit to an IVF specialist after six unsuccessful attempts of IVF. participants are asked to imagine they are now trying to decide whether to continue or stop IVF treatment. The scenario details the cost of another round of IVF, the time taken off work for appointments, and the emotional and physical toll the process takes on participants and their partners. The participant is told they have less than 5% chance of success with another round. Participants randomised to an intervention arm will then receive further information through anecdotal stories of success or failure. The two intervention arms consist of: A hypothetical scenario with a positive anecdote of success against the odds, or A hypothetical scenarios with both a positive and a negative anecdote (anecdote of failure) In the positive anecdote scenario, the IVF specialist will describe a story about a couple in a similar situation who tried once more and had success. In the paired positive and negative anecdote scenario, a story is told of a couple who had success with one more attempt, and of another couple who tried again for three more cycles and had no luck, with significant strain on their relationship and finances. The scenarios are included below: Exact hypothetical scenario text: Imagine that you have been undergoing in vitro fertilisation (IVF) with your partner for the past two years in attempts to conceive your first child. You have had six unsuccessful cycles to date, and are now trying to decide whether to continue or stop IVF treatment. Although most of the cost is covered by Medicare, each cycle has an out-of-pocket cost of around $5000. Each cycle requires you to take some time off work for appointments (e.g. ultrasounds, egg collection, embryo transfers). Treatment has also had an emotional and physical toll, as well as strained your relationship with your partner. With each failed cycle, you feel like you lose a piece of yourself, but the only way to get those pieces back is by having a baby. Although this process is incredibly difficult, having a baby is something you have always wanted and imagined for yourself. You have an appointment with your fertility specialist to discuss next steps. Your doctor says: “Although IVF is a long-term process and failed attempts are part of the process, success is most likely within five to six attempts. As you have now had six cycles of IVF, your chances of success with another cycle are less than 5%. Deciding to continue or stop is an incredibly difficult decision. [Positive anecdote] I had a couple with six very similar cycle results to you. They were despairing that they hadn’t had a successful pregnancy yet and were trying to work out if it was worth continuing. They decided to give it another go – and got pregnant! They’ve now got baby Oliver and are so glad they kept trying. [Paired positive and negative anecdotes] I’ve had two couples with six very similar cycle results to you. They were despairing that they hadn’t had a successful pregnancy yet, and were trying to work out if it was worth continuing. Both couples decided to give it another go - The first got pregnant! They’ve now got baby Oliver and are so glad they kept trying. But the other couple went on to have a further three cycles but sadly still had no luck. They’ve since stopped trying due to the strain it placed on their relationship and finances. I am happy to support you with whatever decision you decide.” Adherence to and/or fidelity of the intervention will be monitored through access to Qualtrics analytic data. Implausibly fast response times will be deleted and attention check question is included to ensure participants are paying attention to the study.