Examining the Relationships Among Uncertainty, Control, Emotionality, and Information Behavior in Patient Experience During In-Vitro Fertilization Treatments

Abstract

Patients undergoing in-vitro fertility treatment (IVF) live challenging and complex lives. IVF is a highly demanding, high-stakes procedure involving an exacting self-administered medication regimen. The IVF experience is characterized by heightened emotionality, severe life disruptions, and physical and psychological difficulties. Additionally, it is marked by uncertainty; despite IVF’s established safety, patients feel unsure about side effects and their chances, given IVF’s perceived low success rate (4% to 40%). Nonetheless, patients typically achieve exemplary compliance, in striking contrast to what might be expected in theory, given the emotionality and difficulties that might undermine the self-control required. Although IVF patient experience studies have been performed, little is known about how patients actually experience the treatment day by day; i.e., how they navigate through these challenges, regulate their emotions, and manage their lives outside of the clinic. This study addresses the evolution of the patients’ thinking and feeling and the psychological mechanisms by which certain behaviors are instigated and performed.

The study rests on data collected in in-depth semi-structured interviews conducted with 29 IVF patients, along with notes from extensive field observation. I used constructed grounded theory, which involves line-by-line coding and iterative comparison methods, to analyze my interview transcripts. My analysis of the interview data uses the appraisal theory framework, which emphasizes the interconnectedness of emotionality, cognition, actions, and treatment context.

Some important findings include:

1.the predominant behavioral driver was the desire for control, which provoked emotion episodes and prompted patients to engage in particular information behavior using calibrated uncertainty, a psychological mechanism driven by simultaneous seeking of contradictory valences and varying levels of certainty in response to the desire for control and emotional needs at the moment.

2.patients experienced two different types of emotions, immediate, or those triggered directly by past or current events, and anticipatory, or those triggered by imagination of future events and states. The two types exhibited dissimilar trajectories and patterns of occurrence.

3.patients sought to regulate their emotions to stay within an optimal self-constructed emotional range and thus to preserve their well-being and persevere through the treatment. To do so, patients used calibrated uncertainty to appraise information that they acquired and thus to maintain emotional equilibrium. They also used both up- and down-regulation when they felt that they were falling out of their optimal emotional range.

The study has several important conclusions and implications, both for theory and for practice. One theoretical contribution is the demonstration that immediate and anticipatory emotions differ in their generation and effects and thus should be treated differently in discussions of emotional experience. For the practitioner, this implies that the design of patient support systems should reflect awareness of the different types of emotions that a patient is likely to be experiencing at given points.

A second contribution is the development of a profile of the appraisal dimensions or lenses (control, uncertainty, personal importance) that correspond to emotions of specific valences and intensities and shows how these interact and evolve to construct the emotional experience. While the profile may be specific to the IVF context, it could be extended to the study of emotionality in other types of experiences in high-uncertainty contexts. For the practitioner, it suggests that the design of information delivery systems, communication protocols, and caring interventions could benefit from this more nuanced understanding of patients’ emotionality.