The latest online event organised by the Progress Educational Trust (PET) gathered a panel of speakers to provide insight into the various aspects of counselling in the context of assisted reproduction. 'Counselling and Assisted Reproduction: When, Why and by Whom Should It Be Offered?', addressed confusion surrounding the language used, the differing expectations among patients, and the need for clear guidelines regarding the provision and facilitation of fertility counselling.
Opening the conversation, Sarah Norcross, director of PET, emphasised the difficulty in refining the definitions of counselling types to align with the current landscape of counselling in the fertility clinic setting. For example, 'implications counselling' has somewhat fallen into a grey area, with unanswered questions surrounding who is qualified to deliver this type of counselling, whether it is or should be therapeutic in style, and whether it should be a condition of valid consent. The definitions refined by PET with members of the British Infertility Counselling Association (BICA), listed below, are paramount to understanding the different types of counselling, when it is typically offered, and the appropriate professionals involved.
- Information counselling – This involves the provision of medical information. Under UK regulation, such counselling must be provided in order for a fertility patient's consent to be valid. This sort of counselling would usually be provided by a member of the medical team.
- Therapeutic counselling – This involves helping a person deal with (current, future or potential) challenges, decisions, difficulties, distress or emotions. Under UK regulation, such counselling is not required in order for consent to be valid (indeed, it is an important principle that such counselling is voluntary). The content and outcome of such counselling is usually confidential..
- Implications counselling – This involves the provision or clarification of information about the implications of treatment or donation, and also involves exploring these implications.
The first speaker, Alison McTavish, member of the Human Fertilisation and Embryology Authority (HFEA), trustee at PET and trustee at the British Fertility Society, provided an overview of the current counselling requirements outlined in legislation and the HFEA Code of Practice. McTavish acknowledged the need for modifications and stressed the importance of separating the provision of information from the offer of counselling. Furthermore, she highlighted the necessity for treatment centres to establish robust patient support policies before, during, and after treatment. Recent updates to the Code of Practice also now mandate the offer of counselling before renewing any storage consent.
Angela Park, a fertility counsellor at Aberdeen Fertility Centre , proceeded to highlight research figures from the Fertility Network UK, which McTavish also shared. These figures underscored that 79 percent of patients desired free counselling, while approximately 60 percent of patients who received counselling had to self-fund. The research demonstrated the adverse psychosocial impact of infertility and revealed a disparity between the number of people experiencing poor mental health and those seeking professional help. Park discussed the multifaceted role of a clinic counsellor, which includes collaborating with the multidisciplinary team to develop standard operating procedures, patient information, and training programmes for staff. She emphasised the necessity for counsellors to possess comprehensive and up-to-date knowledge of fertility treatment and its emotional impact, and an understanding of the patient's journey before attending a treatment centre.
Next to speak was Lee Noquet, egg donor coordinator and senior staff nurse at the Edinburgh Fertility Centre, who emphasised that implications counselling extends beyond the immediate lens of the clinic setting, impacting the lifelong relationships of patients, donor-conceived people, and their wider circles. She described implications counselling as a mosaic-like process that requires piecing together various elements over multiple sessions to be truly effective. Noquet also highlighted the emotionally charged nature of counselling, drawing similarities with the roller coaster of emotions experienced by people receiving a diagnosis of a terminal illness.
The last speaker, Professor Jacky Boivin, chair at Cardiff University's School of Psychology and lead researcher at Cardiff Fertility Studies, provided a comprehensive review of the historical changes in fertility-related counselling outlined in the HFEA Code of Practice. Professor Boivin strongly reinforced the 2019 requirement for patient support policies in treatment centres. However, she expressed concerns that the mandatory registration with a single specialist counselling association might create a barrier for other qualified professionals capable of delivering 'proper' counselling and potentially limit patient access to such services. Professor Boivin emphasised the nuanced nature of counselling within fertility treatment, encompassing both psychosocial needs and specialised therapeutic knowledge.
The Q&A session following the presentations highlighted a consensus among attendees and speakers that counselling should be provided by qualified professionals who can address the specific needs of patients in the given context. Suggestions were made to differentiate between different strands of counselling, with information and knowledge provision possibly handled by suitably trained clinic team members, while counsellors focus on therapeutic aspects.
The discrepancy between the offer and uptake of counselling was also discussed, prompting the need for further exploration into the impact of counselling on treatment plans and the experiences of intended parents and donor-conceived people. Affordability, access, and the need to revise regulatory requirements to prioritise patient wellbeing were common themes. The audience was told BICA is working on policy guidelines for delivering implications counselling, which are eagerly awaited to reduce the risk of harm to patients and donors, their existing and yet to be born children.
This PET online event succeeded in shedding light on the intricate nature of fertility counselling. By bringing together experts in the field, the session provided valuable insights into the definitions, requirements, and delivery of counselling, ultimately aiming to enhance patient experiences and ensure comprehensive support for their wellbeing.
PET is grateful to the Scottish Government for supporting this event.
The next free-to-attend online event from PET, taking place on Wednesday 19 July 2023, will be 'The Women's Health Strategy, One Year On'. Register here.
Registration will also open soon for the 2023 PET Annual Conference, which this year is entitled 'How Much Change Do We Want? Updating Fertility, Embryo and Surrogacy Law'.
The conference is in person only, and will be held in central London on Wednesday 6 December 2023. Further details will be announced in BioNews shortly.
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