Redefining care processes for and with patients.

The new paradigm in health care is giving patients active rather than passive roles. This implies that care processes should be redefined in collaboration with patients. Whether this will improve health care is unknown. We will start redefining care processes in collaboration with the following two groups of subfertile couples: those with a good prognosis obliged to continue attempting natural conception and those offered medically assisted reproduction (MAR). For couples continuing to attempt natural conception, we will design a novel support program by first allowing patients and professionals to individually suggest components and than to judge all proposed components in three rounds while receiving feedback on judgements of others in between rounds. For couples offered MAR, we will facilitate joint meetings in which professionals and patients construct a novel decision aid together that will facilitate shared treatment decision-making. Subsequently, within each patient group, we will conduct a randomized trial comparing the novel care process to standard care in terms of ongoing pregnancy rates (only for couples continuing to attempt natural conception), decisional conflict (only for couples offered MAR), self-reported psychosocial wellbeing, biomarkers for stress and health care expenditure. This research will support or refute the hypothesis that care processes redefined in collaboration with patients truly improve physical and psychosocial health care outcomes.