fertiShare Evaluation

Modified intention-to-treat (mITT, all FHPs randomized) and per protocol (PP, only FHPs who completed a sufficient dose) analyses of mean differences in patient reported FHPs' sharing bad news performance (primary outcome) between patients in the baseline (pre FHPs training) and follow-up (post FHPs training) cohort. Patient reported FHPs' sharing bad news performance will be assessed with an adapted version of the Sharing Bad News Behavioural Assessment Scale. The scale is composed of 23 items that list evidence-based best practice behaviours on how to share bad news (e.g., warn you they would be sharing bad news). Patients are asked to rate the degree to which the FHP did each behaviour on a Likert scale from 1- not at all to 5 - completely (or 6 - does not apply). A global average score is calculated that ranges from 1 to 5, with higher values indicating better sharing bad news performance.

Modified intention-to-treat (mITT, all FHPs randomized) and per protocol (PP, only FHPs who completed a sufficient dose) analyses of changes in confidence in SBN (secondary outcome) from pre to post training with fertiShare or control eLearning. Confidence in sharing bad news will be assessed with an adapted version of the Breaking Bad News Assessment Scale. The scale is composed of 23 items that list evidence-based best practice behaviours on how to share bad news (e.g., warn patients you will be sharing bad news). FHPs are asked to rate how confident they feel doing each behaviour listed on a Likert scale from 1- not at all to 5 - completely (or 6 - does not apply). A global average score is calculated that ranges from 1 to 5, with higher values indicating higher confidence in sharing bad news.

Modified intention-to-treat (mITT, all FHPs randomized) and per protocol (PP, only FHPs who completed a sufficient dose) analyses of mean differences in patient trust in their FHP (secondary outcome) between patients in the baseline and follow-up cohort. Trust will be assessed with the Wake Forest Physician Trust Scale. The scale is composed of ten statements describing care provided (e.g., They will do whatever it takes to get you all the care you need.). Patients are asked to rate their level of agreement with each statement on a Likert scale from 1- strongly disagree to 5-strongly agree. Trust is measured by the sum of the 10 item scores (reverse-scored for negative items), ranging from 10 to 50, with a higher score indicating more trust.

Modified intention-to-treat (mITT, all FHPs randomized) and per protocol (PP, only FHPs who completed a sufficient dose) analyses of mean differences in patient satisfaction with care at the clinic (secondary outcome) between patients in the baseline and follow-up cohort. Assessed with five questions used by the Human Fertility and Embryology Authority for patients to rate their satisfaction with care provided at UK based fertility clinics (e.g., To what extent did you feel you were treated with privacy and dignity?). Patients answer on a Likert scale from 1-never to 5-always (answer scale anchors vary with question), with higher values indicating higher satisfaction with care.

Modified intention-to-treat (mITT, all FHPs randomized) and per protocol (PP, only FHPs who completed a sufficient dose) analyses of mean differences in patient satisfaction with shared decision-making support about continuing fertility treatment (secondary outcome) between patients in the baseline and follow-up cohort. Assessed with the Decisional Conflict Scale. Patients are asked to select which treatment option they prefer (doing another treatment cycle at clinic, doing another treatment cycle at a different clinic, stopping fertility treatment, other) and to rate the degree to which they agree with a list of 16 statements related to their decision (e.g., I know which options are available to me) on a Likert scale from 0-strongly agree to 4-strongly disagree. Total decisional conflict and sub-dimension scores (uncertainty, informed, values clarity, support) are calculated and linearly transformed to range from 0 to 100, with higher scores indicating more of the construct.

Modified intention-to-treat (mITT, all staff randomized) and per protocol (PP, only staff who completed a sufficient dose) analysis of mean differences in patient uptake of (yes, no, not recommended) and time to another stimulated IVF cycle (in days, not applicable) between patients in the baseline and follow-up cohort: data obtained via patient record review.

Number of Fertility Healthcare Professionals who registered with the eLearning and completed each lesson. module, and quiz

Demographic and professional profile of FHPs who registered and completed the intervention (fertiShare, control training)

Quantitative ratings regarding 5 items describing the experience of doing the eLearning (e.g., I benefited, I learned). FHPs answer on a Likert-type scale ranging from 1 (not at all) to 5 (an extreme amount), presented in the eLearning evaluation form. Higher scores indicate higher acceptability of intervention.

Proportion of staff reporting they recommend fertiShare to other colleagues in their situation, fertiShare improved their preparation to have difficult conversations with their patients, and fertiShare reduced their anxiety when having difficult conversations with their patients: post-exposure (fertiShare, control training) staff assessment

Patient self-reported satisfaction with how their FHP shared the bad news with them. Assessed with a single question "Overall, how satisfied are you with the way [name of participating staff member] shared or discussed with you the news that the IVF cycle was unsuccessful?", with a Likert-type response scale ranging from 1 (very dissatisfied) to 5 (very satisfied), presented in the patient pre- and post-cohorts' assessments

Open ended questions included in semi-structured process evaluation interviews with staff (e.g., Which aspects of FertiShare were particularly useful, if any?) and patients (e.g., What are your views about how staff shared with you the news that the IVF cycle was unsuccessful?)

Number of Fertility Healthcare Professionals who completed all intervention (fertiShare, control training) Modules (i.e., used intervention as intended) and completed Module 1 and 2 only (i.e., completed sufficient dose) during the 4-week training period: data stored by the eLearning

Open ended questions included in semi-structured process evaluation interviews with FHPs (e.g., Can you describe any changes you made in the way you SBN with your patients (if any) because of doing the fertiShare eLearning and why?) and patients (e.g., Can you think of any factors that made it harder or easier for staff to share the news with you in a sensitive way?)

Fertility Healthcare Professionals' answers to multiple choice question (yes, no) about experiencing technical issues during the intervention (fertiShare, control training), presented in the intervention Evaluation form

Open ended questions included in semi-structured process evaluation interviews with FHPs (e.g., Where there any factors that made it easier or harder for you to do fertiShare?) and patients (e.g., Can you think of any factors that made it harder or easier for staff to share the news with you in a sensitive way?)

FHPs' and patients' participation (proportion of invited FHPs and patients who consent to participate) rates

FHPs' and patients' retention rates (proportion of FHPs and patients who fill each assessment).

Proportion of patients in the pre- and post-training cohorts who complete their respective online assessments

Proportion of FHPs who completed background and professional form, and pre- and post- exposure (fertiShare, control training) assessments

Issues reported by FHPs and patients to research team relating to study procedures or materials and reasons for non-participation/withdrawal from the study

Time taken by FHPs and patients to complete assessments and process evaluation interview

Open-ended questions included in semi-structured process evaluation interviews with FHPs and patients about the study methods (e.g., 'How demanding was participation in this study?' and, for staff only, 'How did you find the randomization process?')