173 Impact of the COVID-19 pandemic on infertility and endometriosis patients 8 INTRODUCTION The global outbreak of coronavirus disease 2019 (COVID-19) has led to a significant increase of pressure on healthcare systems all over the world. In the spring of 2020 all elective care and other ‘non-essential’ medical care was largely restricted or even shut down during the lockdown in the Netherlands in order to prevent the spread of COVID19 and to focus all resources and healthcare providers on COVID-19 care. For infertility patients and endometriosis patients, this first lockdown period resulted in a temporary cancellation of physical appointments, elective surgery and assisted reproductive technology (ART) during the COVID-19 pandemic in the Netherlands. In order to maintain continuity of care for both patient groups during the first COVID-19 lockdown, virtual care options such as telephone consultations and video consultations were quickly implemented in most hospitals throughout the Netherlands. Telephone consultations were already being used prior to the pandemic, mainly to communicate the results of diagnostic tests. Video consultations were not widely used in fertility and endometriosis care. With the use of these virtual care alternatives, healthcare providers were able to replace at least a proportion of the cancelled physical appointments in outpatient clinics, thus providing continuity in fertility and endometriosis care. Under normal circumstances, infertility patients already experience high levels of stress, as well as a high sense of urgency to obtain treatment (1, 2). In addition, patients undergoing fertility treatments show higher levels of depression in comparison to the general population (3, 4). The turbulent period of the first COVID-19 lockdown, with the temporary care restrictions resulting in cancellation of fertility treatments, might have led to additional stress and had a negative impact on the patients’ quality of life. For patients with a chronic disease, such as endometriosis, continuity of care and more specifically the patient-centeredness of the healthcare provided are very important as they are possibly associated with health-related quality of life (5). Patient-centred care is a method of providing care to patients while taking into account ‘the preferences, needs and values of the individual patient’ (6, 7). The cancellation of physical appointments, elective surgeries and fertility treatments during the COVID-19 lockdown could have a negative impact on the perceived quality of endometriosis care as patients might experience less support from their healthcare providers accompanied by an increase in waiting lists for consultations, surgery and ART. The aim of this study was to evaluate patient and healthcare provider experiences of the alternative virtual care consultations and to investigate the impact of the restrictive
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