A first look at parents sequential decisions when co-creating a telling plan to inform their donor conceived children about their birth origins: results from the tell tool intervention trial

To understand gamete and embryo donation recipient parents’ decisions when they co-create a TELLING plan within the digital TELL Tool intervention to inform their children, 1-16 years, about their birth origins. Parents who conceived their children, ages 1-16 years, through donor gametes and embryo donation, lived in the United States, and expressed an interest in learning how to talk with and tell their children about their birth origins were recruited into the TELL Tool feasibility, randomized-controlled trial (ClinicalTrials.gov ID: NCT04841967). In this longitudinal study, parents who met eligibility requirements were randomized to either the TELL Tool intervention or an attention control group. Parents in the TELL Tool intervention group co-created a TELLING Plan within the intervention through a process whereby parents received information about who, when, how, and strategiesto facilitate disclosure. Parents then entered their responses to decision points embedded within the intervention to co-create their TELLING Plan. Parents were evaluated for actual disclosure to their children 4-weeks post intervention. Responses wereanalyzed though descriptive quantitative and qualitative analyses. Thirty married (n=21), solo (n=7), and divorced or widowed (n=2) parents that used egg (n=12), sperm (n=12), egg and sperm (n=1), and embryo (n=5) donation and who had children 1-16 years (mean=4.5, SD=3.4) co-created TELLING Plans. Parents reported their decisions about who will participate in the initial telling conversation (one parent, n=11; two parents, n=19). The timeline for when to implement their TELLING Plan ranged from 1 day (n=3) to 1 year (n=4) with a mode of 1 month (n=7). The language chosen for how to tell most often included the word “donor” (n=18) or “special” as in “special man/women/person/part” (n=6). Preferred strategies selected to assist with telling were children’s books (n=19) and photos/videos (n=11) for parents with young children; drawings (n=4) and photos/videos for parents with middle-aged children; and writing a letter (n=1) and photos/videos (n=1) for parents with teenagers. Parents who reported engaging in disclosure with their children at 4-weeks post intervention were more likely to be parents that opted to tell with 2 partners; used language that included the words “donor”, “helper”, “egg”, “sperm”, or “embryo”, and used children’s books, photos/videos or drawings as strategies. Insight into parents’ underlying decisions provides foundational understanding about parents’ preferences and the types of decision support that parents need to facilitate disclosure to their children. Future research with a larger sample size that explores correlations between disclosure and parents’ decisions is our next step.