STUDY QUESTIONDo heterosexual parents of young children following oocyte donation (OD) and sperm donation (SD) tell or intend to tell their offspring about the way he/she was conceived?SUMMARY ANSWERFollowing successful treatment with oocytes or sperm from identity-release donors in Sweden, almost all heterosexual couples intend to tell their offspring about the way he/she was conceived and some start the information-sharing process very early.WHAT IS KNOWN AND WHAT THIS PAPER ADDSAlthough the Swedish legislation on identity-release gamete donors has been in effect since 1985, there is a discrepancy between the behaviour of donor-insemination parents and the legal intention that offspring be informed about their genetic origin. The present study contributes data on a relatively large sample of oocyte and sperm recipient couples' intended compliance with the Swedish legislation.DESIGN AND DATA COLLECTION METHODThe present study constitutes a follow-up assessment of heterosexual couples who had given birth to a child following treatment with donated oocytes. Data collection was performed during 2007–2011; participants individually completed a questionnaire when the child was between 1 and 4 years of age.PARTICIPANTS AND SETTINGThe present study is part of the Swedish Study on Gamete Donation, a prospective longitudinal cohort study including all fertility clinics performing gamete donation in Sweden. For children conceived via OD, 107 individuals (including 52 couples and 3 individuals) agreed to participate (73% response). For children conceived via SD, the response rate was 70% (n = 122 individuals, including 59 couples and 4 individuals). Mean age of participants was 34 years (SD 4.4) and they reported a high level of education.MAIN RESULTSThe majority of participants (78%) planned to tell the child about the donation, 16% had already started the information-sharing process and 6% planned not to tell their child about the donation or were undecided. Many were unsure about a suitable time to start the disclosure process and desired more information about strategies and tools for information sharing. Agreement on disclosure to offspring within the couple was related to the quality of the partner relationship.BIAS AND GENERALIZABILITYThere is a risk of selection bias, with gamete recipients preferring secrecy and non-disclosure declining study participation. The results may be regarded as partly generalizable to heterosexual couples with young children following treatment with gametes from legislatively mandated identity-release donors in an established donor programme.STUDY FUNDING/COMPETING INTERESTSStudy funding by Merck Serono, The Swedish Research Council and The Family Planning Fund in Uppsala. No conflicts of interest to declare.

BACKGROUND Two decades after the introduction of Swedish legislation that allows children born as a result of gamete donation access to identifying information about the donor, a nationwide multicentre study on the psychosocial consequences of this legislation for recipients and donors of gametes was initiated in 2005. The aim of the present study was to investigate recipient couples' attitudes and behaviour regarding disclosure to offspring and others, attitudes towards genetic parenthood and perceptions of information regarding parenthood after donation. METHODS The present study is part of the prospective longitudinal 'Swedish study on gamete donation', including all fertility clinics performing donation treatment in Sweden. A consecutive cohort of 152 heterosexual recipient couples of donated oocytes (72% response) and 127 heterosexual recipient couples of donated sperm (81% response) accepted participation in the study. In connection with the donation treatment, male and female participants individually completed two questionnaires with study-specific instruments concerning disclosure, genetic parenthood and informational aspects. RESULTS About 90% of participants (in couples receiving anonymous donated gametes) supported disclosure and openness to the offspring concerning his/her genetic origin. Only 6% of all participants had not told other people about their donation treatment. Between 26 and 40% of participants wanted additional information/support about parenthood following donation treatment. CONCLUSIONS Two decades after the Swedish legislation of identifiable gamete donors, recipient couples of anonymously donated sperm and oocytes are relatively open about their treatment and support disclosure to offspring. Recipient couples may benefit from more information and support regarding parenthood after gamete donation. Further studies are required to follow-up on the future parents' actual disclosure behaviour directed to offspring.

STUDY QUESTIONHow do heterosexual parents reason about and experience information-sharing with offspring following identity-release sperm donation?SUMMARY ANSWERSharing information about using donor-conception with offspring is a complex process at several levels, with the parent's personal beliefs and the child's responses serving as driving or impeding forces for the information-sharing process.WHAT IS KNOWN ALREADYThe overall view of disclosure in gamete donation has shifted from secrecy to openness, but there is still uncertainty among parents concerning how and when to tell the child about his/her genetic origin. Most research on donor-conceived families has focused on donation treatment under anonymous or known circumstances, and there is a lack of studies in settings with identity-release donations.STUDY DESIGN, SIZE, DURATIONA qualitative interview study among 30 parents following identity-release sperm donation treatment. Interviews were conducted from February 2014 to March 2015.PARTICIPANTS/MATERIALS, SETTING, METHODSThe present study is part of the prospective longitudinal Swedish Study on Gamete Donation (SSGD), including all fertility clinics performing gamete donation in Sweden. A sample of participants in the SSGD, consisting of heterosexual parents with children aged 7–8 years following identity-release sperm donation, participated in individual semi-structured interviews.MAIN RESULTS AND THE ROLE OF CHANCEThe analysis revealed one main theme: information-sharing is a process, with three subthemes; (i) the parent as process manager, (ii) the child as force or friction and (iii) being in the process. The first two subthemes were viewed as being linked together and their content served as driving or impeding forces in the information-sharing process.LIMITATIONS, REASONS FOR CAUTIONThe fact that the study was performed within the context of the Swedish legislation on identity-release donation must be taken into consideration as regards transferability to other populations, as this may affect parents' reasoning concerning their information-sharing with the child.WIDER IMPLICATIONS OF THE FINDINGSThe present findings highlight the role of the donor-conceived child in the information-sharing process and may contribute to develop counselling that increases parents' confidence in handling children's reactions to information about their genetic origin.STUDY FUNDING/COMPETING INTEREST(S)Financial support from The Swedish Research Council, The Family Planning Fund in Uppsala and Ferring Pharmaceuticals. There are no conflicts of interest to declare.TRIAL REGISTRATION NUMBERN/A.

Several years after donation, a majority of identity-release oocyte and sperm donors show positive attitudes toward future contact with their offspring. Donors appear to have different preferences for information and support regarding such contact. Fertility clinics and health-care services should provide counseling regarding contact with an offspring to the donors who express a need for this.

Aim The Green Cross method was developed to support healthcare staff in daily patient safety work. The aim of this study was to describe users’ experiences of the method when working with patient safety and their views on the core elements. Background Patient safety systems need to be user‐friendly to facilitate learning from adverse events. The Green Cross method is described as a simple visual method to recognise risks and preventable adverse events (PAEs) in real time. There are no previous studies describing users’ experiences of the Green Cross method. Design A qualitative descriptive design. Methods 32 healthcare workers and managers from different specialties in a Swedish hospital were interviewed, from May–September 2018 about their experiences of the Green Cross method; either individually or as part of a group. The interviews were analysed using thematic analysis. The study follows the COREQ guidelines for qualitative data. Results Participants associated the Green Cross method with patient safety, but no core elements of the method were identified. Instead, the opportunity to be engaged in patient safety work in a systematic way was underlined by all study participants. Highlighted key areas were the simplicity and the systematic framework of the method along with a need of distinct leadership. The daily meetings promoted trust and dialogue and developed the patient safety mindset. Daily meetings, together with the visualisation of the cross, were emphasised as important by users who otherwise had limited knowledge of the entire method. Conclusion This study offers valuable information that can help deepen the understanding of how the method specifically supports patient safety work. Relevance to clinical practice Healthcare workers are expected to report patient safety issues. This study presents user‐friendly aspects of the method as well as limitations, relevant for present and future users.