Purpose: Fertility preservation decisions among cancer patients are complex and require balancing multiple competing demands as well as the integration of preferences and values with the risks of infertility and fertility preservation options. Analytic Hierarchy Process (AHP) is a multi-criteria decision making method well-suited for fertility decisions because it helps decision-makers make trade-offs among competing demands and integrate quantitative data with difficult to quantify data such as values and preferences. The current study sought to create a decision model of the fertility preservation decision and to elicit feedback regarding the content and format of a decision aid (DA) based on AHP for these decisions.
Method: Six focus groups of 2-5 participants were conducted with women aged 18-45 at time of diagnosis. Women were recruited from breast oncology centers, health fairs, and advocacy groups to participate in small group discussions regarding cancer treatment and fertility preservation decisions, and what criteria (outcomes) were important in their decision-making process. In addition, women were presented with an AHP-based on-line DA to review and provide feedback for the development of a fertility-preservation DA. A focus group script was developed with input from oncologists, survivors, reproductive endocrinologists and social workers. All focus groups were tape-recorded, transcribed, and stripped of identifying information.
Result: Age at diagnosis was 29-43yrs and 33% were from a racial/ethnic minority. Two-thirds (67%) of women had a partner when diagnosed and half had children. A third of women pursued fertility preservation before treatment. Three main decision-making criteria were identified: 1) costs of fertility preservation (sub-criteria included time, money, emotional & physical costs); 2) safety of fertility preservation (sub-criteria included woman’s own health and health of potential offspring); and 3) success rates for live birth. Women’s preferences for the content and format of an AHP-based DA included: 1) tailoring to their particular medical and social situation; 2) flexibility to control the level and detail of information presented; and 3) summary sheet of the results which they could print out for their own reference and for their providers.
Conclusion: Cost, safety and success of fertility preservation options were identified as the most important criteria for decision making. Women were very receptive to an AHP-based decision aid but wanted it tailored to their individual needs and a printable summary.
Candidate for the Lee B. Lusted Student Prize Competition