A NOVEL METHOD TO ADDRESS UNCERTAINTY WITHIN A FERTILITY PRESERVATION DECISION AID

Purpose:

   Many women are uncertain about having children or more children in the future.  A new cancer diagnosis often forces women to confront this question urgently, as many cancer treatments can impair fertility.  We describe a novel feature within a fertility preservation (FP) decision aid (DA) that is designed to help women address this uncertainty when considering FP.

Method:

   A FP DA was developed using the International Patient Decision Aid Standards (IPDAS) guidelines. Twenty-eight semi-structured interviews and one focus group were conducted with cancer survivors to ascertain their thoughts and feelings about cancer and fertility as well as their personal experience with making decision about FP. The interviews were analyzed for content using grounded theory methods. This content was used to generate a values-clarification exercise (VCE) designed to address reproductive uncertainty.

Result:

   Female cancer survivors identified multiple factors leading to reproductive uncertainty when considering FP. These factors included the presence (or absence) of romantic partners, current developmental/life stage and the impact of a cancer diagnosis on their reproductive plans. The VCE was designed to address these competing priorities by focusing issues such as personal desire for parenthood, opinions on family-building options and cancer-related concerns. The VCE is presented in the DA at two distinct points: prior to specific information about the various FP options available and well as after this information has been presented.

Conclusion:

   Women with cancer must consider their personal desires for parenthood during a short, stressful period of time before treatment. To help women make appropriate decisions about FP, preexisting uncertainties about reproductive desires should be addressed. A dual VCE model may accomplish this by allowing patients to clarify their initial values and then refine their responses after receiving additional information about FP.