Patients’ and Providers’ Needs and Preferences When Considering Fertility Preservation Before Cancer Treatment: Decision-Making Needs Assessment

Abstract

Background As cancer treatments continue to improve, it is increasingly important that women of reproductive age have an opportunity to decide whether they want to undergo fertility preservation treatments to try to protect their ability to have a child after cancer. Clinical practice guidelines recommend that providers offer fertility counseling to all young women with cancer; however, as few as 12% of women recall discussing fertility preservation. The long-term goal of this program is to develop an interactive web-based patient decision aid to improve awareness, access, knowledge, and decision making for all young women with cancer. The International Patient Decision Aid Standards collaboration recommends a formal decision-making needs assessment to inform and guide the design of understandable, meaningful, and usable patient decision aid interventions. Objective This study aims to assess providers’ and survivors’ fertility preservation decision-making experiences, unmet needs, and initial design preferences to inform the development of a web-based patient decision aid. Methods Semistructured interviews and an ad hoc focus group assessed current decision-making experiences, unmet needs, and recommendations for a patient decision aid. Two researchers coded and analyzed the transcripts using NVivo (QSR International). A stakeholder advisory panel guided the study and interpretation of results. Results A total of 51 participants participated in 46 interviews (18 providers and 28 survivors) and 1 ad hoc focus group (7 survivors). The primary themes included the importance of fertility decisions for survivorship, the existence of significant but potentially modifiable barriers to optimal decision making, and a strong support for developing a carefully designed patient decision aid website. Providers reported needing an intervention that could quickly raise awareness and facilitate timely referrals. Survivors reported needing understandable information and help with managing uncertainty, costs, and pressures. Design recommendations included providing tailored information (eg, by age and cancer type), optional interactive features, and multimedia delivery at multiple time points, preferably outside the consultation. Conclusions Decision making about fertility preservation is an important step in providing high-quality comprehensive cancer care and a priority for many survivors’ optimal quality of life. Decision support interventions are needed to address gaps in care and help women quickly navigate toward an informed, values-congruent decision. Survivors and providers support developing a patient decision aid website to make information directly available to women outside of the consultation and to provide self-tailored content according to women’s clinical characteristics and their information-seeking and deliberative styles.

The experience of female oncological patients and fertility preservation: A phenomenology study

“…Incorporating fertility issues in the treatment and care of patients diagnosed with cancer at a reproductive age has therefore become an increasingly important topic in clinical and research contexts (Abdul et al, 2021; Anazodo et al, 2019; Chen et al, 2022; Harada & Osuga, 2019). Fertility emerged as an integral component of quality of life for cancer survivors receiving gonadotoxic treatments, and it is considered an essential component of the comprehensive approach to cancer patients' care (Hoffman et al, 2021; Vuković et al, 2019; Zaami et al, 2021).…”

Information needs and research priorities in long‐term survivorship of breast cancer: Patients and health professionals' perspectives

“…Research about fertility preservation in the context of BC and different procedures to become pregnant, considering the risks and benefits, has emerged as a priority research area in the present study and in other studies about the subject (Brown et al, 2021; Hoffman et al, 2021; Thewes et al, 2005; Torres‐Castaño et al, 2021).…”

Fertility Preservation Practices at Pediatric Oncology Institutions in the United States: A Report From the Children's Oncology Group

“…15,31 Offering FP interventions on the basis of individual interpretations of patient risk or other patient factors instead of standardized criteria raises ethical concerns including loss of patient/parent autonomy for decision making and non-malfeasance. [32][33][34][35] Patients and families cannot make informed decisions if not provided with clear and comprehensive information on their risk of future infertility, even if only to advise that their risk is low or negligible. 4 To some degree, institutions cannot be faulted for lacking rigorous guidelines as clarifying who is at increased risk for fertility impairment can be challenging.…”