Decisional Regret in Female Oncofertility Decision Making-An Integrative Narrative Review.

Abstract

Simple SummaryWomen diagnosed with cancer at reproductive age often face potential impairments in fertility due to cancer treatments and complex and uncertain fertility decisions. The complexity of the decision-making process is often associated with psychological distress and a potential for long-term decisional regret around a decision made at diagnosis, which may have a negative impact on patients’ Quality of Life (QoL). Some factors have been associated with the experience of regret, such as patients’ perceived quality and satisfaction with the fertility counseling received, the decision to undergo fertility preservation procedures, desire for children and decisional regret. Awareness of these factors is of utmost importance to support and guide this population through their fertility decision-making process.It is well established that fertility is an important issue for young women with cancer at reproductive age, as many have not initiated or completed their parenthood goals when diagnosed. Because cancer treatments may impair fertility, women face fertility decisions that are often complex and surrounded by uncertainty. This may put patients at risk for psychological distress and the experience of regret regarding decisions made at diagnosis, which may be associated with a negative impact on women’s QoL. This narrative review addresses current knowledge about decisional regret regarding fertility preservation decisions in adult female cancer patients at reproductive age. Electronic searches were conducted on Pubmed database for articles published in English from 1 January 2000 to 1 July 2021 that assessed decisional regret following fertility decisions in young women diagnosed at childbearing age. Of the 96 articles identified, nine provided information on decisional regret regarding fertility decisions. Studies reported that, overall, decisional regret regarding oncofertility decisions was low. Factors associated with the experience of decisional regret were patients’ perceived quality and satisfaction with fertility counseling received, the decision to undergo fertility preservation, desire for children and decisional conflict. Health providers should be aware of the factors that are potentially modifiable and prone to improvement in order to reduce decisional regret. All efforts should be made to improve availability of and access to tailored high quality fertility counseling and fertility preservation. Given the growing evidence that decision aids (DAs) are effective in increasing knowledge and reducing decisional conflict and regret, their use in a routine and timely manner to complement fertility counseling is recommended.