Fertility preservation consultation for women with cancer: are we helping patients make high-quality decisions?

Abstract

To investigate the efficacy of the current fertility preservation consultation process in patients’ decision-making and socio-demographic and cognitive factors that may affect patients’ decision-making, a prospective pilot survey was conducted at university-based IVF centres and included women aged 18–43 years seen for fertility preservation between April 2009 and December 2010. Patients’ views on consultation and decision-making about fertility preservation were measured. Among 52 women who completed the survey, more than half (52%) requested their consultation. All patients answered that consultation was a helpful resource of information, and 73% made their decision about treatment after consultation. Decisional conflict was lower in patients who felt strongly that they were given opportunities to ask questions during the consultation (P=0.001) and higher those who reported that cost was strongly influential in the treatment decision (P<0.001) and who did not receive treatment (P<0.001). Although consultation appeared to play a critical role in patients’ decision-making about fertility preservation, the referral rate for consultation by oncologists is still poor. Decision-making appears to be significantly impaired in patients grappling with financial concerns and when the opportunity to ask questions is not felt to be sufficient.Fertility preservation, a medical technique that helps cancer survivors preserve their fertility options before gonadotoxic cancer treatment such as chemotherapy and radiation, is now considered a major issue in young patients with cancer because of the increased survival after cancer treatment. Making decisions about fertility preservation is a complex process and several factors may make the decision an especially difficult one for patients. The fertility preservation consultation with a fertility specialist plays a key role in patients’ decision-making because it is the main source of information and supports patients’ desire to learn about and seek treatment. This study investigated the efficacy of the current fertility preservation consultation in patients’ decision-making and the socio-demographic and cognitive factors that may affect their decision-making. Women aged 18–43 years seen for fertility preservation consultation between April 2009 and December 2010 were included. Among 52 women who completed the survey, more than half of the patients (52%) requested their own fertility preservation consultation referral. All patients answered that the consultation was a helpful resource of information and 73% made their decision about treatment after the consultation. Decision-making appears to be significantly impaired in patients grappling with financial concerns and when the opportunity to ask questions was not felt to be sufficient. Although the fertility preservation consultation appeared to play a critical role in patients’ decision-making about treatment, the referral rate for consultation by oncologists is still poor.