title: Making hard choices easier: a prospective, multicentre study to assess the efficacy of a fertility-related decision aid in young women with early-stage breast cancer.
abstract: BACKGROUND
  Fertility is a priority for many young women with breast cancer. Women need to be informed about interventions to retain fertility before chemotherapy so as to make good quality decisions. This study aimed to prospectively evaluate the efficacy of a fertility-related decision aid (DA).
  
  
  METHODS
  A total of 120 newly diagnosed early-stage breast cancer patients from 19 Australian oncology clinics, aged 18-40 years and desired future fertility, were assessed on decisional conflict, knowledge, decision regret, and satisfaction about fertility-related treatment decisions. These were measured at baseline, 1 and 12 months, and were examined using linear mixed effects models.
  
  
  RESULTS
  Compared with usual care, women who received the DA had reduced decisional conflict (β=-1.51; 95%CI: -2.54 to 0.48; P=0.004) and improved knowledge (β=0.09; 95%CI: 0.01-0.16; P=0.02), after adjusting for education, desire for children and baseline uncertainty. The DA was associated with reduced decisional regret at 1 year (β=-3.73; 95%CI: -7.12 to -0.35; P=0.031), after adjusting for education. Women who received the DA were more satisfied with the information received on the impact of cancer treatment on fertility (P<0.001), fertility options (P=0.005), and rated it more helpful (P=0.002), than those who received standard care.
  
  
  CONCLUSIONS
  These findings support widespread use of this DA shortly after diagnosis (before chemotherapy) among younger breast cancer patients who have not completed their families.
authors.affiliation: Prince of Wales Clinical School, University of NSW, Randwick, New South Wales, Australia. michelle.peate@sydney.edu.au
authors.forename: M
authors.initials: M
authors.lastname: Peate
authors.forename: B
authors.initials: B
authors.lastname: Meiser
authors.forename: B C
authors.initials: BC
authors.lastname: Cheah
authors.forename: C
authors.initials: C
authors.lastname: Saunders
authors.forename: P
authors.initials: P
authors.lastname: Butow
authors.forename: B
authors.initials: B
authors.lastname: Thewes
authors.forename: R
authors.initials: R
authors.lastname: Hart
authors.forename: K-A
authors.initials: KA
authors.lastname: Phillips
authors.forename: M
authors.initials: M
authors.lastname: Hickey
authors.forename: M
authors.initials: M
authors.lastname: Friedlander
mesh_terms: D000328:Adult; D001007:Anxiety; D001943:Breast Neoplasms / Q000473:pathology* / Q000523:psychology; D003220:Conflict, Psychological; D003657:Decision Making; D003661:Decision Support Techniques; D003863:Depression; D004644:Emotions; D005260:Female; D059247:Fertility Preservation; D006801:Humans; D009367:Neoplasm Staging; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D011446:Prospective Studies; D012017:Referral and Consultation; D011795:Surveys and Questionnaires