title: To preserve or not to preserve: how difficult is the decision about fertility preservation?
abstract: BACKGROUND
  The decision to pursue fertility preservation (FP) after a cancer diagnosis is complex. We examined the prevalence of high decisional conflict and specific factors that influence this decision using the Decisional Conflict Scale (DCS).
  
  
  METHODS
  The FIRST project is a web-based survey of female cancer survivors (ages 18-44 years) who have undergone gonadotoxic treatment. We evaluated the association between recalled decisional conflict and referral to FP counseling and demographic, socioeconomic, and cancer variables.
  
  
  RESULTS
  Of 208 participants, 115 subjects (55%) had scores consistent with high decisional conflict (DCS score >37.5 of 100), and 43 (21%) were in the moderate range (25-37.5). In unadjusted analysis, high decisional conflict was associated with lack of referral to FP consultation, not undergoing FP treatment, concerns regarding FP cost, length of survivorship, lower income, education, partner status, and cancer type. In multivariable analysis, significantly higher prevalence of high decisional conflict was observed in participants who were not referred for FP consultation (prevalence ratio [PR], 1.25; 95% confidence interval [CI], 1.06-1.47), as well as in participants who reported cost of FP services to be prohibitive (PR, 1.16 [95% CI, 1.03-1.31]). Prevalence of high DCS was lower for women who underwent FP treatment (PR, 0.67 [95% CI, 0.52-0.86]).
  
  
  CONCLUSIONS
  In this study of female young adult cancer survivors, the majority recalled significant decisional conflict about FP at cancer diagnosis. Increasing access to FP via referral for counseling and cost reduction may decrease decisional conflict about FP for young patients struggling with cancer and fertility decisions.
authors.affiliation: University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Mersereau
authors.forename: Linnea R
authors.initials: LR
authors.lastname: Goodman
authors.forename: Allison M
authors.initials: AM
authors.lastname: Deal
authors.forename: Jessica R
authors.initials: JR
authors.lastname: Gorman
authors.forename: Brian W
authors.initials: BW
authors.lastname: Whitcomb
authors.forename: H Irene
authors.initials: HI
authors.lastname: Su
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003657:Decision Making; D005260:Female; D059247:Fertility Preservation / Q000379:methods*; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy*; D011446:Prospective Studies; D017741:Survivors / Q000523:psychology*
keywords: cancer; decisional conflict; fertility preservation
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