Cargando…
Patients’ and Providers’ Needs and Preferences When Considering Fertility Preservation Before Cancer Treatment: Decision-Making Needs Assessment
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 re...
Autores principales: | , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
JMIR Publications
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8218210/ https://www.ncbi.nlm.nih.gov/pubmed/34096871 http://dx.doi.org/10.2196/25083 |
_version_ | 1783710727197949952 |
---|---|
author | Hoffman, Aubri Crocker, Laura Mathur, Aakrati Holman, Deborah Weston, June Campbell, Sukhkamal Housten, Ashley Bradford, Andrea Agrawala, Shilpi Woodard, Terri L |
author_facet | Hoffman, Aubri Crocker, Laura Mathur, Aakrati Holman, Deborah Weston, June Campbell, Sukhkamal Housten, Ashley Bradford, Andrea Agrawala, Shilpi Woodard, Terri L |
author_sort | Hoffman, Aubri |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-8218210 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | JMIR Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-82182102021-07-02 Patients’ and Providers’ Needs and Preferences When Considering Fertility Preservation Before Cancer Treatment: Decision-Making Needs Assessment Hoffman, Aubri Crocker, Laura Mathur, Aakrati Holman, Deborah Weston, June Campbell, Sukhkamal Housten, Ashley Bradford, Andrea Agrawala, Shilpi Woodard, Terri L JMIR Form Res Original Paper 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. JMIR Publications 2021-06-07 /pmc/articles/PMC8218210/ /pubmed/34096871 http://dx.doi.org/10.2196/25083 Text en ©Aubri Hoffman, Laura Crocker, Aakrati Mathur, Deborah Holman, June Weston, Sukhkamal Campbell, Ashley Housten, Andrea Bradford, Shilpi Agrawala, Terri L Woodard. Originally published in JMIR Formative Research (https://formative.jmir.org), 07.06.2021. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Formative Research, is properly cited. The complete bibliographic information, a link to the original publication on https://formative.jmir.org, as well as this copyright and license information must be included. |
spellingShingle | Original Paper Hoffman, Aubri Crocker, Laura Mathur, Aakrati Holman, Deborah Weston, June Campbell, Sukhkamal Housten, Ashley Bradford, Andrea Agrawala, Shilpi Woodard, Terri L Patients’ and Providers’ Needs and Preferences When Considering Fertility Preservation Before Cancer Treatment: Decision-Making Needs Assessment |
title | Patients’ and Providers’ Needs and Preferences When Considering Fertility Preservation Before Cancer Treatment: Decision-Making Needs Assessment |
title_full | Patients’ and Providers’ Needs and Preferences When Considering Fertility Preservation Before Cancer Treatment: Decision-Making Needs Assessment |
title_fullStr | Patients’ and Providers’ Needs and Preferences When Considering Fertility Preservation Before Cancer Treatment: Decision-Making Needs Assessment |
title_full_unstemmed | Patients’ and Providers’ Needs and Preferences When Considering Fertility Preservation Before Cancer Treatment: Decision-Making Needs Assessment |
title_short | Patients’ and Providers’ Needs and Preferences When Considering Fertility Preservation Before Cancer Treatment: Decision-Making Needs Assessment |
title_sort | patients’ and providers’ needs and preferences when considering fertility preservation before cancer treatment: decision-making needs assessment |
topic | Original Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8218210/ https://www.ncbi.nlm.nih.gov/pubmed/34096871 http://dx.doi.org/10.2196/25083 |
work_keys_str_mv | AT hoffmanaubri patientsandprovidersneedsandpreferenceswhenconsideringfertilitypreservationbeforecancertreatmentdecisionmakingneedsassessment AT crockerlaura patientsandprovidersneedsandpreferenceswhenconsideringfertilitypreservationbeforecancertreatmentdecisionmakingneedsassessment AT mathuraakrati patientsandprovidersneedsandpreferenceswhenconsideringfertilitypreservationbeforecancertreatmentdecisionmakingneedsassessment AT holmandeborah patientsandprovidersneedsandpreferenceswhenconsideringfertilitypreservationbeforecancertreatmentdecisionmakingneedsassessment AT westonjune patientsandprovidersneedsandpreferenceswhenconsideringfertilitypreservationbeforecancertreatmentdecisionmakingneedsassessment AT campbellsukhkamal patientsandprovidersneedsandpreferenceswhenconsideringfertilitypreservationbeforecancertreatmentdecisionmakingneedsassessment AT houstenashley patientsandprovidersneedsandpreferenceswhenconsideringfertilitypreservationbeforecancertreatmentdecisionmakingneedsassessment AT bradfordandrea patientsandprovidersneedsandpreferenceswhenconsideringfertilitypreservationbeforecancertreatmentdecisionmakingneedsassessment AT agrawalashilpi patientsandprovidersneedsandpreferenceswhenconsideringfertilitypreservationbeforecancertreatmentdecisionmakingneedsassessment AT woodardterril patientsandprovidersneedsandpreferenceswhenconsideringfertilitypreservationbeforecancertreatmentdecisionmakingneedsassessment |