The development and evaluation of a fertility-related decision aid for young women with early breast cancer

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Copyright: Peate, Michelle Lisa Suifun
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Abstract
Introduction: All patients faced with decisions about treatment for cancer need to weigh up the benefits and side-effects of treatment, in particular the effects on future fertility. For many young women this is of enormous importance. Yet, many are not fully informed of or fail to take in the potential adverse effects of treatment. It is imperative that information be provided at diagnosis, as some options may not be feasible following commencement of adjuvant therapies. Aim: To develop a fertility-related decision aid, assess the current understanding of fertility-related issues and evaluate the tool amongst younger women with breast cancer. Method: The decision aid was developed and pilot-tested retrospectively amongst 17 young breast cancer patients recruited through two tertiary hospitals. To assess the efficacy of the decision aid compared to usual care a prospective nationwide study involving 22 oncology clinics was undertaken. Women aged 40 years or younger with early breast cancer were recruited prior to commencement of adjuvant therapy. Data was collected prior to commencement of adjuvant therapy, at one and at 12 months, via self-administered questionnaires using validated measures of psychological and decision-related outcomes. Results and discussion: Young breast cancer patients prioritise fertility-related information around the time of diagnosis and have relatively poor levels of information. Information needs vary, however, generally women felt conflicted about fertility-related decisions. Women who considered fertility-related information important and were actively seeking it had better knowledge, and lower decisional conflict. The decision aid was well-received by women with a previous diagnosis of breast cancer. In newly diagnosed women, the decision aid reduced decisional conflict and anxiety, and increased informed choice, compared to usual care, in women with a high decisional conflict at baseline. Conclusion and significance: This research resulted in the production of a high-quality and detailed decision aid that should be targeted at women with high levels of decisional conflict at the time of diagnosis. It also demonstrated that assumptions about preferences for fertility information or wish to consider fertility options should not be based on socio-demographic characteristics or family planning intentions. This research also highlights the importance of assessing the efficacy of tools in a clinical setting.
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Author(s)
Peate, Michelle Lisa Suifun
Supervisor(s)
Meiser, Bettina
Friedlander, Michael
Hickey, Martha
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Publication Year
2010
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Thesis
Degree Type
PhD Doctorate
UNSW Faculty
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