Women diagnosed with breast cancer must not only face a variety of invasive, lengthy treatments that can involve surgery, chemotherapy, and radiation therapy, they also often face a threat to their fertility as a result of these treatments. Young women who have undergone cancer treatment consistently identify fertility concerns among the most troubling issues and these concerns do not abate with time. Options for preserving fertility are available, but decisions to pursue available options complicated as these decisions potentially affect a woman's risk for recurrence, mortality, and her quality of life. When there is no single option to be advocated, it is imperative to incorporate a woman's preferences into the decision making process. Decision aids can assist with difficult decisions that involve evaluating uncertain scientific evidence and weighing the benefits and risks of treatment options. They have been found to be acceptable to patients and feasible to implement.
The Specific Aims of this project are to: 1) Characterize the decision making needs of young (aged 21-45) breast cancer patients regarding fertility preservation by conducting focus groups that explore the knowledge, personal risk information, and weighing of competing factors;2) Develop a decision analytic model of the fertility preservation decision in women with breast cancer, based on information gleaned from qualitative studies;3) Measure the preferences for fertility preservation in young women diagnosed with breast cancer, using the Time Trade-Off method derived from expected utility theory;4) Develop a decision aid for the fertility preservation decision using the decision model;5) Pilot test the decision aid in a small sample of young women diagnosed with breast cancer who are at risk of fertility loss and are facing the fertility preservation decision. This research will be the first decision aid for fertility preservation decisions in a breast cancer population that specifically incorporates patient preferences. The information gained from this research will be invaluable in developing future tools for women to make decisions regarding fertility and will have a beneficial effect on breast cancer survivors'lives, and relieve morbidity associated with cancer treatments.
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