Academic journal article Research and Theory for Nursing Practice

Toward Theoretical Understanding of the Fertility Preservation Decision-Making Process: Examining Information Processing among Young Women with Cancer

Academic journal article Research and Theory for Nursing Practice

Toward Theoretical Understanding of the Fertility Preservation Decision-Making Process: Examining Information Processing among Young Women with Cancer

Article excerpt

Background: Young women with cancer now face the complex decision about whether to undergo fertility preservation. Yet little is known about how these women process information involved in making this decision. Objective: The purpose of this article is to expand theoretical understanding of the decision-making process by examining aspects of information processing among young women diagnosed with cancer. Methods: Using a grounded theory approach, 27 women with cancer participated in individual, semistructured interviews. Data were coded and analyzed using constant-comparison techniques that were guided by 5 dimensions within the Contemplate phase of the decision-making process framework. Results: In the first dimension, young women acquired information primarily from clinicians and Internet sources. Experiential information, often obtained from peers, occurred in the second dimension. Preferences and values were constructed in the third dimension as women acquired factual, moral, and ethical information. Women desired tailored, personalized information that was specific to their situation in the fourth dimension; however, women struggled with communicating these needs to clinicians. In the fifth dimension, women offered detailed descriptions of clinician behaviors that enhance or impede decisional debriefing. Conclusion: Better understanding of theoretical underpinnings surrounding women's information processes can facilitate decision support and improve clinical care.

Keywords: decision theory; information-seeking behavior; health communication; oncofertility; survivorship; young adult cancer

October 22, 2012 marked a new era for young women with cancer. Egg freez- ing, long considered an experimental procedure in the United States, moved from "experimental" to nonexperimental and joined embryo freezing as an acceptable and recognized fertility preservation option available to postpubertal women diagnosed with cancer (American Society for Reproductive Medicine, 2012; Practice Committees of the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology, 2013). Although fertility preservation for postpubertal males has been successful and evolving since 1953 (Anger, Gilbert, & Goldstein, 2003; Bunge & Sherman, 1953), advances in female preservation have proven more difficult to achieve (Cobo & Diaz, 2011; Smith, Motta, & Serafini, 2011). In fact, it was only in 2006 that the American Society of Clinical Oncology (Lee et al., 2006) advised clinicians to inform patients of reproductive age about the potential loss of fertility associated with gonadotoxic cancer therapy, discuss basic questions about fertility preservation options, and refer interested patients to fertility preservation specialists.

Fertility preservation has been recently defined by the National Center for Biotechnology Information at the U.S. National Library of Medicine (2012; i.e., PubMed) as,

A method of providing future reproductive opportunities before a medical treatment with known risk of loss of fertility. Typically reproductive organs or tissues (e.g., sperm, egg, embryos and ovarian or testicular tissues) are cryopreserved for future use before the medical treatment (e.g., chemotherapy, radiation) begins.

The advances in female fertility preservation to establish options such as egg and embryo freezing are groundbreaking and, if available previously, may have altered the opportunity for biological motherhood for many of the estimated 7,196,020 female cancer survivors who are 20 years of age or greater in the United States alone (Siegel et al., 2012). The decision whether to undergo fertility preservation should ideally take place before the onset of cancer therapy; therefore, there is an urgent need for research to explore and explicate how nurses, physicians, and other clinicians can best assist women in the decision-making process regarding these complex fertility preservation options (Canada & Schover, 2005; Lamar & DeCherney, 2009; Peate, Meiser, Hickey, & Friedlander, 2009; Quinn et al. …

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