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Fertility Preferences and Cognition: Religiosity and Experimental Effects of Decision Context on College Women.

ABSTRACT: Better models of culture and cognition may help researchers understand fertility and family formation. We examine cognition about fertility using an experimental survey design to investigate how fertility preferences of college women are affected by two prompts that bring to mind fertility-relevant factors: career aspirations and financial limitations. We test the effects of these prompts on fertility preferences and ask how effects vary with respondent religiosity, an aspect of social identity related to fertility preferences. We find significant effects of treatment on fertility preferences when accounting for religiosity: less religious women who considered their career aspirations or financial limitations reported smaller desired family size, but this effect was attenuated for more religious women. Our study demonstrates how fertility preferences are shaped by decision contexts for some socio-demographic groups. We discuss how the findings support a social-cognitive model of fertility.

SUBMITTER: Marshall EA

PROVIDER: S-EPMC6377249 | biostudies-literature | 2018 Apr

REPOSITORIES: biostudies-literature

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Fertility Preferences and Cognition: Religiosity and Experimental Effects of Decision Context on College Women.

Marshall Emily A EA Shepherd Hana H

Journal of marriage and the family 20171114 2

Better models of culture and cognition may help researchers understand fertility and family formation. We examine cognition about fertility using an experimental survey design to investigate how fertility preferences of college women are affected by two prompts that bring to mind fertility-relevant factors: career aspirations and financial limitations. We test the effects of these prompts on fertility preferences and ask how effects vary with respondent religiosity, an aspect of social identity ...[more]

PMID: 30778264

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Project description:BackgroundAs 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.ObjectiveThis 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.MethodsSemistructured 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.ResultsA 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.ConclusionsDecision 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.

Project description:PurposeFertility preservation (FP) is an important issue for young survivors of breast cancer. Although international guidelines recommend pre-treatment fertility counseling for women with breast cancer, there is no standardized protocol or referral system for FP in South Korea. There are also barriers to discussing FP that make patient-centered decision making difficult. This study aimed to develop a shared decision making program for FP and compare the rates of FP procedures between the usual care and shared decision making groups. We hypothesized that multidisciplinary shared decision making for FP would increase the rate of FP procedures and patient satisfaction.MethodsThe multidisciplinary shared decision making for FP in young women with breast cancer (MYBC) is a multicenter, clustered, stepped-wedge, randomized trial. A total of 1100 patients with breast cancer, aged 19-40 years, from nine hospitals in South Korea, will be enrolled. They will be randomized at the institutional level and assigned to usual care and shared decision making groups. Four institutions, each of which can recruit more than 200 patients, will each become a cluster, whereas five institutions, each of which can recruit more than 50 patients, will become one cluster, for a total of five clusters. The shared decision making groups will receive multidisciplinary programs for FP developed by the investigator. The primary outcome is the rate of FP procedures; secondary outcomes include fertility results, satisfaction, and quality of life. Outcomes will be measured at enrollment, treatment initiation, and the 1-, 3-, and 5-year follow-ups after starting breast cancer treatment.DiscussionA multidisciplinary shared decision making program for FP is expected to increase fertility rates and satisfaction among young patients with breast cancer. This study will provide the evidence to implement a multidisciplinary system for patients with breast cancer.Trial registrationClinicalTrials.gov Identifier: NCT05139641. Registered on December 1, 2021.

Dataset Information

Fertility Preferences and Cognition: Religiosity and Experimental Effects of Decision Context on College Women.

Publications

Fertility Preferences and Cognition: Religiosity and Experimental Effects of Decision Context on College Women.

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