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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:BackgroundWomen with a new cancer diagnosis face complex decisions about interventions aiming to preserve their fertility. Decision aids are more effective in supporting decision making than traditional information provision. We describe the development and field testing of a novel patient decision aid designed to support women to make fertility preservation treatment decisions around cancer diagnosis.MethodsA prospective, mixed-method, three stage study involving: 1) co-development of the resource in collaboration with a multi-disciplinary group of key stakeholders including oncology and fertility healthcare professionals and patient partners (n=24), 2) alpha testing with a group of cancer patients who had faced a fertility preservation treatment decision in the past (n=11), and oncology and fertility healthcare professionals and stakeholders (n=14) and, 3) beta testing with women in routine care who had received a recent diagnosis of cancer and were facing a fertility preservation treatment decision (n=41) and their oncology and fertility healthcare professionals (n=3). Ten service users recruited from a closed Breast Cancer Now Facebook group and the support group Cancer and Fertility UK also provided feedback on CFM via an online survey.ResultsA 60-page paper prototype of the Cancer, Fertility and Me patient decision aid was initially developed. Alpha testing of the resource found that overall, it was acceptable to cancer patients, healthcare professionals and key stakeholders and it was considered a useful resource to support fertility preservation treatment decision-making. However, the healthcare professionals felt that the length of the patient decision aid, and elements of its content may be a barrier to its use. Subsequently, the prototype was reduced to 40 pages. During beta testing of the shortened version in routine care, women who received the resource described its positive impact on their ability to make fertility preservation decisions and support them at a stressful time. However, practical difficulties emerged which impacted upon its wider dissemination in clinical practice and limited some elements of the evaluation planned.DiscussionWomen receiving the decision aid within the cancer treatment pathway found it helped them engage with decisions about fertility preservation, and make better informed, values-based care plans with oncology and fertility teams. More work is needed to address access and implementation of this resource as part of routine oncology care pathways.

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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