[O-29] TO PRESERVE OR NOT TO PRESERVE: DECISIONAL CONFLICT ASSOCIATED WITH FERTILITY PRESERVATION.

L. R. Goodman, A. M. Deal, H. I. Su, S. Bailey, FIRST Research Group, J. E. Mersereau. Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC; Obstetrics and Gynecology, University of California, San Diego, La Jolla, CA.

OBJECTIVE: The decision to pursue fertility preservation (FP) after an oncologic diagnosis is complex. We examined specific factors that influence this decision using the decisional conflict scale (DCS).
DESIGN: Cross-sectional study.
MATERIALS AND METHODS: The FIRST project is a web-based survey of reproductive-aged women (18-44) from around the United States with a new cancer diagnosis and who received gonadotoxic treatment within the last 10 years. The associations of demographic, socioeconomic and cancer variables with DCS were evaluated using Wilcoxon Rank Sum statistics.
RESULTS: Of the 177 women included for analysis, 94 subjects (53%) had scores consistent with high decisional conflict (>37.5 out of 100), 40 (22%) were in the moderate range (25 - 37.5), and 43 (24%) patients had low DCS (<25). Univariable analyses found that subjects had significantly greater DCS if they had lower income, did not attend college, and were single. Subjects who were referred for FP consultation (FPC), received FP treatment and those with breast cancer had significantly lower DCS (Table 1). Age, race, and insurance status were not associated with DCS.

Variable	Variable Present (Median DCS)	Variable Absent (Median DCS)	P-Value
Income: <$25,000	56.2	39.1	0.01
Education: No college	50.0	37.5	0.03
Relationship Status: Single	48.4	35.9	0.02
Attitude: Cost Prohibitive of FP	56.3	34.4	<0.01
Breast Cancer	35.9	42.2	0.02
FPC	31.2	50.0	<0.01
FP Treatment	28.1	50.0	<0.01

Table 1: Predictors of decisional conflict


CONCLUSION: A significant portion (75%) of young women with cancer have moderate to severe decisional conflict about their FP options. Studies in other fields have found that patients with high DCS are more likely to have emotional distress, delay decision-making, and have future regret. Modifiable factors associated with higher DCS include lack of FP referral and treatment and attitudes regarding FP costs. This supports the need for increased FP awareness, FPC referral rates and education of both patients and providers.
Supported by: 1. UL1 RR024926 Pilot funding.

Monday, October 22, 2012 5:45 PM

Oral Session: Fertility Preservation