Shared Decision-Making on Fertility Preservation in Reproductive-Aged Women with Gynecological Cancer: A Qualitative Study of Patients’ and Health Care Professionals’ Perspectives

Abstract

Purpose: Guided by the Ottawa Decision Support Framework (ODSF), this study aimed to explore the experiences, perceived barriers, and support needs of both reproductive-aged women with gynecological cancer and health care professionals (HCPs) during the process of fertility preservation (FP) shared decision-making (SDM), in order to identify alignments and discrepancies between the two groups. Patients and methods: A descriptive phenomenological qualitative study was conducted using semi-structured interviews with reproductive-aged women diagnosed with gynecological cancers and HCPs from gynecology, oncology, and reproductive medicine specialties. Patients were recruited via hospital records during outpatient visits or hospitalization, and professionals via departmental announcements and invitations. The ODSF informed the development of the interview guide. Data were analyzed using Colaizzi’s descriptive phenomenological method. Results: A total of 11 reproductive-aged women with gynecological cancer and 12 multidisciplinary HCPs participated in the study. Among the HCPs, 7 were physicians and 5 were nurses. Analysis yielded 35 meaning unites, which were clustered into two main themes: gaps and fragmentation in meeting decisional needs and facilitators of high-quality fertility preservation decision support. Conclusion: This study suggests that FP SDM among reproductive-aged women with gynecological cancer in China may be influenced by multiple challenges, including limited and untimely information, fragmented referral mechanisms, psychological distress, financial concerns, and sociocultural factors. Multidisciplinary team involvement, nursing support, and culturally adapted decision aids may help enhance patient participation, support preference-sensitive decision-making, and reduce decisional conflict. These findings indicate that integrating structured counseling processes, optimizing multidisciplinary pathways, and developing personalized, culturally sensitive decision aids may contribute to more patient-centered fertility care.