Decision-Making Process Regarding Fertility Among Reproductive-Age Women With Cancer in Taiwan

Background: Previous studies indicate that women with cancer experience infertility after cancer-related treatment. With the rapid progress in fertility science, women face diverse and uncertain choices regarding pregnancy. Objective: The aim of this study is to understand the decision-making process regarding fertility choices among reproductive-age women with cancer in Taiwan. Methods: Grounded theory methodology guided data collection using in-depth interviews with 18 women diagnosed and treated for cancer. Verbatim transcriptions were analyzed using constant comparative analysis and open, axial, and selective coding. Results: The core category that describes the decision-making process regarding fertility among reproductive-age women with cancer is “searching for balance in life and creating value in life.” The decision process was divided into 3 phases: needing to have children before treatment, struggling with self-living during cancer treatment, and returning to life after treatment. The style of cancer participants' decision making in pregnancy was divided into 3 patterns: action taking, hesitation, and persistence. Conclusions: Decision making regarding fertility among women with cancer was affected by the need for children before treatment and their experience during treatment. Implications for Practice: Health providers should be aware of and understand the needs of women with cancer to balance their need for children with their perception of their cancer prognosis and its effects on fertility, and help them with pregnancy planning if desired.

[1]  M. Andrykowski,et al.  Spirituality in Arab Muslim Hematopoietic Stem Cell Transplantation Survivors: A Qualitative Approach , 2016, Cancer nursing.

[2]  Ming-Tsang Wu,et al.  Hormone replacement therapy and risk of atrial fibrillation in Taiwanese menopause women: A nationwide cohort study , 2016, Scientific Reports.

[3]  A. Loke,et al.  Gender differences in experiences with and adjustments to infertility: A literature review. , 2015, International journal of nursing studies.

[4]  G. Unsal,et al.  Psychosocial Problems and Coping Strategies among Turkish Women with Infertility. , 2015, Asian nursing research.

[5]  J. Inthout,et al.  Decision-making in female fertility preservation is balancing the expected burden of fertility preservation treatment and the wish to conceive. , 2015, Human reproduction.

[6]  C. Gracia,et al.  Infertility in reproductive‐age female cancer survivors , 2015, Cancer.

[7]  M. de Pedro,et al.  Fertility preservation and breast cancer: a review , 2015, Ecancermedicalscience.

[8]  M. Trudeau,et al.  Outcome of patients with pregnancy during or after breast cancer: a review of the recent literature. , 2014, Current oncology.

[9]  J. Neuhaus,et al.  Predictors of Initial Levels and Trajectories of Anxiety in Women Before and for 6 Months After Breast Cancer Surgery , 2014, Cancer nursing.

[10]  Kathy L. MacLaughlin,et al.  Caring for the breast cancer survivor's health and well-being. , 2014, World journal of clinical oncology.

[11]  J. Ford,et al.  Cancer-Related Disclosure Among Adolescent and Young Adult Cancer Survivors: A Qualitative Study. , 2014, Journal of adolescent and young adult oncology.

[12]  J. Ussher,et al.  Loss, uncertainty, or acceptance: subjective experience of changes to fertility after breast cancer. , 2014, European journal of cancer care.

[13]  C. Lampic,et al.  Desire for children, difficulties achieving a pregnancy, and infertility distress 3 to 7 years after cancer diagnosis , 2014, Supportive Care in Cancer.

[14]  Sushma Agrawal,et al.  Late effects of cancer treatment in breast cancer survivors , 2014, South Asian Journal of Cancer.

[15]  J. Goossens,et al.  Cancer patients' and professional caregivers' needs, preferences and factors associated with receiving and providing fertility-related information: a mixed-methods systematic review. , 2014, International journal of nursing studies.

[16]  G. Quinn,et al.  Childbearing attitudes and decisions of young breast cancer survivors: a systematic review , 2013, Human reproduction update.

[17]  R. L. Roudsari,et al.  A grounded theory approach to understand the process of decision making on fertility control methods in urban society of Mashhad, Iran , 2013, Iranian journal of nursing and midwifery research.

[18]  H. Holzer,et al.  Oncofertility in Canada: the impact of cancer on fertility. , 2013, Current oncology.

[19]  K. Czene,et al.  Birth rates among female cancer survivors , 2013, Cancer.

[20]  S. Altfeld,et al.  Toward Theoretical Understanding of the Fertility Preservation Decision-Making Process: Examining Information Processing Among Young Women With Cancer , 2013, Research and Theory for Nursing Practice.

[21]  P. Pierce,et al.  The decision-making process of young adult women with cancer who considered fertility cryopreservation. , 2013, Journal of obstetric, gynecologic, and neonatal nursing : JOGNN.

[22]  L. Chien,et al.  Decision-Making Process for Choosing an Elective Cesarean Delivery Among Primiparas in Taiwan , 2013, Maternal and Child Health Journal.

[23]  P. Katz,et al.  Racial, socioeconomic, and demographic disparities in access to fertility preservation in young women diagnosed with cancer , 2012, Cancer.

[24]  S. Ogle,et al.  Fertility preservation for patients with cancer , 2022, Journal of the Korean Medical Association.

[25]  J. Litton Breast Cancer and Fertility , 2012, Current Treatment Options in Oncology.

[26]  E. Olshansky,et al.  The decision-making process of genetically at-risk couples considering preimplantation genetic diagnosis: initial findings from a grounded theory study. , 2012, Social science & medicine.

[27]  P. Ganz,et al.  Quality of life, fertility concerns, and behavioral health outcomes in younger breast cancer survivors: a systematic review. , 2012, Journal of the National Cancer Institute.

[28]  A. Khetarpal,et al.  Infertility: Why can't we classify this inability as disability? , 2012, The Australasian medical journal.

[29]  S. Missmer,et al.  Cultural factors contributing to health care disparities among patients with infertility in Midwestern United States. , 2011, Fertility and sterility.

[30]  J. Pierce,et al.  Young Breast Cancer Survivors: Their Perspectives on Treatment Decisions and Fertility Concerns , 2011, Cancer nursing.

[31]  M. Lourenço,et al.  Psychological and cross-cultural aspects of infertility and human sexuality. , 2011, Advances in psychosomatic medicine.

[32]  Oguzhan Alagoz,et al.  Markov Decision Processes: A Tool for Sequential Decision Making under Uncertainty , 2010, Medical decision making : an international journal of the Society for Medical Decision Making.

[33]  S. Payne,et al.  Evolving Grounded Theory Methodology: towards a discursive approach. , 2010, International journal of nursing studies.

[34]  J. Pierce,et al.  Depressive symptoms among young breast cancer survivors: the importance of reproductive concerns , 2010, Breast Cancer Research and Treatment.

[35]  J. Prochaska Decision Making in the Transtheoretical Model of Behavior Change , 2008, Medical decision making : an international journal of the Society for Medical Decision Making.

[36]  Laura Johnson,et al.  How Many Interviews Are Enough? , 2006 .