Testing the efficacy of a decision aid and planning tool for family building after cancer

Up to 93% of young adult female (YA-F) cancer survivors report fertility distress; 30-46% meet criteria for moderate-severe fertility-related trauma. Gonadotoxic cancer treatments can cause infertility, early menopause, or problems getting pregnant and carrying a pregnancy to term. Family building after cancer often requires in vitro fertilization, surrogacy, or adoption, which have medical/physical, psychosocial, financial, legal, and logistical barriers. Prior work shows that YA-Fs are unprepared for the challenges of family building after cancer, have unrealistic expectations (such as overestimating the likelihood of success), and risk missing their narrowed reproductive window and experiencing greater difficulty, distress, and higher costs than expected. The long-term goal of the proposed research is to improve oncofertility care in post-treatment survivorship. We propose to test the efficacy of the Roadmap to Parenthood software, an interactive web-based decision aid and planning tool for family building after cancer for YA-F survivors (18-45 years old) and explore its implementation potential. First, we will conduct a rigorous 12-month randomized controlled trial (Aim 1). YA-F cancer survivors (N=256) will be randomized into the (a) Roadmap intervention condition or (b) time and attention control condition that includes a web-based young adult cancer survivorship informational booklet. Surveys will be administered at baseline (pre-intervention) and 1-, 6-, and 12-month follow up timepoints. We hypothesize the intervention group compared to the control group will report lower decisional conflict about family building (primary outcome), more planning behaviors aligned with family-building goals (e.g., fertility testing, financial planning), and improved quality of life (secondary outcomes). Then, we will test mediators and moderators of intervention efficacy (Aim 2). We hypothesize age, partnership status, fertility preservation history, and engagement with the decision aid will moderate the relationship between the intervention and decisional conflict, and increased levels of knowledge and self-efficacy and improved communication with providers will mediate the intervention effect on decisional conflict. Finally, we will evaluate future implementation potential of the Roadmap tool in clinical settings (Aim 3). Guided by the Capability-Opportunity-Motivation Behavior (COM-B) implementation model, we will conduct qualitative interviews with providers representing four specialties (N=32; 8 from each) to understand barriers and facilitators to the implementation of the Roadmap tool across clinics. Providers working in diverse settings in oncology, primary care, gynecology, and reproductive medicine, all of whom address reproductive health clinically, will be included. Themes related to barriers/facilitators within the categories of ‘capability’ (e.g., skills, knowledge), ‘opportunity’ (e.g., resources), and ‘motivation’ (e.g., emotion, beliefs) will be identified. This research will comprehensively respond to the identified needs of YA-F survivors that hope to have a child after cancer through a novel intervention that provides information and support for decision making and early planning.