Investigating the Efficacy of a Paediatric Fertility Preservation Decision Aid in Parents and Adolescents and Young Adults (CAYA) Cancer Survivors (FOCUS)

A Double Blind Randomised Controlled Trial of a Paediatric Fertility Preservation Decision Aid in Parents and Adolescents and Young Adults (CAYA) Cancer Survivors

The current standard of care for paediatric patients with cancer regarding preservation of their fertility (FP) is to provide high-quality information during the clinical consultation process. However, this approach depends on health provider knowledge and communication and has been shown to be sub-optimal in some situations. This impairs the critical decision-making of patients regarding fertility testing, utilization of gametes, and continuing payment of storage fees. The fertility preservation decision aid (FP DA) may lead to a greater understanding of their fertility status for participants. This knowledge may allow participants the opportunity to assess potential fertility issues prior to the end of their reproductive window, helping to minimize missed opportunities for parenthood.

This research study aims to assess the effectiveness of the use of the FP DA on unmet fertility information needs when it is provided in addition to high-quality information in parents of cancer survivors and CAYA cancer survivors compared to high-quality information alone.

Study Overview

• Status: Recruiting
• Conditions: Unmet Fertility Information Needs
• Intervention / Treatment: Other: Decision-aid

Detailed Description

Medical advances over recent decades have increased the overall survival rates of children, adolescents and young adults diagnosed with cancer, with survival rates now exceeding 80%. The pressure points are not only at diagnosis - research has shown that cancer treatment can potentially affect fertility later in life. Survivorship is an important time for addressing the following issues: fertility status, reproductive monitoring, decisions about interval fertility preservation, ongoing tissue storage and utilization. Options to preserve fertility are possible. Decision Aids (DA) have been developed to provide patients and their families with the required information to make informed reproductive health decisions that align with their values. The prevalence of fertility information needs that are unmet remains high at around 40% amongst cancer survivors. Research evaluating the effectiveness of DAs in survivorship is lacking.

This is a parallel group double-blind randomised controlled trial for parents and Child Adolescent and Young Adults (CAYA) cancer survivors assessing the Fertility Preservation Decision Aid (FP DA) when provided in conjunction with high-quality information.

Eligible participants will be randomly allocated to either a control group receiving high-quality information or a treatment group that will receive the FP DA in addition to high-quality information. Participants will be blinded to their group allocation as they will be instructed to review information regarding fertility preservation without informing them of the type of information they are reviewing.

• Study Type: Interventional
• Enrollment (Estimated): 358
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Yasmin Jayasinghe, FRANZCOG, PhD; Email: yasmin.jayasinghe@unimelb.edu.au
• Study Contact Backup: Name: Diana Navarro-Perez, PhD; Phone Number: +61 430 734 262; Email: d.navarroperez@unimelb.edu.au

Study Locations

• Australia
  • Victoria
    • Melbourne, Victoria, Australia, 3052
      • Recruiting
      • Murdoch Children's Research Institute
      • Contact: Zobaida Edib, MBBS, MPH, PhD; Phone Number: +61 470 630 182; Email: edibz@unimelb.edu.au
      • Contact: Yasmin Jayasinghe; Email: yasmin.jayasinghe@unimelb.edu.au
      • Principal Investigator: Yasmin Jayasinghe

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

Inclusion Criteria for both parents and survivors:

• Be able to communicate in English.
• Signed written informed consent form.

Inclusion Criteria for parents only:

• Parents/guardians of CAYA survivors who were ≤25 years (2) when diagnosed with cancer and have completed curative gonadotoxic treatment

Inclusion Criteria for survivors only

• CAYA cancer survivors aged 16 years or over who have completed curative gonadotoxic treatment.
• Participants can be on long-term adjuvant or endocrine therapy.
• Participants may have achieved a pregnancy or livebirth.

Exclusion Criteria:

Exclusion Criteria for both parents and survivors:

• CAYA patients currently undergoing cancer treatment and their parents/guardians.
• CAYA patients who are palliative and their parents/guardians
• A family member already in the study.

Exclusion Criteria for survivors only:

• Minors who are not deemed to be mature minors as per protocol

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Decision aid group; Participants will have access to fertility preservation Decision Aid (DA) in addition to high-quality information (intervention group).	Other: Decision-aid; Decision Aids (DA) are evidence-based clinical tools developed for patients to supplement clinicians' discussions and facilitate difficult preference-sensitive decisions. They are the gold standard approach (recommended by the Australian Commission of Safety and Quality in Healthcare) to facilitate complex healthcare decisions where there is more than one reasonable choice and where patients may value benefits and risks differently.
No Intervention: CanTeen group; Participants will have access to high-quality information from CanTeen website (Control group).

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Unmet information needs as measured by the Unmet Information Needs Scale within 8 weeks of randomisation	Unmet information needs will be measured within 8 weeks post-randomisation using the Unmet Information Needs Scale. Items included in the questionnaire are: knowledge regarding fertility status, future parenthood goals, and information regarding fertility preservation procedures carried out at either the treatment or survivorship period. Needs are assessed on a 6-point scale, ranging from 0 to 5, with higher scores indicating greater unmet information needs.	within 8 weeks from randomisation

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in unmet fertility information needs as measured by questionnaire at 6 months post-randomisation	Unmet fertility information needs will be measured at 6 months post-randomisation using the Unmet Information Needs Scale. Items included in the questionnaire are: knowledge regarding fertility status, future parenthood goals, and information regarding fertility preservation procedures carried out at either the treatment or survivorship period. Needs are assessed on a 6-point scale, ranging from 0 to 5, with higher scores indicating greater unmet information needs.	6 months post-randomisation
Change in fertility knowledge as measured using a purposively designed knowledge scale within 8 weeks of randomisation and at 6 months post-randomisation	Changes in fertility knowledge will be measured using a purposively designed knowledge scale within 8 weeks of randomisation and at 6 months after randomisation. The knowledge scale that ranges from 0 to 6, with higher values indicated better knowledge.	within 8 weeks of randomisation, 6 months after randomisation
Change in decision making preparedness regarding fertility preservation measured by the Preparation for Decision Making Scale within 8 weeks of randomisation and at 6 months post-randomisation	Preparation for decision making will be measured by the utility of the information provided by participants using the Preparation for Decision Making Scale. The preparation for decision making scaling regarding fertility preservation comprises a 10 item scale with each answer scored 1 (not at all) to 5 (a great deal). The 10 items are summed and divided by 10. A higher score reflects greater preparation for decision making.	within 8 weeks of randomisation, 6 months after randomisation
Change in decisional conflict as measured by the a validated decisional conflict scale within 8 weeks of randomisation and at 6 months post-randomisation	Decisional conflict is defined as uncertainty around the decision to see a health professional for further advice about sexual and reproductive health and uncertainty around choices available to achieve parenthood. This will be measured using a validated decisional conflict scale. Scores range from 0 [feels extremely supported in decision making] to 100 [feels extremely unsupported in decision making].	within 8 weeks and 6 months after randomisation
Change in feasibility and acceptability of the information resources measured using a validated feasibility and acceptability scale within 8 weeks of randomisation and at 6 months post-randomisation	Feasibility and acceptability of using the information resources will be measured using a validated feasibility and acceptability scale. They are assessed on a 5-point scale, ranging from 1 to 5, with higher scores indicating greater feasibility and acceptability.	within 8 weeks of randomisation, 6 months after randomisation
Change in Fertility Preservation Decision Aid (FP DA) usage analytic- bounce rate	FP DA usage analytic- bounce rate will be collected using a first-party analytics provider (Mixpanel).	within 8 weeks of randomisation, 6 months after randomisation
Change in Fertility Preservation Decision Aid (FP DA) usage analytic- average session duration	FP DA usage analytic- average session duration will be collected using a first-party analytics provider (Mixpanel).	within 8 weeks of randomisation, 6 months after randomisation
Change in Fertility Preservation Decision Aid (FP DA) usage analytic- average time on pages	FP DA usage analytic- average time on pages will be collected using a first-party analytics provider (Mixpanel).	within 8 weeks of randomisation, 6 months after randomisation
Change in Fertility Preservation Decision Aid (FP DA) usage analytic- pages view per visit	FP DA usage analytic- total number of pages view across the website per visit will be collected using a first-party analytics provider (Mixpanel).	within 8 weeks of randomisation, 6 months after randomisation
Change in Fertility Preservation Decision Aid (FP DA) usage analytic- user behavior flow	FP DA usage analytic- user behavior flow will be collected using a first-party analytics provider (Mixpanel).	within 8 weeks of randomisation, 6 months after randomisation
Change in Fertility Preservation Decision Aid (FP DA) usage analytic- exit rate	FP DA usage analytic- exit rate will be collected using a first-party analytics provider (Mixpanel).	within 8 weeks of randomisation, 6 months after randomisation
Change in Fertility Preservation Decision Aid (FP DA) usage analytic- returning users	FP DA usage analytic- returning users will be collected using a first-party analytics provider (Mixpanel).	within 8 weeks of randomisation, 6 months after randomisation
Change in Fertility Preservation Decision Aid (FP DA) usage analytic- heatmap	FP DA usage analytic- heatmap will be collected using a first-party analytics provider (Mixpanel).	within 8 weeks of randomisation, 6 months after randomisation
Change in Fertility Preservation Decision Aid (FP DA) usage analytic- individual page rating	FP DA usage analytic- individual page rating will be collected using a first-party analytics provider (Mixpanel).	within 8 weeks of randomisation, 6 months after randomisation
Change in Fertility Preservation Decision Aid (FP DA) usage analytic- the proportion of values clarification exercises completed	FP DA usage analytic- the proportion of values clarification exercises completed will be collected using a first-party analytics provider (Mixpanel).	within 8 weeks of randomisation, 6 months after randomisation
Change in Fertility Preservation Decision Aid (FP DA) usage analytic- the responses to the exercises	FP DA usage analytic- the responses to the exercises completed will be collected using a first-party analytics provider (Mixpanel).	within 8 weeks of randomisation, 6 months after randomisation

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Changes in perceived usefulness of the information resources measured by a 5-item Decision Aid development scale at the time of diagnosis	A five-point scale, ranging from 0 to 4, adapted from a Decision Aid (DA) development study will be used to assess the perceived usefulness of the information resources as a decision-making tool and whether it would have been helpful at the time of diagnosis. The higher scores will indicate greater perceived usefulness.	within 8 weeks of randomisation, 6 months after randomisation

Collaborators and Investigators

• Sponsor: Murdoch Childrens Research Institute
• Collaborators: University of Melbourne

Publications and helpful links

General Publications

• McDougall RJ, Gillam L, Delany C, Jayasinghe Y. Ethics of fertility preservation for prepubertal children: should clinicians offer procedures where efficacy is largely unproven? J Med Ethics. 2018 Jan;44(1):27-31. doi: 10.1136/medethics-2016-104042. Epub 2017 Oct 30.
• Turcotte S, Guerrier M, Labrecque M, Robitaille H, Rivest LP, Hess B, Legare F. Dyadic validity of the Decisional Conflict Scale: common patient/physician measures of patient uncertainty were identified. J Clin Epidemiol. 2015 Aug;68(8):920-7. doi: 10.1016/j.jclinepi.2015.03.005. Epub 2015 Mar 21.
• Lehmann V, Keim MC, Nahata L, Shultz EL, Klosky JL, Tuinman MA, Gerhardt CA. Fertility-related knowledge and reproductive goals in childhood cancer survivors: short communication. Hum Reprod. 2017 Nov 1;32(11):2250-2253. doi: 10.1093/humrep/dex297.
• Benedict C, Stal J, Davis A, Zeidman A, Pons D, Schapira L, Diefenbach M, Ford JS. Greater fertility distress and avoidance relate to poorer decision making about family building after cancer among adolescent and young adult female survivors. Psychooncology. 2023 Oct;32(10):1606-1615. doi: 10.1002/pon.6212. Epub 2023 Sep 11.

Study record dates

Study Major Dates

• Study Start (Actual): December 8, 2025
• Primary Completion (Estimated): July 1, 2026
• Study Completion (Estimated): July 1, 2026

Study Registration Dates

• First Submitted: February 20, 2025
• First Submitted That Met QC Criteria: March 19, 2025
• First Posted (Actual): March 25, 2025

Study Record Updates

• Last Update Posted (Actual): December 16, 2025
• Last Update Submitted That Met QC Criteria: December 8, 2025
• Last Verified: June 1, 2025

More Information

Terms related to this study

• Keywords: Decision Aid; Cancer Survivors; Fertility preservation; CAYA; Child Adolescent and Young Adults
• Additional Relevant MeSH Terms: Investigative Techniques; Decision Support Techniques
• Other Study ID Numbers: HREC 107901

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: The current protocol states that data will not be shared. The protocol will be modified in due course to include data sharing and the record will be updated to reflect this.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No