Reproductive concerns and fertility intentions in cancer survivors: A longitudinal study of decision-making conflict as mediator.
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OBJECTIVE: To investigate the impact of reproductive concerns on fertility intentions among cancer survivors of childbearing age and evaluate the mediating role of decision-making conflicts in this relationship. METHODS: A prospective longitudinal survey was conducted with 223 cancer patients (aged 18-50) across three regions in China. Assessments using validated scales for fertility intentions, reproductive concerns, and decision-making conflicts were completed at three timepoints: 3, 6, and 9 months post-treatment. A longitudinal path model was constructed using cross-lagged analysis RESULTS: Decision-making conflict significantly mediated the relationship between reproductive concerns and fertility intentions (β = -0.031, 95 % CI = [-0.075, -0.006]). Reproductive concerns predicted increased decision-making conflict (β = 0.347, p < 0.001), which subsequently led to decreased fertility intentions (β = -0.167, p < 0.001). These relationships remained stable across measurement timepoints. CONCLUSION: Decision-making conflict serves as a key mediator between reproductive concerns and fertility intentions among cancer survivors of childbearing age, suggesting a potential intervention target for enhancing fertility outcomes in this population. PRACTICE IMPLICATIONS: Healthcare providers should address decision-making conflict through structured counseling interventions, particularly in the context of precision medicine where fertility implications of novel therapies may be uncertain. Developing tailored decision support tools could help reduce decision-making conflict and potentially improve alignment between patients' fertility values and intentions.