Critical appraisal:Yee S 2016 2

Critical Appraisal

Article being appraised

Yee S. Factors associated with the receipt of fertility preservation services along the decision-making pathway in young Canadian female cancer patients. J Assist Reprod Genet 2016 Feb;33(2):265-80 Available from: http://www.ncbi.nlm.nih.gov/pubmed/26560157.

Applicable clinical question

Do patients who are referred to fertility specialists experience less decisional conflict? Are they more likely to access fertility preservation treatments?

Key Facts

Study Design

cross sectional study

Study aims:

Assessed whether there is an association between the uptake of FP procedure and the quality of pre-FPC fertility
discussion with oncologist.

Number of Patients:

188

Reported outcome(s):

143 of the 188 participants had a fertility discussion with the oncologist. 72 participants self-initiated the FP discussion.

Results of outcome(s):

Degree of fertility concern at diagnosis 1.81 (1.38 to 2.38, p<.05) was found to be significant in the final regression model. Women who found their oncologists supportive of their FP plan were nine times more likely to proceed with FP compared to those who found their oncologists either non-supportive or neutral (OR 9.61, CI 1.60 to 57.85, p<.05). The odds increased by more than five times for each additional increment on the 5-point Likert scale examining their fertility concern at the time of cancer diagnosis (OR 5.5, CI: 1.45 to 21.05, p<.05).

Comments on results:

- Susceptible to bias due to potential misclassification due to recall bias.
- Cannot identify if the characteristics of non-responders differ from responders, which can result in bias of the measures of outcome.

Includes an economic evaluation

no

Evidence ratings

Level of evidence

IV

Risk of bias

Moderate risk of bias

Comments: - Non-probability convenience sampling was used to recruit potential participants through cancer organizations and survivor networks - no response rate available.

- Very wide retrospective recruitment timeframe (from 2000). - Risk of recall bias is high for this study - one quarter (n=45, 23.9 %) did not recall having a fertility discussion with their oncologists.

Size of effect