Preferred roles in treatment decision-making, decisional conflict and depression: a longitudinal study of Chinese women making decisions on IVF treatment

Abstract

STUDY QUESTION: What is the relationship between decisional conflict and depression among women undergoing IVF treatment, and does role preference on treatment decision-making (TDM) moderate the relationship? SUMMARY ANSWER: Decisional conflict at TDM led to higher-depression 3 months after decision, mediated by regret. Women preferring active TDM were less-depressed despite of conflict and regret. WHAT IS KNOWN ALREADY: Infertility treatment is marked by open-ended nature, and patients need to decide whether to continue or terminate treatment when the current cycle fails. While there have been studies on treatment decisionmaking role preference among infertile women, little is known about the mental health consequences of such role preference across the time of treatment decision-making. STUDY DESIGN, SIZE, DURATION: A longitudinal study was conducted where infertile women indicated TDM preference at cycle failure (T0), decisional conflict when they decided on continuation/termination for next cycle (T1), and decision regret 3 months later (T2). They reported depression at 3 time points. 151 out of 246 women completed questionnaires (attrition rate: 39%). Mean age was 37.2, and they had had 1.12 cycles (range: 0–8) on average at the time of study. The study spanned for 2 years. PARTICIPANTS/MATERIALS, SETTING, METHODS: The study population was comprised of Chinese female patients who failed to get pregnant in IVF treatment. They were recruited from a fertility clinic of a university-affiliated hospital in Hong Kong. Patients were approached after being notified about the negative pregnancy results. They were asked to complete scales on Fertility-Related Quality of Life and anxiety/depression across three time points and measures on role preference in treatment decision-making, decisional conflict, and regret at different time points. MAIN RESULTS AND THE ROLE OF CHANCE: Mediation analysis showed that the relationship between decisional conflict and depressed mood at T2 (controlling for depressed mood at T1) was mediated by decisional regret. Unstandardized direct effect between decisional conflict and depressed mood was 0.071 (p < 0.001), while indirect effect through mediation of decisional regret was found to be moderated by the role preference of treatment decision-making (TDM) (unstandardized indirect effect = 0.0002 and 0.0167 for passive and active TDM role preference respectively). Bootstrapping test confirmed that the mediation and moderation effects were statistically significant at 0.05 level. TDM role preference did not have significant effect on either decisional conflict or regret (F = 0.10 and 1.24 respectively, ns). Regret in IVF treatment can be interpreted as a consequence of preoccupation with comparing one’s chosen treatment alternative to a second, non–chosen alternative. Decisional regret after making treatment-related decision becomes an important factor in addressing the psychological distress in terms of depression. Results have demonstrated another direction in healthcare communication regarding treatment decision-making. LIMITATIONS, REASONS FOR CAUTION: Although there was no significant difference in age and education between those who completed the study and those who dropped out, self-selection bias remains a concern. WIDER IMPLICATIONS OF THE FINDINGS: This study shows for the first time how treatment decision-making role preference leads to mental health consequences among women undergoing infertility treatment. Healthcare professionals should be aware of such preference and, when necessary, openly discuss issues of TDM conflict and possible regret regarding treatment decisions with clients.