A Study to Evaluate the Effectiveness of a Web-based Tool for Fertility Preservation in Cancer Patients

Name of the measurement: Decisional conflict score assessed by the Decisional Conflict Scale (DCS)

Measurement tool: The Decisional Conflict Scale (DCS) - low literacy version Measure description: The level of decisional conflict experienced by participants regarding a health-related decision will be assessed using the Decisional Conflict Scale (DCS) - low literacy version, a validated 10-item questionnaire. Each item is rated on yes(0), unsure(2), no(4), and scores are converted to a 0-100 scale, with higher scores indicating greater decisional conflict. The unit of measure will be the mean total score on the DCS at the specified timepoint. Subscale scores (e.g., uncertainty, informed, values clarity, support, and effective decision) may also be calculated.

Unit of measure: Mean scores range from 0 (no decisional conflict) to 100 (extremely high decisional conflict)

Name of the measurement: Knowledge about fertility preservation Measurement tool: Questionnaire developed by researchers Measure description: Knowledge about fertility preservation will be assessed using a questionnaire developed by researchers. To develop the questionnaire items, guidelines and prior studies on the development and evaluation of fertility preservation decision aids will be reviewed to extract essential and frequently asked information for cancer patients. A panel of experts will be consulted to evaluate the relevance of each item. After item selection, researchers will develop corresponding questions and response options, which will be reviewed and revised based on expert feedback.

The measurement tool will be a customized questionnaire assessing FP knowledge, and the unit of measure will be the percentage of participants who answer each knowledge item correctly.

Unit of measure: % of participants with correct answers (per item)

Name of the measurement: Depression severity assessed by the Patient Health Questionnaire-9 (PHQ-9) Measurement tool: Patient Health Questionnaire-9 (PHQ-9) Measure description: Depression severity will be assessed using the Patient Health Questionnaire-9 (PHQ-9), a validated 9-item self-report questionnaire widely used to screen for and measure the severity of depressive symptoms. Each of the 9 items is scored on a 4-point Likert scale from 0 (not at all) to 3 (nearly every day). The total score ranges from 0 to 27, with higher scores indicating greater severity of depression. The unit of measure will be the mean total PHQ-9 score at each time point. Depression severity levels based on PHQ-9 score will be categorized as follows: 0-4: Minimal or no depression/5-9: Mild depression/10-14: Moderate depression/15-19: Moderately severe depression/20-27: Severe depression

Unit of measure: Mean PHQ-9 total score (range: 0-27; higher scores = worse outcome)

Name of the measurement: Health-Related Quality of life assessed by the EuroQol 5-dimension 5-level (EQ-5D-5L) Measurement tool: EuroQol 5-dimension 5-level (EQ-5D-5L) Measure description: Health-related quality of life will be assessed using the EuroQol 5-Dimension 5-Level (EQ-5D-5L) instrument, a standardized and validated questionnaire developed by the EuroQol Group. The EQ-5D-5L evaluates five dimensions of health: Mobility, Self-care, Usual activities, Pain/discomfort, Anxiety/depression Each dimension is rated on 5 levels: no problems, slight problems, moderate problems, severe problems, and extreme problems. The responses generate a health profile that is converted into a utility index score based on a population-specific value set. The units of measure is EQ-5D-5L index score (range from <0 [worse than death] to 1 [full health])

Unit of measure: Mean EQ-5D-5L index score (from 0 [worse than death] to 1 [full health])

Name of the measurement: Decision-Making Confidence Assessed by the Decision Self-Efficacy Scale Measurement tool: Decision self-efficacy scale Measure description: Confidence in decision-making will be assessed using the Decision Self-Efficacy Scale, a validated 11-item questionnaire developed to measure individuals' self-confidence in engaging in health-related decision-making. Each item is rated on a 5-point Likert scale ranging from 0 (not at all confident) to 4 (very confident). The total raw score (0-44) is converted to a standardized score ranging from 0 to 100, where higher scores indicate greater decision-making self-efficacy. The scale assesses perceived ability to ask questions, express opinions, evaluate options, and participate in decisions about one's health care.

Unit of measure: Mean score (0-100); higher = better decision-making self-efficacy

Name of the measurement: Counseling on fertility preservation Measurement tool: Study-developed question (investigator-designed, not previously validated) Measure description:This outcome will assess whether participants received any counseling regarding fertility preservation after participation in the clinical trial. A validated measurement tool will not be used; instead, participants will be asked a direct yes/no question about whether they were counseled on fertility preservation options (e.g., egg or embryo freezing, ovarian tissue preservation) by a healthcare provider.

Unit of measure: % of participants reporting receipt of counseling

Name of the measurement: Decision-making about fertility preservation Measurement tool: Study-developed question (investigator-designed, not previously validated) Measure description: This outcome assesses whether participants have made an actual decision regarding fertility preservation after participation in the clinical trial. A study-developed question will be used to ask participants directly whether they have decided to undergo fertility preservation procedures (such as egg freezing, embryo freezing, or ovarian tissue preservation) or have decided against it.

The measurement tool is a study-specific, investigator-developed yes/no question, not based on a previously validated instrument.

Unit of measure: % of participants reporting receipt of counseling

Name of the measurement: Readiness for decision-making assessed by the Preparation for Decision-Making Scale Measurement tool: Preparation for Decision-Making Scale Measure description: Readiness for decision-making will be evaluated using the Preparation for Decision-Making Scale (PrepDM Scale), a validated questionnaire designed to assess how well individuals feel prepared to make health-related decisions after receiving information or decision support. The scale consists of 10 items, each rated on a 5-point Likert scale ranging from 1 (not at all) to 5 (a great deal). The total score is calculated by summing item scores, then converted to a standardized score ranging from 0 to 100, where higher scores indicate greater perceived preparedness for decision-making. The unit of measure will be the mean PrepDM score (0-100).

Unit of measure: Mean score (0-100); higher = better preparation for decision-making