Title: Patients’ and Providers’ Perspectives on the Decision to Undergo Non-Urgent Egg
Freezing: A Needs Assessment
Version: 0 Date: 23 Mar 2023
Reviewer's report:
General notes:
This paper describes a study conducted to determine the factors that increase patients’ decisional
difficulty when considering egg freezing, as well as to examine potential ways patients could
be supported in this decision-making process. The study succeeds in addressing these 2 areas
of inquiry and the authors do a good job of clearly articulating the study purpose, methods, and
findings, as well as drawing insightful conclusions about how these findings can be used to
improve the patient experience.
A few minor changes and/or clarifications will strengthen the paper.
Also, I did notice some sources are referenced using parenthetical citations and others using
numbers? Is this the policy of the journal? If not, please select a consistent method for citing.
Abstract:
Clear, concise, useful
Background:
Clear, concise, useful. A few points of information could be added to increase reader
comprehension.
It would be good to include a brief summary of “each option,” so a reader who is unfamiliar
with fertility preservations efforts understands what alternatives might be available to the patient
when this is referenced by the authors.
The goals of the study were made clear and there is good justification for the study itself as well
as the focus on decision aids.
It would also be good to include a brief overview of the ODSF (and perhaps include a sample
of the guidelines in an appendix) to better inform readers who are unfamiliar with that tool and
also to further validate the authors’ choice to model their interview guide accordingly.
Methods:
Generally sufficient in clarity and detail – just a few illustrative examples are needed.
Can the authors include an example to demonstrate the modifications that were made to the
interview guides according to this statement? -  “Previous interviews informed the interview
guide which was modified accordingly in an effort to explore concepts more fully.”
In the data analysis section, it would be useful to provide at least some examples of ODSF
concepts that were used by the authors for comparison purposes in constructing their own codes.
Results:
Well organized and effective use of quotations from participants to illustrate the factors that
were identified. Again, a few points of clarification as listed below would be helpful.
As mentioned in the Background comments section, it would be helpful to have a brief
explanation of the options beyond egg freezing (e.g., embryo freezing) so that when this enters
the discussion in the results the reader is already aware of the options the patient is choosing
between. I kept feeling as though this was a really vague reference until I went and reviewed
the options presented in the graph in Figure 1. I would’ve preferred to read about those options
earlier in the paper rather than looking for the graph.
The wording of this - “Decision timing also impacted the recruitment of patients for this study.
Only patients who chose to pursue EF were recruited.” - is a little confusing as it creates the
perception that the authors intentionally only recruited individuals who had already undergone
egg freezing (i.e., used that as exclusion criteria), but it seems that in reality the authors recruited
anyone who was considering egg freezing and it turned out that among the sample who ended
up participating, all but one had gone through with the egg freezing. If that’s true, I would
suggest rewording to explain that the sample population ended up including only patients who
had undergone EF.
In section 5, Voiced Uncertainty, the physical risks associated with egg freezing are mentioned
as a potential barrier. It might be useful to include a brief summary/explanation of egg freezing
in the background section of the paper (including a mention of what these physical risks are) to
help the reader better understand how the specific details of the EF process might affect patients’
decisions.
Also, I’m not sure that “voiced uncertainty” is an accurate descriptor of the findings in that
section. The findings definitely indicate uncertainty, but this label doesn’t quite align with
the other 5 factors influencing decisional difficulty. To me it sounds like uncertainty about
outcomes, both in terms of outcomes related to achieving their goal of fertility preservation as
well as outcomes related to their post-decisional wellbeing.
Discussion:
Provided clear and concrete recommendations for how this decision-making process and related
patient-provider interactions could be improved. I noted a couple of opportunities to expand
upon findings, as described below.
In the discussion section the authors mention using the ODSF and incorporating new categories
in their interview tool. It would be good to specify what new categories the authors added for
this study.
The authors address the limiting factor of having recruited only women who were already highly
motivated to undergo EF (and do a good job of describing characteristics of the sample that
likely increased their attraction to and motivation to undergo EF), but it would be helpful if
the authors could add any suggestions for recruiting individuals who are less motivated/more
uncertain about their decision so future researchers could better locate those individuals in their
sampling.