Initial development and usability testing of a digital fertility preservation navigator for newly diagnosed young adult cancer survivors

Clinical Snapshot

Key Findings

• P Value: Not reported

• Effect Size: Not applicable — no comparative effect size reported; this is a descriptive usability study

• Primary Outcome: Usability of Fertilit-e was rated as 'excellent' across both waves and both devices (iPad and computer) using the System Usability Scale. Participants understood the purpose of the tool and found modules comprehensive and easy to understand.

• Nnt Or Sensitivity: Not applicable for this study design; qualitative usability study with no efficacy endpoint. Key actionable findings include participant-identified improvements: reduction and clarification of medical terminology, and addition of captions/text to embedded videos to enhance comprehensibility.

• Confidence Interval: Not reported

Clinical Application

Digital delivery via iPad and computer is feasible in outpatient oncology settings. The tool's modular structure and self-directed navigation may allow integration into pre-treatment consultations or as a take-home resource. However, implementation at scale requires further development beyond the alpha phase, including beta testing, efficacy evaluation, and integration with clinical workflows. Time constraints at diagnosis remain a significant implementation challenge. Fertility preservation is a recognised priority in Australian cancer care. RACGP and Cancer Australia guidelines recommend oncofertility counselling for all patients of reproductive age prior to gonadotoxic treatment. In Australia, fertility preservation procedures (e.g., oocyte cryopreservation, sperm banking) attract partial Medicare rebates, though out-of-pocket costs remain substantial and access is inequitable across geographic and socioeconomic groups. A digital navigator such as Fertilit-e could complement existing resources (e.g., Fertility Society of Australia guidance, Livestrong Fertility equivalents) and support oncofertility referral pathways. TGA oversight would not apply to a decision aid of this nature unless it incorporates diagnostic or therapeutic claims. Integration with My Health Record or telehealth platforms could enhance reach in rural and remote Australia, where access to reproductive specialists is limited. Young adults (approximately 18–39 years) newly diagnosed with cancer who face treatment-related fertility risk and require timely decision support regarding fertility preservation options prior to commencing oncological treatment

Abstract

PURPOSE: Young adults with cancer (YAs) are rarely provided the necessary resources to make informed decisions about fertility preservation (FP) prior to beginning treatment. Digital decision aids are a promising strategy to ensure YAs receive timely, guideline-concordant information. We developed an alpha version Fertilit-e, a digital FP navigator, and conducted usability testing to obtain feedback from YAs. METHODS: We designed an alpha version of Fertilit-e that drew from existing evidence-based FP resources. Feedback was obtained from two waves of participants using a think-aloud framework, and modifications were made to the decision aid. RESULTS: Across waves, participants (n = 12) understood the purpose of Fertilit-e and thought modules were comprehensive and easy to understand. The usability of Fertilit-e was rated as excellent across waves and devices (iPad and computer). Participants suggested reducing the use of and better defining medical terminology and adding text to videos to enhance comprehensibility. CONCLUSIONS: YAs reported that Fertilit-e provided important information regarding FP in an understandable manner. Participants made suggestions for how to improve comprehensibility and usability that will guide future iterations of Fertilit-e. For example, tailoring algorithms and reorganization may direct users to the most relevant information. IMPLICATIONS FOR CANCER SURVIVORS: Digital decision aids may be a feasible and useful strategy for helping YAs navigate decisions regarding whether to pursue FP at the time of diagnosis. Additional research is needed to refine and evaluate such tools before integration into routine care.

References

1. 1.Ingram, K. M., Bunch, S., Rose, M. V., Tooze, J. A., Duque, M., Victorson, D., Yanez, B., Smith, K. N., Quinn, G. P., Miller, D. P., & Salsman, J. M. (2026). Initial development and usability testing of a digital fertility preservation navigator for newly diagnosed young adult cancer survivors. Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer. https://doi.org/10.1002/cam4.3711