Agha, A. (2026). Assessing the Applicability of Fertility Decision Aids in Low- and Middle-Income Countries: An Ottawa Framework Review. , (), 147-156. doi: 10.33899/iraqij.p.2026.171464.1207
Abdulrahman Mohammed Taqi Agha. "Assessing the Applicability of Fertility Decision Aids in Low- and Middle-Income Countries: An Ottawa Framework Review". , , , 2026, 147-156. doi: 10.33899/iraqij.p.2026.171464.1207
Agha, A. (2026). 'Assessing the Applicability of Fertility Decision Aids in Low- and Middle-Income Countries: An Ottawa Framework Review', , (), pp. 147-156. doi: 10.33899/iraqij.p.2026.171464.1207
Agha, A. Assessing the Applicability of Fertility Decision Aids in Low- and Middle-Income Countries: An Ottawa Framework Review. , 2026; (): 147-156. doi: 10.33899/iraqij.p.2026.171464.1207

Assessing the Applicability of Fertility Decision Aids in Low- and Middle-Income Countries: An Ottawa Framework Review

Iraqi Journal of Pharmacy
Articles in Press, Accepted Manuscript, Available Online from 15 July 2026    PDF (854.9 K)
Document Type: Review Paper
DOI: 10.33899/iraqij.p.2026.171464.1207
Author
Abdulrahman Mohammed Taqi Agha*
Department of Clinical Pharmacy, College of Pharmacy, University of Mosul, Mosul, Iraq
Abstract
Background: Fertility preservation (FP) is critical for reproductive-age cancer patients, yet the complexity of decision-making remains a significant clinical challenge. While patient decision aids (DAs) are standard evidence-based tools utilized in developed healthcare systems to mitigate decisional conflict, their implementation and efficacy remains understudied in Low- and Middle- Income countries (LMIC). Aim: This narrative review utilizes the Ottawa Decision Support Framework (ODSF) to critically evaluate the transferability of existing oncofertility decision support tools to LMIC. Method: A structured review identified 11 DAs, which were evaluated via thematic analysis. The ODSF was used to compare Western design elements with systemic realities in LMIC. Conclusion: Current DAs prioritize individual emotional conflict over the systemic barriers—financial, clinical, and cultural—prevalent in LMICs. Effective implementation may require a shift toward family-centered consensus models, active financial navigation, and low-literacy multimedia formats, and the proposed integration of trained clinical pharmacists to bridge crucial knowledge gaps in clinical utility in resource-poor settings.

Highlights
  • Current fertility preservation Decision Aids might be ineffective in developing countries due to many systemic barriers.
  • The burden of the “out-of-pocket” costs affects the decision-making about Fertility Preservation in developing countries.
  • In developing countries, the decision is discussed among the whole family unlike the western individual centered model.
  • The decisional conflict scales may be of limited use, if there was no access to the choices offered in the Decision Aids.
  • Busy oncologists cannot provide adequate knowledge on Fertility Preservation, clinical pharmacists can fill this gap.
  • Decision Aids designers need to account for the financial, cultural and legal differences for each targeted country.
Keywords
Cancer survivorship; Clinical pharmacy; Healthcare disparities; Oncofertility
Supplementary Files
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