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

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.