Decisional conflict regarding fertility preservation among women of reproductive age with systemic lupus erythematosus: a cross-sectional study of its level and associated factors

To describe the level of decisional conflict regarding fertility preservation among women of reproductive age with systemic lupus erythematosus (SLE) and to identify factors associated with it. Using convenience sampling, we recruited women of reproductive age with SLE attending the outpatient department or admitted to a tertiary Grade A hospital in Shanxi Province between January and May 2026. Data were collected using a general information questionnaire, the Decisional Conflict Scale (DCS), the Chinese version of the Reproductive Concerns After Cancer Scale (RCAC-C), the Social Support Rating Scale (SSRS), and a fertility preservation (FP) knowledge questionnaire. Before completing the DCS, all participants received a standardised description of fertility preservation. All 16 candidate variables, specified a priori with reference to the Ottawa Decision Support Framework, were entered simultaneously into a multiple linear regression model (forced entry, 28 terms after dummy coding). Model assumptions were formally assessed, and heteroscedasticity-consistent (HC3) standard errors, median regression, and bootstrapping were used as sensitivity analyses. Of 260 questionnaires distributed, 250 were valid (effective response rate 96.15%). The DCS score was 51.19 ± 13.46 [median 50.00 (40.62, 62.50)]. Applying O’Connor’s cut-offs, 3 women (1.2%) scored below 25, 47 (18.8%) scored 25–37.5, and 200 (80.0%) scored above 37.5. Fertility-preservation knowledge was poor: the mean converted score was 24.07 ± 21.74 out of 100, 66 women (26.4%) answered none of the six items correctly, and no participant answered all six. Social support was low (SSRS 26.36 ± 4.55; observed range 18–36 against a theoretical range of 11–72). In the adjusted model (R² = 0.622, adjusted R² = 0.574), higher reproductive concerns (β = 0.628), lower social support (β = −0.203), lower FP knowledge (β = −0.207), township residence (β = 0.157), and having children (β = −0.210) were independently associated with decisional conflict; associations with education level and with severe disease activity were also observed but are reported as exploratory because of limited robustness or sparse subgroup support. Among women of reproductive age with SLE without severe organ involvement, decisional conflict regarding fertility preservation was high, and the factors most strongly associated with it (reproductive concerns, social support, and knowledge) are potentially modifiable. Because the design was cross-sectional, these are associations rather than causes. Care should centre on individualised assessment of fertility-preservation candidacy and timely multidisciplinary referral rather than on uniform counselling for all patients.