What are the fertility preservation decision-making psychological subgroups among reproductive-age breast cancer patients? A cross-sectional study using latent profile analysis

Reproductive-age breast cancer patients often face fertility preservation decisions. Limited knowledge and anxiety about future reproductive function can adversely affect their decision-making psychological state. Therefore, exploring patients’ decision psychology and its associated factors may help improve decision quality. A cross-sectional survey was conducted in three Grade-A hospitals in China between February 2024 and July 2024, with 279 participants included in the final analysis. Participants completed a socio-demographic questionnaire and four validated scales: the Chinese Reproductive Concerns After Cancer Scale (RCACS), the Decision Self-Efficacy Scale (DSES), the Decision Conflict Scale (DCS), and the Decision Regret Scale (DRS). Three components of decision-making psychological state—pre-decision cognition, in-decision conflict, and post-decision evaluation—were measured cross-sectionally. Latent profile analysis (LPA) was used to identify distinct decision-making profiles, and pairwise Firth-penalized logistic regression was used to identify factors associated with profile membership and to reduce bias from sparse cell data. Three latent profiles were identified: resolute and regret-free (Class 1, 25.09%), stable-rational (Class 2, 61.65%), and ambivalent and regret-prone (Class 3, 13.26%). Class 3 showed the highest conflict and regret but the lowest self-efficacy; Class 1 showed the opposite pattern; Class 2 was intermediate. Overall, 62.0% ( n = 173) intended to receive fertility preservation, and the median fertility-concern score was 55.00 (P₂₅ = 43.00, P₇₅ = 68.00). With Class 1 as reference, FP willingness (OR = 3.036, 95% CI 1.313–7.381, P = 0.009), higher fertility concern (OR = 1.112, 95% CI 1.073–1.158, P < 0.001), and age 40–45 years (OR = 0.154, 95% CI 0.050–0.423, P < 0.001) were associated with Class 2 membership; with Class 2 as reference, fertility preservation willingness (OR = 7.617, 95% CI 1.752–71.912, P = 0.004) and higher education (OR = 10.239, 95% CI 2.645–58.482, P < 0.001) were associated with Class 3 membership. The Class 3 versus Class 1 comparison did not converge and was therefore not interpreted. Reproductive-age breast cancer patients show considerable heterogeneity in their fertility preservation decision-making psychological state, with a distinct subgroup reporting the highest decision conflict and regret. Clinical care providers should prioritize targeted psychological and decision-making support for this high-risk subgroup.