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JAMA Netw Open. 2019 Nov 1;2(11):e1914511. doi: 10.1001/jamanetworkopen.2019.14511.

Clinicians' Perspectives on Barriers to Discussing Infertility and Fertility Preservation With Young Women With Cancer.

Author information

1
Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
2
Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
3
Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada.
4
Department of Medicine, St Michael's Hospital, Toronto, Ontario, Canada.
5
Department of Oncology, Hospital for Sick Children, Toronto, Ontario, Canada.
6
Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada.
7
Department of Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
8
Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.

Abstract

Importance:

Infertility can be a devastating adverse effect of cancer treatment for young women. Fertility preservation may be an important and influential factor in treatment decisions. Despite American Society of Clinical Oncology guidelines recommending discussion around potential infertility with patients, nearly 50% of young women with cancer remain uninformed.

Objective:

To understand and describe from clinicians' perspectives the barriers to discussing infertility and fertility preservation with young women with cancer.

Design, Setting, and Participants:

This qualitative study used purposeful, maximum variation, and snowball sampling strategies to recruit 22 clinicians from cancer centers and community hospitals in 5 Canadian provinces, 5 practice areas, and 12 practice sites. Eligibility criteria included clinicians who regularly treat young women with cancer who might need fertility preservation. Telephone interviews that lasted between 30 to 75 minutes were conducted between May and November 2014 using a semistructured interview guide. Thematic analysis was used to discern the nature of barriers, and the Cabana framework was used to organize and interpret these findings. Analysis was conducted from May 2014 until May 2015.

Main Outcomes and Measures:

Clinician perspectives on what influences their nonadherence to American Society of Clinical Oncology guidelines, which recommend discussing fertility preservation with patients.

Results:

A total of 22 clinicians were interviewed, including 8 medical oncologists, 4 surgical oncologists, 4 fertility specialists, 3 hematology and oncology specialists, and 3 nurse practitioners or clinician nurse specialists. Seventeen clinicians were women and 5 clinicians were men; the median (range) time in practice was 10 (0.67-37) years. Analysis suggested that clinicians' unfamiliarity with infertility risks, fertility preservation technologies, referral processes, and procedures, as well as environmental factors and their perceptions of fertility preservation, influenced their practices regarding fertility discussions.

Conclusions and Relevance:

The findings of this qualitative study suggest that the individual and environmental challenges that clinicians experience might negatively affect their willingness and ability to raise fertility-related issues with young women with cancer. Multiple strategies are needed to address these challenges to improve overall care of young women with cancer.

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