Purpose: Oncofertility care at cancer diagnosis remains under-implemented across oncology and fertility care settings, with limited tools to scale up effective implementation strategies. Using implementation science theory, we systematically assessed factors that influence oncofertility care implementation and map scalable strategies, particularly electronic health record (EHR)-enabled ones, that fit adult and pediatric oncology care contexts.Methods: Using purposeful sampling, we recruited healthcare providers and female, reproductiveaged survivors of adolescent and young adult cancers (AYA survivors) from a comprehensive cancer center and a freestanding children's hospital to semi-structured interviews and focus groups. Using thematic analysis combining inductive codes with deductive codes using the Consolidated Framework for Implementation Research (CFIR), we characterized barriers and facilitators to care and designed responsive strategies. Two coders independently coded each transcript.Results: We recruited 19 oncology and fertility providers and 9 cancer survivors. We identified barriers and facilitators to oncofertility care in the CFIR domains of individual, inner setting, outer setting, and process, allowing us to conceptualize oncofertility care to encompass three core components (screening, referral, and fertility preservation counseling) and map five strategies to these components that fit an adult and a children's context and bridge oncology and fertility practices. The strategies were screening using a best practice advisory, referral order, telehealth fertility counseling, provider audit and feedback, and provider education. All but provider education were EHR tools with embedded efficiencies.Conclusions: An implementation science approach systematically assessed oncofertility care and mapped strategies to provide a theory-based approach and scalable EHR tools to support wider dissemination.
MATERIALS AND METHODS: TNB adolescents and their cisgender siblings participated in a one-time, one-on-one semi-structured interview and survey. Interview data was coded to develop themes that then guided analysis of the survey data. To assess the fertility attitudes of TNB and their cisgender siblings, a modified version of the Transgender Youth Fertility Attitudes Questionnaire (TYFAQ) was utilized. Possible answers to the TYFAQ survey included ''agree,'' ''maybe,'' or ''disagree.'' Outcomes were treated as ordinal and associations were analyzed using the Mann-Whitney U test.RESULTS: A total of 40 participants were included in the analysis (29 TNB adolescents, 11 cisgender siblings). Four major themes were noted when comparing the two groups: 1) the role of gender identity and gender dysphoria 2) desire for future economic and social stability 3) perceived personal reproductive potential 4) future partner's gamete compatibility. TNB adolescents were more likely to say they would consider adoption someday (93% vs 54%, p ¼ .0068). Cisgender adolescents were more likely than TNB adolescents to say it is important to have biological children (65.5% vs 27%, p ¼ 0.05). Cisgender boys were more likely to feel pressured by their family to have biological children than their transmasculine TNB peers (20% vs 0%, ¼ 0.04). In comparing heterosexual adolescents to those who identify as lesbian, gay, bisexual, or queer (LGBQ), heterosexual adolescents were more likely to say it is important to have biological children in the future (77% vs 18%, p¼0.0023). Among TNB adolescents, those currently using gender-affirming hormones were less likely to think their feelings about children might change in the future (p ¼ 0.029). TNB adolescents with a prior diagnosis of gender dysphoria were more likely to say they wanted to have kids someday (71% vs 37%, p ¼ 0.003) and less likely to say their family would be sad if they did not have biological children (0% vs 25%, p ¼ 0.03). TNB adolescents who endorsed parental support were more likely to say it is not important to have biological children in the future (72% vs 25%, p ¼ 0.05), and those that that do not participate in a support group were more likely to say their parents would be disappointed if they did not have biological children (25% vs 0%, p ¼ 0.003).CONCLUSIONS: Sexual orientation and gender identity are important factors to consider when assessing an adolescent's desire for future family building. TGN youth, on average, express lower desires for biological children when compared to their cisgender siblings, which is influenced by their experience with dysphoria and perception of community support. These factors should be considered when counseling adolescents on their future fertility and family building options.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.