Oncofertility Decision Making: Findings from Israeli Adolescents and Parents

Abstract

As in other cultural contexts, Israeli adolescents and parents demonstrate multifaceted decision making with respect to oncofertility. A significant finding from this study suggests that health professionals shy from discussing posthumous planning of cryopreserved materials with adolescent cancer patients and their parents. Further investigation is warranted to determine whether this is a uniquely Israeli phenomenon, the cause for it, and how to overcome it.

Barriers and Facilitators to Fertility-Related Discussions with Teenagers and Young Adults with Cancer: Nurses' Experiences

“…One possible explanation why parents may not allow TYAs to be approached may be attributed to their sole preoccupation with immediate survival, 47 assumption that TYAs cannot comprehend the process, 61,62 and parental/family concerns about further distressing the TYA who may be emotionally overwhelmed following a traumatic cancer diagnosis. 29,44,48 However, research has demonstrated that patient and parent discomfort/anxiety levels are often overestimated by health care professionals. 30,63 TYAs desire to be active decision makers [29][30][31][32] and can indeed cope with fertility matters being raised alongside a cancer diagnosis with support.…”

“…29,44,48 However, research has demonstrated that patient and parent discomfort/anxiety levels are often overestimated by health care professionals. 30,63 TYAs desire to be active decision makers [29][30][31][32] and can indeed cope with fertility matters being raised alongside a cancer diagnosis with support. 64 While parental concerns are understandable, evidence suggests that parenthood priorities shift over time and become a significant concern into survivorship.…”

“…Nurses saw this as a way of supporting TYA participatory decision-making. Balancing TYA engagement with parental involvement is pivotal, considering that parents and TYAs do not view oncofertility decision-making in the same way 29 and may have discrepant priorities regarding future fertility intentions. 65 If they desire, TYAs should participate in discussions, taking account of their emotional and mental maturity to freely voice their preferences.…”

“…28 In addition, TYAs strongly desire a participatory decisionmaking role. [29][30][31][32] As research consistently indicates that receiving information about the impact of cancer on fertility is associated with lower patient distress, 19 improved quality of life, 10,20,26 less regret, 33,34 and improved coping, 15 it is critically important to engage in timely discussions to maximize future FP opportunities.…”

Parent recommendation to bank sperm among at‐risk adolescent and young adult males with cancer

“…Among post‐pubertal males diagnosed with cancer, sperm cryopreservation is considered the gold standard among fertility preservation options 10 . Although the demands of collecting sperm are relatively low, the decision to bank is typically accompanied by time constraints, due to the urgency to initiate cancer therapy 11 . Despite valuing parenthood, 12 many adolescents do not bank sperm prior to initiation of gonadotoxic cancer treatment 11,13 …”