Oncology Nurses' Perceptions of Barriers to Discussion of Fertility Preservation With Patients With Cancer

Abstract

Infertility is a common result of cancer treatment; however, opportunities exist for patients to preserve fertility prior to treatment. Recent evidence suggests that healthcare providers, including nurses, do not consistently discuss fertility preservation (FP) with patients. This qualitative, cross-sectional pilot study used a focus group and in-depth interviews to explore knowledge, attitudes, and practice behaviors related to nurses' discussion of FP with patients with cancer. Results indicate that only half of the nurses discuss FP methods with patients, even though most believe that having discussions with patients about fertility is part of their role. Factors associated with the discussion of FP among nurses included (a) knowledge (FP procedures, fertility institutes and clinics, resources for patients, and practice guidelines), (b) attitudes (difficulty finding facilities, time constraints, role, comfort level, ethical issues, financial considerations, and patient characteristics), and (c) behaviors (patient initiation, physician behaviors, patient characteristics, and timing). Discussion should be stimulated among nurses about the role of nurses in the FP discussion, and educational interventions and practice guidelines should be developed that are aimed at oncology nurses to help facilitate discussions with patients.

Nurses’ knowledge, attitudes, and practices regarding provision of sexual health care in patients with cancer: critical review of the evidence

“…Quinn [86] found that while the nurses were vaguely aware of the fertility options existing for men (such as sperm banking), they did not know what the procedure entailed; consequently, they were rendered unable to offer any kind of effective support. Recently, various methodologically similar studies evinced nurses' inadequate knowledge regarding sperm banking and fertility options in either pediatric or adult cancer populations [65,82,89] (see Table 1). King et al [65] concluded that although most participants were aware of the standard fertility preservation options for both genders, few knew more experimental ones, or were aware of some fertility institutes and clinics, while most did not have any educational material for their clinics.…”

“…Recently, various methodologically similar studies evinced nurses' inadequate knowledge regarding sperm banking and fertility options in either pediatric or adult cancer populations [65,82,89] (see Table 1). King et al [65] concluded that although most participants were aware of the standard fertility preservation options for both genders, few knew more experimental ones, or were aware of some fertility institutes and clinics, while most did not have any educational material for their clinics. Inadequate knowledge was also observed among a sample of Dutch oncology nurses specifically when the sexual problem and intervention involved love-making activities, intercourse and masturbation, and when there was a need for planning care through intra-and inter-professional cooperation [38].…”

Listening through Narratives: Using a Narrative Approach When Discussing Fertility Preservation Options with Young Cancer Patients

“…According to Charon, narrative medicine is medicine practiced with "narrative competence"-the ability to "acknowledge, absorb, interpret, and act on the stories and plight of others" 28 . Narrative medicine fosters empathy and trust between patients and providers, improves communication, and has a therapeutic effect for patients 29,30 . Medical students are taught skills in narrative analysis 31,32 , and narrative-based workshops are now being offered to hcps to "enhance reflective practice in inter-professional clinical and/or teaching settings" and "creatively champion patient-centred care" by shifting the story back to the patient experience a .…”

Implementing a Systematic Approach to Meeting Patients' Cancer and Fertility Needs: A Review of the Fertile Hope Centers of Excellence Program

“…Use of impartial triggers could ameliorate subjective barriers to notification and discussion noted in the literature, including provider discomfort with the subject matter, perceived financial status of the patient, biases about patients' sexual orientation or marital status, poor prognosis, and so on. 1,16,17 Systems that capture fertility disclosures, discussions, and requests for referrals electronically also offer practical means for documenting and evaluating notification practices. Patterns and gaps in disclosure could be more easily identified (compared with similar hard-copy file reviews) and consequently remedied.…”

“…1 Although the exact definition of reproductive age varies, we included everyone diagnosed at age Ͻ 45 years, including pediatric patients (age 0 to 15 years), because they are also at risk for reproductive damage. Although patients with cancer frequently report anxiety about their ability to have children in the future, 2,3 many do not recall discussing potential infertility with their physicians or other health care providers, 4 and some remain unsure of their reproductive status after completion of treatment.…”