Patient-Physician Communication and Knowledge Regarding Fertility Issues from German Oncologists’ Perspective—a Quantitative Survey

Abstract

Many people diagnosed with haematologic malignancies are of child-bearing age. Typical treatment courses pose a high risk of infertility, and a lot of people affected by this are in the midst of starting or growing their families. Thus, it is crucial that they are well informed about fertility preservation options and can discuss these with an oncologist early on in the development of their treatment plans. Unfortunately, however, this does not always happen. One hundred twenty oncologists from 37 German adult clinical facilities were surveyed regarding their discussions with young patients about fertility, family planning, and fertility preservation. Almost all of them said that they consider fertility preservation to be an important issue. They also reported several factors as having an influence on the likelihood and practicability of discussing these subjects. Most knew about the existence of cryoconservation of germ cells and the use of GnRH analogues (95 %), but only half of them claimed to have a thorough understanding of these options. Many said they would like to learn more about this and that informational brochures could be helpful. Even though many oncologists do have good working knowledge of the subject, patients of reproductive age are not yet consistently given comprehensive information about the options available to them. To improve oncologists' knowledge of reproductive medicine, cooperation with fertility specialists should be facilitated, and informational leaflets should be made available both to patients and their medical care providers.

Oncologists and hematologists’ perceptions of fertility-related communication – a nationwide survey

“…Our results confirmed earlier findings indicating that many physicians are less likely to discuss fertility issues with patients who already have children [10,11,18,21], are single [10,11] or are homosexual [9,10,18]. Since none of these circumstances are obstacles for desiring or pursuing parenthood, they should not be accepted as reasons for not discussing fertility issues.…”

“…A poor prognosis was the most frequently stated reason for choosing not to initiate a discussion of fertility issues with cancer patients, in both this survey and previous studies [8,10,18,19]. This is not particularly surprising.…”

“…Previous studies have indicated that physicians in general consider it important to discuss fertility-related issues with patients of reproductive age [7,17,18], but refrain from such discussions in cases of specific circumstances related to the patient, organization or physician. Patient-related reasons for not discussing fertility issues (including fertility risk and FP) include a poor prognosis [8,10,18,19], a disease requiring immediate treatment [9,10], marital or parenthood status [10,11,18] and sexual orientation [9,10,18].…”

“…Patient-related reasons for not discussing fertility issues (including fertility risk and FP) include a poor prognosis [8,10,18,19], a disease requiring immediate treatment [9,10], marital or parenthood status [10,11,18] and sexual orientation [9,10,18]. Organizationrelated barriers to communication include unclear referral paths for FP [12,15], a lack of inter-professional cooperation [7,12,15] and the cost of FP in insurance or patient-funded settings [9][10][11]13].…”

“…However, no corresponding studies have been found investigating the influence of potentially explanatory factors on physicians' practice behavior with regard to discussing fertility risks with young cancer patients. Since previous research indicates that oncologists and hematologists in general are positively inclined towards communicating fertility issues [7,17,18], the identification of factors hindering such communication may contribute to the development of cancer care.…”