Talking about fertility in the context of cancer: health care professional perspectives

Abstract

Health care professionals (HCPs) play a key role in providing information and counselling about the implications of cancer for fertility, however, many patients do not receive such information. The aim of this study was to examine the perspectives and practices of Australian HCPs in relation to discussing fertility with cancer patients. A mixed-methods design, comprising of an online survey of 263 HCPs [41.4% nurses; 25.5% doctors; 31% allied health care professionals (AHP)] and qualitative interviews with 49 HCPs, was utilised. HCPs reported that fertility is an important concern for patients and their partners; however, only 50% of doctors and nurses, and 24% of AHPs reported that they always addressed this issue. The primary barriers to discussing fertility were poor patient prognosis; patient gender or age; time constraints; and absence of appropriate resources and materials. Only a minority of HCPs (29%) had undergone training in discussing fertility with cancer patients. The majority wanted further training or education: including nurses (81.8%), AHPs (80.6%) and doctors (55.4%). HCPs agreed that a number of resources would assist them to raise fertility with their patients, including a list of appropriate referral sources, fact sheets, information booklets, a fertility consultation checklist and on-line resources.

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

“…Our finding that about 70% of the physicians in our sample stated that they always or often discuss the treatment impacts on fertility with their patients is consistent with some studies [7,21], and indicates a markedly higher frequency than those reported by others [11,12,17]. 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].…”

“…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].…”

“…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.…”

Fertility preservation and cancer

“…Although providers are increasingly addressing fertility with their patients (43), recent studies indicate improvements are still needed (44, 45), and both patient- and provider-reported frequency of fertility-related discussions vary greatly (43, 46, 47). In a review of the literature, patients’ unmet fertility information needs ranged from 66% to 100%, and between 11% to 90% of patients rated the information they received as sufficient (43).…”

“…While physicians indicated greater comfort than nurses discussing fertility, the majority of oncology providers report a desire for further training and education (43, 47). A number of studies have documented barriers preventing optimal management of fertility issues in oncology settings.…”