Cargando…

Clinicians’ Perspectives on Barriers to Discussing Infertility and Fertility Preservation With Young Women With Cancer

IMPORTANCE: Infertility can be a devastating adverse effect of cancer treatment for young women. Fertility preservation may be an important and influential factor in treatment decisions. Despite American Society of Clinical Oncology guidelines recommending discussion around potential infertility wit...

Descripción completa

Detalles Bibliográficos
Autores principales: Covelli, Andrea, Facey, Marcia, Kennedy, Erin, Brezden-Masley, Christine, Gupta, Abha A., Greenblatt, Ellen, Baxter, Nancy N.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6865261/
https://www.ncbi.nlm.nih.gov/pubmed/31693121
http://dx.doi.org/10.1001/jamanetworkopen.2019.14511
_version_ 1783472054116286464
author Covelli, Andrea
Facey, Marcia
Kennedy, Erin
Brezden-Masley, Christine
Gupta, Abha A.
Greenblatt, Ellen
Baxter, Nancy N.
author_facet Covelli, Andrea
Facey, Marcia
Kennedy, Erin
Brezden-Masley, Christine
Gupta, Abha A.
Greenblatt, Ellen
Baxter, Nancy N.
author_sort Covelli, Andrea
collection PubMed
description IMPORTANCE: Infertility can be a devastating adverse effect of cancer treatment for young women. Fertility preservation may be an important and influential factor in treatment decisions. Despite American Society of Clinical Oncology guidelines recommending discussion around potential infertility with patients, nearly 50% of young women with cancer remain uninformed. OBJECTIVE: To understand and describe from clinicians’ perspectives the barriers to discussing infertility and fertility preservation with young women with cancer. DESIGN, SETTING, AND PARTICIPANTS: This qualitative study used purposeful, maximum variation, and snowball sampling strategies to recruit 22 clinicians from cancer centers and community hospitals in 5 Canadian provinces, 5 practice areas, and 12 practice sites. Eligibility criteria included clinicians who regularly treat young women with cancer who might need fertility preservation. Telephone interviews that lasted between 30 to 75 minutes were conducted between May and November 2014 using a semistructured interview guide. Thematic analysis was used to discern the nature of barriers, and the Cabana framework was used to organize and interpret these findings. Analysis was conducted from May 2014 until May 2015. MAIN OUTCOMES AND MEASURES: Clinician perspectives on what influences their nonadherence to American Society of Clinical Oncology guidelines, which recommend discussing fertility preservation with patients. RESULTS: A total of 22 clinicians were interviewed, including 8 medical oncologists, 4 surgical oncologists, 4 fertility specialists, 3 hematology and oncology specialists, and 3 nurse practitioners or clinician nurse specialists. Seventeen clinicians were women and 5 clinicians were men; the median (range) time in practice was 10 (0.67-37) years. Analysis suggested that clinicians’ unfamiliarity with infertility risks, fertility preservation technologies, referral processes, and procedures, as well as environmental factors and their perceptions of fertility preservation, influenced their practices regarding fertility discussions. CONCLUSIONS AND RELEVANCE: The findings of this qualitative study suggest that the individual and environmental challenges that clinicians experience might negatively affect their willingness and ability to raise fertility-related issues with young women with cancer. Multiple strategies are needed to address these challenges to improve overall care of young women with cancer.
format Online
Article
Text
id pubmed-6865261
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher American Medical Association
record_format MEDLINE/PubMed
spelling pubmed-68652612019-12-23 Clinicians’ Perspectives on Barriers to Discussing Infertility and Fertility Preservation With Young Women With Cancer Covelli, Andrea Facey, Marcia Kennedy, Erin Brezden-Masley, Christine Gupta, Abha A. Greenblatt, Ellen Baxter, Nancy N. JAMA Netw Open Original Investigation IMPORTANCE: Infertility can be a devastating adverse effect of cancer treatment for young women. Fertility preservation may be an important and influential factor in treatment decisions. Despite American Society of Clinical Oncology guidelines recommending discussion around potential infertility with patients, nearly 50% of young women with cancer remain uninformed. OBJECTIVE: To understand and describe from clinicians’ perspectives the barriers to discussing infertility and fertility preservation with young women with cancer. DESIGN, SETTING, AND PARTICIPANTS: This qualitative study used purposeful, maximum variation, and snowball sampling strategies to recruit 22 clinicians from cancer centers and community hospitals in 5 Canadian provinces, 5 practice areas, and 12 practice sites. Eligibility criteria included clinicians who regularly treat young women with cancer who might need fertility preservation. Telephone interviews that lasted between 30 to 75 minutes were conducted between May and November 2014 using a semistructured interview guide. Thematic analysis was used to discern the nature of barriers, and the Cabana framework was used to organize and interpret these findings. Analysis was conducted from May 2014 until May 2015. MAIN OUTCOMES AND MEASURES: Clinician perspectives on what influences their nonadherence to American Society of Clinical Oncology guidelines, which recommend discussing fertility preservation with patients. RESULTS: A total of 22 clinicians were interviewed, including 8 medical oncologists, 4 surgical oncologists, 4 fertility specialists, 3 hematology and oncology specialists, and 3 nurse practitioners or clinician nurse specialists. Seventeen clinicians were women and 5 clinicians were men; the median (range) time in practice was 10 (0.67-37) years. Analysis suggested that clinicians’ unfamiliarity with infertility risks, fertility preservation technologies, referral processes, and procedures, as well as environmental factors and their perceptions of fertility preservation, influenced their practices regarding fertility discussions. CONCLUSIONS AND RELEVANCE: The findings of this qualitative study suggest that the individual and environmental challenges that clinicians experience might negatively affect their willingness and ability to raise fertility-related issues with young women with cancer. Multiple strategies are needed to address these challenges to improve overall care of young women with cancer. American Medical Association 2019-11-06 /pmc/articles/PMC6865261/ /pubmed/31693121 http://dx.doi.org/10.1001/jamanetworkopen.2019.14511 Text en Copyright 2019 Covelli A et al. JAMA Network Open. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Covelli, Andrea
Facey, Marcia
Kennedy, Erin
Brezden-Masley, Christine
Gupta, Abha A.
Greenblatt, Ellen
Baxter, Nancy N.
Clinicians’ Perspectives on Barriers to Discussing Infertility and Fertility Preservation With Young Women With Cancer
title Clinicians’ Perspectives on Barriers to Discussing Infertility and Fertility Preservation With Young Women With Cancer
title_full Clinicians’ Perspectives on Barriers to Discussing Infertility and Fertility Preservation With Young Women With Cancer
title_fullStr Clinicians’ Perspectives on Barriers to Discussing Infertility and Fertility Preservation With Young Women With Cancer
title_full_unstemmed Clinicians’ Perspectives on Barriers to Discussing Infertility and Fertility Preservation With Young Women With Cancer
title_short Clinicians’ Perspectives on Barriers to Discussing Infertility and Fertility Preservation With Young Women With Cancer
title_sort clinicians’ perspectives on barriers to discussing infertility and fertility preservation with young women with cancer
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6865261/
https://www.ncbi.nlm.nih.gov/pubmed/31693121
http://dx.doi.org/10.1001/jamanetworkopen.2019.14511
work_keys_str_mv AT covelliandrea cliniciansperspectivesonbarrierstodiscussinginfertilityandfertilitypreservationwithyoungwomenwithcancer
AT faceymarcia cliniciansperspectivesonbarrierstodiscussinginfertilityandfertilitypreservationwithyoungwomenwithcancer
AT kennedyerin cliniciansperspectivesonbarrierstodiscussinginfertilityandfertilitypreservationwithyoungwomenwithcancer
AT brezdenmasleychristine cliniciansperspectivesonbarrierstodiscussinginfertilityandfertilitypreservationwithyoungwomenwithcancer
AT guptaabhaa cliniciansperspectivesonbarrierstodiscussinginfertilityandfertilitypreservationwithyoungwomenwithcancer
AT greenblattellen cliniciansperspectivesonbarrierstodiscussinginfertilityandfertilitypreservationwithyoungwomenwithcancer
AT baxternancyn cliniciansperspectivesonbarrierstodiscussinginfertilityandfertilitypreservationwithyoungwomenwithcancer