Understanding Decision Making and Barriers to Fertility Preservation in Young Women With Cancer [21S

Abstract

INTRODUCTION: Many women recognize a cancer diagnosis as a time to evaluate their desire for future fertility. While financial barriers to fertility preservation are well documented, other barriers are not often addressed. We sought to explore patients' experiences when considering fertility preservation options after cancer diagnosis and their perceived barriers to pursing those options. METHODS: We conducted twenty semi-structured interviews with female oncology patients ages 18-45 years who were stable on treatment or had completed therapy within the last 24 months at an urban northeast medical center. We analyzed data using direct content analysis using the Promoting Action on Research Implementation in Health Services (PARiHS) framework. We continued participant recruitment until we reached thematic saturation. RESULTS: Patients struggle to process complex, future-based decision-making when coping with a cancer diagnosis. Three subthemes emerged: 1) patients' personal biases and fears, rather than data, about pregnancy post-chemotherapy contribute notably to decision making; 2) patients perceive biases from their providers against fertility preservation; and 3) fertility desires are fluid, thus patients may regret not exploring fertility preservation options. CONCLUSION: Decision-making regarding fertility preservation in women with a cancer diagnosis is complex. Within the current model of care, patients may not be able to fully explore their fertility preservation options, particularly in the acute diagnosis setting. A shared-decision making approach, with their own obstetrician–gynecologist, may facilitate difficult decision-making. The general obstetrician-gynecologist may play a crucial role in helping patients to navigate their desires to engage in fertility preservation options after the specialist consult.