Pediatric Oncology Providers’ Attitudes and Practice Patterns Regarding Fertility Preservation in Adolescent Male Cancer Patients

Abstract

Background The aim of this study was to evaluate pediatric oncology providers’ attitudes toward fertility preservation (FP), their use of educational materials, their approach to FP discussion, and their FP knowledge specifically pertaining to adolescent males. Methods A 40-item online survey was distributed to physicians, advanced practice nurses (APN), and nurses within pediatric oncology. Results About 78.7% of physicians, 81.4% of APN, and 51.9% of nurses reported high levels of comfort in discussing FP options with adolescent males (P<0.05). Fifty-one percent of physicians and 54.2% of APN reported using educational materials, compared with 38.9% of nurses (P<0.05). Regarding knowledge of FP technologies, 48.7% of physicians, 52.5% of APN, and 81.1% of nurses reported being unfamiliar with intracytoplasmic sperm injection (P<0.05). An overwhelming majority (92.9%) of respondents reported having no formal training in discussing FP. Finally, 84.8% of respondents believed formal training on this issue would be useful to them. Conclusions This study illustrates an unmet need in the education of pediatric oncology providers, as knowledge gaps and discomfort are common themes reported by health care professionals within the context of adolescent male FP care. In addition, this study reveals a high level of receptiveness to FP training by these same providers.

Clinician provision of oncofertility support in cancer patients of a reproductive age: A systematic review

“…Four studies reported on clinicians' use of written materials when informing patients of fertility or fertility preservation . Half of physicians and advanced practice nurses reported using fertility educational materials “usually” to “always”; however, the adult language, adult content, and overall reading level were a shortcoming of this material when supplied to young patients of reproductive age . A second study reported that only 13.6% of oncologists “always” to “often” give patients educational materials about fertility preservation, while the majority (60.2%) reported “rarely” to “never” providing written materials .…”

“…Clinicians will always discuss fertility with an adolescent, even when parents show doubt or when parents refuse to give permission, and sometimes clinicians talk to adolescents alone without parent's knowledge . Almost all physicians (93%), advanced practice nurses (75%), and half of nurses (48%) reported discussing the impact of cancer treatment on future fertility with adolescent male patients “usually” to “always.”…”

“…Nurses and allied health professionals were more likely to desire further training than doctors . Almost all clinicians (83%) reporting formal training on fertility preservation or a clear referral pathway would be beneficial and would welcome a guideline for discussing fertility preservation in routine practice …”

“…International and national guidelines advocate for all cancer health care providers to engage in fertility discussions with newly diagnosed cancer patients of reproductive age and that these discussions should be guided by institutional policies and practices . Although the majority of clinicians report routinely discussing fertility with cancer patients of reproductive age, recorded rates of fertility discussions are significantly lower; negatively impacted by factors such as heightened level of patient risk, clinician type, patient pubertal status, or patient female gender status . Moreover, the extent or quality of these discussions was often unclear, lacked a systematic process for being recorded, and the focus of discussions was on practical rather than emotional issues .…”

“…• Clinicians unaware of current guidelines, with one quarter (26%) of physicians were unfamiliar with current guidelines for FP, compared to 36% of advanced practice nurses and 65% of nurses …”