The Abigail Wexner Research Institute at Nationwide Children's Hospital, 431 S 18th St, Columbus, OH, 43205, USA.
Nationwide Children's Hospital, Columbus, OH, USA.
J Assist Reprod Genet. 2023 Dec;40(12):2809-2817. doi: 10.1007/s10815-023-02944-3. Epub 2023 Sep 21.
To examine processes, barriers, and facilitators to sperm banking counseling and decision-making for adolescent males newly diagnosed with cancer from the perspective of clinicians who completed Oncofertility communication training. We also identify opportunities for improvement to inform future interventions and implementation.
A survey (N=104) and subsequent focus groups (N=15) were conducted with non-physician clinicians practicing in pediatric oncology who completed Oncofertility communication training.
Most survey participants were confident in communicating about the impact of cancer on fertility (n=87, 83.7%) and fertility preservation options (n=80, 76.9%). Most participants reported never/rarely using a sperm banking decision tool (n=70, 67.3%), although 98.1% (n=102) said a decision tool with a family-centered approach would be beneficial. Primary themes in the subsequent focus groups included variable processes/workflows (inconsistent approaches to consult initiation; involvement of adolescents, caregivers, and various clinician types; assessment of puberty/sexual experience), structural and psychosocial barriers (cost and logistics, developmental, cultural, clinical acuity/prognosis), and facilitators (educational materials, alternative options for banking). Opportunities and strategies for improvement (including fertility preservation in existing research protocols; additional staffing/resources; oncologist education and buy-in; and development of decision tools) were informed by challenges identified in the other themes.
Barriers to adolescent sperm banking remain, even among clinicians who have completed Oncofertility training. Although training is one factor necessary to facilitate banking, structural and psychosocial barriers persist. Given the complexities of offering sperm banking to pediatric populations, continued efforts are needed to mitigate structural barriers and develop strategies to facilitate decision-making before childhood cancer treatment.
从接受过生育力保存沟通培训的临床医生的角度，研究新诊断为癌症的青少年男性接受精子库咨询和决策的过程、障碍和促进因素。我们还确定了改进的机会，以为未来的干预和实施提供信息。
对接受过生育力保存沟通培训的从事儿科肿瘤学的非医师临床医生进行了一项调查（n=104）和随后的焦点小组（n=15）。
大多数调查参与者对沟通癌症对生育能力的影响（n=87，83.7%）和生育力保存选择（n=80，76.9%）非常有信心。大多数参与者报告从未/很少使用精子库决策工具（n=70，67.3%），尽管 98.1%（n=102）表示有一个以家庭为中心的决策工具将是有益的。随后的焦点小组的主要主题包括不同的过程/工作流程（咨询启动的方法不一致；青少年、照顾者和各种临床医生类型的参与；青春期/性经验的评估）、结构和心理社会障碍（成本和后勤、发育、文化、临床紧迫性/预后）以及促进因素（教育材料、银行的替代选择）。通过其他主题中确定的挑战，提出了改进的机会和策略（包括在现有研究方案中进行生育力保存；增加人员/资源；肿瘤学家的教育和认同；以及决策工具的开发）。
即使在接受过生育力培训的临床医生中，青少年精子库的障碍仍然存在。虽然培训是促进银行服务的一个必要因素，但结构和心理社会障碍仍然存在。鉴于向儿科人群提供精子库服务的复杂性，需要继续努力减轻结构障碍，并制定策略，在儿童癌症治疗前促进决策。
