闭门探讨：一项定性研究，从美国国立癌症研究所指定的综合癌症中心的肿瘤学家视角，探索肿瘤学家与其青少年及青年癌症患者之间生育力讨论的内容。
Behind closed doors: a qualitative study exploring the content of fertility discussions between oncologists and their adolescent and young adult cancer patients from the perspective of oncologists at an NCI-designated comprehensive cancer center.
作者信息
Stal Julia, Roche Charleen I, Yi Serena Y, Freyer David R, Ceasar Rachel C, Kim Sue E, Milam Joel E, Miller Kimberly A
机构信息
Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 1845 N Soto St. Third Floor, Los Angeles, CA, 90033, USA.
Cancer and Blood Disease Institute, Children'S Hospital los Angeles, Los Angeles, CA, USA.
出版信息
Support Care Cancer. 2025 Mar 21;33(4):308. doi: 10.1007/s00520-025-09269-0.
PURPOSE
To qualitatively explore the content of fertility discussions between oncologists and their adolescent and young adult (AYA; 15-39 years) cancer patients from the perspective of oncologists at an NCI-designated comprehensive cancer center.
METHODS
We recruited oncologists of various specialties employed at an NCI-designated comprehensive cancer center in California who treat AYAs at risk for infertility. We collected demographics and fertility-related information (if they discuss fertility with AYA patients and level of confidence doing so) via REDCap prior to conducting a semi-structured interview via HIPAA-compliant Zoom. Audio files were transcribed verbatim and reviewed for themes using an inductive codebook thematic analysis approach.
RESULTS
Oncologists (n = 12) were female (66.7%), of White or Asian race (41.7% each), and were on average in practice for 14.3 years (SD = 6.7). All endorsed discussing fertility with AYAs and were on average somewhat/fairly confident doing so. The detail with which oncologists reported discussing fertility with AYAs varied substantially and only some reported discussing costs associated with fertility preservation. Oncologists also reported assorted information they always mention, mention on a case-by-case basis, avoid, or feel is not necessary when discussing fertility.
CONCLUSION
This study provides a detailed description of information delivered by oncologists during fertility discussions to their AYA patients, revealing unstandardized oncofertility counseling. Fertility discussions were described to vary widely in depth and content, suggesting adherence to clinical practice guidelines limited. Interventions to increase provision of guideline-concordant counseling are needed to provide actionable pathways by which AYAs can proactively mitigate adverse reproductive health outcomes.
目的
从美国国立癌症研究所指定的综合癌症中心的肿瘤学家角度，定性探索肿瘤学家与其青少年及年轻成人（15 - 39岁）癌症患者之间关于生育问题讨论的内容。
方法
我们招募了在加利福尼亚州一家美国国立癌症研究所指定的综合癌症中心工作、治疗有不孕风险的青少年及年轻成人的各专业肿瘤学家。在通过符合健康保险流通与责任法案（HIPAA）的Zoom进行半结构化访谈之前，我们通过REDCap收集了人口统计学和生育相关信息（他们是否与青少年及年轻成人患者讨论生育问题以及进行此类讨论的信心程度）。音频文件逐字转录，并使用归纳编码本主题分析方法审查主题。
结果
肿瘤学家（n = 12）为女性（66.7%），白人或亚洲人种（各占41.7%），平均从业14.3年（标准差 = 6.7）。所有人都认可与青少年及年轻成人讨论生育问题，并且平均而言对此有些/比较有信心。肿瘤学家报告与青少年及年轻成人讨论生育问题的详细程度差异很大，只有一些人报告讨论了与生育力保存相关的费用。肿瘤学家还报告了他们在讨论生育问题时总是提及、根据具体情况提及、避免提及或认为不必要提及的各种信息。
结论
本研究详细描述了肿瘤学家在生育问题讨论中向其青少年及年轻成人患者提供的信息，揭示了肿瘤生育学咨询的不标准化。生育问题讨论的深度和内容差异很大，表明遵循临床实践指南的情况有限。需要采取干预措施以增加符合指南的咨询服务，为青少年及年轻成人提供可行的途径，使其能够积极减轻不良生殖健康后果。
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