Tirsina Alla, de Freitas Cláudia, Silva Susana
EPIUnit ITR, Instituto de Saúde Pública da Universidade do Porto, Universidade do Porto, Porto, Portugal.
Departamento de Ciências da Saúde Pública e Forenses, e Educação Médica | Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
Hum Reprod Update. 2025 Sep 1;31(5):497-511. doi: 10.1093/humupd/dmaf014.
The number of people who could benefit from fertility preservation is increasing. However, access to fertility preservation services has been hampered by a lack of awareness and misconceptions among healthcare providers (HCPs). There is a need for multifaceted educational programs that consider the perceptions and needs of HCPs. Systematic knowledge of the factors influencing the awareness and attitudes of HCPs toward the use of fertility preservation can help to identify the topics to be included in curricula and the specialties where these programs are most needed.
This comprehensive scoping review aims to synthesize quantitative evidence on the factors influencing the awareness and attitudes of HCPs toward fertility preservation, identifying the segments of HCPs (i.e. occupation groups and specialties) that are considered and the fertility preservation indications and topics assessed.
The protocol and the scoping review were conducted according to the PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Literature searches were conducted in three databases: PubMed®, Web of Science™, and PsycINFO®. Original empirical, peer-reviewed, and full-length quantitative or mixed-methods articles concerning the awareness and attitudes of HCPs toward fertility preservation were included. Studies involving undergraduate students, interns, residents, and fellows were not considered, nor was qualitative data. The variables of interest were extracted using an individualized data charting tool, and an MS Excel spreadsheet was used to chart the data.
The studies reviewed, comprising 54 quantitative studies and 6 mixed-methods studies, were primarily sourced from the USA, Asian countries (China, Japan, Turkey, India, Iran), and European countries (Netherlands, France, UK). The study participants were predominantly composed of specialist medical practitioners and/or nursing professionals with expertise in the fields of oncology, obstetrics and gynecology, and pediatrics. Almost all studies assessed the awareness and attitudes of HCPs toward fertility preservation in the context of oncologic diseases and oocyte freezing. The primary topics addressed in the literature are information needs and provision and the organization of care and practice. Additional topics include legal aspects, access and coverage, as well as fertility preservation interventions. The results suggested that awareness and attitudes of HCPs toward fertility preservation tended to be influenced by factors related to their professional trajectories (level of involvement in fertility preservation issues with peers and patients, number of patients treated, and advanced training), rather than their sociodemographic characteristics or perceptions of patient's characteristics.
Further empirical research is required, including studies involving HCPs working in primary healthcare institutions and those specializing in psychosocial care, as well as studies into fertility preservation for reproductive aging and gender-transitioning reasons. It is necessary to invest in the provision of education regarding fertility preservation to a diverse range of HCPs, extending beyond specialist medical practitioners involved in oncology. The implementation of educational programs encompassing the legal aspects, access, coverage, and fertility preservation interventions could enhance awareness and attitudes of HCPs toward fertility preservation. Changes in policy and advocacy are needed to support better integration of fertility preservation as a tool for patients in their reproductive health journey.
osf.io/h56ds.
可从生育力保存中获益的人数正在增加。然而，医疗服务提供者（HCPs）缺乏认识和存在误解，阻碍了生育力保存服务的获取。需要开展多方面的教育项目，同时考虑HCPs的认知和需求。系统了解影响HCPs对生育力保存使用的认识和态度的因素，有助于确定课程中应涵盖的主题以及最需要这些项目的专业领域。
本全面的范围综述旨在综合关于影响HCPs对生育力保存的认识和态度的因素的定量证据，确定所考虑的HCPs群体（即职业群体和专业领域）以及所评估的生育力保存适应症和主题。
本方案和范围综述按照《系统综述与Meta分析扩展版：范围综述的PRISMA清单和解释》（PRISMA-ScR）进行。在三个数据库中进行文献检索：PubMed®、科学网（Web of Science™）和PsycINFO®。纳入了关于HCPs对生育力保存的认识和态度的原创实证研究、同行评审的全长定量或混合方法文章。不考虑涉及本科生、实习生、住院医师和研究员的研究，也不考虑定性数据。使用个性化的数据图表工具提取感兴趣的变量，并使用MS Excel电子表格对数据进行图表绘制。
所综述的研究包括54项定量研究和6项混合方法研究，主要来自美国、亚洲国家（中国、日本、土耳其、印度、伊朗）和欧洲国家（荷兰、法国、英国）。研究参与者主要由肿瘤学、妇产科和儿科领域的专科医生和/或护理专业人员组成。几乎所有研究都在肿瘤疾病和卵母细胞冷冻的背景下评估了HCPs对生育力保存的认识和态度。文献中涉及的主要主题是信息需求与提供以及护理和实践的组织。其他主题包括法律方面、获取和覆盖范围以及生育力保存干预措施。结果表明，HCPs对生育力保存的认识和态度往往受到与其职业轨迹相关的因素（与同行和患者在生育力保存问题上的参与程度、治疗的患者数量以及高级培训）的影响，而不是其社会人口学特征或对患者特征的认知。
需要进一步的实证研究，包括涉及在基层医疗机构工作的HCPs以及专门从事心理社会护理的人员的研究，以及关于因生殖衰老和性别转变原因进行生育力保存的研究。有必要投资为各类HCPs提供关于生育力保存的教育，而不仅仅是涉及肿瘤学的专科医生。实施涵盖法律方面、获取、覆盖范围和生育力保存干预措施的教育项目，可以提高HCPs对生育力保存的认识和态度。需要政策和宣传方面的变革，以支持更好地将生育力保存作为患者生殖健康旅程中的一种工具进行整合。
osf.io/h56ds。
