Barriers and facilitators to fertility-related discussions with Teenagers and Young Adults with cancer: Nurses’ experiences.

Background Improvements in cancer survival rates for Teenagers and Young Adults (TYAs) have resulted in quality-of-life issues into survivorship becoming increasingly important. However, infertility is a potential late side-effect of cancer treatment which can negatively impact on quality-of-life. Advances in assisted reproductive technologies have resulted in increasingly effective fertility preservation options.

Purpose This study aimed to explore nurses’ experiences and feelings of undertaking fertility-related discussions with TYA cancer patients aged 13-24 years.

Method An Interpretive Phenomenological Analysis (IPA) approach was employed. Eleven purposively recruited nurses working on a specialist TYA cancer unit in England participated in semi-structured interviews. Data were analysed using IPA.

Results Nurses experienced parents/family as self-appointed informal gatekeepers who were perceived to hold the ability to control nurses’ access to communicate with young people about fertility issues. Nurses adopted an on-going supportive role which was enhanced by the positive nature of their relationship with the TYA. Uncertainty was expressed over whether the TYA had been fully informed of their infertility risk and potential fertility preservation options.

Conclusions Nurses should manage parental involvement sensitively if TYAs are to make informed decisions regarding their future reproductive health. Further research is needed to explore ways of engaging with parents to ensure TYA participation in discussions. There is a need for clear role delineation to ensure that TYAs are provided with the opportunity to discuss infertility risk and be referred to a specialist before initiating cancer treatment. Nurses should cultivate and optimise the nurse-TYA relationship to improve fertility care.