Barriers and facilitators of oncofertility discussions among healthcare providers and patients in Japanese oncology practice: A qualitative study.

Abstract

This study aimed to 1) identify barriers and facilitators to oncofertility discussions in Japanese oncology practice from the providers' perspective, and 2) describe patient preferences regarding these discussions. We conducted semi-structured interviews with 20 healthcare providers (HCPs: 16 physicians, 4 nurses) across 10 designated cancer treatment hospitals and 10 adolescents and young adults with cancer (5 male, 5 female). HCP data were analyzed thematically using the Consolidated Framework for Implementation Research (CFIR). Patient data were analyzed using qualitative content analysis, with preferences organized using the SHARE communication model. 1) Barriers and facilitators were found in the 18 CFIR constructs. While key barriers included lack of training (access to knowledge & information), lack of knowledge and difficulty in discussing sexuality (knowledge & beliefs), and beliefs that it is not a physician's role (knowledge & beliefs), facilitators included the presence of champions (champions), involvement of the director (leadership engagement), and patients' statements and questions (patient needs).　2) Patients preferred to discuss with knowledgeable, same-gender HCPs before treatment, and expressed a desire for careful explanations using documents and emotional support. This study underscores the need for multi-level, context-specific strategies to promote oncofertility discussions that align with both patient communication preferences and institutional settings. Supporting patient-centered communication and strengthening organizational infrastructure may help address the informational and emotional needs of adolescents and young adults with cancer and bridge the evidence-practice gap in oncofertility discussions.