Addressing fertility preservation with a newly diagnosed cancer patient may seem like a daunting task for a healthcare provider, but studies show that cancer survivors who did not learn about fertility preservation options were more likely to feel distressed by this, impacting their quality of life. Whether or not an individual pursues fertility preservation, patients want to know what their options are so they can make an informed decision regarding their future fertility. So why do many healthcare providers fail to discuss fertility preservation with their patients after diagnosis?
Many physicians face communication challenges when discussing fertility preservation with their patients. These barriers can be related to either a physician’s own personality or relationship with the patient, but oftentimes it stems from a lack of knowledge about fertility preservation options and referral sources. Although male fertility preservation is pretty straightforward, female fertility preservation isn’t. This is a particular problem with emerging technologies that are still experimental as a healthcare provider may not know all the available options well enough to comfortably speak about them with patients.
Physicians also struggle with discussing fertility preservation with patients that have low health literacy, patients from cultures or religions that do not support assisted reproduction or patients who do not speak English. Patient and provider interactions are already complex, but these factors make the conversation particularly challenging. In the event of a non-native speaker, even when an interpreter is used, it’s unclear what is “lost in translation” between patient and provider and how much has been effectively communicated.
Finally, one of the most delicate issues a physician faces is broaching fertility preservation with a patient who has a poor prognosis or is in the late stages of cancer. Healthcare providers have expressed their discomfort with telling a patient they have a low survival rate and broaching fertility preservation in the same conversation. The dynamic involved with giving someone a grim diagnosis and then changing gears and asking them whether or not they’ve ever thought about having children, is complicated in the best case scenario.
These are only a few examples of the challenges physicians face when discussing fertility preservation with a patient. Other factors include the age of the patient at the time of diagnosis and a physician’s attitude toward delaying treatment, particularly in the case of female patients. Understanding these challenges is important to overcoming them. The Oncofertility Consortium identifies such barriers, works to find solutions, and then promotes those solutions to the clinical community through the National Physicians Cooperative. To learn more about this topic, please read “Healthcare Provider Perspectives on Fertility Preservation for Cancer Patients,” by Gwendolyn P. Quinn, PhD and Caprice A. Knapp, PhD in Oncofertility: Ethical, Legal, Social, and Medical Perspectives.