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Clinicians’ perspectives on barriers and facilitators to sperm banking in adolescent males with cancer: a mixed-methods study

  • Fertility Preservation
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Abstract

Purpose

To examine processes, barriers, and facilitators to sperm banking counseling and decision-making for adolescent males newly diagnosed with cancer from the perspective of clinicians who completed Oncofertility communication training. We also identify opportunities for improvement to inform future interventions and implementation.

Methods

A survey (N=104) and subsequent focus groups (N=15) were conducted with non-physician clinicians practicing in pediatric oncology who completed Oncofertility communication training.

Results

Most survey participants were confident in communicating about the impact of cancer on fertility (n=87, 83.7%) and fertility preservation options (n=80, 76.9%). Most participants reported never/rarely using a sperm banking decision tool (n=70, 67.3%), although 98.1% (n=102) said a decision tool with a family-centered approach would be beneficial. Primary themes in the subsequent focus groups included variable processes/workflows (inconsistent approaches to consult initiation; involvement of adolescents, caregivers, and various clinician types; assessment of puberty/sexual experience), structural and psychosocial barriers (cost and logistics, developmental, cultural, clinical acuity/prognosis), and facilitators (educational materials, alternative options for banking). Opportunities and strategies for improvement (including fertility preservation in existing research protocols; additional staffing/resources; oncologist education and buy-in; and development of decision tools) were informed by challenges identified in the other themes.

Conclusion

Barriers to adolescent sperm banking remain, even among clinicians who have completed Oncofertility training. Although training is one factor necessary to facilitate banking, structural and psychosocial barriers persist. Given the complexities of offering sperm banking to pediatric populations, continued efforts are needed to mitigate structural barriers and develop strategies to facilitate decision-making before childhood cancer treatment.

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Data Availability

Deidentified survey data are available upon request to the corresponding author.

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Author contributions

LN, GPQ, CAG, SHO, and STV contributed to the study conception and design. Material preparation, data collection, and analysis were performed by LN, SML, DJ, and GPQ. The first draft of the manuscript was written by LN, SML, DJ, and GPQ. All authors read, revised, and approved the final manuscript.

Funding

This study was funded by NIH/NCI-K08CA237338 (PI Nahata) and 2R25CA142519-11 (MPIs Quinn and Vadaparampil) and NYU Grossman School of Medicine.

Author information

Authors and Affiliations

  1. The Abigail Wexner Research Institute at Nationwide Children’s Hospital, 431 S 18th St, Columbus, OH, 43205, USA

    Leena Nahata, Sophia M. Liles, Cynthia A. Gerhardt & Sarah H. O’Brien

  2. Nationwide Children’s Hospital, Columbus, OH, USA

    Leena Nahata & Sarah H. O’Brien

  3. Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA

    Leena Nahata, Cynthia A. Gerhardt & Sarah H. O’Brien

  4. Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Ashley J. Housten

  5. Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA

    Susan T. Vadaparampil

  6. Department of Obstetrics and Gynecology, NYU School of Medicine, New York, NY, USA

    Dona Jalili & Gwendolyn P. Quinn

Authors
  1. Leena Nahata
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  2. Sophia M. Liles
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  3. Cynthia A. Gerhardt
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  4. Ashley J. Housten
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  6. Sarah H. O’Brien
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  7. Susan T. Vadaparampil
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  8. Gwendolyn P. Quinn
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Corresponding author

Correspondence to Leena Nahata.

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Ethics approval

This study was deemed non-human subjects by the New York University Institutional Review Board.

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Informed consent was obtained from all individual participants included in the study.

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The authors declare no competing interests.

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Nahata, L., Liles, S.M., Gerhardt, C.A. et al. Clinicians’ perspectives on barriers and facilitators to sperm banking in adolescent males with cancer: a mixed-methods study. J Assist Reprod Genet 40, 2809–2817 (2023). https://doi.org/10.1007/s10815-023-02944-3

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  • DOI: https://doi.org/10.1007/s10815-023-02944-3

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