Behind closed doors: a qualitative study exploring the content of fertility discussions between oncologists and their adolescent and young adult cancer patients from the perspective of oncologists at an NCI-designated comprehensive cancer center

PURPOSE: To qualitatively explore the content of fertility discussions between oncologists and their adolescent and young adult (AYA; 15-39 years) cancer patients from the perspective of oncologists at an NCI-designated comprehensive cancer center. METHODS: We recruited oncologists of various specialties employed at an NCI-designated comprehensive cancer center in California who treat AYAs at risk for infertility. We collected demographics and fertility-related information (if they discuss fertility with AYA patients and level of confidence doing so) via REDCap prior to conducting a semi-structured interview via HIPAA-compliant Zoom. Audio files were transcribed verbatim and reviewed for themes using an inductive codebook thematic analysis approach. RESULTS: Oncologists (n = 12) were female (66.7%), of White or Asian race (41.7% each), and were on average in practice for 14.3 years (SD = 6.7). All endorsed discussing fertility with AYAs and were on average somewhat/fairly confident doing so. The detail with which oncologists reported discussing fertility with AYAs varied substantially and only some reported discussing costs associated with fertility preservation. Oncologists also reported assorted information they always mention, mention on a case-by-case basis, avoid, or feel is not necessary when discussing fertility. CONCLUSION: This study provides a detailed description of information delivered by oncologists during fertility discussions to their AYA patients, revealing unstandardized oncofertility counseling. Fertility discussions were described to vary widely in depth and content, suggesting adherence to clinical practice guidelines limited. Interventions to increase provision of guideline-concordant counseling are needed to provide actionable pathways by which AYAs can proactively mitigate adverse reproductive health outcomes.