Multilevel factors related to fertility preservation decision-making among women of reproductive age with breast cancer: A mixed-methods systematic review

This is the authors' abstract. We don't add key points for this paper.

Objective To synthesize quantitative and qualitative evidence on multilevel factors related to fertility preservation (FP) decision-making among women of reproductive age with breast cancer. Methods Eight databases were searched from inception to June 20, 2026: Ovid MEDLINE, Embase, CINAHL Complete, APA PsycINFO, SinoMed, CNKI, Wanfang Data, and VIP. Studies were appraised using Joanna Briggs Institute (JBI) tools; synthesis followed the JBI convergent integrated approach, with findings organized and interpreted using the socio-ecological model. Results Thirty-one reports (19 quantitative and 12 qualitative) representing 30 studies were included. The synthesis distinguished FP consideration/intention, actual uptake/completion, and decisional conflict, with service-pathway factors analyzed separately. Evidence spanned four socio-ecological levels. Individual-level factors included sociodemographic and clinical characteristics; reproductive history and intentions; knowledge and self-efficacy; perceived benefits, risks, and burdens; and emotional responses. Interpersonal and organizational factors included family involvement, relationships with clinicians, communication, decision support, referral, service access, and care coordination. Sociocultural and policy factors included reproductive norms, funding, and eligibility rules. Four cross-level themes emerged: financial feasibility; information, communication, and decision support; time for pretreatment FP; and reproductive history and intentions within family and policy contexts. No community-level evidence was identified. Conclusions FP decision-making is related to reproductive goals, fertility-related knowledge and concerns, clinical circumstances, family involvement, service organization, and sociocultural and policy conditions. Oncology nurses and multidisciplinary teams may support decisions through early fertility discussions, tailored information, psychological support, and timely referral and coordination. Costs and eligibility requirements may pose access barriers largely beyond clinical teams' control. Systematic review registration PROSPERO (CRD420251054968).