Catherine Benedict1, Alexandria L Hahn2, Alyssa McCready3, Joanne F Kelvin4, Michael Diefenbach3, Jennifer S Ford5. 1. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd, Stanford, CA, 94305, USA. cbenedict@stanford.edu. 2. Albert Einstein College of Medicine, The Bronx, NY, USA. 3. Center for Health Innovation and Outcomes Research, Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA. 4. Memorial Sloan Kettering Cancer Center, New York, NY, USA. 5. Hunter College and The Graduate Center, City University of New York (CUNY), New York, NY, USA.
Abstract
PURPOSE: Family-building after gonadotoxic treatment often requires in vitro fertilization, surrogacy, or adoption, with associated challenges such as uncertain likelihood of success, high costs, and complicated laws regulating surrogacy and adoption. This study examined adolescent and young adult female (AYA-F) survivors' experiences and decision-making related to family-building after cancer. METHODS: Semi-structured interviews explored fertility and family-building themes (N = 25). Based on an a priori conceptual model, hypothesis coding and grounded theory coding methods guided qualitative analysis. RESULTS: Participants averaged 29 years old (SD = 6.2) were mostly White and educated. Four major themes were identified: sources of uncertainty, cognitive and emotional reactions, coping behaviors, and decision-making. Uncertainty stemmed from medical, personal, social, and financial factors, which led to cognitive, emotional, and behavioral reactions to reduce distress, renegotiate identity, adjust expectations, and consider "next steps" toward family-building goals. Most AYA-Fs were unaware of their fertility status, felt uninformed about family-building options, and worried about expected challenges. Despite feeling that "action" was needed, many were stalled in decision-making to evaluate fertility or address information needs; postponement and avoidance were common. Younger AYA-Fs tended to be less concerned. CONCLUSION: AYA-Fs reported considerable uncertainty, distress, and unmet needs surrounding family-building decisions post-treatment. Support services are needed to better educate patients and provide opportunity for referral and early preparation for potential challenges. Reproductive counseling should occur throughout survivorship care to address medical, psychosocial, and financial difficulties, allow time for informed decision-making, and the opportunity to prepare for barriers such as high costs.
PURPOSE: Family-building after gonadotoxic treatment often requires in vitro fertilization, surrogacy, or adoption, with associated challenges such as uncertain likelihood of success, high costs, and complicated laws regulating surrogacy and adoption. This study examined adolescent and young adult female (AYA-F) survivors' experiences and decision-making related to family-building after cancer. METHODS: Semi-structured interviews explored fertility and family-building themes (N = 25). Based on an a priori conceptual model, hypothesis coding and grounded theory coding methods guided qualitative analysis. RESULTS:Participants averaged 29 years old (SD = 6.2) were mostly White and educated. Four major themes were identified: sources of uncertainty, cognitive and emotional reactions, coping behaviors, and decision-making. Uncertainty stemmed from medical, personal, social, and financial factors, which led to cognitive, emotional, and behavioral reactions to reduce distress, renegotiate identity, adjust expectations, and consider "next steps" toward family-building goals. Most AYA-Fs were unaware of their fertility status, felt uninformed about family-building options, and worried about expected challenges. Despite feeling that "action" was needed, many were stalled in decision-making to evaluate fertility or address information needs; postponement and avoidance were common. Younger AYA-Fs tended to be less concerned. CONCLUSION:AYA-Fs reported considerable uncertainty, distress, and unmet needs surrounding family-building decisions post-treatment. Support services are needed to better educate patients and provide opportunity for referral and early preparation for potential challenges. Reproductive counseling should occur throughout survivorship care to address medical, psychosocial, and financial difficulties, allow time for informed decision-making, and the opportunity to prepare for barriers such as high costs.
Entities:
Keywords:
Decisional conflict; Fertility; Health decision-making; Infertility; Uncertainty; Young adult cancer
Authors: Linda D Cameron; Barbara Bowles Biesecker; Ellen Peters; Jennifer M Taber; William M P Klein Journal: Soc Personal Psychol Compass Date: 2017-05-05
Authors: Clare Meernik; Jennifer E Mersereau; Christopher D Baggett; Stephanie M Engel; Lisa M Moy; Nancy T Cannizzaro; Mary Peavey; Lawrence H Kushi; Chun R Chao; Hazel B Nichols Journal: Cancer Epidemiol Biomarkers Prev Date: 2022-05-04 Impact factor: 4.090
Authors: Catherine Benedict; Katherine L Dauber-Decker; Jennifer S Ford; D'Arcy King; David Spiegel; Lidia Schapira; Pamela Simon; Michael Diefenbach Journal: JMIR Cancer Date: 2022-05-31
Authors: Catherine Benedict; Katherine L Dauber-Decker; D'Arcy King; Alexandria Hahn; Jennifer S Ford; Michael Diefenbach Journal: JMIR Form Res Date: 2021-01-22
Authors: Catherine Benedict; Jen-Ling Nieh; Alexandria L Hahn; Alyssa McCready; Michael Diefenbach; Jennifer S Ford Journal: Support Care Cancer Date: 2020-09-05 Impact factor: 3.359