A mixed methods approach to examining decisional needs and contextual factors influencing fertility status assessment outcomes among young female survivors of childhood cancer.

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PROJECT SUMMARY/ABSTRACT Female survivors of childhood cancer who received gonadotoxic cancer treatment are at risk for treatment- related infertility. Potential infertility is a top concern among young cancer survivors, yet many survivors are unsure of their fertility status and this uncertainty contributes to fertility-related distress. Little is known about the perceived reproductive health needs and factors associated with receipt of a fertility status assessment (FSA) among female cancer survivors, a gap that will be addressed in the proposed study. Emerging adulthood (period of transition from adolescence to adulthood) is a developmental period ripe for family planning and prioritizing reproductive health needs. There is a lack of developmentally appropriate reproductive health and fertility-related psychoeducational and decisional support interventions available for emerging adult cancer survivors. The purpose of this study is to explore the perceived reproductive health needs of emerging adult female cancer survivors and to identify decisional and contextual factors that influence pursuit of FSA using a sequential explanatory mixed method design. This study will enroll 325 female survivors (currently aged 18 to 29 years and >1-year post treatment; diagnosed with cancer < age 21 years) from four cancer centers in the United States to complete a quantitative survey; a subset of participants will take part in qualitative interview. The specific aims of this study are to (1) establish a knowledge base of the perceived reproductive health needs among young adult cancer survivors and identify relevant factors related to FSA, (2) elucidate patient experiences with FSA and preferences for a decisional support intervention, and (3) explore decisional satisfaction as an outcome for a future intervention. The long-term objective of this patient-oriented research is to inform the testing of a decisional support intervention for survivors interested in an FSA. The focus of this research aligns with the National Institute of Nursing Research research priority of “improving quality of life among individuals with chronic disease” by supporting female cancer survivors who are at risk for treatment-related infertility and fertility-related distress. The candidate’s long-term career goal is to become an independent investigator with a program of research focused on improving reproductive health outcomes among cancer survivors. Under the mentorship of international leaders in cancer survivorship at Emory University and Children’s Healthcare of Atlanta, the candidate will achieve her short-term goals to expand expertise in reproductive health among cancer survivors, obtain training in mixed methods research, and gain experience with team science. The proposed training aims include a combination of focused interdisciplinary mentorship, didactic courses, and structured learning activities that will enrich candidate’s research knowledge and skills, providing her with a solid foundation for a career as an independent investigator.