F32 Administrative Supplement for Childcare Costs: Addressing Fertility Information Needs and Fertility-related Distress among Female Adult Survivors of Childhood Cancer

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Impaired fertility is a highly distressing, under-addressed, late effect of cancer and cancer treatment among female adult survivors of childhood cancer. Many female survivors are uncertain about their fertility status and report unmet fertility information needs and fertility-related distress. For those who desire biological children, overestimation of risk for impaired fertility may cause unnecessary emotional and relational distress. Underestimation may lead to a missed opportunity to pursue having biological children due to factors such as premature ovarian insufficiency. Yet, to date, fertility-related information needs and distress remain largely unaddressed in this population. Following the ORBIT Model for behavioral intervention development, the proposed study seeks to design and refine a behavioral intervention to address unmet fertility-related information needs and fertility-related distress among female adult survivors of childhood cancer (aged 18-44). Phase I of the study will involve conducting individual interviews with female adult survivors of childhood cancer (N=20) and medical providers who care for this population (N=10) to inform the development of a preliminary, manualized, intervention. Based on existing literature and feedback from experts in behavioral interventions for cancer survivors, adult survivors of childhood cancer, and infertility, it is anticipated that an intervention combining strategies from Patient Activation Theory and Acceptance and Commitment Therapy will be developed. Intervention development is flexible and will be tailored based on feedback received from stakeholders. In Phase 2, preliminary intervention content will be delivered to a small sample of the target population (N=30). Feasibility and acceptability, as well as examination of pre- to post-intervention patterns of change in intervention targets (primary: fertility health knowledge, fertility-related distress; secondary: psychological flexibility, patient activation, and self-efficacy), will be assessed and utilized to further refine the intervention (e.g., intervention strategies, intervention length, and delivery modality). In line with the National Cancer Institute’s priority research area focused on cancer survivorship, the overall goal of the fellowship is to support Dr. Stalls to develop expertise that will enable her to become a leading clinical researcher in the development and evaluation of behavioral interventions to address reproductive and sexual health late effects among cancer survivors. To do so requires a unique combination of knowledge and skills in the areas of, 1) Reproductive and Sexual Health, 2) Behavioral Intervention Development and Evaluation, and 3) Professional Development. Training in these areas will be accomplished through guidance from expert sponsors and collaborators as well as the many resources and training opportunities offered at Duke University. Completion of this fellowship would not only advance the survivorship literature in this area and propel Dr. Stalls toward her career goals, but help address the significant gap in well-trained clinical researchers who are equipped to address these highly personal and time-sensitive reproductive and sexual health late effects of cancer and cancer treatment.