Assessing providers’ views and needs in paediatric fertility preservation surgery

Background

Fertility is a major survivorship consideration for childhood cancer survivors. Ovarian tissue cryopreservation has recently transitioned into clinical practice, however, is still a novel procedure in children. Testicular tissue cryopreservation remains experimental and can only be undertaken under special governance protocols. There are no specific credentialing criteria in fertility preservation care and surgery and little data addressing the unmet needs of clinicians for surgical care in this discipline (1).

Aim

To understand and describe the views and unmet needs of health providers involved in the preoperative, intraoperative, or postoperative care of paediatric patients having fertility preservation surgery.

Methods

A cross-sectional qualitative study using semistructured interviews were undertaken with leading oncofertility experts from the Australian and New Zealand Consortium in Oncofertility. Participants were asked to share their insights and unmet needs in the preoperative, intraoperative, and postoperative care of ovarian and testicular tissue cryopreservation and ovarian tissue grafting. Analysis was via NVivo 12 software, where inductive content analysis was conducted to generate themes that emerged from the data.

Results

Of the 28 candidates invited to form the reference group, 1 no longer was involved in fertility preservation (and thus excluded). 18 were able to attend their interviews (participation rate: 66.7%). They comprised of 4 general paediatric surgeons, 2 paediatric adolescent gynaecologists/reproductive endocrinologists, 2 reproductive consultants, 2 reproductive fellows, 3 paediatric oncologists, 2 scientists, an ethicist, a research manager, and an oncofertility coordinator. Clinical experience, training and guidance, current fertility preservation care, barriers to care and ethical concerns were the main themes. Most surgeons (apart from one with significant experience) reported low surgical volume of fertility preservation procedures. The majority thought that tissue harvesting was within the scope of general surgery, paediatric gynaecology, or urology and did not require additional credentialing. Further education through training videos and surgical proctorship was desired. Non-surgeons, including scientists and oncologists, recommended improved certification for themselves for preoperative counselling, postoperative care, cryopreservation tissue processing, and also training for the surgical specialties to improve quality of biopsies. Findings indicated that there were many barriers that hindered the provision of care such as lack of opportunities for training, lack of coordinated care, lack of funding and quality control for laboratory tissue preparation. Most believed the procedures were ethically sound.

Conclusion

The findings in this qualitative study suggest that guidance and training for surgeons and non-surgeons could improve quality of preoperative, intraoperative, and postoperative care for fertility preservation in children.

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