Understanding facilitators and barriers to contraception screening and referral in young women with cancer
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BACKGROUND: Young women with cancer often worry about impaired fertility after treatment but can experience devastating consequences from an unplanned pregnancy during treatment. Contraception screening and referral appear to occur infrequently in cancer care. OBJECTIVES: We sought to understand oncologic providers’ current practices, perceptions of facilitators and barriers to screening for adequate contraception during cancer treatment, and to understand patient perspectives on these processes. METHODS: We interviewed 19 oncologic providers and 20 female reproductive-aged oncology patients stable on treatment or who had completed therapy within the last 24 months. We recruited participants from an urban, northeast medical center where they worked or received oncologic care. Semi-structured interview questions examined components of the Promoting Action on Research Implementation in Health Services (PARiHS) framework, and subsequent constant comparative analysis identified similar themes. FINDINGS: Providers vary significantly in their current contraception screening practices with many focusing on diagnosing pregnancy rather than prevention. Providers identified many institutional and organizational barriers, including lack of education and lack of clear provider responsibility. Providers also identified resources and supports that would assist with contraception screening and referral, including education and enhanced interdisciplinary collaboration with gynecologic providers. Patients infrequently recalled contraception conversations with oncology providers and expressed challenges determining the most appropriate provider with whom to discuss contraception. CONCLUSION: Cancer centers should address barriers to contraception screening and referral locally in future implementation of contraception screening and referral. National organizations should work to develop guidelines to inform and support this process in clinical practice.