1. The Role of Nursing in Fertility Preservation of Cancer Patients
Alexis Shanahan, MS
Research Advisor: Elizabeth Hartman, PhD, RN
The Role of Nursing in Fertility Preservation of Cancer Patients
An Integrative Review of Literature
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Background
According to the National Cancer Institute, about 70,000 young people between the ages of 15 and 39 are diagnosed with cancer in the United States (National Cancer Institute, 2018). Concurrently, ideal child bearing ages also fall within this age range. Cancer survivors of childbearing age have reported that the effects of treatment on their fertility is their greatest concern (King et al., 2008). Fortunately, reproductive technology development can greatly increase fertility preservation.
Presently, researchers indicate that fertility preservations options for cancer patients are under-addressed by healthcare providers. Less than 50% of cancer survivors who were diagnosed under the age of 35 had received information from their healthcare provider about the risks of infertility (King et al., 2008).
Incorporating fertility preservation options within treatment is the best way to allow survivors the ability to reproduce. The simplest way to incorporate this is through education. The nurse’s role most significantly aligns with the responsibility of education (King et al., 2008).
Research Question:
What role can nursing play in preserving a cancer patients fertility prior to receiving cancer treatment?
Results and Discussion
The role of nurses in fertility preservation of cancer patients is education. However, after reviewing the articles in this peer review, there are three perceived barriers to nurses providing adequate education to cancer patients in or before child bearing years: knowledge, attitude, and behavior.
Most nurses do not have the adequate training and knowledge in understanding the options that patients have when facing a cancer diagnosis, therefore do not want to give the patient false information. Still, most nurses do not have negative attitudes towards fertility discussion. They do not believe that the discussion of fertility preservation falls under their responsibility as a nurse. However, the behavior of most nurses result in not wanting to discuss fertility preservation unless the patient brings it up themselves. Research supports that higher levels of nursing education leads to better outcomes of fertility preservation (King et al., 2008).
Conceptual Framework
Ernestine Wiedenbach’s “Helping Art of Clinical Nursing Model” defines nursing as “the practice of identifying a patient's need for help” (Schlotfeldt & Wiedenbach, 1965). In this theory, help can be defined as need for care, need for teaching, or need for advice. After a cancer diagnosis and development of a treatment plan, the patient’s fertility risk should be assessed by a physician and presented to the patient. It is the nurse’s responsibility to assess the patient’s interest in having children in the future after the patient is aware of their infertility risk. By establishing the patients need for help, the nurse can then respond accordingly. (Kelvin, Kroon, & Ogle, 2012).
Methods
An electronic search of literature was conducted using Academic Search Complete, Cumulative Index to Nursing and Health Literature (CINAHL), and PubMed. Key words used to in multiple text combinations include the following terms: fertility, fertility preservation, cancer, cancer patients, neoplasms, education, nurse.
Inclusion: Peer reviewed articles that were published within the last ten years. The chosen articles had to focus on human patients between the age of birth and 44 years of age. The articles needed to be written in English and available as full text through Rosalind Franklin University of Medicine and Science’s online library database.
Exclusion: Articles that were not in English were excluded. Articles that were published before the year 2008 were also excluded. Articles were omitted if they focused on non-human subjects. If the article did not contain participants that were at an age where fertility needed to be preserved, it was ignored. Since this integrated literature review wanted to explore the role of nursing in fertility preservation, articles that did not focus on nursing were excluded from the search.
Nursing Practice Implications
Fertility preservation of cancer patients takes a team including physicians, nurses, clinical health psychologists and social workers. However, nurses play an integral role in the process by providing a majority of the assessment and education (Murray, Chrisler & Robbins, 2016). As a member of the care team, the nurse can assess the patient’s interest in having children in the future and determine whether they have spoken with anyone or read about the potential impact of cancer treatment on fertility. The nurse can ensure that the patient understands the risk of infertility emphasizing that the precise risk is impossible to predict. A description of the options to preserve fertility and provision of resources with more information to review is imperative. If patients are interested in seeing a reproductive specialist, the nurse should ensure that the referral is made (King et al., 2008).
Problem Statement
Infertility is a common result of cancer treatment; however, opportunities exist for patients to preserve fertility prior to treatment. Recent evidence suggests that healthcare providers, including nurses, do not consistently discuss fertility preservation with patients (King et al., 2008). This integrative literature review will evaluate and identify ways nurses can intervene to help patients explore their options in fertility preservation after their cancer diagnosis.
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