An Imperial led survey reveals gaps in clinicians’ knowledge, confidence and training in discussing female fertility preservation with cancer patients

New research, published in Cancers after an online survey conducted among healthcare professionals (HCPs) in the United Kingdom, underscores the need for enhanced education and training within the medical community to ensure better patient care and support.

"As fertility preservation becomes an increasingly important aspect of patient care, particularly for those undergoing treatments that may affect fertility, it is crucial that healthcare professionals are adequately equipped to provide the necessary guidance." Dr Srdjan Saso Honorary Clinical Senior Lecturer

The cross-sectional survey, led by researchers from Imperial College London, reveals that while a majority of healthcare professionals acknowledge the importance of fertility preservation (FP) and feel responsible for initiating discussions with patients, many lack the necessary knowledge and confidence to do so effectively.

Of the 415 participants who completed the survey, distributed via Instagram between February 25th and March 11th, 2021, a substantial 87.2% reported never having received formal training in fertility preservation. This lack of training is reflected in the frequency with which fertility preservation techniques are discussed with patients.

A significant portion of respondents indicated that they rarely, if ever, initiate conversations about FP. Specifically, 39.5% of participants reported that they never discuss FP techniques with their patients, while 20.7% do so only once a year, and 17.8% just once a month.

Discrepancies in knowledge and referral pathways

The survey further identified discrepancies in healthcare professionals' knowledge regarding the various methods of fertility preservation. Many respondents rated their understanding of each FP technique as either "very poor" or "poor." This lack of knowledge extends to referral pathways and available educational resources for patients, presenting a barrier to the effective implementation of FP services.

Despite this, there is a strong recognition among healthcare professionals of their role in discussing FP with patients. The majority of respondents either agreed (37.8%) or strongly agreed (22.2%) that it is their responsibility to discuss FP. Additionally, 38.1% agreed and 19.5% strongly agreed that they consider the patient's desire for future fertility when planning treatment.

Need for improved training and communication skills

Encouragingly, the study indicates that overall awareness among clinicians of long-term survival rates following cancer treatment has improved. As a result, many now recognise the importance of fertility preservation, regardless of a patient’s prognosis, and understand their responsibility to initiate these discussions. Additionally, there has been an improvement in the understanding that fertility preservation may not delay cancer treatment.

However, despite these positive developments, the study highlights the scarcity of formal training in fertility preservation, which continues to be a significant barrier. The authors suggest that regular training, particularly in communication skills such as breaking bad news, could help clinicians overcome the personal discomfort often associated with initiating challenging discussions about fertility preservation.

Dr Lorraine Kasaven, the study’s first author and a Research Postgraduate in the Department of Surgery and Cancer, said: "The findings of this survey highlight the urgent need for enhanced training programs for healthcare professionals in the UK regarding fertility preservation. Such programs would not only improve the knowledge and confidence of HCPs but also ensure that patients receive the necessary information and support to make informed decisions about their reproductive future."

Dr Srdjan Saso, the senior author and principle investigator of the study and Honorary Clinical Senior Lecturer in the Department of Metabolism, Digestion and Reproduction, said: "In the current climate of declining fertility rates, this area carries national, social and ethical implications. As fertility preservation becomes an increasingly important aspect of patient care, particularly for those undergoing treatments that may affect fertility, it is crucial that healthcare professionals are adequately equipped to provide the necessary guidance. Addressing the current discrepancies in knowledge and training is a critical step towards achieving this goal."

A Cross-Sectional Survey of Healthcare Professionals’ Knowledge, Attitude and Current Behaviours towards Female Fertility Preservation Services within the UK. Lorraine S. Kasaven, Anita Mitra, Mehar Chawla, Sughashini Murugesu, Nicholas Anson, Jara Ben Nag, Efstathios Theodorou, Bassel Al-Wattar, Michael P. Rimmer on behalf of the UKARCOG Working Group, Joseph Yazbek, Benjamin P. Jones and Srdjan Saso. Cancers 2024, 16(15), 2649; https://doi.org/10.3390/cancers16152649