Dual Perspectives on Fertility Information Needs and Clinical Support Barriers in Breast Cancer Care: A Qualitative Investigation

Dual Perspectives on Fertility Information Needs and Clinical Support Barriers in Breast Cancer Care: A Qualitative Investigation | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Dual Perspectives on Fertility Information Needs and Clinical Support Barriers in Breast Cancer Care: A Qualitative Investigation Xiaotong Yang, Wei Zhang, Quanbo Huo, Xuanyue Yan, Yaxin Fu, Ling Yan, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6702998/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The fertility preservation needs of childbearing-age breast cancer patients are frequently overlooked in China, significantly impacting their long-term quality of life. Currently, standardized protocols for fertility information support—including both content frameworks and delivery methods—remain underdeveloped. Methods Based on the Contextual Model of Health Information Seeking, 34 participants were selected from January 2025 to March 2025. We used semi-structured interviews and directed content analysis. Results Fifteen breast cancer patients (childbearing-age, with expressed reproductive goals post-diagnosis) and 13 medical staff from 3 comprehensive cancer hospitals or centers completed the interviews. There were three themes, including Critical Need for Reproductive Health Information, The deep driving force behind information demand, and Fulfillment of fertility information demands entails multifaceted challenges. Conclusion This study adopts a dual-perspective approach (patients and clinicians) to systematically examine fertility-related information needs among childbearing-age breast cancer patients and identify existing barriers in clinical information support systems. It emphasizes the actual information needs of patients in the face of fertility problems. The findings reveal significant gaps in both the content quality and accessibility of existing informational resources. It suggests that in the future, we should improve fertility support services from various angles such as society, medical institutions, and the state, and pay attention to the fertility needs of breast cancer patients in childbearing age. Introduction According to the 2024 statistics released by the International Agency for Research on Cancer (IARC), global cancer incidence reached 20 million new cases in 2022, with a persistent upward trajectory[1]. Breast cancer has emerged as the second most prevalent malignancy worldwide, while China currently bears the highest national burden of breast cancer cases globally. This epidemiological pattern demonstrates two notable characteristics: a sustained annual increase in incidence rates accompanied by a progressive trend toward younger age at onset. International data reveal that women under 40 years old constitute 17.0% of total breast cancer cases worldwide, with this proportion having increased at an annual rate of 1.55% since 1990[2]. Particularly in China, accelerated socioeconomic development and gradual adoption of Westernized lifestyles have contributed to distinct epidemiological features in recent years. The proportion of young breast cancer patients under 35 years old significantly exceeds that observed in Western populations. National statistics indicate that 64.32% of new breast cancer cases occur among women aged 30–59 years, highlighting the substantial disease burden within this demographic[1,3–4]. Furthermore, the incidence pattern demonstrates an atypical age distribution compared to Western countries, with earlier peak onset ages and higher proportional representation of premenopausal cases. With advancements in early screening programs and continuous breakthroughs in medical technologies, the global five-year survival rate for breast cancer has reached 90%, reflecting significant prognostic improvements [5]. This progress has shifted clinical priorities from mere survival to optimizing long-term quality of life [6]. However, cancer diagnosis and treatment impose substantial treatment burdens and psychological distress on patients, while also indirectly disrupting critical life planning. Notably, breast cancer patients of reproductive age face distinct challenges specific to their developmental phase, with fertility-related concerns emerging as an essential yet frequently overlooked component of quality-of-life assessments [7,8]. Current clinical evidence indicates no significant adverse effects of post-treatment pregnancy on breast cancer prognosis, with studies confirming the oncological safety of pregnancy in young survivors following comprehensive therapy. Available data suggest that such pregnancies do not compromise overall survival rates [9,10]. Consequently, patients expressing reproductive intentions should receive proactive support, including timely fertility preservation interventions. Nevertheless, critical gaps persist in clinical practice. Fertility risks associated with cancer therapies—including reproductive system toxicity—and corresponding preservation strategies remain inadequately addressed in patient education. This oversight has resulted in systemic neglect of fertility-related concerns and informational needs among breast cancer patients, particularly regarding family planning post-treatment. Current research highlights significant gaps in fertility-related information accessibility for oncology patients. Breast cancer patients demonstrate particularly limited awareness of fertility preservation strategies, with younger survivors requiring enhanced informational support regarding post-treatment reproductive health and sexual well-being. Unmet needs for fertility counseling rank highest among the informational priorities of reproductive-age breast cancer patients [11–13], directly influencing fertility decisions, pregnancy-related anxieties, and family planning outcomes in this population [14]. Clinical guidelines recommend that clinicians inform breast cancer patients about potential treatment-induced fertility impairment at diagnosis; however, adherence to these protocols remains suboptimal. Current oncofertility services fail to meet guideline standards due to persistent knowledge-practice gaps among healthcare providers and ill-defined clinical responsibilities in fertility counseling [15]. This discrepancy is particularly pronounced in China, where systemic barriers—including sociocultural stigma surrounding cancer-related infertility and disparities in resource allocation—interact with suboptimal patient-provider dialogues to create critical care deficits in reproductive health management. A critical evidence gap persists in contemporary oncofertility research, with reproductive-age breast cancer patients' informational needs remaining inadequately addressed[8]. Investigating these unmet needs holds dual significance: it could advance translational research in reproductive oncology while informing evidence-based service models to optimize patient-centered care.Current scholarship reveals a paucity of domestic and international studies addressing fertility-related informational support for this population. Existing studies remain limited in scope, primarily concentrated on fertility preservation decision-making processes while overlooking the longitudinal complexity of patients' reproductive health information requirements across the disease trajectory—from diagnosis through survivorship care. To address these gaps, this study employs a descriptive approach grounded in Contextual Model of Health Information Seeking to examine patients’ reproductive health information needs during their cancer journey, as well as the reproductive health-related information they may overlook. This study seeks to establish a foundation for delivering standardized, comprehensive, and individualized reproductive health information support services to patients, with the goal of enhancing clinical reproductive care quality and safeguarding their reproductive health. Methods 2.1 Design A qualitative descriptive study was undertaken. As such studies are commonly selected when the research aims to provide a direct description of a specific phenomenon [16](Sandelowski, 2000). The Contextual Model of Health Information Seeking posits that patients' health information needs arise from multifaceted contextual factors (e.g., individual attributes, sociocultural networks, and healthcare system dynamics)[17]. Grounded in the Contextual Model of Health Information Seeking and informed by a synthesis of relevant literature, the research team developed a preliminary interview guide through iterative discussions. This guide was then pilot-tested (data excluded from final analysis) and revised based on expert feedback to finalize the interview protocol (Tables 1 and 2 ). Therefore, this study employs a qualitative descriptive design with maximum variation sampling to systematically investigate fertility-related information needs and existing support service characteristics among the target patient population who has different contextual factors. This reporting of this study adhered to the consolidated criteria for reporting qualitative studies (COREQ) checklist. Table 1 Semi-structured interview guide for patients No. Interview questions 1 What fertility information have you explored? Primary concerns? 2 What additional fertility information would you like to know? 3 What factors could influence your approach to researching fertility information? 4 What emotional and cognitive reflections have emerged for you during your exploration of fertility-related resources? 5 How has seeking fertility information influenced your medical decisions, treatment journey, and personal life? 6 How do you typically access information about fertility preservation related to breast cancer? What specific resource or method has been most helpful to you? Table 2 Semi-structured interview guide for medical staff No. Interview questions 1 What do you consider to be the essential fertility-related information that should be included for breast cancer patients of reproductive age? 2 In your conversations with patients, what other fertility-related issues are of greatest concern to breast cancer patients of reproductive age? 3 In your prior professional experience, how frequently did you provide fertility preservation support to breast cancer patients of reproductive age? Do you think there is anything that needs to be changed 4 How would you describe your perspective and emotional experience in offering such support? 5 What methods do you use to deliver fertility preservation guidance to patients in your clinical practice? How do you perceive the effectiveness of the support you provide to patients༟ 2.2 Participants This study was conducted between January 2025 and March 2025 in 3 comprehensive cancer hospitals or centers located in mainland China. A purposeful sampling method was employed to recruit patients and medical staff who met the standard. The inclusion criteria were designed based on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Breast Cancer.[18] The inclusion criteria were as follows: (1)pathologically confirmed breast cancer; (2)age at breast cancer diagnosis: 18–40 years; (3)history of childbirth or current childbearing intention/plan post-diagnosis; (4)informed of diagnosis and voluntarily agreed to participate. Exclusion criteria were comorbid conditions directly impairing fertility, withdrawal, and existing psychiatric or neurological disorders. The inclusion criteria for medical workers were as follows: (1) valid medical license professional certification; (2) Clinical or research experience in oncofertility; (3) ≥ 5 years of clinical/research experience; (4) Understanding of the study protocol and voluntary agreement to participate. Medical staff who quit due to personal reasons, who were in training, and were not on duty due to sick leave, maternity leave, and other reasons were excluded. 2.3 Data collection Prior to conducting interviews, participants were briefed about the study's purpose, interview topics, and consent procedures. Written informed consent was obtained following a detailed explanation of their rights and data confidentiality. Immediately before each interview, the research theme was reiterated and participants were assured of recording confidentiality (recordings were stored securely and anonymized during transcription). Data were collected through semi-structured face-to-face interviews, and a quiet, comfortable environment was established to encourage participants to share their perspectives. In the event of emotional distress or physical/mental discomfort during the interview, steps must be taken to prioritize the participant’s well-being by promptly addressing their needs and discontinuing the conversation if necessary. The participant retains the right to withdraw from the interview at any time without stating a reason. Their decision to continue or discontinue participation will be fully respected. Informed consent was obtained from all individual participants included in the study. 2.4 Date analysis To ensure the credibility and confirmability of this study, the following procedures were rigorously implemented: Within 24 hours of each interview, audio recordings were transcribed verbatim by two independent researchers(YF and XY) to minimize data loss. Transcripts were returned to participants for verification (member checking), enabling them to review content accuracy and clarify ambiguities. Two primary researchers(XY and WZ) immersed themselves in the data by: Repeatedly listening to recordings; Conducting line-by-line coding of transcripts to identify patterns and contradictions;Generating initial codes, sub-themes, and candidate themes. Regular research team meetings were held to critically review emerging themes under the guidance of a professor (YL) with extensive qualitative research expertise. Discrepancies in coding interpretations were resolved through consensus to ensure analytical rigor. Participants received personalized summaries of themes and sub-themes derived from their interviews and were invited to assess whether these interpretations aligned with their experiences. Co-authors independently evaluated the accuracy of themes, sub-themes, and representative quotes, providing structured feedback. Final themes were refined through iterative team discussions integrating participant and peer insights. 2.5 Ethics Approval was obtained from the Human Research Ethics Committee of Tianjin Medical University Cancer Institute & Hospital (bc20250887). The procedures used in this study adhere to the tenets of the Declaration of Helsinki. Results Among the 18 patients, 15 agreed to participate in the interviews and successfully completed them. One patient voluntarily withdrew from the study due to emotional agitation midway through the conversation, while two others declined participation due to scheduling conflicts with their treatment. Of the 16 medical personnel, 13 agreed to participate and successfully completed their interviews, with 2 withdrawing due to insufficient time and 1 failing to complete the interview for the same reason. Each interview lasted between 40 and 60 minutes, the average duration amounted to 39 minutes, and data saturation was achieved after interviewing 16 patients and 13 medical personnel. The general information of the participants is presented in Tables 3 and 4 . Table 3 Characteristics of participants (patients). Code Age Highest Education Marital status Duration of diagnosis (years) Pre-diagnosis, Post-diagnosis live births (the interval) Fertility Preservation Strategies Utilized P1 25 Master's Degree Never married 2 0, 0 (--) GnRH agonists P2 34 Bachelor's Degree Married 7 0, 0 (--) N/A P3 28 Bachelor's Degree Married 1 0, 0(--) GnRH agonists P4 37 High School Married 8 1, 1 (5 years) N/A P5 33 Bachelor's Degree Married 3 0, 0 (--) Ovarian tissue cryopreservation P6 36 Bachelor's Degree Married 4 1, 0 (--) GnRH agonists P7 35 Bachelor's Degree Married 3 1, 0 (--) N/A P8 30 Bachelor's Degree Never married 3 0, 0 (--) Oocyte cryopreservation P9 43 Bachelor's Degree Married 9 0, 1 (6 years) N/A P10 33 Bachelor's Degree Divorced 5 1, 0 (--) N/A P11 27 Bachelor's Degree Married 1 0, 0 (--) GnRH agonists P12 25 Bachelor's Degree Never married 3 0, 0 (--) GnRH agonists P13 31 Bachelor's Degree Married 6 0, 0 (--) Oocyte cryopreservation P14 44 Associate Degree Married 5 1, 0 (--) N/A P15 40 Master's Degree Married 8 0, 1 (4 years) N/A Table 4 Characteristics of participants (medical staff). Code Age Gender Highest education Department Professional title Working hours (years) H1 47 Male Doctoral Degree Department of breast medicine Associate senior professional title 21 H2 44 Female Doctoral Degree Breast reconstruction Department Associate senior professional title 14 H3 39 Female Bachelor's Degree Department of breast medicine Medium grade professional title 16 H4 42 Male Doctoral Degree Radiotherapy department professional title 12 H5 46 Female Master's Degree Daytime chemotherapy ward Associate senior professional title 23 H6 38 Female Master's Degree Department of breast medicine Medium grade professional title 13 H7 53 Male Doctoral Degree Breast surgery department professional title 30 H8 56 Female Master's Degree Breast reconstruction Department Associate senior professional title 33 H9 41 Female Master's Degree Breast surgery department Medium grade professional title 16 H10 53 Female Master's Degree Department of breast medicine Associate senior professional title 30 H11 50 Female Doctoral Degree Department of breast medicine professional title 27 H12 45 Male Master's Degree Breast surgery department Associate senior professional title 21 H13 35 Female Bachelor's Degree Breast surgery department Junior professional title 10 Theme 1: Critical Need for Reproductive Health Information Basic information on diseases and treatments Maslow's hierarchy of needs theory posits that physiological requirements constitute the most fundamental human needs. Within the value framework of most patients, the preservation of life and health emerges as the paramount concern, serving as an essential prerequisite for addressing subsequent reproductive considerations. These individuals demonstrate an urgent need for comprehensive medical information regarding their diagnoses and treatment options. H12 “ The priority is to work out the next treatment plan with patients and their families urgently. Some cases, particularly younger patients, are in critical condition and might require immediate adjuvant chemotherapy and surgery.” P12 “ Right now, I need to focus completely on my treatment plan. My health has to be the priority — only after that can I even think about starting a family.” The five-year survival rate for breast cancer has demonstrated consistent upward trends in recent years, a promising development that is instilling renewed optimism among patients regarding long-term prognosis. Following the fulfillment of their core information requirements, patients often transition to seeking in-depth, context-specific details to optimize health-related outcomes, including, but not limited to disease etiology, fertility-sparing therapeutic interventions, and prognostic trajectories, to fulfill informational demands and optimize sustained health-related quality of life(HRQoL). P8 “ I've consulted multiple physicians regarding my cancer diagnosis, particularly given the absence of familial predisposition and my sustained adherence to preventive health behaviors. This etiological ambiguity raises significant concerns about potential genetic implications for my children.” P15 “ After learning the chemotherapy might influence my ability to have children later, I specifically asked about treatment choices that are gentler on fertility when we were setting up the plan.” P9 “ I need to find out how long I have left, understand what shape I'll be in, and whether I'll get to spend enough quality time with my kids.” Hazard factors for fertility impairment According to the theory of planned behavior (TPB), behavioral intention serves as the primary determinant of individuals' behaviors, fertility information-seeking behaviors.Patients with future fertility plans are particularly concerned about the potential effects of the entire cancer treatment regimen on their reproductive capacity. However, there remains a critical need for more comprehensive data to accurately assess the extent of reproductive damage caused by cancer therapies. P3 “My husband and I have been married a few years now, and we haven't started a family yet. We're definitely planning to have kids down the road. But I'm really concerned — could treatments like chemo or radiation affect my chances of having children in the future?” H5 “Fertility outcomes are influenced by multiple determinants. For patients requiring chemotherapy, proactive disclosure of its ovarian toxicity and potential fertility impairment should be prioritized during treatment planning.” However, while patients understandably concentrate on iatrogenic ovarian reserve depletion given the unavoidable nature of cancer therapies, there is a clinically significant oversight of non-treatment-related fertility determinants such as advancing age, elevated BMI, and chronic psychological stress. H6 “I once had a patient hoping to have kids later in life. After reviewing her case, it became clear her overall health wasn't sufficient to sustain a pregnancy, especially with the ongoing endocrine therapy requiring long-term treatment. Looking back, we should've discussed fertility timelines and age-related risks much earlier in the process” H1 “For patients with elevated BMI, obesity can present challenges to achieving conception, with studies indicating potential impacts on long-term oocyte quality. Regardless of pregnancy goals, we strongly advise maintaining a healthy weight through balanced nutrition and regular exercise, as recommended by the ESHRE fertility preservation guidelines.” Balance between fertility and cancer treatment information Patients influenced by traditional Chinese cultural values surrounding family lineage often demonstrate profound difficulty reconciling infertility diagnoses, a psychological challenge compounded by the iatrogenic fertility risks inherent in oncologic therapies. Moreover, younger demographics presenting with acute clinical manifestations at diagnosis are particularly vulnerable to information overload during initial treatment consultations. This cognitive saturation frequently leads to inadvertent neglect of fertility preservation discussions, creating critical gaps in patient education and shared decision-making processes. P11 “When I got that scary diagnosis, everything happened so fast. My doctors were saying I needed to start chemo and have surgery right away. But with all the appointments and tests piling up, I just felt completely overwhelmed — there was no time to really process what it all meant for my body or my future (family plan).” P2 “We should ask more questions and choose a treatment that has a relatively small impact on fertility... Now there is no way.” As cancer therapies advance, patients' need for fertility-related information has emerged as a critical concern, driving a pressing demand for readily accessible guidance on evidence-based fertility preservation strategies throughout treatment trajectories. Fertility preservation (FP) refers to the method of protecting the fertility of people at risk of infertility through surgery, drugs or assisted reproductive technology[19].Some patients described experiencing considerable stress during fertility preservation decision-making. Factors such as time-sensitive treatment plans and uncertainty about the risks versus benefits of fertility preservation frequently contributed to decisional conflict. P11 “What’s the cost of freezing eggs or ovarian tissues? The treatment for my condition is already expensive. Can I afford these options? How much will my health insurance cover, and what’s the success rate of each procedure? Which one should I choose?” P1 “I’ve heard that leuprolide might cause the endometrium to thicken. If it gets too thick, could I end up needing a procedure like Curettage (similar to an abortion)? I’m really worried about how that might affect my body.” P5 “I have learned that there are some ovulation promoting drugs that may aggravate tumors if used for breast cancer, but I still don't know how to choose.” The treatment and fertility preservation knowledge available to patients significantly influences their subsequent medical and reproductive choices. Healthcare providers also emphasize the importance of providing comprehensive information, while maintaining a balance between disease-specific details and fertility-related guidance. P12 “After surgery, I really need more details on how to preserve my fertility. It’d help me feel calmer and more ready for whatever treatment comes next.” H8 “Starting a family is a big deal for many women. With breast cancer survival rates being so good these days, patients should get help if they want kids. Doctors need to explain their options clearly once they know the facts about their cancer — because living well is just as important as getting treated.” Reproductive health information throughout the entire anti-cancer cycle The potential reproductive health hazards caused by tumor treatment could seriously affect patients' quality of life. Reproductive health is the basis of ensuring fertility, encompassing the physical, mental, and social well-being related to the reproductive system and its functions[20]. Damage to the reproductive system caused by cancer treatment can be unavoidable, potentially leading to adverse physical and psychological effects on patients. Patients may also experience harm due to inadequate access to timely or accurate information about treatment risks. P14 “When I was on chemo, my periods got really unpredictable. I had no clue why, and it honestly freaked me out a bit.” P10 “Ever since I started these hormone meds(endocrine drugs), I’ve been feeling awful—like my body’s falling apart and my mood’s all over the place. Everything just irritates me. The doctor says it’s ‘menopause or something,’ but honestly, it makes me feel like I’ve turned into an old lady overnight!” H10 “If patients fail to take contraceptive precautions, unintended pregnancies may occur, potentially leading to adverse effects on their reproductive health and long-term fertility.” A cornerstone of reproductive health is ensuring safe and fulfilling sexual well-being. Patients who undergo treatments such as breast surgery or chemotherapy often have pressing needs for sexual health education. Yet in China, deeply ingrained cultural norms—particularly the stigma associated with open discussions of sexuality—frequently lead both patients and medical professionals to avoid these conversations, resulting in critical information gaps. P13 “After my breast reconstruction surgery, my body has changed completely, and I know I need to adjust to this new reality. But when people touch or try to adjust parts of my body, it makes me really uncomfortable—and I’m not sure how to handle it.” P3 “My vagina feels constantly dry and uncomfortable. Ever since my cancer treatment, I haven’t been able to have sex, and now I feel completely disconnected from intimacy—like I’ve shut down emotionally. I just don’t know how to start addressing this.” H2 “When patients inquire about sexual health, the presence of others in the room may cause embarrassment. As a result, we often struggle to offer them adequate support in these situations.” Information related to eugenics and child rearing For many patients, reproductive goals extend beyond the physical safety of conception and childbirth to encompass long-term family well-being and quality of life. However, during cancer treatments—such as chemotherapy and hormonal therapies that carry risks of fetal malformation—comprehensive contraceptive counseling must be prioritized to support informed family planning decisions throughout their care journey. H11 “In a previous case, a patient conceived while undergoing hormonal therapy. Although the pregnancy outcome was favorable, it remains critical to emphasize the importance of contraception, as certain medications in such treatments carry teratogenic risks. What non-hormonal contraceptive options are available to mitigate these risks?” H5 “To prevent unintended pregnancies, patients undergoing breast cancer treatment should adhere to reliable contraception consistently. we must counsel them on appropriate contraceptive methods and clarify the optimal timing for contraception based on their treatment regimen.” Breast cancer exhibits a familial clustering pattern. For women at any age, having a relative diagnosed at an earlier age (e.g., < 50 years) significantly elevates their risk.[21] Therefore, the hereditary predisposition to breast cancer in childbearing-age women necessitates heightened clinical attention, particularly in genetic counseling and early-risk stratification. Some patients voice concerns regarding hereditary risks and specifically request that healthcare providers initiate discussions about genetic cancer predisposition and evidence-based risk management strategies. P10 “My aunt had breast cancer too. I’ve asked before if this might run in the family—now that I have a daughter, could she be at risk? Should I get her tested?” P5 “Is there any way to prevent passing this on to my child?” H7 “Prior to conception planning, patients are advised to undergo genetic testing. If pathogenic variants are identified, early interventions should be considered.” Information related to pregnancy As advancements in cancer treatment continue to progress, fertility preservation has emerged as a critical consideration in clinical practice. To achieve optimal reproductive outcomes, patients require comprehensive clinical guidance and evidence-based information support. Despite China's persistently declining national fertility rates, breast cancer patients of childbearing age continue to demonstrate substantial demand for family planning. These patients exhibit dual priorities: adherence to offspring health optimization principles and commitment to ensuring quality of life for future generations. However, distinct physiological profiles compared to standard obstetric populations create unique health information requirements throughout the pregnancy continuum. This manifests as differentiated informational needs across three critical phases: preconception counseling, antenatal management, and postpartum care. Patient priorities during the preconception phase focus on some critical parameters: determining the optimal post-treatment conception window, and implementing evidence-based fertility optimization protocols. P5 “I’d like to understand the safest time for me to get pregnant after treatment — both for my health and my baby’s future.” P3 “After all the chemotherapy I’ve had, could this affect my future children’s health? I worry if they might face more health challenges than other kids growing up” P6 “I’d really appreciate some trusted advice on preparing for pregnancy after breast cancer treatment. Could you walk me through things like what foods to avoid, medications that might need adjusting, and any lifestyle changes I should make? I also want to make sure I’m taking the scientific supplements to support a healthy pregnancy.” Many cancer patients worry about staying safe during pregnancy—like what precautions to take, how often to check for cancer recurrence, and whether monitoring might affect their baby. P7 “I’ve read a lot about pregnancy online, but since my situation is unique, I’m really concerned about potential complications or things I need to watch out for specifically.” P13 “I’m concerned about how hormonal changes during pregnancy might affect my tumor. Could this risk be significant? How closely should I be monitored, and could any of this affect my baby?” Many patients explore breastfeeding questions after childbirth, such as how it might interact with their medical history or what steps to take for safety. P15 “Since I had a mastectomy, breastfeeding was a big concern after my baby was born. I talked to my nurse about how to manage it, like what to do if one breast isn’t making enough milk.” H9 “Some patients think about how surgery could impact their sex life or ability to breastfeed later. For those diagnosed with breast cancer while pregnant, these concerns are often a top priority.” Theme2: The deep driving force behind information demand Reproductive information systems exhibit supply-demand disparities amid growing clinical focus. As overall survival rates for breast cancer patients have significantly improved, the focus of clinical practice and research has shifted from survival extension to optimizing multidimensional health management strategies. Rooted in the biopsychosocial model, this paradigm aims to systematically enhance patients’ long-term quality of life. Within this framework, reproductive health—a critical component of quality of life—has emerged as a key priority in clinical oncology. P4 “At first, I was terrified of how my diagnosis might affect having a baby. But after learning about my options and working closely with my doctors, I realized I could still prioritize both my health and my dream of becoming a parent.” H8 “In some families, if someone isn’t married or doesn’t have kids, it can become a big focus—like they see it as something that affects everyone’s happiness.” Significant gaps persist in both basic research and clinical practice regarding fertility preservation and pregnancy management for breast cancer patients. Current evidence-based guidelines and standardized clinical protocols in this field remain limited, necessitating further research to establish robust frameworks for patient care. P13 “When it comes to having kids, I get the sense that some things aren’t fully figured out yet—even the doctors don’t always have clear answers.” H4 “We know our hospital isn’t fully set up yet for fertility preservation, and we’re still catching up on the research side of things. But we’re working hard to change that—especially for younger patients who want to keep their options open for the future.” Social Support Enhances Psychological Resilience Subjective norms, as conceptualized in behavioral theory, posit that patients exhibit heightened information-seeking behaviors when they perceive societal expectations to understand specific health risks.[22] Familial support—particularly through empathic understanding and companionship—serves as a critical facilitator of patient engagement in addressing information gaps and navigating fertility-related decisions. Furthermore, supportive intimate relationships are associated with increased proactive coping strategies in confronting fertility challenges. P8 “My family’s pretty traditional. Even though I don’t really want kids right now, my mom keeps suggesting I look into what it takes to start a family.” P5 “After learning I had breast cancer, my partner didn't pull away or reject me. Instead, he stood by me, encouraged us to face it together, and treated me with unwavering care. We still hold hope of having our own children in the future.” The sense of hope occasionally acquired by some patients when their information needs are met can be transformed into the endogenous motivation of proactive fertility information-seeking, thereby forming a continuous cycle of health behavior maintenance. Healthcare providers said they would actively share successful cases and empower patients to cope with fertility problems through situational transplantation of therapeutic experiences. P3 “When scrolling through Xiaohongshu (a lifestyle-sharing platform), I often come across patients documenting their parenting journeys. Seeing them bond with their babies motivates me to actively research relative resources, and gradually builds my confidence that I can do this too.” P15 “Through a support group I joined, members consistently share uplifting stories about their journeys. This community has been profoundly healing for me — particularly a compassionate woman who guided me through the IVF process. Thanks to her support, my husband and I now have our miracle baby, Doudou.” H3 “We share success stories from patients around the same age to show them real examples. It helps people see how others have done it, so they don't have to stress as much.” Under the Healthy China Initiative framework, safeguarding reproductive autonomy for breast cancer patients has been elevated to a policy priority in national fertility health governance. Some patients report receiving tangible institutional support and targeted financial protections for fertility preservation options. H11 “The recent national policy reforms signal enhanced fertility preservation support for cancer patients. Should Beijing implement proposed insurance coverage for assisted reproductive technologies (ART), such measures would significantly improve treatment accessibility for affected individuals.” P8 “I recently came across this foundation that helps people through tough times. Seeing their success stories honestly warms my heart — I find myself cheering them on every step of the way!” Theme3: Fulfillment of fertility information demands entails multifaceted challenges Clinician-patient cognitive disparities create informational barriers While clinicians possess comprehensive knowledge of disease pathology, time constraints during clinical encounters often limit communication to prioritized critical information. This operational reality, compounded by inherent challenges in accurately discerning patients' evolving informational needs, creates systemic barriers to effective clinician-patient information exchange.Empirical studies reveal significant discrepancies between patients' expected and actual information acquisition experiences. These gaps primarily stem from the dynamic nature of informational priorities throughout treatment progression, with notable interindividual variability observed across patient cohorts. P11 “Honestly, I was too overwhelmed to really process that question at the time. But after surgery, lying in my hospital bed, it suddenly hit me — I needed proper answers. The doctors doing rounds though... they seemed too rushed to really hear what I was trying to ask.” H10 “While some patients revisit fertility concerns during adjuvant endocrine therapy, current oncology guidelines emphasize the critical importance of comprehensive fertility preservation counseling prior to initiating cytotoxic chemotherapy regimens.” Some patients hold high expectations regarding the quality of care and healthcare providers' communication. They seek comprehensive medical information, though such expectations often prove unrealistic in clinical practice. Specifically, patients expect clinicians to proactively provide guidance on reproductive referrals and resource accessibility, aiming to fulfill their informational needs regarding fertility-related matters. H1 “Some patients will ask what they need to be aware of during pregnancy. I can only focus on tumor-related issues, which may not cover the content of Obstetrics and gynecology. I need to refer them to a specialist.” P5 “While there might not be many fertility specialists available here, would they have any information about fertility specialists we could contact? Is there a fertility clinic we particularly trust for complex cases?” Current fertility counseling primarily relies on verbal communication, which faces significant challenges due to some interrelated factors: varying patient health literacy levels, inherent physician-patient information asymmetry, and non-standardized reproductive health content. These systemic limitations result in inadequate personalization of information delivery and suboptimal patient comprehension/acceptance of provided guidance. P7 “Then I got weird vibes in that room, you know? When I mentioned it to the nurse later, I was like - man, I really suck at dealing with this stuff. No clue how people handle it normally.” P11 “The doctor started talking frozen eggs and hormones – total info overload! I spent all night Googling that stuff.” P14 “Before my procedure, I noticed they had preoperative guidelines displayed on the wall. Would it be possible to get similar written materials about fertility and childbirth preparation? That way we could review the information whenever needed.” Constrained Information Channels and Quality Disparities Patients primarily rely on medical institutions as their main source of information. However, due to insufficient foundational research in this field, healthcare providers currently lack the evidence-based data required to communicate accurate recurrence rates, optimal conception timelines, and other personalized metrics. This gap in clinically validated information has led to patient skepticism regarding both the scientific validity and practical applicability of fertility-related guidance. H12 “We don’t always have clear answers for every fertility issue.” P2 “Doctors’ opinions differ, and their advice isn’t consistent. We’re not sure who to trust.” P1 “A doctor told me this was the newest achievement.I’m not sure if that’s true.I don’t dare ask.This might be an exception.” Patients frequently turn to external sources—including interpersonal networks and digital media—to fulfill their information-seeking behaviors;however, the reliability and accuracy of such information remain inconsistent. P10 “I ask relatives, friends, and family chat groups who have medical knowledge for advice. I also search on platforms like Xiaohongshu , Tieba , and Zhihu to find reliable information.” P9 “My family says I shouldn’t have sex because of this illness. I also read online that it could cause changes in hormones.” Concurrent Emergence of Information Empowerment and Decision-Making Dilemmas Health information empowerment may moderately improve patients’ engagement in medical decision-making and strengthen their capacity to participate in care. Effectively addressing patients’ reproductive health information needs can enhance their adaptive coping strategies and support evidence-based decision-making. P12 “Before deciding, I might feel more confident and know what outcomes to expect.” H7 “Provide patients with all necessary information in clear detail, as they and their family will ultimately decide. Encourage them to make informed choices early on to prevent potential regrets.” Some patients may be exposed to excessive, complex, or contradictory medical information, and their cognitive load may exceed their processing capacity, resulting in anxiety, decision-making delays, and other issues. P4 “A friend told me all about what he went through, and I did some research too. All of that played a role in my delayed decision.” H13 “Managing tumor progression requires coordination across multiple specialties—such as obstetrics, gynecology, and endocrinology. This interconnected complexity can make it challenging for patients to navigate their care options effectively.” The technical nature of fertility preservation in oncology demands that patients process complex medical data and clarify their personal values. Failure to address these challenges may lead to intense uncertainty in decision-making. H6 “While patient safety remains the highest priority in clinical care, fertility preservation is equally critical for many patients due to its profound impact on their long-term quality of life. This dual focus often leads to significant hesitation when considering chemotherapy.” P1 “We’re confused too, so we’re relying on the doctor’s advice.” Discussion The primary aim of this qualitative study is to comprehensively explore the reproductive information needs of childbearing-age breast cancer patients throughout the disease trajectory, as well as their perceptions and experiences regarding the fulfillment of these information needs. The findings may inform the enhancement of reproductive information support systems in clinical practice and contribute to the development of personalized reproductive support services. The findings of this study revealed significant interindividual variability in informational needs among childbearing-age breast cancer patients. All patients emphasized the necessity of integrating oncotherapeutic decision-making with fertility preservation counseling when addressing reproductive priorities, though systemic gaps in patient-centered information delivery were universally observed. Systemic gaps in patient education were observed, as evidenced by unmet demands for FP-related clinical guidance. These results align with Peate et al.'s cohort analysis [23], wherein 100% of respondents identified fertility-related knowledge as critical to treatment decision-making, a significant proportion of breast cancer patients demonstrate limited awareness of fertility preservation interventions. And nearly all participants expressed a need for information regarding fertility treatment and fertility-preservation interventions. Information needs arise from the gap between available information resources and required knowledge. The information gap theory posits that when individuals recognize a discrepancy between their current knowledge base and the knowledge needed to achieve their goals, they will proactively seek information. The patients interviewed in this study evaluated some key factors when making reproductive decisions: how their current health status might affect future offspring, potential genetic risks to their children, and available maternal healthcare options before and after pregnancy. After carefully weighing these considerations, they made informed choices regarding fertility treatments and family planning. Consistent with prior research findings, participants expressed concerns about intergenerational health implications and demonstrated strong desire for comprehensive medical information to support their decision-making processes. The availability of comprehensive medical information directly impacts individuals' confidence in decision-making. Participants in this study reported a pronounced disparity between disease treatment information and fertility-related guidance, with disproportionate emphasis placed on therapeutic interventions. This imbalance may be attributed to the study's hospital setting—oncology specialty centers where medical resources are unevenly distributed. Specifically, limited fertility preservation infrastructure and healthcare providers' insufficient expertise in reproductive health have resulted in inadequate attention to patients' fertility needs. Patients cannot access integrated fertility solutions within these cancer-focused institutions. Therefore, it is crucial to strengthen collaborations with leading hospitals specializing in reproductive medicine and expand inter-institutional healthcare networks to advance integrated clinical management in oncology and reproductive medicine. We recommend leveraging regional medical alliances to establish a multicenter clinical research platform. This platform could utilize electronic systems to enable real-time monitoring of fertility impairment data in cancer patients and support multimodal data integration. Furthermore, patients' information needs arise not only from decision-making requirements but also from concerns regarding their reproductive health. Given chemotherapy-induced damage to the reproductive system and the ovarian-suppressive effects of endocrine therapy, there exists a significant demand for reproductive health guidance. The primary concerns identified among study participants included maintaining healthy sexual function, managing menopausal symptoms, and addressing other physiological changes affecting the reproductive system. The premature onset of menopausal symptoms triggers multifaceted physiological and psychological manifestations; compromises sexual satisfaction; and impairs social functioning in patients. Deep-rooted traditional cultural norms in China create communication barriers between nurses and patients when discussing sexual health-related concerns. Current clinical guidelines advocate for healthcare professionals to engage in open dialogues regarding sexual health concerns, with particular emphasis on the critical role nurses play in comprehensive sexual health management[24]. To address these challenges, we propose that healthcare providers pioneer the development of structured communication frameworks for sexual health discourse. This initiative should integrate standardized assessment protocols into clinical workflows, systematically embedding sexual health evaluations within routine care pathways to mitigate sociocultural communication barriers. Furthermore, clinician interviews revealed that patients frequently overlooked non-treatment-related risk factors for fertility impairment. International models such as the Fertility and Cancer Project (FCP) have implemented online reproductive health education programs addressing modifiable factors including advanced age, obesity, and tobacco use[25]. Notably, treatment-induced delays in family planning—particularly during prolonged endocrine therapy—exacerbate age-related declines in ovarian reserve and physiological fertility potential. Concurrently, obesity adversely affects oocyte quality through adipose-mediated disruptions in sex hormone biosynthesis and pulsatile release, ultimately precipitating ovulatory dysfunction[26]. The interview data of this study did not identify information about associations between smoking exposure and fertility outcomes. While Chinese women demonstrate substantially lower smoking prevalence compared to global averages—potentially attributable to sociocultural constraints[27]—the clinical imperative persists to implement proactive fertility preservation counseling. This ensures breast cancer patients receive comprehensive risk mitigation strategies, enabling informed decision-making to optimize preconception health and enhance reproductive outcomes. Genetic health and maternal-child wellness serve as foundational components for enhancing population vitality and represent a critical implementation pathway within China's national health strategy. The guideline [28] emphasizes the necessity of consistent contraceptive use during the full course of cancer therapy to prevent abortion from exacerbating fertility impairment. The interview data revealed heightened clinical prioritization of contraceptive counseling among healthcare providers. However, systemic deficiencies in interdepartmental coordination within respondent institutions contribute to fragmented health education delivery and inadequate post-intervention monitoring. This operational gap elevates unintended pregnancy risks through suboptimal contraceptive adherence, ultimately compromising reproductive health service quality. Furthermore, a documented discrepancy exists between patient expectations for comprehensive reproductive health continuity and current clinical protocols, with multiple participants reporting insufficient access to structured fertility guidance. Consistent with Harries et al.'s observations [29], clinicians prioritized pregnancy prevention during active treatment over delivering structured contraceptive counseling across the care continuum. Healthcare systems should prioritize patient-centered fertility care by (1) aligning services with demonstrated reproductive health needs, (2) implementing comprehensive fertility preservation protocols spanning pre-, intra-, and post-treatment phases, and (3) establishing integrated family planning support systems to safeguard reproductive health outcomes throughout the care continuum. A subset of participants voiced concerns regarding fragmented counseling, highlighting systemic communication discontinuities between oncofertility protocols and primary cancer care. Healthcare professionals have also indicated that they currently lack the capacity to deliver specialized gynecologic oncology counseling, compromising evidence-based patient education in cancer care contexts. And a significant care coordination disconnect persists between oncofertility care and primary oncology protocols, compromising patient-centered treatment integration. Consistent with international research findings, a significant proportion of patients failed to undergo structured fertility preservation counseling prior to initiating cancer treatment[30,31]. Notably, even those breast cancer patients who received such counseling demonstrated persistent gaps in accessing evidence-based reproductive guidance and post-procedural support. While global clinical guidelines (e.g., ASCO, ESMO) mandate pretreatment fertility counseling for breast cancer patients, China's healthcare system demonstrates critical gaps in implementing standardized oncofertility protocols and coordinated referral pathways[32,33]. This disparity requires urgent systemic intervention. Current oncological evidence substantiates the safety of post-treatment pregnancy, with family planning considerations significantly influencing quality-of-life metrics in survivorship care[34~35]. To address this imperative, healthcare reforms must prioritize: (1)Interdisciplinary Integration: Establishing multidisciplinary tumor boards integrating reproductive endocrinologists and oncology specialists. (2)Patient-Centered Pathways: Implementing structured referral mechanisms between cancer centers and ART facilities. (3)Tailored Education: Delivering risk-stratified reproductive counseling through information-support tools. Within contemporary healthcare frameworks, patient empowerment strategies demonstrate measurable efficacy in enhancing therapeutic engagement, centering on collaborative knowledge transfer and participatory care models that enable patients to actively contribute to treatment decision-making and self-management processes[36]. This study reveals that informed decision-making capacity—crucial for optimizing oncofertility care choices—is fundamentally compromised by systemic barriers including clinical-information asymmetry, data complexity, and cognitive overload. These factors collectively contribute to decisional conflicts and therapeutic ambivalence among patients. The efficacy of clinical decision-making is fundamentally mediated by (1) health literacy thresholds among patients/kin cohorts and (2) systematic values clarification exercises. Cognitive overload induced by excessive information disclosure paradoxically impedes risk-benefit synthesis , necessitating precision education frameworks. This mandates literacy-calibrated disclosure protocols that dynamically adapt content density and presentation modalities to individual. Implement patient-tailored educational interventions calibrated to health literacy levels and decision-making preferences. Respondents in this study indicated that the current information delivery method was inadequate, and content required dynamic adaptation to address evolving practical needs. Clinical demands were not being fully met in practice. Therefore, targeted reproductive health information should be provided according to patients' needs and clinical contexts. This approach would broaden the scope of research by employing diverse methodologies to investigate the oncofertility information requirements of childbearing-age breast cancer patients across distinct treatment phases. By refining informational content and delivering comprehensive, phase-specific support aligned with therapeutic milestones, healthcare providers can mitigate informational dissonance. Furthermore, innovative patient education tools—such as question prompt lists and treatment process animations—should be developed to address clinical needs, thereby safeguarding reproductive health outcomes through evidence-based knowledge dissemination. The findings revealed that patients experienced multifaceted physical and psychological distress, where familial/social support served as a crucial protective factor. However, clinicians frequently overlooked patients' psychosocial needs during fertility information consultations. Simultaneously, constrained by current healthcare limitations, some patients resorted to digital platforms for emotional support. Existing evidence demonstrates that cancer survivors with fertility concerns express strong preferences for integrated psychological support services throughout clinical encounters[37]. As healthcare professionals with the most sustained clinical engagement with cancer patients, oncology nurses should leverage their pivotal role within multidisciplinary care teams (MDTs) by: providing evidence-based oncofertility counseling, implementing systematic psychosocial needs assessments across treatment trajectories, and facilitating patient navigation through complex decision-making processes. Furthermore, research demonstrates that patient-led information-sharing behaviors significantly influence treatment decision-making, particularly regarding the uptake of fertility preservation options[38]. An international peer-support initiative, Spirit, has shown efficacy in mitigating psychological distress through structured emotional coping strategies[39]. In conclusion, oncology nurses should leverage their clinical expertise and interdisciplinary competencies to proactively address childbearing-related psychological distress through targeted psychosocial interventions. Simultaneously, healthcare systems must mobilize patient empowerment by establishing structured peer-support networks where shared experiential learning occurs among cohorts facing similar fertility challenges. This multidimensional approach addresses the biopsychosocial continuum of needs, ultimately optimizing quality-of-life outcomes through integrated clinical-community support ecosystems. This study highlights patients' prevalent concerns regarding the financial burdens associated with fertility preservation. While China has incorporated assisted reproductive technology (ART) costs into medical insurance schemes in selected regions, policy frameworks remain under refinement, with nationwide insurance coverage anticipated through ongoing reforms[40]. Given cancer patients' unique socioeconomic vulnerabilities, we propose systemic adjustments to reimbursement scopes and ratios at the national level, advocating for comprehensive insurance integration across all provinces. The empirical evidence from participants provides policymakers and healthcare institutions with critical insights for developing patient-centric health policies and service models, ultimately ensuring equitable access to fertility preservation safeguards for all oncology patients. The interviewees recruited in this article mentioned that currently, there are still no standardized clinical pathways, such as fertility counseling and information support, in China, and they cannot access effective information and resources. Similar to one research finding, in the field of fertility protection, fertility preservation for tumor patients is the weakest area in China, which significantly differs from that in developed countries[41]. There are few centers providing fertility preservation services for tumor patients, and only a few medical institutions can perform ovarian tissue cryopreservation and establish standardized clinical processes. To improve the current situation, it is urgent to learn from the mature experience of other countries to formulate national strategies, establish standardized registration and full-cycle management mechanisms for fertility preservation in tumor patients, create a network management system for data sharing, strengthen collaborative linkages among cross-regional centers. and promote the standardized development of the tumor reproductive supporting services. Conclusion This study employed a dual-perspective approach (patient-provider dyads) to examine oncofertility information needs among reproductive-age breast cancer patients. The findings delineate critical knowledge gaps. These insights reveal fundamental disconnects between current clinical practices and patient-centered care imperatives, necessitating multilevel interventions, including Clinical Implementation, Health System Reform, and Country Policy. It will advance global cancer control objectives by operationalizing reproductive healthcare access through measurable quality-of-life enhancements in oncology survivorship care. Funded by Tianjin Key Medical Disciplines(Specialty) Construction Project (TJYXZDXK-011A) Declarations Author Contribution All authors contributed to the conception and design of the study. Material preparation, data collection, and analysis were performed by Y XT, Z W, H QB, Y XY and F YX. Y L recruited all participants, and Y XT conducted qualitative interviews. The first draft of the manuscript was written by Y XT. Y L, Y XY, F YX and WZ supervised the entire project and critically revised the first draft for important content. All the coauthors read and approved the final manuscript. References Bray F, Laversanne M, Sung H, et al(2024) Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. 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Journal of Nursing Administration 24(08):673-677. https://doi.org/10.3969/j.issn.1671-315x.2024.08.006. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6702998","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":476002905,"identity":"1db96ca2-3db9-4477-8d9e-158006163d77","order_by":0,"name":"Xiaotong Yang","email":"","orcid":"","institution":"Tianjin University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Xiaotong","middleName":"","lastName":"Yang","suffix":""},{"id":476002906,"identity":"0430c06a-e4d3-4a83-9ad8-d6525e9271ee","order_by":1,"name":"Wei Zhang","email":"","orcid":"","institution":"Tianjin University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Wei","middleName":"","lastName":"Zhang","suffix":""},{"id":476002907,"identity":"32f9470e-0962-43dd-8a84-71ee001a79ba","order_by":2,"name":"Quanbo Huo","email":"","orcid":"","institution":"Tianjin University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Quanbo","middleName":"","lastName":"Huo","suffix":""},{"id":476002908,"identity":"8d576485-7a3f-4e7e-8753-7ee3e28d646e","order_by":3,"name":"Xuanyue Yan","email":"","orcid":"","institution":"Tianjin Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xuanyue","middleName":"","lastName":"Yan","suffix":""},{"id":476002909,"identity":"698e3940-f9e1-47af-9cd1-39374ae31906","order_by":4,"name":"Yaxin Fu","email":"","orcid":"","institution":"Tianjin Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yaxin","middleName":"","lastName":"Fu","suffix":""},{"id":476002910,"identity":"6255898d-0eb0-4f75-9f3b-d85f63d99130","order_by":5,"name":"Ling Yan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyUlEQVRIiWNgGAWjYHACxgMJDAxyDAwHgMwGIvWAtBjzkKYFiBN7wBYSo8Xg+NkDBx7uqE3fz3g6TeLnDgZ5frEDBLScyUs4kHjmeG4Pw9ltkr1nGAxnzk4goOVAjsGBxLZjYC3SjG0MCQa3CWk5/wasJZ2HeC03wLbUJBCvRfIG2JYDhj0Hzm627G2TIOwXvvM5hg9/ttXJs884u/HGzzYbeX5pAloUDoCpwwwMEmCWBH7lICDfAKbqGBj4GwirHgWjYBSMgpEJACPQTpg24LxcAAAAAElFTkSuQmCC","orcid":"","institution":"Tianjin Medical University Cancer Institute and Hospital, China, Key laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education","correspondingAuthor":true,"prefix":"","firstName":"Ling","middleName":"","lastName":"Yan","suffix":""},{"id":476002911,"identity":"2ce5d536-add6-43c1-b4df-93846cc3edf7","order_by":6,"name":"Zhao Wang","email":"","orcid":"","institution":"Tianjin Medical University Cancer Institute and Hospital, China, Key laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education","correspondingAuthor":false,"prefix":"","firstName":"Zhao","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2025-05-20 02:53:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6702998/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6702998/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":92909819,"identity":"6450f969-4281-4772-be96-dc8293efa8b1","added_by":"auto","created_at":"2025-10-07 03:02:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1072197,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6702998/v1/866f71cf-d39a-4801-9cf8-dfb8aa4b9048.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Dual Perspectives on Fertility Information Needs and Clinical Support Barriers in Breast Cancer Care: A Qualitative Investigation","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAccording to the 2024 statistics released by the International Agency for Research on Cancer (IARC), global cancer incidence reached 20\u0026nbsp;million new cases in 2022, with a persistent upward trajectory[1]. Breast cancer has emerged as the second most prevalent malignancy worldwide, while China currently bears the highest national burden of breast cancer cases globally. This epidemiological pattern demonstrates two notable characteristics: a sustained annual increase in incidence rates accompanied by a progressive trend toward younger age at onset. International data reveal that women under 40 years old constitute 17.0% of total breast cancer cases worldwide, with this proportion having increased at an annual rate of 1.55% since 1990[2]. Particularly in China, accelerated socioeconomic development and gradual adoption of Westernized lifestyles have contributed to distinct epidemiological features in recent years. The proportion of young breast cancer patients under 35 years old significantly exceeds that observed in Western populations. National statistics indicate that 64.32% of new breast cancer cases occur among women aged 30\u0026ndash;59 years, highlighting the substantial disease burden within this demographic[1,3\u0026ndash;4]. Furthermore, the incidence pattern demonstrates an atypical age distribution compared to Western countries, with earlier peak onset ages and higher proportional representation of premenopausal cases.\u003c/p\u003e \u003cp\u003eWith advancements in early screening programs and continuous breakthroughs in medical technologies, the global five-year survival rate for breast cancer has reached 90%, reflecting significant prognostic improvements [5]. This progress has shifted clinical priorities from mere survival to optimizing long-term quality of life [6]. However, cancer diagnosis and treatment impose substantial treatment burdens and psychological distress on patients, while also indirectly disrupting critical life planning. Notably, breast cancer patients of reproductive age face distinct challenges specific to their developmental phase, with fertility-related concerns emerging as an essential yet frequently overlooked component of quality-of-life assessments [7,8].\u003c/p\u003e \u003cp\u003eCurrent clinical evidence indicates no significant adverse effects of post-treatment pregnancy on breast cancer prognosis, with studies confirming the oncological safety of pregnancy in young survivors following comprehensive therapy. Available data suggest that such pregnancies do not compromise overall survival rates [9,10]. Consequently, patients expressing reproductive intentions should receive proactive support, including timely fertility preservation interventions. Nevertheless, critical gaps persist in clinical practice. Fertility risks associated with cancer therapies\u0026mdash;including reproductive system toxicity\u0026mdash;and corresponding preservation strategies remain inadequately addressed in patient education. This oversight has resulted in systemic neglect of fertility-related concerns and informational needs among breast cancer patients, particularly regarding family planning post-treatment.\u003c/p\u003e \u003cp\u003eCurrent research highlights significant gaps in fertility-related information accessibility for oncology patients. Breast cancer patients demonstrate particularly limited awareness of fertility preservation strategies, with younger survivors requiring enhanced informational support regarding post-treatment reproductive health and sexual well-being. Unmet needs for fertility counseling rank highest among the informational priorities of reproductive-age breast cancer patients [11\u0026ndash;13], directly influencing fertility decisions, pregnancy-related anxieties, and family planning outcomes in this population [14].\u003c/p\u003e \u003cp\u003e Clinical guidelines recommend that clinicians inform breast cancer patients about potential treatment-induced fertility impairment at diagnosis; however, adherence to these protocols remains suboptimal. Current oncofertility services fail to meet guideline standards due to persistent knowledge-practice gaps among healthcare providers and ill-defined clinical responsibilities in fertility counseling [15]. This discrepancy is particularly pronounced in China, where systemic barriers\u0026mdash;including sociocultural stigma surrounding cancer-related infertility and disparities in resource allocation\u0026mdash;interact with suboptimal patient-provider dialogues to create critical care deficits in reproductive health management.\u003c/p\u003e \u003cp\u003eA critical evidence gap persists in contemporary oncofertility research, with reproductive-age breast cancer patients' informational needs remaining inadequately addressed[8]. Investigating these unmet needs holds dual significance: it could advance translational research in reproductive oncology while informing evidence-based service models to optimize patient-centered care.Current scholarship reveals a paucity of domestic and international studies addressing fertility-related informational support for this population. Existing studies remain limited in scope, primarily concentrated on fertility preservation decision-making processes while overlooking the longitudinal complexity of patients' reproductive health information requirements across the disease trajectory\u0026mdash;from diagnosis through survivorship care.\u003c/p\u003e \u003cp\u003eTo address these gaps, this study employs a descriptive approach grounded in Contextual Model of Health Information Seeking to examine patients\u0026rsquo; reproductive health information needs during their cancer journey, as well as the reproductive health-related information they may overlook. This study seeks to establish a foundation for delivering standardized, comprehensive, and individualized reproductive health information support services to patients, with the goal of enhancing clinical reproductive care quality and safeguarding their reproductive health.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003e2.1 Design\u003c/h2\u003e\n \u003cp\u003eA qualitative descriptive study was undertaken. As such studies are commonly selected when the research aims to provide a direct description of a specific phenomenon [16](Sandelowski, 2000). The Contextual Model of Health Information Seeking posits that patients\u0026apos; health information needs arise from multifaceted contextual factors (e.g., individual attributes, sociocultural networks, and healthcare system dynamics)[17]. Grounded in the Contextual Model of Health Information Seeking and informed by a synthesis of relevant literature, the research team developed a preliminary interview guide through iterative discussions. This guide was then pilot-tested (data excluded from final analysis) and revised based on expert feedback to finalize the interview protocol (Tables\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). Therefore, this study employs a qualitative descriptive design with maximum variation sampling to systematically investigate fertility-related information needs and existing support service characteristics among the target patient population who has different contextual factors. This reporting of this study adhered to the consolidated criteria for reporting qualitative studies (COREQ) checklist.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSemi-structured interview guide for patients\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNo.\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eInterview questions\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWhat fertility information have you explored? Primary concerns?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWhat additional fertility information would you like to know?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWhat factors could influence your approach to researching fertility information?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWhat emotional and cognitive reflections have emerged for you during your exploration of fertility-related resources?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHow has seeking fertility information influenced your medical decisions, treatment journey, and personal life?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHow do you typically access information about fertility preservation related to breast cancer? What specific resource or method has been most helpful to you?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003ctable id=\"Tab2\" border=\"1\" class=\"fr-table-selection-hover\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSemi-structured interview guide for medical staff\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNo.\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eInterview questions\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWhat do you consider to be the essential fertility-related information that should be included for breast cancer patients of reproductive age?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIn your conversations with patients, what other fertility-related issues are of greatest concern to breast cancer patients of reproductive age?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIn your prior professional experience, how frequently did you provide fertility preservation support to breast cancer patients of reproductive age? Do you think there is anything that needs to be changed\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHow would you describe your perspective and emotional experience in offering such support?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWhat methods do you use to deliver fertility preservation guidance to patients in your clinical practice? How do you perceive the effectiveness of the support you provide to patients༟\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003e2.2 Participants\u003c/h2\u003e\n \u003cp\u003eThis study was conducted between January 2025 and March 2025 in 3 comprehensive cancer hospitals or centers located in mainland China. A purposeful sampling method was employed to recruit patients and medical staff who met the standard. The inclusion criteria were designed based on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Breast Cancer.[18] The inclusion criteria were as follows: (1)pathologically confirmed breast cancer; (2)age at breast cancer diagnosis: 18\u0026ndash;40 years; (3)history of childbirth or current childbearing intention/plan post-diagnosis; (4)informed of diagnosis and voluntarily agreed to participate. Exclusion criteria were comorbid conditions directly impairing fertility, withdrawal, and existing psychiatric or neurological disorders. The inclusion criteria for medical workers were as follows: (1) valid medical license professional certification; (2) Clinical or research experience in oncofertility; (3)\u0026thinsp;\u0026ge;\u0026thinsp;5 years of clinical/research experience; (4) Understanding of the study protocol and voluntary agreement to participate. Medical staff who quit due to personal reasons, who were in training, and were not on duty due to sick leave, maternity leave, and other reasons were excluded.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003e2.3 Data collection\u003c/h2\u003e\n \u003cp\u003ePrior to conducting interviews, participants were briefed about the study\u0026apos;s purpose, interview topics, and consent procedures. Written informed consent was obtained following a detailed explanation of their rights and data confidentiality. Immediately before each interview, the research theme was reiterated and participants were assured of recording confidentiality (recordings were stored securely and anonymized during transcription). Data were collected through semi-structured face-to-face interviews, and a quiet, comfortable environment was established to encourage participants to share their perspectives. In the event of emotional distress or physical/mental discomfort during the interview, steps must be taken to prioritize the participant\u0026rsquo;s well-being by promptly addressing their needs and discontinuing the conversation if necessary. The participant retains the right to withdraw from the interview at any time without stating a reason. Their decision to continue or discontinue participation will be fully respected. Informed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n \u003ch2\u003e2.4 Date analysis\u003c/h2\u003e\n \u003cp\u003eTo ensure the credibility and confirmability of this study, the following procedures were rigorously implemented: Within 24 hours of each interview, audio recordings were transcribed verbatim by two independent researchers(YF and XY) to minimize data loss. Transcripts were returned to participants for verification (member checking), enabling them to review content accuracy and clarify ambiguities. Two primary researchers(XY and WZ) immersed themselves in the data by: Repeatedly listening to recordings; Conducting line-by-line coding of transcripts to identify patterns and contradictions;Generating initial codes, sub-themes, and candidate themes. Regular research team meetings were held to critically review emerging themes under the guidance of a professor (YL) with extensive qualitative research expertise. Discrepancies in coding interpretations were resolved through consensus to ensure analytical rigor. Participants received personalized summaries of themes and sub-themes derived from their interviews and were invited to assess whether these interpretations aligned with their experiences. Co-authors independently evaluated the accuracy of themes, sub-themes, and representative quotes, providing structured feedback. Final themes were refined through iterative team discussions integrating participant and peer insights.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003e2.5 Ethics\u003c/h2\u003e\n \u003cp\u003eApproval was obtained from the Human Research Ethics Committee of Tianjin Medical University Cancer Institute \u0026amp; Hospital (bc20250887). The procedures used in this study adhere to the tenets of the Declaration of Helsinki.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eAmong the 18 patients, 15 agreed to participate in the interviews and successfully completed them. One patient voluntarily withdrew from the study due to emotional agitation midway through the conversation, while two others declined participation due to scheduling conflicts with their treatment. Of the 16 medical personnel, 13 agreed to participate and successfully completed their interviews, with 2 withdrawing due to insufficient time and 1 failing to complete the interview for the same reason. Each interview lasted between 40 and 60 minutes, the average duration amounted to 39 minutes, and data saturation was achieved after interviewing 16 patients and 13 medical personnel. The general information of the participants is presented in Tables \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e and \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCharacteristics of participants (patients).\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCode\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHighest Education\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDuration of diagnosis (years)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePre-diagnosis, Post-diagnosis live births (the interval)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFertility Preservation Strategies Utilized\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMaster\u0026apos;s Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNever married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0, 0 (--)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGnRH agonists\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBachelor\u0026apos;s Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0, 0 (--)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBachelor\u0026apos;s Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0, 0(--)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGnRH agonists\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1, 1 (5 years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBachelor\u0026apos;s Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0, 0 (--)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOvarian tissue cryopreservation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBachelor\u0026apos;s Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1, 0 (--)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGnRH agonists\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBachelor\u0026apos;s Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1, 0 (--)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBachelor\u0026apos;s Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNever married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0, 0 (--)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOocyte cryopreservation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBachelor\u0026apos;s Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0, 1 (6 years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBachelor\u0026apos;s Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1, 0 (--)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBachelor\u0026apos;s Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0, 0 (--)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGnRH agonists\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBachelor\u0026apos;s Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNever married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0, 0 (--)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGnRH agonists\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBachelor\u0026apos;s Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0, 0 (--)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOocyte cryopreservation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAssociate Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1, 0 (--)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMaster\u0026apos;s Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0, 1 (4 years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCharacteristics of participants (medical staff).\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCode\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHighest education\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDepartment\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eProfessional title\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eWorking hours (years)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eH1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDoctoral Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDepartment of breast medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAssociate senior professional title\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eH2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDoctoral Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBreast reconstruction Department\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAssociate senior professional title\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eH3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBachelor\u0026apos;s Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDepartment of breast medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedium grade professional title\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eH4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDoctoral Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRadiotherapy department\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eprofessional title\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eH5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMaster\u0026apos;s Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDaytime chemotherapy ward\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAssociate senior professional title\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eH6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMaster\u0026apos;s Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDepartment of breast medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedium grade professional title\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eH7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDoctoral Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBreast surgery department\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eprofessional title\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eH8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMaster\u0026apos;s Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBreast reconstruction Department\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAssociate senior professional title\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eH9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMaster\u0026apos;s Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBreast surgery department\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedium grade professional title\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eH10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMaster\u0026apos;s Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDepartment of breast medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAssociate senior professional title\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eH11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDoctoral Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDepartment of breast medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eprofessional title\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eH12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMaster\u0026apos;s Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBreast surgery department\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAssociate senior professional title\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eH13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBachelor\u0026apos;s Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBreast surgery department\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJunior professional title\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 1: Critical Need for Reproductive Health Information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBasic information on diseases and treatments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMaslow\u0026apos;s hierarchy of needs theory posits that physiological requirements constitute the most fundamental human needs. Within the value framework of most patients, the preservation of life and health emerges as the paramount concern, serving as an essential prerequisite for addressing subsequent reproductive considerations. These individuals demonstrate an urgent need for comprehensive medical information regarding their diagnoses and treatment options.\u003c/p\u003e\n\u003cp\u003eH12 \u0026ldquo; The priority is to work out the next treatment plan with patients and their families urgently. Some cases, particularly younger patients, are in critical condition and might require immediate adjuvant chemotherapy and surgery.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eP12 \u0026ldquo; Right now, I need to focus completely on my treatment plan. My health has to be the priority \u0026mdash; only after that can I even think about starting a family.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eThe five-year survival rate for breast cancer has demonstrated consistent upward trends in recent years, a promising development that is instilling renewed optimism among patients regarding long-term prognosis. Following the fulfillment of their core information requirements, patients often transition to seeking in-depth, context-specific details to optimize health-related outcomes, including, but not limited to disease etiology, fertility-sparing therapeutic interventions, and prognostic trajectories, to fulfill informational demands and optimize sustained health-related quality of life(HRQoL).\u003c/p\u003e\n\u003cp\u003eP8 \u0026ldquo; I\u0026apos;ve consulted multiple physicians regarding my cancer diagnosis, particularly given the absence of familial predisposition and my sustained adherence to preventive health behaviors. This etiological ambiguity raises significant concerns about potential genetic implications for my children.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eP15 \u0026ldquo; After learning the chemotherapy might influence my ability to have children later, I specifically asked about treatment choices that are gentler on fertility when we were setting up the plan.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eP9 \u0026ldquo; I need to find out how long I have left, understand what shape I\u0026apos;ll be in, and whether I\u0026apos;ll get to spend enough quality time with my kids.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHazard factors for fertility impairment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to the theory of planned behavior (TPB), behavioral intention serves as the primary determinant of individuals\u0026apos; behaviors, fertility information-seeking behaviors.Patients with future fertility plans are particularly concerned about the potential effects of the entire cancer treatment regimen on their reproductive capacity. However, there remains a critical need for more comprehensive data to accurately assess the extent of reproductive damage caused by cancer therapies.\u003c/p\u003e\n\u003cp\u003eP3 \u0026ldquo;My husband and I have been married a few years now, and we haven\u0026apos;t started a family yet. We\u0026apos;re definitely planning to have kids down the road. But I\u0026apos;m really concerned \u0026mdash; could treatments like chemo or radiation affect my chances of having children in the future?\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eH5 \u0026ldquo;Fertility outcomes are influenced by multiple determinants. For patients requiring chemotherapy, proactive disclosure of its ovarian toxicity and potential fertility impairment should be prioritized during treatment planning.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eHowever, while patients understandably concentrate on iatrogenic ovarian reserve depletion given the unavoidable nature of cancer therapies, there is a clinically significant oversight of non-treatment-related fertility determinants such as advancing age, elevated BMI, and chronic psychological stress.\u003c/p\u003e\n\u003cp\u003eH6 \u0026ldquo;I once had a patient hoping to have kids later in life. After reviewing her case, it became clear her overall health wasn\u0026apos;t sufficient to sustain a pregnancy, especially with the ongoing endocrine therapy requiring long-term treatment. Looking back, we should\u0026apos;ve discussed fertility timelines and age-related risks much earlier in the process\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eH1 \u0026ldquo;For patients with elevated BMI, obesity can present challenges to achieving conception, with studies indicating potential impacts on long-term oocyte quality. Regardless of pregnancy goals, we strongly advise maintaining a healthy weight through balanced nutrition and regular exercise, as recommended by the ESHRE fertility preservation guidelines.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBalance between fertility and cancer treatment information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients influenced by traditional Chinese cultural values surrounding family lineage often demonstrate profound difficulty reconciling infertility diagnoses, a psychological challenge compounded by the iatrogenic fertility risks inherent in oncologic therapies. Moreover, younger demographics presenting with acute clinical manifestations at diagnosis are particularly vulnerable to information overload during initial treatment consultations. This cognitive saturation frequently leads to inadvertent neglect of fertility preservation discussions, creating critical gaps in patient education and shared decision-making processes.\u003c/p\u003e\n\u003cp\u003eP11 \u0026ldquo;When I got that scary diagnosis, everything happened so fast. My doctors were saying I needed to start chemo and have surgery right away. But with all the appointments and tests piling up, I just felt completely overwhelmed \u0026mdash; there was no time to really process what it all meant for my body or my future (family plan).\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eP2 \u0026ldquo;We should ask more questions and choose a treatment that has a relatively small impact on fertility... Now there is no way.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eAs cancer therapies advance, patients\u0026apos; need for fertility-related information has emerged as a critical concern, driving a pressing demand for readily accessible guidance on evidence-based fertility preservation strategies throughout treatment trajectories. Fertility preservation (FP) refers to the method of protecting the fertility of people at risk of infertility through surgery, drugs or assisted reproductive technology[19].Some patients described experiencing considerable stress during fertility preservation decision-making. Factors such as time-sensitive treatment plans and uncertainty about the risks versus benefits of fertility preservation frequently contributed to decisional conflict.\u003c/p\u003e\n\u003cp\u003eP11 \u0026ldquo;What\u0026rsquo;s the cost of freezing eggs or ovarian tissues? The treatment for my condition is already expensive. Can I afford these options? How much will my health insurance cover, and what\u0026rsquo;s the success rate of each procedure? Which one should I choose?\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eP1 \u0026ldquo;I\u0026rsquo;ve heard that leuprolide might cause the endometrium to thicken. If it gets too thick, could I end up needing a procedure like Curettage (similar to an abortion)? I\u0026rsquo;m really worried about how that might affect my body.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eP5 \u0026ldquo;I have learned that there are some ovulation promoting drugs that may aggravate tumors if used for breast cancer, but I still don\u0026apos;t know how to choose.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eThe treatment and fertility preservation knowledge available to patients significantly influences their subsequent medical and reproductive choices. Healthcare providers also emphasize the importance of providing comprehensive information, while maintaining a balance between disease-specific details and fertility-related guidance.\u003c/p\u003e\n\u003cp\u003eP12 \u0026ldquo;After surgery, I really need more details on how to preserve my fertility. It\u0026rsquo;d help me feel calmer and more ready for whatever treatment comes next.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eH8 \u0026ldquo;Starting a family is a big deal for many women. With breast cancer survival rates being so good these days, patients should get help if they want kids. Doctors need to explain their options clearly once they know the facts about their cancer \u0026mdash; because living well is just as important as getting treated.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eReproductive health information throughout the entire anti-cancer cycle\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe potential reproductive health hazards caused by tumor treatment could seriously affect patients\u0026apos; quality of life. Reproductive health is the basis of ensuring fertility, encompassing the physical, mental, and social well-being related to the reproductive system and its functions[20]. Damage to the reproductive system caused by cancer treatment can be unavoidable, potentially leading to adverse physical and psychological effects on patients. Patients may also experience harm due to inadequate access to timely or accurate information about treatment risks.\u003c/p\u003e\n\u003cp\u003eP14 \u0026ldquo;When I was on chemo, my periods got really unpredictable. I had no clue why, and it honestly freaked me out a bit.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eP10 \u0026ldquo;Ever since I started these hormone meds(endocrine drugs), I\u0026rsquo;ve been feeling awful\u0026mdash;like my body\u0026rsquo;s falling apart and my mood\u0026rsquo;s all over the place. Everything just irritates me. The doctor says it\u0026rsquo;s \u0026lsquo;menopause or something,\u0026rsquo; but honestly, it makes me feel like I\u0026rsquo;ve turned into an old lady overnight!\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eH10 \u0026ldquo;If patients fail to take contraceptive precautions, unintended pregnancies may occur, potentially leading to adverse effects on their reproductive health and long-term fertility.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eA cornerstone of reproductive health is ensuring safe and fulfilling sexual well-being. Patients who undergo treatments such as breast surgery or chemotherapy often have pressing needs for sexual health education. Yet in China, deeply ingrained cultural norms\u0026mdash;particularly the stigma associated with open discussions of sexuality\u0026mdash;frequently lead both patients and medical professionals to avoid these conversations, resulting in critical information gaps.\u003c/p\u003e\n\u003cp\u003eP13 \u0026ldquo;After my breast reconstruction surgery, my body has changed completely, and I know I need to adjust to this new reality. But when people touch or try to adjust parts of my body, it makes me really uncomfortable\u0026mdash;and I\u0026rsquo;m not sure how to handle it.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eP3 \u0026ldquo;My vagina feels constantly dry and uncomfortable. Ever since my cancer treatment, I haven\u0026rsquo;t been able to have sex, and now I feel completely disconnected from intimacy\u0026mdash;like I\u0026rsquo;ve shut down emotionally. I just don\u0026rsquo;t know how to start addressing this.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eH2 \u0026ldquo;When patients inquire about sexual health, the presence of others in the room may cause embarrassment. As a result, we often struggle to offer them adequate support in these situations.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformation related to eugenics and child rearing\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor many patients, reproductive goals extend beyond the physical safety of conception and childbirth to encompass long-term family well-being and quality of life. However, during cancer treatments\u0026mdash;such as chemotherapy and hormonal therapies that carry risks of fetal malformation\u0026mdash;comprehensive contraceptive counseling must be prioritized to support informed family planning decisions throughout their care journey.\u003c/p\u003e\n\u003cp\u003eH11 \u0026ldquo;In a previous case, a patient conceived while undergoing hormonal therapy. Although the pregnancy outcome was favorable, it remains critical to emphasize the importance of contraception, as certain medications in such treatments carry teratogenic risks. What non-hormonal contraceptive options are available to mitigate these risks?\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eH5 \u0026ldquo;To prevent unintended pregnancies, patients undergoing breast cancer treatment should adhere to reliable contraception consistently. we must counsel them on appropriate contraceptive methods and clarify the optimal timing for contraception based on their treatment regimen.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eBreast cancer exhibits a familial clustering pattern. For women at any age, having a relative diagnosed at an earlier age (e.g., \u0026lt;\u0026thinsp;50 years) significantly elevates their risk.[21] Therefore, the hereditary predisposition to breast cancer in childbearing-age women necessitates heightened clinical attention, particularly in genetic counseling and early-risk stratification. Some patients voice concerns regarding hereditary risks and specifically request that healthcare providers initiate discussions about genetic cancer predisposition and evidence-based risk management strategies.\u003c/p\u003e\n\u003cp\u003eP10 \u0026ldquo;My aunt had breast cancer too. I\u0026rsquo;ve asked before if this might run in the family\u0026mdash;now that I have a daughter, could she be at risk? Should I get her tested?\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eP5 \u0026ldquo;Is there any way to prevent passing this on to my child?\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eH7 \u0026ldquo;Prior to conception planning, patients are advised to undergo genetic testing. If pathogenic variants are identified, early interventions should be considered.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformation related to pregnancy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs advancements in cancer treatment continue to progress, fertility preservation has emerged as a critical consideration in clinical practice. To achieve optimal reproductive outcomes, patients require comprehensive clinical guidance and evidence-based information support. Despite China\u0026apos;s persistently declining national fertility rates, breast cancer patients of childbearing age continue to demonstrate substantial demand for family planning. These patients exhibit dual priorities: adherence to offspring health optimization principles and commitment to ensuring quality of life for future generations. However, distinct physiological profiles compared to standard obstetric populations create unique health information requirements throughout the pregnancy continuum. This manifests as differentiated informational needs across three critical phases: preconception counseling, antenatal management, and postpartum care.\u003c/p\u003e\n\u003cp\u003ePatient priorities during the preconception phase focus on some critical parameters: determining the optimal post-treatment conception window, and implementing evidence-based fertility optimization protocols.\u003c/p\u003e\n\u003cp\u003eP5 \u0026ldquo;I\u0026rsquo;d like to understand the safest time for me to get pregnant after treatment \u0026mdash; both for my health and my baby\u0026rsquo;s future.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eP3 \u0026ldquo;After all the chemotherapy I\u0026rsquo;ve had, could this affect my future children\u0026rsquo;s health? I worry if they might face more health challenges than other kids growing up\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eP6 \u0026ldquo;I\u0026rsquo;d really appreciate some trusted advice on preparing for pregnancy after breast cancer treatment. Could you walk me through things like what foods to avoid, medications that might need adjusting, and any lifestyle changes I should make? I also want to make sure I\u0026rsquo;m taking the scientific supplements to support a healthy pregnancy.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eMany cancer patients worry about staying safe during pregnancy\u0026mdash;like what precautions to take, how often to check for cancer recurrence, and whether monitoring might affect their baby.\u003c/p\u003e\n\u003cp\u003eP7 \u0026ldquo;I\u0026rsquo;ve read a lot about pregnancy online, but since my situation is unique, I\u0026rsquo;m really concerned about potential complications or things I need to watch out for specifically.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eP13 \u0026ldquo;I\u0026rsquo;m concerned about how hormonal changes during pregnancy might affect my tumor. Could this risk be significant? How closely should I be monitored, and could any of this affect my baby?\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eMany patients explore breastfeeding questions after childbirth, such as how it might interact with their medical history or what steps to take for safety.\u003c/p\u003e\n\u003cp\u003eP15 \u0026ldquo;Since I had a mastectomy, breastfeeding was a big concern after my baby was born. I talked to my nurse about how to manage it, like what to do if one breast isn\u0026rsquo;t making enough milk.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eH9 \u0026ldquo;Some patients think about how surgery could impact their sex life or ability to breastfeed later. For those diagnosed with breast cancer while pregnant, these concerns are often a top priority.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme2: The deep driving force behind information demand\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eReproductive information systems exhibit supply-demand disparities amid growing clinical focus.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs overall survival rates for breast cancer patients have significantly improved, the focus of clinical practice and research has shifted from survival extension to optimizing multidimensional health management strategies. Rooted in the biopsychosocial model, this paradigm aims to systematically enhance patients\u0026rsquo; long-term quality of life. Within this framework, reproductive health\u0026mdash;a critical component of quality of life\u0026mdash;has emerged as a key priority in clinical oncology.\u003c/p\u003e\n\u003cp\u003eP4 \u0026ldquo;At first, I was terrified of how my diagnosis might affect having a baby. But after learning about my options and working closely with my doctors, I realized I could still prioritize both my health and my dream of becoming a parent.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eH8 \u0026ldquo;In some families, if someone isn\u0026rsquo;t married or doesn\u0026rsquo;t have kids, it can become a big focus\u0026mdash;like they see it as something that affects everyone\u0026rsquo;s happiness.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eSignificant gaps persist in both basic research and clinical practice regarding fertility preservation and pregnancy management for breast cancer patients. Current evidence-based guidelines and standardized clinical protocols in this field remain limited, necessitating further research to establish robust frameworks for patient care.\u003c/p\u003e\n\u003cp\u003eP13 \u0026ldquo;When it comes to having kids, I get the sense that some things aren\u0026rsquo;t fully figured out yet\u0026mdash;even the doctors don\u0026rsquo;t always have clear answers.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eH4 \u0026ldquo;We know our hospital isn\u0026rsquo;t fully set up yet for fertility preservation, and we\u0026rsquo;re still catching up on the research side of things. But we\u0026rsquo;re working hard to change that\u0026mdash;especially for younger patients who want to keep their options open for the future.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSocial Support Enhances Psychological Resilience\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSubjective norms, as conceptualized in behavioral theory, posit that patients exhibit heightened information-seeking behaviors when they perceive societal expectations to understand specific health risks.[22] Familial support\u0026mdash;particularly through empathic understanding and companionship\u0026mdash;serves as a critical facilitator of patient engagement in addressing information gaps and navigating fertility-related decisions. Furthermore, supportive intimate relationships are associated with increased proactive coping strategies in confronting fertility challenges.\u003c/p\u003e\n\u003cp\u003eP8 \u0026ldquo;My family\u0026rsquo;s pretty traditional. Even though I don\u0026rsquo;t really want kids right now, my mom keeps suggesting I look into what it takes to start a family.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eP5 \u0026ldquo;After learning I had breast cancer, my partner didn\u0026apos;t pull away or reject me. Instead, he stood by me, encouraged us to face it together, and treated me with unwavering care. We still hold hope of having our own children in the future.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eThe sense of hope occasionally acquired by some patients when their information needs are met can be transformed into the endogenous motivation of proactive fertility information-seeking, thereby forming a continuous cycle of health behavior maintenance. Healthcare providers said they would actively share successful cases and empower patients to cope with fertility problems through situational transplantation of therapeutic experiences.\u003c/p\u003e\n\u003cp\u003eP3 \u0026ldquo;When scrolling through Xiaohongshu (a lifestyle-sharing platform), I often come across patients documenting their parenting journeys. Seeing them bond with their babies motivates me to actively research relative resources, and gradually builds my confidence that I can do this too.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eP15 \u0026ldquo;Through a support group I joined, members consistently share uplifting stories about their journeys. This community has been profoundly healing for me \u0026mdash; particularly a compassionate woman who guided me through the IVF process. Thanks to her support, my husband and I now have our miracle baby, Doudou.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eH3 \u0026ldquo;We share success stories from patients around the same age to show them real examples. It helps people see how others have done it, so they don\u0026apos;t have to stress as much.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eUnder the Healthy China Initiative framework, safeguarding reproductive autonomy for breast cancer patients has been elevated to a policy priority in national fertility health governance. Some patients report receiving tangible institutional support and targeted financial protections for fertility preservation options.\u003c/p\u003e\n\u003cp\u003eH11 \u0026ldquo;The recent national policy reforms signal enhanced fertility preservation support for cancer patients. Should Beijing implement proposed insurance coverage for assisted reproductive technologies (ART), such measures would significantly improve treatment accessibility for affected individuals.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eP8 \u0026ldquo;I recently came across this foundation that helps people through tough times. Seeing their success stories honestly warms my heart \u0026mdash; I find myself cheering them on every step of the way!\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme3: Fulfillment of fertility information demands entails multifaceted challenges\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinician-patient cognitive disparities create informational barriers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhile clinicians possess comprehensive knowledge of disease pathology, time constraints during clinical encounters often limit communication to prioritized critical information. This operational reality, compounded by inherent challenges in accurately discerning patients\u0026apos; evolving informational needs, creates systemic barriers to effective clinician-patient information exchange.Empirical studies reveal significant discrepancies between patients\u0026apos; expected and actual information acquisition experiences. These gaps primarily stem from the dynamic nature of informational priorities throughout treatment progression, with notable interindividual variability observed across patient cohorts.\u003c/p\u003e\n\u003cp\u003eP11 \u0026ldquo;Honestly, I was too overwhelmed to really process that question at the time. But after surgery, lying in my hospital bed, it suddenly hit me \u0026mdash; I needed proper answers. The doctors doing rounds though... they seemed too rushed to really hear what I was trying to ask.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eH10 \u0026ldquo;While some patients revisit fertility concerns during adjuvant endocrine therapy, current oncology guidelines emphasize the critical importance of comprehensive fertility preservation counseling prior to initiating cytotoxic chemotherapy regimens.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eSome patients hold high expectations regarding the quality of care and healthcare providers\u0026apos; communication. They seek comprehensive medical information, though such expectations often prove unrealistic in clinical practice. Specifically, patients expect clinicians to proactively provide guidance on reproductive referrals and resource accessibility, aiming to fulfill their informational needs regarding fertility-related matters.\u003c/p\u003e\n\u003cp\u003eH1 \u0026ldquo;Some patients will ask what they need to be aware of during pregnancy. I can only focus on tumor-related issues, which may not cover the content of Obstetrics and gynecology. I need to refer them to a specialist.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eP5 \u0026ldquo;While there might not be many fertility specialists available here, would they have any information about fertility specialists we could contact? Is there a fertility clinic we particularly trust for complex cases?\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eCurrent fertility counseling primarily relies on verbal communication, which faces significant challenges due to some interrelated factors: varying patient health literacy levels, inherent physician-patient information asymmetry, and non-standardized reproductive health content. These systemic limitations result in inadequate personalization of information delivery and suboptimal patient comprehension/acceptance of provided guidance.\u003c/p\u003e\n\u003cp\u003eP7 \u0026ldquo;Then I got weird vibes in that room, you know? When I mentioned it to the nurse later, I was like - man, I really suck at dealing with this stuff. No clue how people handle it normally.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eP11 \u0026ldquo;The doctor started talking frozen eggs and hormones \u0026ndash; total info overload! I spent all night Googling that stuff.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eP14 \u0026ldquo;Before my procedure, I noticed they had preoperative guidelines displayed on the wall. Would it be possible to get similar written materials about fertility and childbirth preparation? That way we could review the information whenever needed.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConstrained Information Channels and Quality Disparities\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients primarily rely on medical institutions as their main source of information. However, due to insufficient foundational research in this field, healthcare providers currently lack the evidence-based data required to communicate accurate recurrence rates, optimal conception timelines, and other personalized metrics. This gap in clinically validated information has led to patient skepticism regarding both the scientific validity and practical applicability of fertility-related guidance.\u003c/p\u003e\n\u003cp\u003eH12 \u0026ldquo;We don\u0026rsquo;t always have clear answers for every fertility issue.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eP2 \u0026ldquo;Doctors\u0026rsquo; opinions differ, and their advice isn\u0026rsquo;t consistent. We\u0026rsquo;re not sure who to trust.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eP1 \u0026ldquo;A doctor told me this was the newest achievement.I\u0026rsquo;m not sure if that\u0026rsquo;s true.I don\u0026rsquo;t dare ask.This might be an exception.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003ePatients frequently turn to external sources\u0026mdash;including interpersonal networks and digital media\u0026mdash;to fulfill their information-seeking behaviors;however, the reliability and accuracy of such information remain inconsistent.\u003c/p\u003e\n\u003cp\u003eP10 \u0026ldquo;I ask relatives, friends, and family chat groups who have medical knowledge for advice. I also search on platforms like \u003cem\u003eXiaohongshu\u003c/em\u003e, \u003cem\u003eTieba\u003c/em\u003e, and \u003cem\u003eZhihu\u003c/em\u003e to find reliable information.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eP9 \u0026ldquo;My family says I shouldn\u0026rsquo;t have sex because of this illness. I also read online that it could cause changes in hormones.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConcurrent Emergence of Information Empowerment and Decision-Making Dilemmas\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHealth information empowerment may moderately improve patients\u0026rsquo; engagement in medical decision-making and strengthen their capacity to participate in care. Effectively addressing patients\u0026rsquo; reproductive health information needs can enhance their adaptive coping strategies and support evidence-based decision-making.\u003c/p\u003e\n\u003cp\u003eP12 \u0026ldquo;Before deciding, I might feel more confident and know what outcomes to expect.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eH7 \u0026ldquo;Provide patients with all necessary information in clear detail, as they and their family will ultimately decide. Encourage them to make informed choices early on to prevent potential regrets.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eSome patients may be exposed to excessive, complex, or contradictory medical information, and their cognitive load may exceed their processing capacity, resulting in anxiety, decision-making delays, and other issues.\u003c/p\u003e\n\u003cp\u003eP4 \u0026ldquo;A friend told me all about what he went through, and I did some research too. All of that played a role in my delayed decision.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eH13 \u0026ldquo;Managing tumor progression requires coordination across multiple specialties\u0026mdash;such as obstetrics, gynecology, and endocrinology. This interconnected complexity can make it challenging for patients to navigate their care options effectively.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eThe technical nature of fertility preservation in oncology demands that patients process complex medical data and clarify their personal values. Failure to address these challenges may lead to intense uncertainty in decision-making.\u003c/p\u003e\n\u003cp\u003eH6 \u0026ldquo;While patient safety remains the highest priority in clinical care, fertility preservation is equally critical for many patients due to its profound impact on their long-term quality of life. This dual focus often leads to significant hesitation when considering chemotherapy.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eP1 \u0026ldquo;We\u0026rsquo;re confused too, so we\u0026rsquo;re relying on the doctor\u0026rsquo;s advice.\u0026rdquo;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe primary aim of this qualitative study is to comprehensively explore the reproductive information needs of childbearing-age breast cancer patients throughout the disease trajectory, as well as their perceptions and experiences regarding the fulfillment of these information needs. The findings may inform the enhancement of reproductive information support systems in clinical practice and contribute to the development of personalized reproductive support services.\u003c/p\u003e\n\u003cp\u003eThe findings of this study revealed significant interindividual variability in informational needs among childbearing-age breast cancer patients. All patients emphasized the necessity of integrating oncotherapeutic decision-making with fertility preservation counseling when addressing reproductive priorities, though systemic gaps in patient-centered information delivery were universally observed. Systemic gaps in patient education were observed, as evidenced by unmet demands for FP-related clinical guidance. These results align with Peate et al.'s cohort analysis [23], wherein 100% of respondents identified fertility-related knowledge as critical to treatment decision-making, a significant proportion of breast cancer patients demonstrate limited awareness of fertility preservation interventions. And nearly all participants expressed a need for information regarding fertility treatment and fertility-preservation interventions.\u003c/p\u003e\n\u003cp\u003eInformation needs arise from the gap between available information resources and required knowledge. The information gap theory posits that when individuals recognize a discrepancy between their current knowledge base and the knowledge needed to achieve their goals, they will proactively seek information. The patients interviewed in this study evaluated some key factors when making reproductive decisions: how their current health status might affect future offspring, potential genetic risks to their children, and available maternal healthcare options before and after pregnancy. After carefully weighing these considerations, they made informed choices regarding fertility treatments and family planning. Consistent with prior research findings, participants expressed concerns about intergenerational health implications and demonstrated strong desire for comprehensive medical information to support their decision-making processes. The availability of comprehensive medical information directly impacts individuals' confidence in decision-making. Participants in this study reported a pronounced disparity between disease treatment information and fertility-related guidance, with disproportionate emphasis placed on therapeutic interventions. This imbalance may be attributed to the study's hospital setting—oncology specialty centers where medical resources are unevenly distributed. Specifically, limited fertility preservation infrastructure and healthcare providers' insufficient expertise in reproductive health have resulted in inadequate attention to patients' fertility needs. Patients cannot access integrated fertility solutions within these cancer-focused institutions. Therefore, it is crucial to strengthen collaborations with leading hospitals specializing in reproductive medicine and expand inter-institutional healthcare networks to advance integrated clinical management in oncology and reproductive medicine. We recommend leveraging regional medical alliances to establish a multicenter clinical research platform. This platform could utilize electronic systems to enable real-time monitoring of fertility impairment data in cancer patients and support multimodal data integration.\u003c/p\u003e\n\u003cp\u003eFurthermore, patients' information needs arise not only from decision-making requirements but also from concerns regarding their reproductive health. Given chemotherapy-induced damage to the reproductive system and the ovarian-suppressive effects of endocrine therapy, there exists a significant demand for reproductive health guidance. The primary concerns identified among study participants included maintaining healthy sexual function, managing menopausal symptoms, and addressing other physiological changes affecting the reproductive system. The premature onset of menopausal symptoms triggers multifaceted physiological and psychological manifestations; compromises sexual satisfaction; and impairs social functioning in patients. Deep-rooted traditional cultural norms in China create communication barriers between nurses and patients when discussing sexual health-related concerns. Current clinical guidelines advocate for healthcare professionals to engage in open dialogues regarding sexual health concerns, with particular emphasis on the critical role nurses play in comprehensive sexual health management[24]. To address these challenges, we propose that healthcare providers pioneer the development of structured communication frameworks for sexual health discourse. This initiative should integrate standardized assessment protocols into clinical workflows, systematically embedding sexual health evaluations within routine care pathways to mitigate sociocultural communication barriers.\u003c/p\u003e\n\u003cp\u003eFurthermore, clinician interviews revealed that patients frequently overlooked non-treatment-related risk factors for fertility impairment. International models such as the Fertility and Cancer Project (FCP) have implemented online reproductive health education programs addressing modifiable factors including advanced age, obesity, and tobacco use[25]. Notably, treatment-induced delays in family planning—particularly during prolonged endocrine therapy—exacerbate age-related declines in ovarian reserve and physiological fertility potential. Concurrently, obesity adversely affects oocyte quality through adipose-mediated disruptions in sex hormone biosynthesis and pulsatile release, ultimately precipitating ovulatory dysfunction[26]. The interview data of this study did not identify information about associations between smoking exposure and fertility outcomes. While Chinese women demonstrate substantially lower smoking prevalence compared to global averages—potentially attributable to sociocultural constraints[27]—the clinical imperative persists to implement proactive fertility preservation counseling. This ensures breast cancer patients receive comprehensive risk mitigation strategies, enabling informed decision-making to optimize preconception health and enhance reproductive outcomes.\u003c/p\u003e\n\u003cp\u003eGenetic health and maternal-child wellness serve as foundational components for enhancing population vitality and represent a critical implementation pathway within China's national health strategy. The guideline [28] emphasizes the necessity of consistent contraceptive use during the full course of cancer therapy to prevent abortion from exacerbating fertility impairment. The interview data revealed heightened clinical prioritization of contraceptive counseling among healthcare providers. However, systemic deficiencies in interdepartmental coordination within respondent institutions contribute to fragmented health education delivery and inadequate post-intervention monitoring. This operational gap elevates unintended pregnancy risks through suboptimal contraceptive adherence, ultimately compromising reproductive health service quality. Furthermore, a documented discrepancy exists between patient expectations for comprehensive reproductive health continuity and current clinical protocols, with multiple participants reporting insufficient access to structured fertility guidance. Consistent with Harries et al.'s observations [29], clinicians prioritized pregnancy prevention during active treatment over delivering structured contraceptive counseling across the care continuum. Healthcare systems should prioritize patient-centered fertility care by (1) aligning services with demonstrated reproductive health needs, (2) implementing comprehensive fertility preservation protocols spanning pre-, intra-, and post-treatment phases, and (3) establishing integrated family planning support systems to safeguard reproductive health outcomes throughout the care continuum. A subset of participants voiced concerns regarding fragmented counseling, highlighting systemic communication discontinuities between oncofertility protocols and primary cancer care. Healthcare professionals have also indicated that they currently lack the capacity to deliver specialized gynecologic oncology counseling, compromising evidence-based patient education in cancer care contexts. And a significant care coordination disconnect persists between oncofertility care and primary oncology protocols, compromising patient-centered treatment integration. Consistent with international research findings, a significant proportion of patients failed to undergo structured fertility preservation counseling prior to initiating cancer treatment[30,31]. Notably, even those breast cancer patients who received such counseling demonstrated persistent gaps in accessing evidence-based reproductive guidance and post-procedural support. While global clinical guidelines (e.g., ASCO, ESMO) mandate pretreatment fertility counseling for breast cancer patients, China's healthcare system demonstrates critical gaps in implementing standardized oncofertility protocols and coordinated referral pathways[32,33]. This disparity requires urgent systemic intervention. Current oncological evidence substantiates the safety of post-treatment pregnancy, with family planning considerations significantly influencing quality-of-life metrics in survivorship care[34~35]. To address this imperative, healthcare reforms must prioritize: (1)Interdisciplinary Integration: Establishing multidisciplinary tumor boards integrating reproductive endocrinologists and oncology specialists. (2)Patient-Centered Pathways: Implementing structured referral mechanisms between cancer centers and ART facilities. (3)Tailored Education: Delivering risk-stratified reproductive counseling through information-support tools.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWithin contemporary healthcare frameworks, patient empowerment strategies demonstrate measurable efficacy in enhancing therapeutic engagement, centering on collaborative knowledge transfer and participatory care models that enable patients to actively contribute to treatment decision-making and self-management processes[36]. \u0026nbsp;This study reveals that informed decision-making capacity—crucial for optimizing oncofertility care choices—is fundamentally compromised by systemic barriers including clinical-information asymmetry, data complexity, and cognitive overload. These factors collectively contribute to decisional conflicts and therapeutic ambivalence among patients. The efficacy of clinical decision-making is fundamentally mediated by (1) health literacy thresholds among patients/kin cohorts and (2) systematic values clarification exercises. Cognitive overload induced by excessive information disclosure paradoxically impedes risk-benefit synthesis , necessitating precision education frameworks. This mandates literacy-calibrated disclosure protocols that dynamically adapt content density and presentation modalities to individual. Implement patient-tailored educational interventions calibrated to health literacy levels and decision-making preferences. Respondents in this study indicated that the current information delivery method was inadequate, and content required dynamic adaptation to address evolving practical needs. Clinical demands were not being fully met in practice. Therefore, targeted reproductive health information should be provided according to patients' needs and clinical contexts. This approach would broaden the scope of research by employing diverse methodologies to investigate the oncofertility information requirements of childbearing-age breast cancer patients across distinct treatment phases. By refining informational content and delivering comprehensive, phase-specific support aligned with therapeutic milestones, healthcare providers can mitigate informational dissonance. Furthermore, innovative patient education tools—such as question prompt lists and treatment process animations—should be developed to address clinical needs, thereby safeguarding reproductive health outcomes through evidence-based knowledge dissemination.\u003c/p\u003e\n\u003cp\u003eThe findings revealed that patients experienced multifaceted physical and psychological distress, where familial/social support served as a crucial protective factor. However, clinicians frequently overlooked patients' psychosocial needs during fertility information consultations. Simultaneously, constrained by current healthcare limitations, some patients resorted to digital platforms for emotional support. Existing evidence demonstrates that cancer survivors with fertility concerns express strong preferences for integrated psychological support services throughout clinical encounters[37]. As healthcare professionals with the most sustained clinical engagement with cancer patients, oncology nurses should leverage their pivotal role within multidisciplinary care teams (MDTs) by: providing evidence-based oncofertility counseling, implementing systematic psychosocial needs assessments across treatment trajectories, and facilitating patient navigation through complex decision-making processes. Furthermore, research demonstrates that patient-led information-sharing behaviors significantly influence treatment decision-making, particularly regarding the uptake of fertility preservation options[38]. An international peer-support initiative, Spirit, has shown efficacy in mitigating psychological distress through structured emotional coping strategies[39]. In conclusion, oncology nurses should leverage their clinical expertise and interdisciplinary competencies to proactively address childbearing-related psychological distress through targeted psychosocial interventions. Simultaneously, healthcare systems must mobilize patient empowerment by establishing structured peer-support networks where shared experiential learning occurs among cohorts facing similar fertility challenges. This multidimensional approach addresses the biopsychosocial continuum of needs, ultimately optimizing quality-of-life outcomes through integrated clinical-community support ecosystems.\u003c/p\u003e\n\u003cp\u003eThis study highlights patients' prevalent concerns regarding the financial burdens associated with fertility preservation. While China has incorporated assisted reproductive technology (ART) costs into medical insurance schemes in selected regions, policy frameworks remain under refinement, with nationwide insurance coverage anticipated through ongoing reforms[40]. Given cancer patients' unique socioeconomic vulnerabilities, we propose systemic adjustments to reimbursement scopes and ratios at the national level, advocating for comprehensive insurance integration across all provinces. The empirical evidence from participants provides policymakers and healthcare institutions with critical insights for developing patient-centric health policies and service models, ultimately ensuring equitable access to fertility preservation safeguards for all oncology patients.\u003c/p\u003e\n\u003cp\u003eThe interviewees recruited in this article mentioned that currently, there are still no standardized clinical pathways, such as fertility counseling and information support, in China, and they cannot access effective information and resources. Similar to one research finding, in the field of fertility protection, fertility preservation for tumor patients is the weakest area in China, which significantly differs from that in developed countries[41]. There are few centers providing fertility preservation services for tumor patients, and only a few medical institutions can perform ovarian tissue cryopreservation and establish standardized clinical processes. To improve the current situation, it is urgent to learn from the mature experience of other countries to formulate national strategies, establish standardized registration and full-cycle management mechanisms for fertility preservation in tumor patients, create a network management system for data sharing, strengthen collaborative linkages among cross-regional centers. and promote the standardized development of the tumor reproductive supporting services.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study employed a dual-perspective approach (patient-provider dyads) to examine oncofertility information needs among reproductive-age breast cancer patients. The findings delineate critical knowledge gaps. These insights reveal fundamental disconnects between current clinical practices and patient-centered care imperatives, necessitating multilevel interventions, including Clinical Implementation, Health System Reform, and Country Policy. It will advance global cancer control objectives by operationalizing reproductive healthcare access through measurable quality-of-life enhancements in oncology survivorship care.\u003c/p\u003e\n\u003cp\u003eFunded by Tianjin Key Medical Disciplines(Specialty) Construction Project (TJYXZDXK-011A)\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors contributed to the conception and design of the study. Material preparation, data collection, and analysis were performed by Y XT, Z W, H QB, Y XY and F YX. Y L recruited all participants, and Y XT conducted qualitative interviews. The first draft of the manuscript was written by Y XT. Y L, Y XY, F YX and WZ supervised the entire project and critically revised the first draft for important content. All the coauthors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBray F, Laversanne M, Sung H, et al(2024) Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 74(3):229-263. https://doi.org/10.3322/caac.21834\u003c/li\u003e\n\u003cli\u003eLima S M, Kehm R D, Terry M B(2021) Global breast cancer incidence and mortality trends by region,age-groups, and fertility patterns. E Clinical Medicine 38:100. https://doi.org/10.1016/j.eclinm.2021.100985\u003c/li\u003e\n\u003cli\u003eWang X, Xia C, Wang Y, et al(2023) Landscape of young breast cancer under 35 years in China over the past decades: a multicentre retrospective cohort study (YBCC-Catts study). E Clinical Medicine 64:102243. https://doi.org/10.1016/j.eclinm.2023.102243\u003c/li\u003e\n\u003cli\u003eXu TT, Yang XL, Li JJ(2024) Status Quo of Global Burden of Female Breast Cancer. 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Sex Reprod Healthc 15:40-45. https://doi.org/10.1016/j.srhc.2017.12.002\u003c/li\u003e\n\u003cli\u003eJEROFKE T，WEISS M，YAKUSHEVA O(2014) Patient perceptions of patient-empowering nurse behaviours，patient activation and functional health status in postsurgical patients with life-threatening long-term illnesses． Journal of Advanced Nursing 70(6)：1310-1322． https://doi.org/10.1111/jan.12286\u003c/li\u003e\n\u003cli\u003eGoossens J, Delbaere I, Beeckman D, et al.(2015) Communication Difficulties and the Experience of Loneliness in Patients With Cancer Dealing With Fertility Issues: A Qualitative Study. Oncology Nursing Forum 42(1):34-43. https://doi.org/10.1188/15.ONF.34-43\u003c/li\u003e\n\u003cli\u003eGorman JR, Drizin JH, Mersereau JE, Su HI(2019) Applying behavioral theory to understand fertility consultation uptake after cancer. Psychooncology 28(4):822-829. https://doi.org/10.1002/pon.5027\u003c/li\u003e\n\u003cli\u003eSchover LR, Rhodes MM, Baum G, et al(2011) Sisters Peer Counseling in Reproductive Issues After Treatment (SPIRIT): a peer counseling program to improve reproductive health among African American breast cancer survivors. Cancer 117(21):4983-4992. https://doi.org/10.1002/cncr.26139\u003c/li\u003e\n\u003cli\u003eLambertini M, Peccatori FA, Demeestere I, et al(2020) Fertility preservation and post-treatment pregnancies in post-pubertal cancer patients: ESMO Clinical Practice Guidelines. Ann Oncol 31(12):1664-1678. https://doi.org/10.1016/j.annonc.2020.09.006\u003c/li\u003e\n\u003cli\u003eLiang XH, Jia Y, Jiang X, et al(2024) Application progress of shared decision making in breast cancer patients. Journal of Nursing Administration 24(08):673-677. https://doi.org/10.3969/j.issn.1671-315x.2024.08.006.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-6702998/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6702998/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e The fertility preservation needs of childbearing-age breast cancer patients are frequently overlooked in China, significantly impacting their long-term quality of life. Currently, standardized protocols for fertility information support—including both content frameworks and delivery methods—remain underdeveloped.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods \u003c/strong\u003eBased on the Contextual Model of Health Information Seeking, 34 participants were selected from January 2025 to March 2025. We used semi-structured interviews and directed content analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003eFifteen breast cancer patients (childbearing-age, with expressed reproductive goals post-diagnosis) and 13 medical staff from 3 comprehensive cancer hospitals or centers completed the interviews. There were three themes, including Critical Need for Reproductive Health Information, The deep driving force behind information demand, and Fulfillment of fertility information demands entails multifaceted challenges.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e This study adopts a dual-perspective approach (patients and clinicians) to systematically examine fertility-related information needs among childbearing-age breast cancer patients and identify existing barriers in clinical information support systems. It emphasizes the actual information needs of patients in the face of fertility problems. The findings reveal significant gaps in both the content quality and accessibility of existing informational resources. It suggests that in the future, we should improve fertility support services from various angles such as society, medical institutions, and the state, and pay attention to the fertility needs of breast cancer patients in childbearing age.\u003c/p\u003e","manuscriptTitle":"Dual Perspectives on Fertility Information Needs and Clinical Support Barriers in Breast Cancer Care: A Qualitative Investigation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-27 13:46:07","doi":"10.21203/rs.3.rs-6702998/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3d9c86a7-75ce-4c14-8d39-b0c88fa11e55","owner":[],"postedDate":"June 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-07T02:53:34+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-27 13:46:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6702998","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6702998","identity":"rs-6702998","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}