From Implicit Participation to Integration: The Evolving Role of Nurses in Oncofertility

From Implicit Participation to Integration: The Evolving Role of Nurses in Oncofertility | 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 From Implicit Participation to Integration: The Evolving Role of Nurses in Oncofertility Ying Lin, Qian Wang, Beijia Liu, Lu Zhou, Yulu Zhang, An Shi, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8324545/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background Fertility preservation is an essential component of cancer care, particularly for reproductive-age cancer patients. Nurses, due to their continuous interaction with patients throughout diagnosis and treatment, are uniquely positioned to implement fertility preservation services. However, while current guidelines mention healthcare providers' roles in fertility preservation, there are significant variations in nurse involvement across countries, and their specific responsibilities remain undefined. This study aims to clearly define the specific roles and responsibilities of nurses in fertility preservation for cancer patients. Methods This study uses a scoping review methodology to comprehensively analyze the research evidence and characteristics of nurse involvement in fertility preservation for cancer patients. A systematic search was conducted across multiple databases, including PubMed, CINAHL, EMBASE, Scopus, PsycINFO, Web of Science, as well as guideline repositories such as BMJ Best Practice, the Scottish Intercollegiate Guidelines Network, the National Guidelines Clearinghouse, the ECRI Guidelines Trust™, and the National Institute for Health and Care Excellence. The search covered the period from the inception of the databases to April 2025. All studies and clinical guidelines published in English that addressed the role, responsibilities, and practices of nurses in fertility preservation were included. Results A total of 18 guidelines and 39 studies were included. The analysis of the guidelines revealed that the majority of documents referred to healthcare providers or medical staff in general terms, including nurses, but without specific details on their roles. Further analysis of the literature identified five key stages of nurse involvement in fertility preservation: (1) assessment and referral, (2) counseling and decision support, (3) treatment implementation, (4) long-term follow-up, and (5) system optimization. Cross-regional comparisons revealed significant differences in the definition of nurses' roles, their responsibilities, and the scope of services they provide: North America has established an institutionalized nurse-led model; Europe is exploring nurse-led consultation services; Australia emphasizes an efficiency-oriented coordination model; and Asia primarily focuses on supportive participation, emphasizing emotional resonance and humanistic care. Conclusion Existing guidelines recognize the importance of nurses in fertility preservation services, and the role of nurses is shifting from implicit participation to institutionalized integration. However, there are significant differences in the roles and responsibilities of nurses in practice across countries. This study defines five key stages and 23 specific tasks for nurses involved in fertility preservation services for cancer patients, providing practical evidence for future guideline revisions, nurse training, and clinical pathway optimization. Fertility Preservation Cancer Nursing Nurse's role Figures Figure 1 1. Background With advancements in cancer treatment and a significant increase in survival rates, more young cancer patients are surviving for extended periods [ 1 ]. However, while treatments such as chemotherapy and radiation therapy have been proven to effectively prolong life, they are frequently associated with severe long-term side effects. In the context of cancer survivors, fertility impairment has emerged as a pivotal factor influencing their quality of life. This challenge has been highlighted in multiple studies, with fertility preservation identified as a critical issue in this population [ 2 – 5 ]. Fertility Preservation refers to the use of surgical, pharmacological, or assisted reproductive technologies to help individuals at risk of infertility, such as cancer patients, preserve their ability to have biological offspring. These interventions enable patients to effectively preserve their fertility before the onset of cancer treatment [ 6 ]. In response to these challenges, authoritative organizations such as the American Society of Clinical Oncology, the European Society for Medical Oncology, and the European Society of Human Reproduction and Embryology have all emphasized that fertility preservation is an essential component of comprehensive cancer care. They stress that providing fertility preservation counseling and services to all reproductive-age cancer patients has become an indispensable element of modern oncology nursing [ 7 – 9 ]. However, the clinical implementation of fertility preservation faces numerous challenges. One of the most significant challenges is time sensitivity, decisions regarding fertility preservation must be made quickly within the limited time frame before cancer treatment begins [ 10 , 11 ]. Moreover, fertility preservation services involve complex interdisciplinary collaboration across fields such as oncology, reproductive medicine, psychology, and ethics [ 7 ]. Under the immense pressure of a cancer diagnosis, patients are required to make rapid, life-altering decisions about their future fertility, creating an additional emotional burden [ 12 , 13 ]. This complexity underscores the need for a central role in providing continuous information, emotional support, and coordination throughout the process. Given that nurses have the most frequent and sustained contact with patients, they are well-positioned to take on this critical role. Nurses have long been recognized for their strengths in health education and patient advocacy, making them ideal candidates for the role of fertility preservation coordinators [ 14 ]. Research has demonstrated that active nurse involvement significantly increases referral rates, patient satisfaction with decisions, and overall care quality in fertility preservation services [ 15 – 18 ]. Despite the widely recognized importance of nurses in fertility preservation, the specific definition of their roles and responsibilities remains vague and inconsistent in the literature and international guidelines [ 14 , 19 , 20 ]. For instance, while the American Society of Clinical Oncology and the European Society of Human Reproduction and Embryology guidelines recommend a multidisciplinary team approach, they only broadly emphasize that nurses, as healthcare providers, should offer information and psychological support, without clearly defining their responsibilities. This lack of clarity has led to significant differences in the practical implementation of nurses’ roles globally. In countries with more developed fertility preservation services, nurses typically undertake core responsibilities such as initial patient consultation, risk communication, referral coordination, and interdisciplinary team communication. In some regions, positions such as "nurse navigator" or "fertility preservation coordinator" have even been established, realizing a nurse-led model for fertility preservation services [ 21 , 22 ]. However, in countries where fertility preservation services are still emerging, influenced by structural issues in the healthcare system, role distribution, and professional culture, nurses perceive fertility preservation as the domain of physicians, thereby limiting their involvement in counselling and referral [ 23 ]. This discrepancy in role recognition and institutional frameworks contributes to the inconsistency in fertility preservation service quality and affects the provision of standardized, comprehensive care for patients [ 24 ]. Therefore, this study employs a scoping review approach to clearly define the core roles and specific responsibilities of nurses in fertility preservation services, thereby providing evidence for the development of standardized nursing models and policy formation. 2. Methods This study constitutes a scoping review with the objective of elucidating the roles and responsibilities of nurses in fertility preservation for cancer patients. The scoping review was not registered. The specific objectives of this study are as follows: 1) To review existing clinical guidelines that delineate the role of nurses in fertility preservation for cancer patients. 2) To conduct a literature review to identify the roles and practices of nurses in fertility preservation for cancer patients. 2.1 Search strategy To ensure a comprehensive search strategy, we followed the three-step search approach recommended by JBI for scoping reviews [ 25 ]. Initially, we searched the PubMed and Embase databases, identifying MeSH terms such as "oncology," "fertility preservation," "nursing," and "nurse." Subsequently, we expanded the scope of the search to include other databases, using a combination of MeSH terms and free-text keywords, along with Boolean operators AND/OR: PubMed, CINAHL, EMBASE, Scopus, PsycINFO, Web of Science, as well as guideline repositories including BMJ Best Practice, the Scottish Intercollegiate Guidelines Network, the National Guidelines Clearinghouse, the ECRI Guidelines Trust™, and the National Institute for Health and Care Excellence. To further ensure comprehensive coverage, we also reviewed the reference lists of included articles. The search encompassed all available data from the inception of each database through April 2025. A detailed search strategy for PubMed can be found in Table 1 of the supplementary materials. Table 1 Roles and Responsibilities of Nurses in Fertility Preservation for Cancer Patients as Described in Guidelines Year Country/Region Guideline Issuing Organization Nurse Role Responsibilities 2006,2013,2018,2025 USA American Society of Clinical Oncology Guideline Update on Fertility Preservation in People With Cancer [ 7 , 27 , 34 , 40 ] American Society of Clinical Oncology (ASCO) 2006: Nurses are not explicitly mentioned, referred to as oncologists. 2013: Responsibilities are assigned to healthcare providers, including nurses. 2018: Nurses explicitly appear in the Target Audience. 2025: Nurses are explicitly listed as a core member of the fertility preservation team. 2006: • Healthcare providers must inform patients of infertility risks before treatment begins. • Provide or refer patients to reproductive specialists for fertility preservation counseling and procedures. • Adopt a multidisciplinary approach, including oncology, psychological support, and ethical counseling. • Document fertility preservation discussions and patient preferences. 2013: • Initiate fertility preservation discussions promptly and document them in writing. • Proactively inquire about patients' fertility preservation preferences and refer them to reproductive specialists. • Provide neutral, standardized fertility preservation information. • Introduce fertility preservation methods, including sperm, oocyte, and embryo cryopreservation. • Clarify the experimental nature of other fertility preservation techniques. 2018: • Initiate fertility preservation discussions as soon as possible after diagnosis. • Inform patients and refer them to reproductive specialists. • Document the fertility preservation discussion process in the medical record. 2025: • Assess and communicate reproductive risks at the time of diagnosis. • For patients who express interest or uncertainty, promptly refer them to reproductive specialists. • Ensure the accessibility of the multidisciplinary fertility preservation team (including nurses, psychologists, social workers, etc.). • Provide standardized written information and conduct ongoing follow-up throughout the process. • fertility preservation counseling should extend through the treatment and follow-up phases. • The medical team should assist patients in advocating for fertility preservation policies and insurance coverage. 2008,2020 USA Preservation of Fertility in Pediatric and Adolescent Patients With Cancer [ 41 , 42 ] American Academy of Pediatrics (AAP) Nurses are not explicitly mentioned, and responsibilities are assigned to both pediatricians and the multidisciplinary team 2008: • Oncologists must inform pediatric patients and their families about the potential infertility risks of treatment and provide comprehensive counseling. • fertility preservation assessment should be conducted by a multidisciplinary team, including pediatric oncologists, reproductive medicine specialists, ethicists, and mental health professionals. • Parental consent should be obtained, clarifying whether the procedure is experimental and its associated risks. • Provide written information on sample storage, disposal, and post-mortem management. 2020: • Physicians should provide communication and counseling regarding treatment-induced infertility risks and available fertility preservation options. • For patients willing or suitable for fertility preservation, they should be promptly referred to a facility with fertility preservation expertise. • fertility preservation should be implemented with moderate delay, without compromising treatment success rates. • Establish institutional-level fertility preservation assessment policies and ensure multidisciplinary team support (oncology, reproductive medicine, urology, radiation oncology, ethics and legal advisors, psychological experts). • fertility preservation decision-making should consider the child's preferences and consent, and the procedure’s nature, expected benefits, and risks should be fully explained. • Pediatricians play a key coordinating role in the fertility preservation process, ensuring timely identification, communication, and helping families build hope. 2011 USA Oncofertility Consortium Program Description and Framework for Fertility Preservation in Young Patients with Cancer [ 28 ] Oncofertility Consortium Nurses are not explicitly mentioned, and responsibilities are described as healthcare providers and interdisciplinary teams • Patient navigation and education through interdisciplinary medical teams to support informed decision-making • Establishment of a multicenter collaborative network to standardize the acquisition and storage process • Ongoing education for patients and professionals to ensure understanding of procedures, limitations, and expectations 2012 International International Society for Fertility Preservation Guideline on Fertility Preservation in Patients with Lymphoma, Leukemia, and Breast Cancer [ 29 ] International Society for Fertility Preservation (ISFP) Nurses are not explicitly mentioned, referred to as healthcare providers • Fertility preservation must be discussed with reproductive-age patients before treatment • Consultation provided by reproductive specialists, with available options introduced • Individualized recommendations made in accordance with ethical standards • Ongoing communication with oncology regarding treatment plans and prognosis 2012,2014,2018,2024 USA National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Adolescent and Young Adult Oncology [ 39 , 43 – 45 ] National Comprehensive Cancer Network (NCCN) 2012: Nurses are not explicitly mentioned, referred to as health care professionals 2014: Nurses are not explicitly mentioned, fertility preservation tasks are collectively carried out by a multidisciplinary team 2018: Nurses are not explicitly mentioned, fertility preservation tasks are still carried out by a team of providers 2024: Nurses are not explicitly mentioned, referred to as a multidisciplinary team of providers with expertise 2012: • Assess and discuss infertility risks and fertility preservation options before treatment begins. • Conduct a comprehensive evaluation that includes reproductive endocrine and psychosocial factors, providing informed communication. • Refer patients to multidisciplinary centers with experience in Adolescent and Young Adult treatment and fertility preservation resources. • In decision-making, address age-specific issues such as fertility plans, financial burden, and adherence. 2014: • Discuss fertility preservation and contraception options before treatment, clearly defining fertility preservation methods by gender. • Strengthen interdisciplinary collaboration between oncology, radiation oncology, gynecology, etc., to ensure the feasibility of fertility preservation plans. • Implement individualized management and interdisciplinary coordination for pregnant cancer patients. 2018: • Conduct pregnancy testing and contraception counseling before treatment, explaining the potential impact of treatment on fertility. • Introduce feasible fertility preservation methods and recommend referral to multidisciplinary cancer centers with fertility preservation services. • Integrate fertility preservation into comprehensive assessment and psychosocial support systems to ensure continuous management. • The medical team should be equipped to provide integrated services, including fertility, education, vocational, and psychological support. 2024: • Systematically discuss fertility and sexual function risks in comprehensive assessments, providing fertility preservation and contraception education. • Ensure timely referral to fertility preservation or reproductive health programs, ensuring accessibility of services. • Facilitate patient expression of preferences and informed decision-making through individual counseling. • Emphasize professional collaboration within the multidisciplinary team for fertility preservation and psychosocial management. 2013 Scotland Long-term Follow-up of Survivors of Childhood Cancer (SIGN 132) [ 33 ] Scottish Intercollegiate Guidelines Network (SIGN) Nurses explicitly mentioned as leading the service • Provide personalized testing, assessment, and fertility preservation strategies for patients at risk of fertility impairment • Referral to assisted reproduction and specialized psychological support when necessary • Nurse-led long-term follow-up and management 2018 Japan Guidelines on the Freezing and Preservation of Unfertilized Oocyte and Ovarian Tissue [ 46 ] Japanese Society for Reproductive Medicine(JSRM) Nurses are not explicitly mentioned, and responsibilities are clearly assigned to the attending physician and reproductive medicine specialists • The attending physician for the underlying disease must provide written information and permission, and jointly with the reproductive specialist, complete the informed consent process (explaining methods, risks, pregnancy chances, treatment effects, and costs). • Sperm/egg cryopreservation and assisted reproductive technology should ideally be performed within the same institution. If not feasible within the same facility, an inter-institutional collaboration mechanism should be established. • The implementing institution is responsible for long-term storage, regularly confirming storage preferences, transferring specimens compliantly when necessary, and registering with the Japan Society of Obstetrics and Gynecology. • For minors, consent must be reconfirmed and re-signed upon reaching adulthood, ensuring full compliance with ethical review and use restrictions throughout the process. 2017 Japan Japanese Society of Clinical Oncology Clinical Practice Guidelines for Fertility Preservation in Childhood, Adolescent, and Young Adult Cancer Patients (Part 1 & Part 2) [ 35 , 36 ] Japanese Society of Clinical Oncology (JSCO) Nurses explicitly included as representatives at the team level • Inform pediatric patients/families about infertility risks and provide relevant information • Identify patients suitable for fertility preservation • Refer to reproductive specialists early for those with clear intentions or needs • Work closely with reproductive specialists to assess feasible options and the optimal timing for interventions • Maintain ongoing collaboration between oncology and reproductive medicine from diagnosis through several years after treatment • In certain cases (e.g., chemotherapy delays in breast cancer, ethical consent issues in pediatric patients), provide detailed counseling and psychological support 2017 Korea Korean Society for Fertility Preservation Clinical Guidelines for Fertility Preservation in Cancer Patients [ 37 ] Korean Society for Fertility Preservation (KSFP) Nurses explicitly mentioned as team members responsible for education and navigation • Arrange for a navigator to handle fertility preservation navigation/appointments, with consultation completed within 24–72 hours • Cross-disciplinary communication and information feedback • Annual follow-up of frozen samples • Provide fertility counseling in various formats (verbal explanations, written materials, online resources, and electronic educational tools) to ensure patients understand the risks and available fertility preservation options 2017 Germany/Austria/Switzerland FertiPROTEKT Network Practical Recommendations on Female Fertility Preservation in Cancer Patients (Part I: Diseases; Part II: Methods) [ 30 , 31 ] FertiPROTEKT Network Nurses are not explicitly mentioned, referred to as part of the physician and laboratory teams • Provide information on disease prognosis and infertility risks to support decision-making • Offer various fertility preservation techniques based on individual needs and timing • Organize follow-up care after preservation, including pregnancy management (monitoring, stimulation, natural conception, or In Vitro Fertilization) 2018 UK British Fertility Society Policy and Practice Guideline: Fertility Preservation for Medical Reasons in Girls and Women [ 38 ] British Fertility Society (BFS) Nurses explicitly mentioned for decision support and pathway management • Initiate early discussions on fertility preservation • Multidisciplinary decision support • Recommend establishing efficient service pathways and timely referrals • Reproductive clinic follow-up, informing patients of long-term impacts and available options 2020 Europe European Society of Human Reproduction and Embryology Guideline on Female Fertility Preservation [ 9 ] European Society of Human Reproduction and Embryology (ESHRE) Nurses explicitly mentioned as requiring education and training • Clinicians provide information (risks, options, storage, assisted reproduction, pregnancy, and alternative pathways) • Establish direct communication and referral mechanisms to the fertility preservation team (a coordinator may be appointed) • The multidisciplinary team assesses risks and holds joint communications • Provide psychological support and counseling services during decision-making • Clinicians and nurses should receive regular fertility preservation education and training 2022 Europe European Society for Medical Oncology Clinical Practice Guideline on Fertility Preservation in Patients with Cancer [ 8 ] European Society for Medical Oncology (ESMO) Nurses explicitly mentioned as members of the multidisciplinary team Inform patients of infertility risks as early as possible before treatment and refer them in a timely manner • Nurses, along with physicians and psychologists, form the multidisciplinary team to ensure timely counseling and decision-making • Provide ongoing counseling and support throughout the treatment process and survival period regarding reproductive issues, psychological needs, and long-term follow-up 2022 Spain Multidisciplinary Consensus on the Criteria for Fertility Preservation in Cancer Patients [ 47 ] Spanish Society of Medical Oncology (SEOM); Spanish Fertility Society (SEF); Spanish Society of Hematology and Hemotherapy (SEHH); Spanish Society of Pediatric Hematology and Oncology (SEHOP); Spanish Society of Radiation Oncology (SEOR) Nurses are not explicitly mentioned, with responsibilities directed towards oncologists and hematologists • Oncologists and hematologists inform patients of infertility risks and introduce preservation options before treatment begins • Fertility preservation requires interdisciplinary collaboration for implementation 2022 Australia Clinical Oncology Society of Australia Guideline: Fertility Preservation for People with Cancer [ 48 ] Clinical Oncology Society of Australia (COSA) Nurses are not explicitly mentioned, referred to as healthcare professionals • Incorporate fertility discussions into routine cancer management and document in medical records • Inform all patients about the potential impact of treatment on fertility • Provide age-appropriate educational materials • Continuously participate in professional education • Assess patients' risk of fertility impairment • Post-cancer treatment reproductive function follow-up • Provide contraception and sexual health counseling 2024 Canada Canadian Fertility and Andrology Society Clinical Practice Guideline on Fertility Preservation in Patients Undergoing Gonadotoxic Treatments [ 32 ] Canadian Fertility and Andrology Society (CFAS) Nurses are not explicitly mentioned, referred to as healthcare providers in general • Provide information on fertility risks and conduct informed consent discussions on preservation options as soon as possible after diagnosis, followed by timely referral • Close collaboration between reproductive medicine and oncology departments to establish a referral network and address knowledge/resource barriers • Childhood cancer survivors enter long-term follow-up clinics and undergo regular reviews of fertility preservation possibilities 2024 Europe Fertility-sparing treatment and follow-up in patients with cervical cancer, ovarian cancer, and borderline ovarian tumours: guidelines from ESGO, ESHRE, and ESGE [ 49 ] The European Society of Gynaecological Oncology (ESGO), the European Society of Human Reproduction (ESHRE) and Embryology, and the European Society for Gynaecological Endoscopy (ESGE) Directed towards multidisciplinary team members, with no explicit mention of nurses as part of the team • Assess and counsel patients with fertility preservation needs before cancer treatment Collaborate with a multidisciplinary team and, when necessary, refer patients to reproductive medicine specialists. • Perform a detailed pre-surgical assessment, implement fertility-preserving surgeries, and assess fertility post-surgery. • Provide patients with comprehensive education on fertility preservation options, along with emotional and psychological support. • Conduct regular follow-up visits to monitor fertility recovery and cancer recurrence. 2.2 Managing the results We used the reference management software EndNote 20 to manage the citations and check for duplicates. All references retrieved from each database were imported into this software to ensure consistency in the total number of references obtained. 2.3 Inclusion and exclusion criteria The inclusion criteria for this review were as follows: Studies and clinical guidelines reporting the role of nurses in fertility preservation for cancer patients. Publications written in English. The following types of studies were excluded: • Studies for which the full text was not accessible. 2.4 Screening process All documents retrieved from the databases were checked for duplicates using EndNote software. Two team members independently reviewed the titles and abstracts of the articles based on the inclusion and exclusion criteria for initial screening. Subsequently, they read the full texts and conducted the final selection. Any discrepancies were resolved through consultation with a third researcher. 2.5 Data extraction and synthesis The information extracted from the included studies included the authors, study title, publication year, country in which the study was conducted, study design, sample, and the role of nurses in fertility preservation. Data extraction was conducted using a chart adapted from the framework proposed by Arksey and O'Malley (2005) [ 26 ], which encompasses both general and specific information on nursing activities related to fertility preservation in cancer care. Two reviewers independently extracted the data, and any discrepancies were resolved through consultation with a third researcher. A narrative synthesis was then used to provide a comprehensive overview of nurse involvement in fertility preservation care. 2.6 Selection of evidence sources After removing duplicate records, a total of 624 articles were retrieved from the database search. Of these, 152 articles were selected based on their titles and abstracts. Following full-text screening, 33 studies were included in this review. Subsequently, through secondary citation searching of the included studies, 6 more relevant articles were identified. Furthermore, 18 relevant clinical guidelines were identified through searches of guideline repositories and organizational websites. The study ultimately included 39 research studies and 18 guidelines. A detailed overview of the study selection process is presented in the PRISMA flow diagram (Fig. 1 ). 3. Results 3.1 Characteristics of included studies This study included 18 clinical practice guidelines on fertility preservation for cancer patients published between 2011 and 2025, encompassing regions including North America, Europe, Asia, and Oceania. The majority of the guidelines were from North America and Europe, followed by some countries in Asia and Oceania. Approximately 70% of the guidelines were published after 2017, indicating a significant increase in international attention to fertility preservation for cancer patients in recent years. The included studies were published between 2003 and 2025. Approximately 70% of the studies were published after 2010, indicating a continuous increase in academic attention to the role of nurses in fertility preservation for cancer patients in recent years. In terms of study design, literature reviews constituted the largest proportion (22 studies), followed by qualitative studies (6), retrospective cohort studies (4), descriptive studies (4), and interventional studies (3). The studies mainly focused on the role and responsibilities of nurses in fertility care for cancer patients. Geographically, the highest number of studies were from the United States (24 studies), followed by Canada (5), the Netherlands (4), and the United Kingdom (3), with one study each from Japan, Australia, and China. 3.2 Synthesis of results 3.2.1 Nurses' roles identified in clinical guidelines This scoping review included 18 guidelines on fertility preservation for cancer patients published between 2006 and 2025, covering regions such as North America, Europe, Asia, and Oceania. The issuing organizations of these guidelines primarily include international professional societies and multidisciplinary alliances, such as the American Society of Clinical Oncology, the European Society of Human Reproduction and Embryology, the Japanese Society of Clinical Oncology, and the Korean Society for Fertility Preservation. Whether or not nurses are explicitly mentioned and the scope of their responsibilities vary significantly across time and regions, as detailed in Table 1 . In the early guidelines, the role of nurses was often implicit or generalized. For example, the 2006 the American Society of Clinical Oncology guideline [ 27 ], the earliest published, attributed the described responsibilities to oncologists, nurses were not specifically mentioned. Similarly, the 2011 Oncofertility Consortium framework [ 28 ] and the 2012 International Society for Fertility Preservation Guideline [ 29 ] emphasized multidisciplinary collaboration and patient education, but referred to healthcare professionals or healthcare providers without explicitly mentioning nurses. Likewise, the FertiPROTEKT network guidelines [ 30 , 31 ] and the Canadian Fertility and Andrology Society guidelines [ 32 ] used terms like healthcare providers or medical personnel, with no clear mention of nurses. Since 2013, some guidelines began to explicitly state that fertility preservation services for cancer patients require the involvement of a multidisciplinary team, with some guidelines recognizing nurses as key members of the team. For example, the Scottish SIGN guideline [ 33 ] proposed nurse-led long-term follow-up and management, and thereafter, the role of nurses was gradually mentioned in various guidelines. In the 2013 update of the American Society of Clinical Oncology guideline [ 34 ], the responsibility was shifted to “healthcare providers,” explicitly including nurses. Since then, an increasing number of guidelines have incorporated nurses into multidisciplinary fertility preservation teams. The Japanese Society of Clinical Oncology [ 35 , 36 ] and the Korean Society for Fertility Preservation [ 37 ] explicitly included nurses at the team level, defining their roles in patient navigation, information provision, and educational counseling. The British Fertility Society [ 38 ] clearly identified nurses’ responsibilities in decision support and care pathway management. The European Society of Human Reproduction and Embryology [ 9 ] further emphasized that both physicians and nurses should receive continuous professional education and training in fertility preservation. Moreover, the European Society for Medical Oncology [ 8 ] designated nurses as core members of the multidisciplinary team, responsible for key tasks such as psychological support, reproductive decision-making, and long-term follow-up. The most recent updates from North America, including the American Society of Clinical Oncology 2025 [ 7 ] and NCCN 2024 [ 39 ], reaffirmed the central position of nurses in the fertility preservation team, clearly defining their roles in risk communication, counseling referrals, psychological support, and long-term health management. These updates reflect the growing institutionalization of nurses' roles throughout the fertility preservation process. Overall, the guidelines demonstrate a clear chronological evolution. Before 2013, nurses were not explicitly mentioned and were only implicitly included under general terms such as “healthcare providers” or “medical personnel.” After 2013, several guidelines began to emphasize the necessity of a multidisciplinary approach to fertility preservation services for cancer patients, and gradually, some explicitly identified nurse-led or nurse-participating roles. With the development of multidisciplinary fertility preservation services, nurses have since been widely integrated as formal members of these teams, with responsibilities encompassing patient education, information coordination, psychological support, and follow-up management. This evolutionary process reflects a clear transition in the role of nurses in fertility preservation practice for cancer patients—from implicit participation to explicit recognition, and from a supportive role to a central, leading position. 3.2.2 Nurses' roles identified in scientific publications Through literature analysis, we identified 23 core tasks that nurses undertake in fertility preservation for cancer patients. These tasks are categorized into five key stages based on the characteristics of the fertility preservation implementation process: (a) assessment and referral, (b) counseling and decision support, (c) treatment implementation, (d) long-term follow-up, and (e) system optimization. The specific roles and tasks for each stage are detailed in Table 2 . Table 2 Roles and Tasks of Nurses in Fertility Preservation for Cancer Patients as Identified in Studies Stage Role Tasks a: Assessment and Referral Identification and Communication of Fertility Risks ① Screen and assess reproductive desires and needs of reproductive-age patients [ 15 , 17 , 50 – 55 ] ② Explain the potential impact of cancer treatments on fertility to patients[ 16 , 24 , 51 , 56 – 67 ] ③ Proactively initiate discussions on fertility preservation, introducing the concept and available options [15, 17 , 19 , 24 , 26 , 52 , 53 , 55 , 58 – 61 , 63 , 65 – 7 1] ④ Coordinate and schedule referrals to fertility preservation specialists [ 15 – 17 , 19 , 24 , 50 – 52 , 62 – 64 , 66 – 68 , 72 – 74 ] b: Counseling and Decision Support Information Support and Multidisciplinary Collaboration ① Provide detailed information on the indications and risks of fertility preservation technologies [ 21 , 58 – 60 , 62 , 64 , 65 , 69 , 70 , 72 , 73 , 75 , 76 ] ② Provide printed materials or online resource links[ 16 , 21 , 50 , 51 , 63 , 74 , 75 , 77 ] ③ Identify and alleviate emotional stress due to fertility loss [62, 64 , 73 , 76 – 7 8] ④ Ensure compliance with legal, ethical, and governmental standards in procedures [ 77 ] ⑤ Provide financial assistance information, insurance guidance, and application support [ 15 , 16 , 64 , 76 ] ⑥ Verify that the physician has discussed fertility preservation with the patient and documented it [ 21 , 63 , 78 , 79 ] ⑦ Ensure that the patient is fully informed and has provided consent before making a decision [ 70 , 77 ] ⑧ Coordinate communication within the multidisciplinary team regarding patient fertility goals and the integration of the fertility preservation process[ 15 – 17 , 21 , 72 , 73 , 76 , 77 , 80 , 81 ] d: Treatment Implementation Clinical Guidance and Process Navigation ① Instruct patients on hormone injection techniques [ 73 , 76 ] ② Coordinate and schedule fertility preservation-related tests (e.g., ultrasound, hormone tests) and provide feedback on results[ 17 , 21 , 73 ] ③ Assist with sperm/egg collection procedures and provide feedback on results [17, 26 , 73 , 8 2] e: Long-term Follow-up Long-term Outcome Tracking and Ongoing Support ① Conduct post-treatment follow-up to evaluate fertility preservation outcomes and patient responses [ 73 ] ② Assess patients' future fertility needs [ 74 ] ③ Provide recommendations for future reproductive options [57] f: System Optimization System Improvement and Capacity Building ① Optimize fertility preservation clinical pathways and nursing standard operating procedures [ 16 ] ② Conduct fertility preservation-related education and training for healthcare personnel[ 16 , 51 , 74 ] ③ Design and distribute fertility preservation toolkits and guidelines [51, 63 , 7 5] ④ Provide administrative management support [67] ⑤ Maintain patient databases to support research [ 51 , 67 ] a. Assessment and Referral The core task in this stage is the nurse’s initial identification and communication of the patient's fertility risks. Nurses must screen and assess the reproductive desires and needs of reproductive-age cancer patients and clearly explain the fertility risks and potential impacts of cancer treatments. Additionally, nurses need to proactively discuss fertility preservation options and feasible measures with patients, taking responsibility for coordinating referrals to fertility preservation specialists to ensure that patients receive timely professional support. b. Counseling and Decision Support In this stage, the nurse’s primary responsibility is to provide informational support. Nurses must not only explain in detail the indications, process, and risks associated with fertility preservation technologies, but also enhance patient understanding through printed materials or online resources. Furthermore, nurses should be alert to the psychological pressure that patients may experience due to fertility impairment, identify it promptly, and intervene when necessary. Nurses are also responsible for ensuring that the procedures comply with ethical, legal, and governmental standards, as well as providing financial aid information and assisting with insurance applications. Additionally, nurses must confirm whether the discussion of fertility preservation between the doctor and patient is sufficient and document this effectively to ensure the integrity and compliance of the decision-making process. c. Treatment Implementation During the treatment implementation stage, nurses provide clinical guidance and process navigation: instructing patients on self-administered hormone injection techniques, coordinating the timing of key tests such as ultrasound monitoring and hormone testing, and providing feedback on results. Nurses also assist during sperm/egg collection, ensuring the safety and correct execution of the fertility preservation procedures. d. Long-term Follow-up After completing fertility preservation treatment, nurses are responsible for long-term outcome tracking and ongoing support. Nurses conduct regular follow-up visits to assess the effectiveness of fertility preservation and the patient’s physical and psychological responses. They dynamically track changes in fertility needs and, based on individual circumstances, offer advice on alternative reproductive pathways, such as adoption or surrogacy, extending support from short-term intervention to long-term fertility planning. e. System Optimization In this stage, nurses are involved in driving system improvements and capacity building, with responsibilities mainly in education, research, and management. By providing continuous feedback, nurses help optimize clinical pathways and standardize processes to improve service quality. They also conduct specialized training for healthcare personnel on fertility preservation and develop clinical tools and guidelines for fertility preservation. Furthermore, nurses actively participate in the collection and analysis of clinical data related to fertility preservation and provide administrative management support, driving continuous improvement and development in related research and practices. 3.2.3 Comparison of Nurses’ Roles in Fertility Preservation for Cancer Patients across Countries The included literature was summarized and analyzed by region, revealing significant differences in the roles, practices, and coverage of service stages for nurses in fertility preservation for cancer patients across these regions, as detailed in Table 3 . Table 3 Comparison of Nurses' Roles and Responsibilities in Fertility Preservation for Cancer Patients Across Different Countries Region Country Role Definition Practice Practice Coverage Stages North America Canada, USA Nurse navigators/coordinators are commonly appointed, and nurses predominantly lead fertility preservation services in institutionalized roles Patient Identification and Screening: Identifying reproductive-age women who may be affected by cancer treatment, proactively offering fertility preservation options, and discussing treatment plans with patients and physicians. Providing Information and Emotional Support: Offering detailed information about fertility preservation, addressing patients' concerns, and alleviating psychological stress related to the reproductive consequences of treatment. Coordinating the Interdisciplinary Team: Coordinating telemedicine consultations, referrals to reproductive specialists, psychologists, and other professionals to ensure comprehensive care across multiple departments. Patient Advocacy and Education: Providing fertility preservation education after initial diagnosis to ensure informed decision-making. Conducting health education activities, promoting fertility preservation options, and providing related resources. Policy and System Advancement: Participating in the development of fertility preservation programs and policy advocacy, such as training nurses to enhance fertility preservation education skills and promoting the standardization of fertility preservation services. a–e Asia China, Japan Nurses participate as team supporters, rather than fully leading the process Perceiving Patient Needs and Emotional Support: Identifying patients' fertility preservation needs during treatment and providing emotional support through empathy, helping them navigate emotional conflicts in fertility preservation decisions. Providing Information and Education: Offering detailed information about fertility preservation, helping patients understand available options, and providing the necessary counseling and education for fertility preservation decisions. Interdisciplinary Team Collaboration: Collaborating closely with other professionals (e.g., oncologists, gynecologists, psychologists, pharmacists, social workers) to provide comprehensive fertility preservation services and holistic support for patients. a–c Oceania Australia Nurses are integrated into the multidisciplinary "rapid response" system as coordinators, playing a key bridging role in the initiation of fertility preservation services Patient Education and Emotional Support: Educating patients about fertility preservation, helping them understand available options, and providing emotional support to alleviate anxiety about fertility consequences of treatment. Process Coordination: Coordinating the fertility preservation service process, ensuring timely responses and referrals for patients. Interdisciplinary Collaboration: Working with physicians, embryologists, social workers, and other professionals to ensure rapid response and continuous patient support. Long-term Follow-up Management: Leading long-term follow-up for patients after fertility preservation services, ensuring continued care and support post-treatment. a–d Europe UK, Netherlands Nurses are part of the fertility preservation service team, primarily responsible for information transfer and pathway coordination, with gradual exploration of nurse-led models Providing Information and Education: Offering detailed information on fertility preservation, including the reproductive consequences of treatment, various fertility preservation options, and their pros and cons, to help patients make informed decisions. Decision Support and Psychological Support: Providing support during the decision-making process, particularly offering emotional support and psychological counseling when patients face the consequences of treatment, helping them manage the psychological stress associated with fertility preservation. Interdisciplinary Team Collaboration: Collaborating with oncologists, gynecologists, embryologists, psychologists, and other professionals, coordinating information flow between specialties to ensure timely and effective care throughout the treatment process. Assisting Referrals and Follow-up: Coordinating patient referrals and follow-ups to ensure patients receive the necessary subsequent treatments and exams, adjusting fertility preservation plans according to treatment progress. Implementing Fertility Preservation: Involved in the implementation of fertility preservation measures, such as sperm freezing, providing procedural guidance, emotional support, and assisting patients through the process. Long-term Support and Information Follow-up: Providing long-term follow-up and information support post-fertility preservation, ensuring continued emotional support and fertility management information after treatment. Education and Training: Participating in peer education and staff training to improve the overall knowledge level of the team, ensuring high-quality patient care. a–e In North America (the United States and Canada), fertility preservation services have become institutionalized, with nurses commonly serving as fertility preservation coordinators or navigators. These nurses lead tasks such as patient identification, early communication, interdisciplinary coordination, informed consent, and follow-up management, covering the entire fertility preservation process. This has resulted in a systematic, nurse-led service model. In Asia (China, Japan), nurses primarily participate as team support members, with their roles focused on identifying patient needs, providing emotional support, assisting in doctor-patient communication, and providing early information. Nurses in this region have not yet fully taken a leading role in the fertility preservation process. Compared to North America and Europe, nurses in Asia have less autonomy but excel in providing humanistic care and emotional resonance. In Australia, nurses are integrated into a multidisciplinary "rapid response" system and often act as coordinators, bridging roles in the fertility preservation service. They are responsible for quickly initiating referrals after diagnosis, providing education, and offering emotional support, ensuring continuity of the fertility preservation process. This reflects an efficiency-driven coordination model. In Europe (the United Kingdom and the Netherlands), nurses are key members of the fertility preservation team, primarily responsible for information transfer, patient education, and pathway coordination. Although most services are still physician-led, the nurse-led consultation model is gradually being explored. Overall, the cross-regional comparison reveals that nurses' core roles in patient education, pathway coordination, and psychosocial support are universally recognized. However, North America and Australia have already established institutionalized nurse-led models, Europe is transitioning towards this model, and Asia is still in the early stages, primarily focused on support and communication. This global trend reflects a gradual evolution from collaborative participation to leading practice. 4. Discussion This review through systematic literature analysis and guideline comparison, revealed a clear temporal evolution and regional differences in the definition of nurses' roles in fertility preservation for cancer patients across different countries and regions. Analysis of 17 international guidelines in this study reveals two main characteristics: a clear evolutionary trend in the role of nurses and the widespread vagueness of their responsibilities. First, the guidelines reflect a global shift in nurses' roles from "implicit involvement" to "institutionalized inclusion." Early guidelines, such as the 2011 Oncofertility Consortium framework [ 28 ] and the 2012 ISFP guidelines [ 29 ], typically described roles using the broad concept of "healthcare providers" without specifically identifying nurses. Since the release of the 2013 SIGN guidelines [ 33 ], the role of nurses is gradually gaining recognition. In recent years, updated guidelines such as the American Society of Clinical Oncology [ 7 ] and NCCN [ 39 ] have formally included nurses as core members of the multidisciplinary fertility preservation team. Second, despite most guidelines now including nurses as part of the fertility preservation team, the specific tasks assigned to them are still not clearly defined, leading to insufficient clinical applicability. This lack of clarity can cause issues such as unclear role boundaries and uneven responsibility distribution in practice [ 20 , 23 ]. Possible reasons for this include differences in fertility preservation legislation and policy support across countries, physician-dominated guideline development processes, and the deliberate blurring of roles in interdisciplinary collaborations to ensure flexibility. This phenomenon suggests that future guideline development and training systems should more clearly define nurses' roles and competency standards, which will help standardize and institutionalize the nursing role in fertility preservation and provide a solid basis for nurses' clinical practice. From the literature results summarized in this study, it is evident that most research on nurses in fertility preservation has focused on the assessment, referral, and initial consultation stages, while studies on treatment implementation, long-term follow-up, and system optimization are still relatively scarce. This has resulted in an overall fragmented fertility preservation nursing process, with nurses' roles not fully developed throughout the entire process. This study elevates nurses' roles in fertility preservation from a series of isolated tasks to a comprehensive role that spans the entire process. It systematically explains how nurses connect patients, multidisciplinary teams, and healthcare systems to ensure the continuity and completeness of fertility preservation services. Nurses' roles across different stages include: early identification of patient needs (assessment and referral), providing information and psychological support (counseling and decision support), guiding and assisting in specific treatments (treatment implementation), tracking patient conditions long-term (long-term follow-up), and promoting system development and quality improvement (system optimization). These five stages and 23 tasks systematically clarify nurses' bridging and coordinating roles throughout the entire fertility preservation process, providing a basis for the future design of standardized fertility preservation nursing pathways, development of job descriptions, and assessment tools. The cross-national comparison further reveals that nurses' clinical roles in fertility preservation vary significantly depending on national healthcare systems, policies, and nursing education backgrounds. In North America, fertility preservation services are highly institutionalized, with nurses often serving as "fertility preservation coordinators" or "navigators," overseeing risk assessment, early communication, interdisciplinary coordination, informed consent, and long-term follow-up, thus forming a systematic, nurse-led service model. In Europe, fertility preservation services are still primarily physician-led, but nurse-led consultation models are gradually emerging. Australia uses a "rapid response" multidisciplinary model, with nurses acting as key coordinators responsible for quick referrals, education, and emotional support, ensuring efficient and continuous service. In Asian countries, nurses are typically involved as support team members, mainly responsible for information provision, emotional resonance, and communication assistance, but they lack autonomy in leading the fertility preservation process. Moreover, some nurses, due to a lack of reproductive medicine training, fear legal liability, or lack institutional support, prefer to hand over fertility preservation-related issues to physicians, further blurring role boundaries and leading to uneven service provision [ 83 ]. Therefore, countries and regions should establish localized fertility preservation nursing models that suit their specific circumstances. In regions with existing fertility preservation nursing models, the "navigator" model from North America and other regions should be adopted systematically, with policy support, educational training, and job setting, forming a nurse-led fertility preservation nursing model. In regions without mature fertility preservation nursing services, focus should be placed on standardizing service processes and evaluating their effectiveness. This study does have several limitations. First, although the review extensively included literature and guidelines, it was limited to English-language sources, which may introduce publication bias. Second, differences in study design and reporting methods limited the comparability of results. Third, most of the included studies are from high-income countries, with limited representation from low- and middle-income regions. Finally, due to the nature of a scoping review, this study did not conduct a systematic evaluation of study quality, which may affect the depth and reliability of the conclusions. This review systematically outlines the roles and tasks of nurses in fertility preservation for cancer patients, providing theoretical support for the development of subsequent training programs, curriculum content, and competency assessment standards. It can serve as an important reference for future guideline development. By promoting standardized models and establishing nurse-led fertility preservation service pathways, the continuity and quality of care for cancer patients can be improved. Future research should further focus on nurses' roles throughout the entire fertility preservation process, particularly their contributions to treatment implementation, long-term follow-up, and quality improvement. Additionally, intervention studies should be conducted to verify the actual impact of nurse-led fertility preservation services on fertility preservation utilization, decision satisfaction, and reproductive outcomes. Furthermore, integrating core competencies related to fertility preservation, such as communication skills, ethical decision-making, and reproductive health counseling, into oncology nursing curricula and continuing education systems will enhance nurses' professional competence. These initiatives will further solidify nurses' professional identity in oncology fertility care, advance nursing practice, and ensure that cancer patients have equal access to high-quality fertility preservation services. 5. Conclusion In summary, this review systematically defines the specific roles of oncology nurses throughout the entire fertility preservation care process. It clearly outlines the professional responsibilities of nurses in this field, highlighting their core value in care coordination, patient navigation, and service improvement. The findings of this study provide a strong theoretical and practical basis for optimizing clinical practice, education, and policy development. It advocates for the integration of specially trained nurses into the fertility preservation care system to meet the fertility needs of cancer patients and improve the overall quality of nursing services. Declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Competing interests The authors have no competing interests to declare. Funding This study is supported by the Science and Technology Program of Department of Human Resources and Social Security of Sichuan Province. Author Contribution The planning and conceptualization of the review were conducted by the first author LY and the corresponding author ZHF. The screening process and data analysis were performed by LY and WQ, supplemented by LBJ and ZL. LY drafted the manuscript, while ZYL and SA contributed to the conceptualization of the results section. Authors ZHF, LFQ, and WC made substantial revisions to the manuscript. All authors have read and approved the final manuscript. Furthermore, they agree to be accountable for their contributions and ensure that any questions raised regarding the accuracy or completeness of any part of the work are appropriately investigated, resolved, and documented. 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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-8324545","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":587378732,"identity":"ba66c515-a75f-4e2b-907c-fa1c076c07eb","order_by":0,"name":"Ying Lin","email":"","orcid":"","institution":"University of Electronic Science and Technology of China","correspondingAuthor":false,"prefix":"","firstName":"Ying","middleName":"","lastName":"Lin","suffix":""},{"id":587378733,"identity":"e7ae4157-4ce7-4986-affa-9fd89d8383c0","order_by":1,"name":"Qian Wang","email":"","orcid":"","institution":"West China Second University Hospital of Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Qian","middleName":"","lastName":"Wang","suffix":""},{"id":587378734,"identity":"f57a9458-c1d3-4ddb-84be-3ec4c44dd419","order_by":2,"name":"Beijia Liu","email":"","orcid":"","institution":"University of Electronic Science and Technology of China","correspondingAuthor":false,"prefix":"","firstName":"Beijia","middleName":"","lastName":"Liu","suffix":""},{"id":587378735,"identity":"8639d8c9-7ad1-4629-af54-2f82ba2b32e8","order_by":3,"name":"Lu Zhou","email":"","orcid":"","institution":"Chengdu Medical College","correspondingAuthor":false,"prefix":"","firstName":"Lu","middleName":"","lastName":"Zhou","suffix":""},{"id":587378736,"identity":"f35ebf3d-7307-4d77-9a64-1b32d95c7780","order_by":4,"name":"Yulu Zhang","email":"","orcid":"","institution":"University of Electronic Science and Technology of China","correspondingAuthor":false,"prefix":"","firstName":"Yulu","middleName":"","lastName":"Zhang","suffix":""},{"id":587378737,"identity":"24fcad7d-3995-4af1-b71b-a0bd61cfc7e4","order_by":5,"name":"An Shi","email":"","orcid":"","institution":"Sichuan Cancer Hospital","correspondingAuthor":false,"prefix":"","firstName":"An","middleName":"","lastName":"Shi","suffix":""},{"id":587378739,"identity":"d0237139-a971-4d0a-b344-22984a2e9658","order_by":6,"name":"Fuqiang Li","email":"","orcid":"","institution":"Sichuan Cancer Hospital","correspondingAuthor":false,"prefix":"","firstName":"Fuqiang","middleName":"","lastName":"Li","suffix":""},{"id":587378745,"identity":"7e018ddf-b3cd-4c77-b0bc-70809d2efba1","order_by":7,"name":"Chun Wang","email":"","orcid":"","institution":"Sichuan Cancer Hospital","correspondingAuthor":false,"prefix":"","firstName":"Chun","middleName":"","lastName":"Wang","suffix":""},{"id":587378748,"identity":"953dd245-9396-4691-8910-c31926b64764","order_by":8,"name":"Hanfeng Zhang","email":"data:image/png;base64,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","orcid":"","institution":"Sichuan Cancer Hospital","correspondingAuthor":true,"prefix":"","firstName":"Hanfeng","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2025-12-10 07:53:59","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8324545/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8324545/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102214511,"identity":"3fae0874-6510-4e7e-a4ef-1ade8b2aeff7","added_by":"auto","created_at":"2026-02-09 12:43:47","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":57960,"visible":true,"origin":"","legend":"\u003cp\u003ePRISMA 2020 flow diagram for new systematic reviews,which included searches of databases, registers,and other sources\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8324545/v1/56c889ecc0b0f4298752ed9a.png"},{"id":102214599,"identity":"d24678cd-b031-4246-a015-c378e7c85c6a","added_by":"auto","created_at":"2026-02-09 12:44:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1320894,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8324545/v1/2fdec743-08f5-4fa6-9492-d49a4a6c78c7.pdf"},{"id":102214593,"identity":"b613d38a-9bdd-46b8-9082-e7574fe7b3e0","added_by":"auto","created_at":"2026-02-09 12:43:59","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":17013,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8324545/v1/53c24ab1f3cdeb323500bb10.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"From Implicit Participation to Integration: The Evolving Role of Nurses in Oncofertility","fulltext":[{"header":"1. Background","content":"\u003cp\u003eWith advancements in cancer treatment and a significant increase in survival rates, more young cancer patients are surviving for extended periods [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. However, while treatments such as chemotherapy and radiation therapy have been proven to effectively prolong life, they are frequently associated with severe long-term side effects. In the context of cancer survivors, fertility impairment has emerged as a pivotal factor influencing their quality of life. This challenge has been highlighted in multiple studies, with fertility preservation identified as a critical issue in this population [\u003cspan additionalcitationids=\"CR3 CR4\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFertility Preservation refers to the use of surgical, pharmacological, or assisted reproductive technologies to help individuals at risk of infertility, such as cancer patients, preserve their ability to have biological offspring. These interventions enable patients to effectively preserve their fertility before the onset of cancer treatment [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn response to these challenges, authoritative organizations such as the American Society of Clinical Oncology, the European Society for Medical Oncology, and the European Society of Human Reproduction and Embryology have all emphasized that fertility preservation is an essential component of comprehensive cancer care. They stress that providing fertility preservation counseling and services to all reproductive-age cancer patients has become an indispensable element of modern oncology nursing [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, the clinical implementation of fertility preservation faces numerous challenges. One of the most significant challenges is time sensitivity, decisions regarding fertility preservation must be made quickly within the limited time frame before cancer treatment begins [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Moreover, fertility preservation services involve complex interdisciplinary collaboration across fields such as oncology, reproductive medicine, psychology, and ethics [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Under the immense pressure of a cancer diagnosis, patients are required to make rapid, life-altering decisions about their future fertility, creating an additional emotional burden [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. This complexity underscores the need for a central role in providing continuous information, emotional support, and coordination throughout the process. Given that nurses have the most frequent and sustained contact with patients, they are well-positioned to take on this critical role. Nurses have long been recognized for their strengths in health education and patient advocacy, making them ideal candidates for the role of fertility preservation coordinators [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Research has demonstrated that active nurse involvement significantly increases referral rates, patient satisfaction with decisions, and overall care quality in fertility preservation services [\u003cspan additionalcitationids=\"CR16 CR17\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite the widely recognized importance of nurses in fertility preservation, the specific definition of their roles and responsibilities remains vague and inconsistent in the literature and international guidelines [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. For instance, while the American Society of Clinical Oncology and the European Society of Human Reproduction and Embryology guidelines recommend a multidisciplinary team approach, they only broadly emphasize that nurses, as healthcare providers, should offer information and psychological support, without clearly defining their responsibilities. This lack of clarity has led to significant differences in the practical implementation of nurses\u0026rsquo; roles globally. In countries with more developed fertility preservation services, nurses typically undertake core responsibilities such as initial patient consultation, risk communication, referral coordination, and interdisciplinary team communication. In some regions, positions such as \"nurse navigator\" or \"fertility preservation coordinator\" have even been established, realizing a nurse-led model for fertility preservation services [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. However, in countries where fertility preservation services are still emerging, influenced by structural issues in the healthcare system, role distribution, and professional culture, nurses perceive fertility preservation as the domain of physicians, thereby limiting their involvement in counselling and referral [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. This discrepancy in role recognition and institutional frameworks contributes to the inconsistency in fertility preservation service quality and affects the provision of standardized, comprehensive care for patients [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTherefore, this study employs a scoping review approach to clearly define the core roles and specific responsibilities of nurses in fertility preservation services, thereby providing evidence for the development of standardized nursing models and policy formation.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003eThis study constitutes a scoping review with the objective of elucidating the roles and responsibilities of nurses in fertility preservation for cancer patients. The scoping review was not registered.\u003c/p\u003e \u003cp\u003eThe specific objectives of this study are as follows:\u003c/p\u003e \u003cp\u003e1) To review existing clinical guidelines that delineate the role of nurses in fertility preservation for cancer patients.\u003c/p\u003e \u003cp\u003e2) To conduct a literature review to identify the roles and practices of nurses in fertility preservation for cancer patients.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Search strategy\u003c/h2\u003e \u003cp\u003eTo ensure a comprehensive search strategy, we followed the three-step search approach recommended by JBI for scoping reviews [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Initially, we searched the PubMed and Embase databases, identifying MeSH terms such as \"oncology,\" \"fertility preservation,\" \"nursing,\" and \"nurse.\" Subsequently, we expanded the scope of the search to include other databases, using a combination of MeSH terms and free-text keywords, along with Boolean operators AND/OR: PubMed, CINAHL, EMBASE, Scopus, PsycINFO, Web of Science, as well as guideline repositories including BMJ Best Practice, the Scottish Intercollegiate Guidelines Network, the National Guidelines Clearinghouse, the ECRI Guidelines Trust\u0026trade;, and the National Institute for Health and Care Excellence. To further ensure comprehensive coverage, we also reviewed the reference lists of included articles. The search encompassed all available data from the inception of each database through April 2025. A detailed search strategy for PubMed can be found in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e of the supplementary materials.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRoles and Responsibilities of Nurses in Fertility Preservation for Cancer Patients as Described in Guidelines\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYear\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCountry/Region\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGuideline\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIssuing Organization\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNurse Role\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eResponsibilities\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2006,2013,2018,2025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmerican Society of Clinical Oncology Guideline Update on Fertility Preservation in People With Cancer [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAmerican Society of Clinical Oncology (ASCO)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2006: Nurses are not explicitly mentioned, referred to as oncologists.\u003c/p\u003e \u003cp\u003e2013: Responsibilities are assigned to healthcare providers, including nurses.\u003c/p\u003e \u003cp\u003e2018: Nurses explicitly appear in the Target Audience.\u003c/p\u003e \u003cp\u003e2025: Nurses are explicitly listed as a core member of the fertility preservation team.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2006:\u003c/p\u003e \u003cp\u003e\u0026bull; Healthcare providers must inform patients of infertility risks before treatment begins.\u003c/p\u003e \u003cp\u003e\u0026bull; Provide or refer patients to reproductive specialists for fertility preservation counseling and procedures.\u003c/p\u003e \u003cp\u003e\u0026bull; Adopt a multidisciplinary approach, including oncology, psychological support, and ethical counseling.\u003c/p\u003e \u003cp\u003e\u0026bull; Document fertility preservation discussions and patient preferences.\u003c/p\u003e \u003cp\u003e2013:\u003c/p\u003e \u003cp\u003e\u0026bull; Initiate fertility preservation discussions promptly and document them in writing.\u003c/p\u003e \u003cp\u003e\u0026bull; Proactively inquire about patients' fertility preservation preferences and refer them to reproductive specialists.\u003c/p\u003e \u003cp\u003e\u0026bull; Provide neutral, standardized fertility preservation information.\u003c/p\u003e \u003cp\u003e\u0026bull; Introduce fertility preservation methods, including sperm, oocyte, and embryo cryopreservation.\u003c/p\u003e \u003cp\u003e\u0026bull; Clarify the experimental nature of other fertility preservation techniques.\u003c/p\u003e \u003cp\u003e2018:\u003c/p\u003e \u003cp\u003e\u0026bull; Initiate fertility preservation discussions as soon as possible after diagnosis.\u003c/p\u003e \u003cp\u003e\u0026bull; Inform patients and refer them to reproductive specialists.\u003c/p\u003e \u003cp\u003e\u0026bull; Document the fertility preservation discussion process in the medical record.\u003c/p\u003e \u003cp\u003e2025:\u003c/p\u003e \u003cp\u003e\u0026bull; Assess and communicate reproductive risks at the time of diagnosis.\u003c/p\u003e \u003cp\u003e\u0026bull; For patients who express interest or uncertainty, promptly refer them to reproductive specialists.\u003c/p\u003e \u003cp\u003e\u0026bull; Ensure the accessibility of the multidisciplinary fertility preservation team (including nurses, psychologists, social workers, etc.).\u003c/p\u003e \u003cp\u003e\u0026bull; Provide standardized written information and conduct ongoing follow-up throughout the process.\u003c/p\u003e \u003cp\u003e\u0026bull; fertility preservation counseling should extend through the treatment and follow-up phases.\u003c/p\u003e \u003cp\u003e\u0026bull; The medical team should assist patients in advocating for fertility preservation policies and insurance coverage.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2008,2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePreservation of Fertility in Pediatric\u003c/p\u003e \u003cp\u003eand Adolescent Patients With Cancer [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAmerican Academy of Pediatrics (AAP)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNurses are not explicitly mentioned, and responsibilities are assigned to both pediatricians and the multidisciplinary team\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2008:\u003c/p\u003e \u003cp\u003e\u0026bull; Oncologists must inform pediatric patients and their families about the potential infertility risks of treatment and provide comprehensive counseling.\u003c/p\u003e \u003cp\u003e\u0026bull; fertility preservation assessment should be conducted by a multidisciplinary team, including pediatric oncologists, reproductive medicine specialists, ethicists, and mental health professionals.\u003c/p\u003e \u003cp\u003e\u0026bull; Parental consent should be obtained, clarifying whether the procedure is experimental and its associated risks.\u003c/p\u003e \u003cp\u003e\u0026bull; Provide written information on sample storage, disposal, and post-mortem management.\u003c/p\u003e \u003cp\u003e2020:\u003c/p\u003e \u003cp\u003e\u0026bull; Physicians should provide communication and counseling regarding treatment-induced infertility risks and available fertility preservation options.\u003c/p\u003e \u003cp\u003e\u0026bull; For patients willing or suitable for fertility preservation, they should be promptly referred to a facility with fertility preservation expertise.\u003c/p\u003e \u003cp\u003e\u0026bull; fertility preservation should be implemented with moderate delay, without compromising treatment success rates.\u003c/p\u003e \u003cp\u003e\u0026bull; Establish institutional-level fertility preservation assessment policies and ensure multidisciplinary team support (oncology, reproductive medicine, urology, radiation oncology, ethics and legal advisors, psychological experts).\u003c/p\u003e \u003cp\u003e\u0026bull; fertility preservation decision-making should consider the child's preferences and consent, and the procedure\u0026rsquo;s nature, expected benefits, and risks should be fully explained.\u003c/p\u003e \u003cp\u003e\u0026bull; Pediatricians play a key coordinating role in the fertility preservation process, ensuring timely identification, communication, and helping families build hope.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOncofertility Consortium Program Description and Framework for Fertility Preservation in Young Patients with Cancer [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOncofertility Consortium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNurses are not explicitly mentioned, and responsibilities are described as healthcare providers and interdisciplinary teams\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026bull; Patient navigation and education through interdisciplinary medical teams to support informed decision-making\u003c/p\u003e \u003cp\u003e\u0026bull; Establishment of a multicenter collaborative network to standardize the acquisition and storage process\u003c/p\u003e \u003cp\u003e\u0026bull; Ongoing education for patients and professionals to ensure understanding of procedures, limitations, and expectations\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInternational\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInternational Society for Fertility Preservation Guideline on Fertility Preservation in Patients with Lymphoma, Leukemia, and Breast Cancer [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eInternational Society for Fertility Preservation (ISFP)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNurses are not explicitly mentioned, referred to as healthcare providers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026bull; Fertility preservation must be discussed with reproductive-age patients before treatment\u003c/p\u003e \u003cp\u003e\u0026bull; Consultation provided by reproductive specialists, with available options introduced\u003c/p\u003e \u003cp\u003e\u0026bull; Individualized recommendations made in accordance with ethical standards\u003c/p\u003e \u003cp\u003e\u0026bull; Ongoing communication with oncology regarding treatment plans and prognosis\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2012,2014,2018,2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNational Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Adolescent and Young Adult Oncology [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan additionalcitationids=\"CR44\" citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNational Comprehensive Cancer Network (NCCN)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2012: Nurses are not explicitly mentioned, referred to as health care professionals\u003c/p\u003e \u003cp\u003e2014: Nurses are not explicitly mentioned, fertility preservation tasks are collectively carried out by a multidisciplinary team\u003c/p\u003e \u003cp\u003e2018: Nurses are not explicitly mentioned, fertility preservation tasks are still carried out by a team of providers\u003c/p\u003e \u003cp\u003e2024: Nurses are not explicitly mentioned, referred to as a multidisciplinary team of providers with expertise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2012:\u003c/p\u003e \u003cp\u003e\u0026bull; Assess and discuss infertility risks and fertility preservation\u003c/p\u003e \u003cp\u003eoptions before treatment begins.\u003c/p\u003e \u003cp\u003e\u0026bull; Conduct a comprehensive evaluation that includes reproductive endocrine and psychosocial factors, providing informed communication.\u003c/p\u003e \u003cp\u003e\u0026bull; Refer patients to multidisciplinary centers with experience in Adolescent and Young Adult treatment and fertility preservation resources.\u003c/p\u003e \u003cp\u003e\u0026bull; In decision-making, address age-specific issues such as fertility plans, financial burden, and adherence.\u003c/p\u003e \u003cp\u003e2014:\u003c/p\u003e \u003cp\u003e\u0026bull; Discuss fertility preservation and contraception options before treatment, clearly defining fertility preservation methods by gender.\u003c/p\u003e \u003cp\u003e\u0026bull; Strengthen interdisciplinary collaboration between oncology, radiation oncology, gynecology, etc., to ensure the feasibility of fertility preservation plans.\u003c/p\u003e \u003cp\u003e\u0026bull; Implement individualized management and interdisciplinary coordination for pregnant cancer patients.\u003c/p\u003e \u003cp\u003e2018:\u003c/p\u003e \u003cp\u003e\u0026bull; Conduct pregnancy testing and contraception counseling before treatment, explaining the potential impact of treatment on fertility.\u003c/p\u003e \u003cp\u003e\u0026bull; Introduce feasible fertility preservation methods and recommend referral to multidisciplinary cancer centers with fertility preservation services.\u003c/p\u003e \u003cp\u003e\u0026bull; Integrate fertility preservation into comprehensive assessment and psychosocial support systems to ensure continuous management.\u003c/p\u003e \u003cp\u003e\u0026bull; The medical team should be equipped to provide integrated services, including fertility, education, vocational, and psychological support.\u003c/p\u003e \u003cp\u003e2024:\u003c/p\u003e \u003cp\u003e\u0026bull; Systematically discuss fertility and sexual function risks in comprehensive assessments, providing fertility preservation and contraception education.\u003c/p\u003e \u003cp\u003e\u0026bull; Ensure timely referral to fertility preservation or reproductive health programs, ensuring accessibility of services.\u003c/p\u003e \u003cp\u003e\u0026bull; Facilitate patient expression of preferences and informed decision-making through individual counseling.\u003c/p\u003e \u003cp\u003e\u0026bull; Emphasize professional collaboration within the multidisciplinary team for fertility preservation and psychosocial management.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eScotland\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLong-term Follow-up of Survivors of Childhood Cancer (SIGN 132) [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eScottish Intercollegiate Guidelines Network (SIGN)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNurses explicitly mentioned as leading the service\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026bull; Provide personalized testing, assessment, and fertility preservation strategies for patients at risk of fertility impairment\u003c/p\u003e \u003cp\u003e\u0026bull; Referral to assisted reproduction and specialized psychological support when necessary\u003c/p\u003e \u003cp\u003e\u0026bull; Nurse-led long-term follow-up and management\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJapan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGuidelines on the Freezing and\u003c/p\u003e \u003cp\u003ePreservation of Unfertilized Oocyte and Ovarian Tissue [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eJapanese Society for\u003c/p\u003e \u003cp\u003eReproductive Medicine(JSRM)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNurses are not explicitly mentioned, and responsibilities are clearly assigned to the attending physician and reproductive medicine specialists\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026bull; The attending physician for the underlying disease must provide written information and permission, and jointly with the reproductive specialist, complete the informed consent process (explaining methods, risks, pregnancy chances, treatment effects, and costs).\u003c/p\u003e \u003cp\u003e\u0026bull; Sperm/egg cryopreservation and assisted reproductive technology should ideally be performed within the same institution. If not feasible within the same facility, an inter-institutional collaboration mechanism should be established.\u003c/p\u003e \u003cp\u003e\u0026bull; The implementing institution is responsible for long-term storage, regularly confirming storage preferences, transferring specimens compliantly when necessary, and registering with the Japan Society of Obstetrics and Gynecology.\u003c/p\u003e \u003cp\u003e\u0026bull; For minors, consent must be reconfirmed and re-signed upon reaching adulthood, ensuring full compliance with ethical review and use restrictions throughout the process.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJapan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJapanese Society of Clinical Oncology Clinical Practice Guidelines for Fertility Preservation in Childhood, Adolescent, and Young Adult Cancer Patients (Part 1 \u0026amp; Part 2) [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eJapanese Society of Clinical Oncology (JSCO)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNurses explicitly included as representatives at the team level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026bull; Inform pediatric patients/families about infertility risks and provide relevant information\u003c/p\u003e \u003cp\u003e\u0026bull; Identify patients suitable for fertility preservation\u003c/p\u003e \u003cp\u003e\u0026bull; Refer to reproductive specialists early for those with clear intentions or needs\u003c/p\u003e \u003cp\u003e\u0026bull; Work closely with reproductive specialists to assess feasible options and the optimal timing for interventions\u003c/p\u003e \u003cp\u003e\u0026bull; Maintain ongoing collaboration between oncology and reproductive medicine from diagnosis through several years after treatment\u003c/p\u003e \u003cp\u003e\u0026bull; In certain cases (e.g., chemotherapy delays in breast cancer, ethical consent issues in pediatric patients), provide detailed counseling and psychological support\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKorea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eKorean Society for Fertility Preservation Clinical Guidelines for Fertility Preservation in Cancer Patients [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eKorean Society for Fertility Preservation (KSFP)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNurses explicitly mentioned as team members responsible for education and navigation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026bull; Arrange for a navigator to handle fertility preservation navigation/appointments, with consultation completed within 24\u0026ndash;72 hours\u003c/p\u003e \u003cp\u003e\u0026bull; Cross-disciplinary communication and information feedback\u003c/p\u003e \u003cp\u003e\u0026bull; Annual follow-up of frozen samples\u003c/p\u003e \u003cp\u003e\u0026bull; Provide fertility counseling in various formats (verbal explanations, written materials, online resources, and electronic educational tools) to ensure patients understand the risks and available fertility preservation options\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGermany/Austria/Switzerland\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFertiPROTEKT Network Practical Recommendations on Female Fertility Preservation in Cancer Patients (Part I: Diseases; Part II: Methods) [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFertiPROTEKT Network\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNurses are not explicitly mentioned, referred to as part of the physician and laboratory teams\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026bull; Provide information on disease prognosis and infertility risks to support decision-making\u003c/p\u003e \u003cp\u003e\u0026bull; Offer various fertility preservation techniques based on individual needs and timing\u003c/p\u003e \u003cp\u003e\u0026bull; Organize follow-up care after preservation, including pregnancy management (monitoring, stimulation, natural conception, or In Vitro Fertilization)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUK\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBritish Fertility Society Policy and Practice Guideline: Fertility Preservation for Medical Reasons in Girls and Women [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBritish Fertility Society (BFS)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNurses explicitly mentioned for decision support and pathway management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026bull; Initiate early discussions on fertility preservation\u003c/p\u003e \u003cp\u003e\u0026bull; Multidisciplinary decision support\u003c/p\u003e \u003cp\u003e\u0026bull; Recommend establishing efficient service pathways and timely referrals\u003c/p\u003e \u003cp\u003e\u0026bull; Reproductive clinic follow-up, informing patients of long-term impacts and available options\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEurope\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEuropean Society of Human Reproduction and Embryology Guideline on Female Fertility Preservation [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEuropean Society of Human Reproduction and Embryology (ESHRE)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNurses explicitly mentioned as requiring education and training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026bull; Clinicians provide information (risks, options, storage, assisted reproduction, pregnancy, and alternative pathways)\u003c/p\u003e \u003cp\u003e\u0026bull; Establish direct communication and referral mechanisms to the fertility preservation team (a coordinator may be appointed)\u003c/p\u003e \u003cp\u003e\u0026bull; The multidisciplinary team assesses risks and holds joint communications\u003c/p\u003e \u003cp\u003e\u0026bull; Provide psychological support and counseling services during decision-making\u003c/p\u003e \u003cp\u003e\u0026bull; Clinicians and nurses should receive regular fertility preservation education and training\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEurope\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEuropean Society for Medical Oncology Clinical Practice Guideline on Fertility Preservation in Patients with Cancer [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEuropean Society for Medical Oncology (ESMO)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNurses explicitly mentioned as members of the multidisciplinary team\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eInform patients of infertility risks as early as possible before treatment and refer them in a timely manner\u003c/p\u003e \u003cp\u003e\u0026bull; Nurses, along with physicians and psychologists, form the multidisciplinary team to ensure timely counseling and decision-making\u003c/p\u003e \u003cp\u003e\u0026bull; Provide ongoing counseling and support throughout the treatment process and survival period regarding reproductive issues, psychological needs, and long-term follow-up\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMultidisciplinary Consensus on the Criteria for Fertility Preservation in Cancer Patients [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSpanish Society of Medical Oncology (SEOM); Spanish Fertility Society (SEF); Spanish Society of Hematology and Hemotherapy (SEHH); Spanish Society of Pediatric Hematology and Oncology (SEHOP); Spanish Society of Radiation Oncology (SEOR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNurses are not explicitly mentioned, with responsibilities directed towards oncologists and hematologists\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026bull; Oncologists and hematologists inform patients of infertility risks and introduce preservation options before treatment begins\u003c/p\u003e \u003cp\u003e\u0026bull; Fertility preservation requires interdisciplinary collaboration for implementation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAustralia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eClinical Oncology Society of Australia Guideline: Fertility Preservation for People with Cancer [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eClinical Oncology Society of Australia (COSA)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNurses are not explicitly mentioned, referred to as healthcare professionals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026bull; Incorporate fertility discussions into routine cancer management and document in medical records\u003c/p\u003e \u003cp\u003e\u0026bull; Inform all patients about the potential impact of treatment on fertility\u003c/p\u003e \u003cp\u003e\u0026bull; Provide age-appropriate educational materials\u003c/p\u003e \u003cp\u003e\u0026bull; Continuously participate in professional education\u003c/p\u003e \u003cp\u003e\u0026bull; Assess patients' risk of fertility impairment\u003c/p\u003e \u003cp\u003e\u0026bull; Post-cancer treatment reproductive function follow-up\u003c/p\u003e \u003cp\u003e\u0026bull; Provide contraception and sexual health counseling\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCanada\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCanadian Fertility and Andrology Society Clinical Practice Guideline on Fertility Preservation in Patients Undergoing Gonadotoxic Treatments [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCanadian Fertility and Andrology Society (CFAS)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNurses are not explicitly mentioned, referred to as healthcare providers in general\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026bull; Provide information on fertility risks and conduct informed consent discussions on preservation options as soon as possible after diagnosis, followed by timely referral\u003c/p\u003e \u003cp\u003e\u0026bull; Close collaboration between reproductive medicine and oncology departments to establish a referral network and address knowledge/resource barriers\u003c/p\u003e \u003cp\u003e\u0026bull; Childhood cancer survivors enter long-term follow-up clinics and undergo regular reviews of fertility preservation possibilities\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEurope\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFertility-sparing treatment and follow-up in patients with cervical cancer, ovarian cancer, and borderline ovarian tumours: guidelines from ESGO, ESHRE, and ESGE [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThe European Society of Gynaecological Oncology (ESGO), the European Society of Human Reproduction (ESHRE) and Embryology, and the European Society for Gynaecological Endoscopy (ESGE)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDirected towards multidisciplinary team members, with no explicit mention of nurses as part of the team\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026bull; Assess and counsel patients with fertility preservation needs before cancer treatment\u003c/p\u003e \u003cp\u003eCollaborate with a multidisciplinary team and, when necessary, refer patients to reproductive medicine specialists.\u003c/p\u003e \u003cp\u003e\u0026bull; Perform a detailed pre-surgical assessment, implement fertility-preserving surgeries, and assess fertility post-surgery.\u003c/p\u003e \u003cp\u003e\u0026bull; Provide patients with comprehensive education on fertility preservation options, along with emotional and psychological support.\u003c/p\u003e \u003cp\u003e\u0026bull; Conduct regular follow-up visits to monitor fertility recovery and cancer recurrence.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Managing the results\u003c/h2\u003e \u003cp\u003eWe used the reference management software EndNote 20 to manage the citations and check for duplicates. All references retrieved from each database were imported into this software to ensure consistency in the total number of references obtained.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Inclusion and exclusion criteria\u003c/h2\u003e \u003cp\u003eThe inclusion criteria for this review were as follows:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eStudies and clinical guidelines reporting the role of nurses in fertility preservation for cancer patients.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePublications written in English.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThe following types of studies were excluded:\u003c/p\u003e \u003cp\u003e\u0026bull; Studies for which the full text was not accessible.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Screening process\u003c/h2\u003e \u003cp\u003eAll documents retrieved from the databases were checked for duplicates using EndNote software. Two team members independently reviewed the titles and abstracts of the articles based on the inclusion and exclusion criteria for initial screening. Subsequently, they read the full texts and conducted the final selection. Any discrepancies were resolved through consultation with a third researcher.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Data extraction and synthesis\u003c/h2\u003e \u003cp\u003eThe information extracted from the included studies included the authors, study title, publication year, country in which the study was conducted, study design, sample, and the role of nurses in fertility preservation. Data extraction was conducted using a chart adapted from the framework proposed by Arksey and O'Malley (2005) [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], which encompasses both general and specific information on nursing activities related to fertility preservation in cancer care. Two reviewers independently extracted the data, and any discrepancies were resolved through consultation with a third researcher. A narrative synthesis was then used to provide a comprehensive overview of nurse involvement in fertility preservation care.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.6 Selection of evidence sources\u003c/h2\u003e \u003cp\u003eAfter removing duplicate records, a total of 624 articles were retrieved from the database search. Of these, 152 articles were selected based on their titles and abstracts. Following full-text screening, 33 studies were included in this review. Subsequently, through secondary citation searching of the included studies, 6 more relevant articles were identified. Furthermore, 18 relevant clinical guidelines were identified through searches of guideline repositories and organizational websites. The study ultimately included 39 research studies and 18 guidelines. A detailed overview of the study selection process is presented in the PRISMA flow diagram (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n\u003ch2\u003e3.1 Characteristics of included studies\u003c/h2\u003e\n\u003cp\u003eThis study included 18 clinical practice guidelines on fertility preservation for cancer patients published between 2011 and 2025, encompassing regions including North America, Europe, Asia, and Oceania. The majority of the guidelines were from North America and Europe, followed by some countries in Asia and Oceania. Approximately 70% of the guidelines were published after 2017, indicating a significant increase in international attention to fertility preservation for cancer patients in recent years.\u003c/p\u003e\n\u003cp\u003eThe included studies were published between 2003 and 2025. Approximately 70% of the studies were published after 2010, indicating a continuous increase in academic attention to the role of nurses in fertility preservation for cancer patients in recent years. In terms of study design, literature reviews constituted the largest proportion (22 studies), followed by qualitative studies (6), retrospective cohort studies (4), descriptive studies (4), and interventional studies (3). The studies mainly focused on the role and responsibilities of nurses in fertility care for cancer patients. Geographically, the highest number of studies were from the United States (24 studies), followed by Canada (5), the Netherlands (4), and the United Kingdom (3), with one study each from Japan, Australia, and China.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n\u003ch2\u003e3.2 Synthesis of results\u003c/h2\u003e\n\u003cdiv id=\"Sec12\" class=\"Section3\"\u003e\n\u003ch2\u003e3.2.1 Nurses' roles identified in clinical guidelines\u003c/h2\u003e\n\u003cp\u003eThis scoping review included 18 guidelines on fertility preservation for cancer patients published between 2006 and 2025, covering regions such as North America, Europe, Asia, and Oceania. The issuing organizations of these guidelines primarily include international professional societies and multidisciplinary alliances, such as the American Society of Clinical Oncology, the European Society of Human Reproduction and Embryology, the Japanese Society of Clinical Oncology, and the Korean Society for Fertility Preservation. Whether or not nurses are explicitly mentioned and the scope of their responsibilities vary significantly across time and regions, as detailed in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003cp\u003eIn the early guidelines, the role of nurses was often implicit or generalized. For example, the 2006 the American Society of Clinical Oncology guideline [\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e], the earliest published, attributed the described responsibilities to oncologists, nurses were not specifically mentioned. Similarly, the 2011 Oncofertility Consortium framework [\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e] and the 2012 International Society for Fertility Preservation Guideline [\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e] emphasized multidisciplinary collaboration and patient education, but referred to healthcare professionals or healthcare providers without explicitly mentioning nurses. Likewise, the FertiPROTEKT network guidelines [\u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e] and the Canadian Fertility and Andrology Society guidelines [\u003cspan class=\"CitationRef\"\u003e32\u003c/span\u003e] used terms like healthcare providers or medical personnel, with no clear mention of nurses.\u003c/p\u003e\n\u003cp\u003eSince 2013, some guidelines began to explicitly state that fertility preservation services for cancer patients require the involvement of a multidisciplinary team, with some guidelines recognizing nurses as key members of the team. For example, the Scottish SIGN guideline [\u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e] proposed nurse-led long-term follow-up and management, and thereafter, the role of nurses was gradually mentioned in various guidelines. In the 2013 update of the American Society of Clinical Oncology guideline [\u003cspan class=\"CitationRef\"\u003e34\u003c/span\u003e], the responsibility was shifted to \u0026ldquo;healthcare providers,\u0026rdquo; explicitly including nurses.\u003c/p\u003e\n\u003cp\u003eSince then, an increasing number of guidelines have incorporated nurses into multidisciplinary fertility preservation teams. The Japanese Society of Clinical Oncology [\u003cspan class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e36\u003c/span\u003e] and the Korean Society for Fertility Preservation [\u003cspan class=\"CitationRef\"\u003e37\u003c/span\u003e] explicitly included nurses at the team level, defining their roles in patient navigation, information provision, and educational counseling. The British Fertility Society [\u003cspan class=\"CitationRef\"\u003e38\u003c/span\u003e] clearly identified nurses\u0026rsquo; responsibilities in decision support and care pathway management. The European Society of Human Reproduction and Embryology [\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e] further emphasized that both physicians and nurses should receive continuous professional education and training in fertility preservation. Moreover, the European Society for Medical Oncology [\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e] designated nurses as core members of the multidisciplinary team, responsible for key tasks such as psychological support, reproductive decision-making, and long-term follow-up.\u003c/p\u003e\n\u003cp\u003eThe most recent updates from North America, including the American Society of Clinical Oncology 2025 [\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e] and NCCN 2024 [\u003cspan class=\"CitationRef\"\u003e39\u003c/span\u003e], reaffirmed the central position of nurses in the fertility preservation team, clearly defining their roles in risk communication, counseling referrals, psychological support, and long-term health management. These updates reflect the growing institutionalization of nurses' roles throughout the fertility preservation process.\u003c/p\u003e\n\u003cp\u003eOverall, the guidelines demonstrate a clear chronological evolution. Before 2013, nurses were not explicitly mentioned and were only implicitly included under general terms such as \u0026ldquo;healthcare providers\u0026rdquo; or \u0026ldquo;medical personnel.\u0026rdquo; After 2013, several guidelines began to emphasize the necessity of a multidisciplinary approach to fertility preservation services for cancer patients, and gradually, some explicitly identified nurse-led or nurse-participating roles. With the development of multidisciplinary fertility preservation services, nurses have since been widely integrated as formal members of these teams, with responsibilities encompassing patient education, information coordination, psychological support, and follow-up management.\u003c/p\u003e\n\u003cp\u003eThis evolutionary process reflects a clear transition in the role of nurses in fertility preservation practice for cancer patients\u0026mdash;from implicit participation to explicit recognition, and from a supportive role to a central, leading position.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section3\"\u003e\n\u003ch2\u003e3.2.2 Nurses' roles identified in scientific publications\u003c/h2\u003e\n\u003cp\u003eThrough literature analysis, we identified 23 core tasks that nurses undertake in fertility preservation for cancer patients. These tasks are categorized into five key stages based on the characteristics of the fertility preservation implementation process: (a) assessment and referral, (b) counseling and decision support, (c) treatment implementation, (d) long-term follow-up, and (e) system optimization. The specific roles and tasks for each stage are detailed in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eRoles and Tasks of Nurses in Fertility Preservation for Cancer Patients as Identified in Studies\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eStage\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eRole\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTasks\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\u003ea: Assessment and Referral\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIdentification and Communication of Fertility Risks\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e① Screen and assess reproductive desires and needs of reproductive-age patients [\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e50\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e55\u003c/span\u003e]\u003c/p\u003e\n\u003cp\u003e② Explain the potential impact of cancer treatments on fertility to patients[\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e56\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e67\u003c/span\u003e]\u003c/p\u003e\n\u003cp\u003e③ Proactively initiate discussions on fertility preservation, introducing the concept and available options [15, \u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e58\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e65\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e1]\u003c/p\u003e\n\u003cp\u003e④ Coordinate and schedule referrals to fertility preservation specialists [\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e50\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e62\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e66\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e72\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e74\u003c/span\u003e]\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eb: Counseling and Decision Support\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eInformation Support and Multidisciplinary Collaboration\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e① Provide detailed information on the indications and risks of fertility preservation technologies [\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e58\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e72\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e76\u003c/span\u003e]\u003c/p\u003e\n\u003cp\u003e② Provide printed materials or online resource links[\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e74\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e77\u003c/span\u003e]\u003c/p\u003e\n\u003cp\u003e③ Identify and alleviate emotional stress due to fertility loss [62, \u003cspan class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e76\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e8]\u003c/p\u003e\n\u003cp\u003e④ Ensure compliance with legal, ethical, and governmental standards in procedures [\u003cspan class=\"CitationRef\"\u003e77\u003c/span\u003e]\u003c/p\u003e\n\u003cp\u003e⑤ Provide financial assistance information, insurance guidance, and application support [\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e76\u003c/span\u003e]\u003c/p\u003e\n\u003cp\u003e⑥ Verify that the physician has discussed fertility preservation with the patient and documented it [\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e78\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e79\u003c/span\u003e]\u003c/p\u003e\n\u003cp\u003e⑦ Ensure that the patient is fully informed and has provided consent before making a decision [\u003cspan class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e77\u003c/span\u003e]\u003c/p\u003e\n\u003cp\u003e⑧ Coordinate communication within the multidisciplinary team regarding patient fertility goals and the integration of the fertility preservation process[\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e72\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e76\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e77\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e80\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e81\u003c/span\u003e]\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ed: Treatment Implementation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eClinical Guidance and Process Navigation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e① Instruct patients on hormone injection techniques [\u003cspan class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e76\u003c/span\u003e]\u003c/p\u003e\n\u003cp\u003e② Coordinate and schedule fertility preservation-related tests (e.g., ultrasound, hormone tests) and provide feedback on results[\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e73\u003c/span\u003e]\u003c/p\u003e\n\u003cp\u003e③ Assist with sperm/egg collection procedures and provide feedback on results [17, \u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e2]\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ee: Long-term Follow-up\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLong-term Outcome Tracking and Ongoing Support\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e① Conduct post-treatment follow-up to evaluate fertility preservation outcomes and patient responses [\u003cspan class=\"CitationRef\"\u003e73\u003c/span\u003e]\u003c/p\u003e\n\u003cp\u003e② Assess patients' future fertility needs [\u003cspan class=\"CitationRef\"\u003e74\u003c/span\u003e]\u003c/p\u003e\n\u003cp\u003e③ Provide recommendations for future reproductive options [57]\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ef: System Optimization\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSystem Improvement and Capacity Building\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e① Optimize fertility preservation clinical pathways and nursing standard operating procedures [\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e\n\u003cp\u003e② Conduct fertility preservation-related education and training for healthcare personnel[\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e74\u003c/span\u003e]\u003c/p\u003e\n\u003cp\u003e③ Design and distribute fertility preservation toolkits and guidelines [51, \u003cspan class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e5]\u003c/p\u003e\n\u003cp\u003e④ Provide administrative management support [67]\u003c/p\u003e\n\u003cp\u003e⑤ Maintain patient databases to support research [\u003cspan class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e67\u003c/span\u003e]\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section3\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"Section3\"\u003ea. Assessment and Referral\u003cbr /\u003e\n\u003cp\u003eThe core task in this stage is the nurse\u0026rsquo;s initial identification and communication of the patient's fertility risks. Nurses must screen and assess the reproductive desires and needs of reproductive-age cancer patients and clearly explain the fertility risks and potential impacts of cancer treatments. Additionally, nurses need to proactively discuss fertility preservation options and feasible measures with patients, taking responsibility for coordinating referrals to fertility preservation specialists to ensure that patients receive timely professional support.\u003c/p\u003e\n\u003cp\u003eb. Counseling and Decision Support\u003c/p\u003e\n\u003cp\u003eIn this stage, the nurse\u0026rsquo;s primary responsibility is to provide informational support. Nurses must not only explain in detail the indications, process, and risks associated with fertility preservation technologies, but also enhance patient understanding through printed materials or online resources. Furthermore, nurses should be alert to the psychological pressure that patients may experience due to fertility impairment, identify it promptly, and intervene when necessary. Nurses are also responsible for ensuring that the procedures comply with ethical, legal, and governmental standards, as well as providing financial aid information and assisting with insurance applications. Additionally, nurses must confirm whether the discussion of fertility preservation between the doctor and patient is sufficient and document this effectively to ensure the integrity and compliance of the decision-making process.\u003c/p\u003e\n\u003cp\u003ec. Treatment Implementation\u003c/p\u003e\n\u003cp\u003eDuring the treatment implementation stage, nurses provide clinical guidance and process navigation: instructing patients on self-administered hormone injection techniques, coordinating the timing of key tests such as ultrasound monitoring and hormone testing, and providing feedback on results. Nurses also assist during sperm/egg collection, ensuring the safety and correct execution of the fertility preservation procedures.\u003c/p\u003e\n\u003cp\u003ed. Long-term Follow-up\u003c/p\u003e\n\u003cp\u003eAfter completing fertility preservation treatment, nurses are responsible for long-term outcome tracking and ongoing support. Nurses conduct regular follow-up visits to assess the effectiveness of fertility preservation and the patient\u0026rsquo;s physical and psychological responses. They dynamically track changes in fertility needs and, based on individual circumstances, offer advice on alternative reproductive pathways, such as adoption or surrogacy, extending support from short-term intervention to long-term fertility planning.\u003c/p\u003e\n\u003cp\u003ee. System Optimization\u003c/p\u003e\n\u003cp\u003eIn this stage, nurses are involved in driving system improvements and capacity building, with responsibilities mainly in education, research, and management. By providing continuous feedback, nurses help optimize clinical pathways and standardize processes to improve service quality. They also conduct specialized training for healthcare personnel on fertility preservation and develop clinical tools and guidelines for fertility preservation. Furthermore, nurses actively participate in the collection and analysis of clinical data related to fertility preservation and provide administrative management support, driving continuous improvement and development in related research and practices.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section3\"\u003e\n\u003ch2\u003e3.2.3 Comparison of Nurses\u0026rsquo; Roles in Fertility Preservation for Cancer Patients across Countries\u003c/h2\u003e\n\u003cp\u003eThe included literature was summarized and analyzed by region, revealing significant differences in the roles, practices, and coverage of service stages for nurses in fertility preservation for cancer patients across these regions, as detailed in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eComparison of Nurses' Roles and Responsibilities in Fertility Preservation for Cancer Patients Across Different Countries\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eRegion\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCountry\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eRole Definition\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePractice\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePractice Coverage Stages\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\u003eNorth America\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCanada, USA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNurse navigators/coordinators are commonly appointed, and nurses predominantly lead fertility preservation services in institutionalized roles\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePatient Identification and Screening: Identifying reproductive-age women who may be affected by cancer treatment, proactively offering fertility preservation options, and discussing treatment plans with patients and physicians.\u003c/p\u003e\n\u003cp\u003eProviding Information and Emotional Support: Offering detailed information about fertility preservation, addressing patients' concerns, and alleviating psychological stress related to the reproductive consequences of treatment.\u003c/p\u003e\n\u003cp\u003eCoordinating the Interdisciplinary Team: Coordinating telemedicine consultations, referrals to reproductive specialists, psychologists, and other professionals to ensure comprehensive care across multiple departments.\u003c/p\u003e\n\u003cp\u003ePatient Advocacy and Education: Providing fertility preservation education after initial diagnosis to ensure informed decision-making. Conducting health education activities, promoting fertility preservation options, and providing related resources.\u003c/p\u003e\n\u003cp\u003ePolicy and System Advancement: Participating in the development of fertility preservation programs and policy advocacy, such as training nurses to enhance fertility preservation education skills and promoting the standardization of fertility preservation services.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ea\u0026ndash;e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAsia\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eChina, Japan\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNurses participate as team supporters, rather than fully leading the process\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePerceiving Patient Needs and Emotional Support: Identifying patients' fertility preservation needs during treatment and providing emotional support through empathy, helping them navigate emotional conflicts in fertility preservation decisions.\u003c/p\u003e\n\u003cp\u003eProviding Information and Education: Offering detailed information about fertility preservation, helping patients understand available options, and providing the necessary counseling and education for fertility preservation decisions.\u003c/p\u003e\n\u003cp\u003eInterdisciplinary Team Collaboration: Collaborating closely with other professionals (e.g., oncologists, gynecologists, psychologists, pharmacists, social workers) to provide comprehensive fertility preservation services and holistic support for patients.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ea\u0026ndash;c\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOceania\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAustralia\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNurses are integrated into the multidisciplinary \"rapid response\" system as coordinators, playing a key bridging role in the initiation of fertility preservation services\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePatient Education and Emotional Support: Educating patients about fertility preservation, helping them understand available options, and providing emotional support to alleviate anxiety about fertility consequences of treatment.\u003c/p\u003e\n\u003cp\u003eProcess Coordination: Coordinating the fertility preservation service process, ensuring timely responses and referrals for patients.\u003c/p\u003e\n\u003cp\u003eInterdisciplinary Collaboration: Working with physicians, embryologists, social workers, and other professionals to ensure rapid response and continuous patient support.\u003c/p\u003e\n\u003cp\u003eLong-term Follow-up Management: Leading long-term follow-up for patients after fertility preservation services, ensuring continued care and support post-treatment.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ea\u0026ndash;d\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEurope\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUK, Netherlands\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNurses are part of the fertility preservation service team, primarily responsible for information transfer and pathway coordination, with gradual exploration of nurse-led models\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eProviding Information and Education: Offering detailed information on fertility preservation, including the reproductive consequences of treatment, various fertility preservation options, and their pros and cons, to help patients make informed decisions.\u003c/p\u003e\n\u003cp\u003eDecision Support and Psychological Support: Providing support during the decision-making process, particularly offering emotional support and psychological counseling when patients face the consequences of treatment, helping them manage the psychological stress associated with fertility preservation.\u003c/p\u003e\n\u003cp\u003eInterdisciplinary Team Collaboration: Collaborating with oncologists, gynecologists, embryologists, psychologists, and other professionals, coordinating information flow between specialties to ensure timely and effective care throughout the treatment process.\u003c/p\u003e\n\u003cp\u003eAssisting Referrals and Follow-up: Coordinating patient referrals and follow-ups to ensure patients receive the necessary subsequent treatments and exams, adjusting fertility preservation plans according to treatment progress.\u003c/p\u003e\n\u003cp\u003eImplementing Fertility Preservation: Involved in the implementation of fertility preservation measures, such as sperm freezing, providing procedural guidance, emotional support, and assisting patients through the process.\u003c/p\u003e\n\u003cp\u003eLong-term Support and Information Follow-up: Providing long-term follow-up and information support post-fertility preservation, ensuring continued emotional support and fertility management information after treatment.\u003c/p\u003e\n\u003cp\u003eEducation and Training: Participating in peer education and staff training to improve the overall knowledge level of the team, ensuring high-quality patient care.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ea\u0026ndash;e\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\u003eIn North America (the United States and Canada), fertility preservation services have become institutionalized, with nurses commonly serving as fertility preservation coordinators or navigators. These nurses lead tasks such as patient identification, early communication, interdisciplinary coordination, informed consent, and follow-up management, covering the entire fertility preservation process. This has resulted in a systematic, nurse-led service model.\u003c/p\u003e\n\u003cp\u003eIn Asia (China, Japan), nurses primarily participate as team support members, with their roles focused on identifying patient needs, providing emotional support, assisting in doctor-patient communication, and providing early information. Nurses in this region have not yet fully taken a leading role in the fertility preservation process. Compared to North America and Europe, nurses in Asia have less autonomy but excel in providing humanistic care and emotional resonance.\u003c/p\u003e\n\u003cp\u003eIn Australia, nurses are integrated into a multidisciplinary \"rapid response\" system and often act as coordinators, bridging roles in the fertility preservation service. They are responsible for quickly initiating referrals after diagnosis, providing education, and offering emotional support, ensuring continuity of the fertility preservation process. This reflects an efficiency-driven coordination model.\u003c/p\u003e\n\u003cp\u003eIn Europe (the United Kingdom and the Netherlands), nurses are key members of the fertility preservation team, primarily responsible for information transfer, patient education, and pathway coordination. Although most services are still physician-led, the nurse-led consultation model is gradually being explored.\u003c/p\u003e\n\u003cp\u003eOverall, the cross-regional comparison reveals that nurses' core roles in patient education, pathway coordination, and psychosocial support are universally recognized. However, North America and Australia have already established institutionalized nurse-led models, Europe is transitioning towards this model, and Asia is still in the early stages, primarily focused on support and communication. This global trend reflects a gradual evolution from collaborative participation to leading practice.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis review through systematic literature analysis and guideline comparison, revealed a clear temporal evolution and regional differences in the definition of nurses' roles in fertility preservation for cancer patients across different countries and regions.\u003c/p\u003e \u003cp\u003eAnalysis of 17 international guidelines in this study reveals two main characteristics: a clear evolutionary trend in the role of nurses and the widespread vagueness of their responsibilities. First, the guidelines reflect a global shift in nurses' roles from \"implicit involvement\" to \"institutionalized inclusion.\" Early guidelines, such as the 2011 Oncofertility Consortium framework [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] and the 2012 ISFP guidelines [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], typically described roles using the broad concept of \"healthcare providers\" without specifically identifying nurses. Since the release of the 2013 SIGN guidelines [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], the role of nurses is gradually gaining recognition. In recent years, updated guidelines such as the American Society of Clinical Oncology [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] and NCCN [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e] have formally included nurses as core members of the multidisciplinary fertility preservation team. Second, despite most guidelines now including nurses as part of the fertility preservation team, the specific tasks assigned to them are still not clearly defined, leading to insufficient clinical applicability. This lack of clarity can cause issues such as unclear role boundaries and uneven responsibility distribution in practice [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Possible reasons for this include differences in fertility preservation legislation and policy support across countries, physician-dominated guideline development processes, and the deliberate blurring of roles in interdisciplinary collaborations to ensure flexibility. This phenomenon suggests that future guideline development and training systems should more clearly define nurses' roles and competency standards, which will help standardize and institutionalize the nursing role in fertility preservation and provide a solid basis for nurses' clinical practice.\u003c/p\u003e \u003cp\u003eFrom the literature results summarized in this study, it is evident that most research on nurses in fertility preservation has focused on the assessment, referral, and initial consultation stages, while studies on treatment implementation, long-term follow-up, and system optimization are still relatively scarce. This has resulted in an overall fragmented fertility preservation nursing process, with nurses' roles not fully developed throughout the entire process. This study elevates nurses' roles in fertility preservation from a series of isolated tasks to a comprehensive role that spans the entire process. It systematically explains how nurses connect patients, multidisciplinary teams, and healthcare systems to ensure the continuity and completeness of fertility preservation services. Nurses' roles across different stages include: early identification of patient needs (assessment and referral), providing information and psychological support (counseling and decision support), guiding and assisting in specific treatments (treatment implementation), tracking patient conditions long-term (long-term follow-up), and promoting system development and quality improvement (system optimization). These five stages and 23 tasks systematically clarify nurses' bridging and coordinating roles throughout the entire fertility preservation process, providing a basis for the future design of standardized fertility preservation nursing pathways, development of job descriptions, and assessment tools.\u003c/p\u003e \u003cp\u003eThe cross-national comparison further reveals that nurses' clinical roles in fertility preservation vary significantly depending on national healthcare systems, policies, and nursing education backgrounds. In North America, fertility preservation services are highly institutionalized, with nurses often serving as \"fertility preservation coordinators\" or \"navigators,\" overseeing risk assessment, early communication, interdisciplinary coordination, informed consent, and long-term follow-up, thus forming a systematic, nurse-led service model. In Europe, fertility preservation services are still primarily physician-led, but nurse-led consultation models are gradually emerging. Australia uses a \"rapid response\" multidisciplinary model, with nurses acting as key coordinators responsible for quick referrals, education, and emotional support, ensuring efficient and continuous service. In Asian countries, nurses are typically involved as support team members, mainly responsible for information provision, emotional resonance, and communication assistance, but they lack autonomy in leading the fertility preservation process. Moreover, some nurses, due to a lack of reproductive medicine training, fear legal liability, or lack institutional support, prefer to hand over fertility preservation-related issues to physicians, further blurring role boundaries and leading to uneven service provision [\u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e]. Therefore, countries and regions should establish localized fertility preservation nursing models that suit their specific circumstances. In regions with existing fertility preservation nursing models, the \"navigator\" model from North America and other regions should be adopted systematically, with policy support, educational training, and job setting, forming a nurse-led fertility preservation nursing model. In regions without mature fertility preservation nursing services, focus should be placed on standardizing service processes and evaluating their effectiveness.\u003c/p\u003e \u003cp\u003eThis study does have several limitations. First, although the review extensively included literature and guidelines, it was limited to English-language sources, which may introduce publication bias. Second, differences in study design and reporting methods limited the comparability of results. Third, most of the included studies are from high-income countries, with limited representation from low- and middle-income regions. Finally, due to the nature of a scoping review, this study did not conduct a systematic evaluation of study quality, which may affect the depth and reliability of the conclusions.\u003c/p\u003e \u003cp\u003eThis review systematically outlines the roles and tasks of nurses in fertility preservation for cancer patients, providing theoretical support for the development of subsequent training programs, curriculum content, and competency assessment standards. It can serve as an important reference for future guideline development. By promoting standardized models and establishing nurse-led fertility preservation service pathways, the continuity and quality of care for cancer patients can be improved. Future research should further focus on nurses' roles throughout the entire fertility preservation process, particularly their contributions to treatment implementation, long-term follow-up, and quality improvement. Additionally, intervention studies should be conducted to verify the actual impact of nurse-led fertility preservation services on fertility preservation utilization, decision satisfaction, and reproductive outcomes. Furthermore, integrating core competencies related to fertility preservation, such as communication skills, ethical decision-making, and reproductive health counseling, into oncology nursing curricula and continuing education systems will enhance nurses' professional competence. These initiatives will further solidify nurses' professional identity in oncology fertility care, advance nursing practice, and ensure that cancer patients have equal access to high-quality fertility preservation services.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eIn summary, this review systematically defines the specific roles of oncology nurses throughout the entire fertility preservation care process. It clearly outlines the professional responsibilities of nurses in this field, highlighting their core value in care coordination, patient navigation, and service improvement. The findings of this study provide a strong theoretical and practical basis for optimizing clinical practice, education, and policy development. It advocates for the integration of specially trained nurses into the fertility preservation care system to meet the fertility needs of cancer patients and improve the overall quality of nursing services.\u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors have no competing interests to declare.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis study is supported by the Science and Technology Program of Department of Human Resources and Social Security of Sichuan Province.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eThe planning and conceptualization of the review were conducted by the first author LY and the corresponding author ZHF. The screening process and data analysis were performed by LY and WQ, supplemented by LBJ and ZL. LY drafted the manuscript, while ZYL and SA contributed to the conceptualization of the results section. Authors ZHF, LFQ, and WC made substantial revisions to the manuscript. All authors have read and approved the final manuscript. Furthermore, they agree to be accountable for their contributions and ensure that any questions raised regarding the accuracy or completeness of any part of the work are appropriately investigated, resolved, and documented.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eLarge language models (LLMs), such as ChatGPT and DeepL, are used to enhance text and English language proficiency.\u003c/p\u003e\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e \u003cp\u003eThe search strategy is publicly available as an additional file.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. World health statistics 2025: monitoring health for the SDGs. Sustainable Development Goals: World Health Organization; 2025.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKoyama H, Wada T, Nishizawa Y, Iwanaga T, Aoki Y. 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Acta Oncol. 2012;51(8):1062\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMeneses K, Holland AC. Current evidence supporting fertility and pregnancy among young survivors of breast cancer. Journal of obstetric, gynecologic, and neonatal nursing. JOGNN / NAACOG. 2014;43(3):374\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKrouwel EM, Nicolai MPJ, van Steijn-van Tol AQMJ, Putter H, Osanto S, Pelger RCM, Elzevier HW. Fertility preservation counselling in Dutch Oncology Practice: Are nurses ready to assist physicians? Eur J Cancer Care 2017, 26(6).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSemler R, Thom B. Fertility Preservation: Improving Access Through Nurse-Advocated Financial Assistance. Clin J Oncol Nurs. 2019;23(5):27\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLien CT, Huang SM, Hua Chen Y, Cheng WT. Evidenced-based practice of decision-making process in oncofertility care among registered nurses: A qualitative study. Nurs Open. 2021;8(2):799\u0026ndash;807.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eScott-Trainer J. The role of a patient navigator in fertility preservation. Cancer Treat Res. 2010;156:469\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWright ML, Theroux CI, Olsavsky AL, DaJusta D, McCracken KA, Hansen-Moore J, Yeager ND, Whiteside S, Audino AN, Nahata L. The impact of hiring a full-time fertility navigator on fertility-related care and fertility preservation at a pediatric institution. Pediatr Blood Cancer 2022, 69(9).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVadaparampil ST, Gwede CK, Meade C, Kelvin J, Reich RR, Reinecke J, Bowman M, Sehovic I, Quinn GP, Enrich Research GRP. ENRICH: A promising oncology nurse training program to implement ASCO clinical practice guidelines on fertility for AYA cancer patients. Patient Educ Couns. 2016;99(11):1907\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSuzuki N. Oncofertility in Japan: Advances in research and the roles of oncofertility consortia. Future Oncol. 2016;12(19):2307\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTomlinson MJ, Pacey AA. Practical aspects of sperm banking for cancer patients. Hum Fertility. 2003;6(3):100\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRotker K, Vigneswaran H, Omil-Lima D, Sigman M, Hwang K. Efficacy of Standardized Nursing Fertility Counseling on Sperm Banking Rates in Cancer Patients. 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Barriers and Facilitators to Fertility-Related Discussions with Teenagers and Young Adults with Cancer: Nurses' Experiences. J Adolesc Young Adult Oncol. 2020;9(4):481\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCohen L, Hamer J, Helwig C, Fergus K, Kiss A, Mandel R, Dawson B, Landsberg A, Shein K, Kay N, et al. Formal evaluation of PYNK: Breast cancer program for young women\u0026mdash;the patient perspective. Curr Oncol. 2016;23(2):e102\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStern C, Agresta F. Setting up a fertility preservation programme. Best Pract Res Clin Obstet Gynecol. 2019;55:67\u0026ndash;78.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeonard M, Hammelef K, Smith GD. Fertility considerations, counseling, and semen cryopreservation for males prior to the initiation of cancer therapy. Clin J Oncol Nurs. 2004;8(2):127\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQuinn GP, Vadaparampil ST, Bell-Ellison BA, Gwede CK, Albrecht TL. Patient\u0026ndash;physician communication barriers regarding fertility preservation among newly diagnosed cancer patients. Soc Sci Med. 2008;66(3):784\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Fertility Preservation, Cancer, Nursing, Nurse's role","lastPublishedDoi":"10.21203/rs.3.rs-8324545/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8324545/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eFertility preservation is an essential component of cancer care, particularly for reproductive-age cancer patients. Nurses, due to their continuous interaction with patients throughout diagnosis and treatment, are uniquely positioned to implement fertility preservation services. However, while current guidelines mention healthcare providers' roles in fertility preservation, there are significant variations in nurse involvement across countries, and their specific responsibilities remain undefined. This study aims to clearly define the specific roles and responsibilities of nurses in fertility preservation for cancer patients.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis study uses a scoping review methodology to comprehensively analyze the research evidence and characteristics of nurse involvement in fertility preservation for cancer patients. A systematic search was conducted across multiple databases, including PubMed, CINAHL, EMBASE, Scopus, PsycINFO, Web of Science, as well as guideline repositories such as BMJ Best Practice, the Scottish Intercollegiate Guidelines Network, the National Guidelines Clearinghouse, the ECRI Guidelines Trust\u0026trade;, and the National Institute for Health and Care Excellence. The search covered the period from the inception of the databases to April 2025. All studies and clinical guidelines published in English that addressed the role, responsibilities, and practices of nurses in fertility preservation were included.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 18 guidelines and 39 studies were included. The analysis of the guidelines revealed that the majority of documents referred to healthcare providers or medical staff in general terms, including nurses, but without specific details on their roles. Further analysis of the literature identified five key stages of nurse involvement in fertility preservation: (1) assessment and referral, (2) counseling and decision support, (3) treatment implementation, (4) long-term follow-up, and (5) system optimization. Cross-regional comparisons revealed significant differences in the definition of nurses' roles, their responsibilities, and the scope of services they provide: North America has established an institutionalized nurse-led model; Europe is exploring nurse-led consultation services; Australia emphasizes an efficiency-oriented coordination model; and Asia primarily focuses on supportive participation, emphasizing emotional resonance and humanistic care.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eExisting guidelines recognize the importance of nurses in fertility preservation services, and the role of nurses is shifting from implicit participation to institutionalized integration. However, there are significant differences in the roles and responsibilities of nurses in practice across countries. This study defines five key stages and 23 specific tasks for nurses involved in fertility preservation services for cancer patients, providing practical evidence for future guideline revisions, nurse training, and clinical pathway optimization.\u003c/p\u003e","manuscriptTitle":"From Implicit Participation to Integration: The Evolving Role of Nurses in Oncofertility","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-09 12:41:25","doi":"10.21203/rs.3.rs-8324545/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-02-16T10:29:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"207383114276412387407417715495046319087","date":"2026-02-12T10:32:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-06T05:26:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"302538009787120449285000956773736830673","date":"2026-02-06T02:30:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"32124088556236511229750139635117379269","date":"2026-02-05T06:16:38+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-05T05:26:22+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-16T06:25:01+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-13T07:30:20+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-13T07:29:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-12-10T07:39:40+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"27956da1-adc5-4533-aefb-780718ab0aba","owner":[],"postedDate":"February 9th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-09T12:41:27+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-09 12:41:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8324545","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8324545","identity":"rs-8324545","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}