Development and Validation of a Questionnaire on Knowledge, Attitudes, and Practices of Breast Specialist Nurses Regarding Fertility Preservation in Breast Cancer Patients of Childbearing Age

Development and Validation of a Questionnaire on Knowledge, Attitudes, and Practices of Breast Specialist Nurses Regarding Fertility Preservation in Breast Cancer Patients of Childbearing Age | 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 Development and Validation of a Questionnaire on Knowledge, Attitudes, and Practices of Breast Specialist Nurses Regarding Fertility Preservation in Breast Cancer Patients of Childbearing Age Qi Wang, Pei Zhao, Hongmei Zhang, Pilei Si This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9328430/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background The pregnancy rate among breast cancer patients is the lowest among all cancer populations, at only 3%, which is 40% lower than that in the general population. In China, breast cancer patients of childbearing age lack comprehensive and systematic knowledge about treatment-related reproductive impairment and fertility preservation. As the primary healthcare providers for these patients, breast care nurses play a crucial role in providing education, referrals, and information consultation regarding fertility preservation. However, the current status of clinical practice involving breast care nurses in fertility preservation for breast cancer patients in China is far from satisfactory. Aims This study aimed to develop a questionnaire on knowledge, attitudes, and practices of breast care nurses regarding fertility preservation in childbearing-age breast cancer patients, and to evaluate the validity of this questionnaire among breast care nurses. Methods The initial draft of the questionnaire was developed through literature review and two rounds of expert consultation. From October 2025 to December 2025, a total of 330 breast care nurses from tertiary Class A hospitals in Henan Province were enrolled for the survey, followed by item analysis, reliability testing, and exploratory factor analysis. Another 420 breast care nurses were recruited for a separate survey to conduct confirmatory factor analysis. Results The final questionnaire comprised 3 dimensions and 38 items. For the overall questionnaire, the Cronbach's α coefficient was 0.956, the split-half reliability was 0.745, the test-retest reliability was 0.936, and the average content validity index was 0.932. Three common factors were extracted by exploratory factor analysis, with factor loadings of individual items ranging from 0.546 to 0.750, and the cumulative variance contribution rate was 60.038%. Results of confirmatory factor analysis indicated that the model fit was acceptable and the questionnaire structure was stable. Conclusions The questionnaire assessing knowledge, attitudes, and practices of breast care nurses regarding fertility preservation in childbearing-age breast cancer patients is valid and reliable. It is recommended for use in clinical practice and research to evaluate the level of knowledge, attitudes, and practices of breast care nurses toward fertility preservation for this patient population. Breast specialty Nurses Fertility preservation Reliability Validity Nursing Figures Figure 1 Figure 2 Introduction According to GLOBOCAN 2022 global cancer statistics, of nearly 20 million new cancer cases, approximately 2.3 million were breast cancer, accounting for 11.60% of all new cancer cases [ 1 ] , ranking as the most common malignant tumor among women. Furthermore, breast cancer is showing a trend toward younger onset, with more than 60% of cases occurring in women of childbearing age [ 2 ] . The 5‑year survival rate of breast cancer patients of childbearing age is as high as 87.1% [ 3 ] , and about 40% of them still express fertility desires after diagnosis and treatment of breast cancer [ 4 ] .Although survival outcomes have improved, comprehensive treatments including surgery, chemotherapy, and endocrine therapy can lead to ovarian dysfunction, which directly impairs patients’ fertility [ 5 ] . Research has indicated [ 6 ] that the pregnancy rate among breast cancer patients of childbearing age is the lowest among all cancer populations, at only 3%, which is 40% lower than that in the general population. Fertility has become a core component affecting the quality of life of breast cancer patients of childbearing age [ 7 ] .Against this background, fertility preservation (FP), as an important intervention, aims to prevent and address infertility risks through various therapeutic approaches. It helps adults and children at risk of infertility preserve their reproductive endocrine function and reproductive potential, enabling them to have genetically related offspring [ 8 ] . Reproductive health has been listed as a key strategic goal in the Healthy China 2030 Blueprint [ 9 ] . However, during the diagnosis and treatment of breast cancer patients of childbearing age, both healthcare providers and patients mostly focus on the treatment of the disease itself, often neglecting the damage of cancer therapy to the reproductive system and patients’ long-term fertility needs [ 10 ] .To meet the fertility needs of this population, the 4th ESO-ESMO International Consensus Guidelines for Young Women with Breast Cancer [ 11 ] and the clinical guidelines on fertility preservation for cancer patients [ 12 ] clearly recommend that clinical healthcare professionals discuss the potential risk of infertility with patients as early as possible before treatment initiation and introduce available fertility preservation options.Nevertheless, fertility preservation for breast cancer patients in China has not received sufficient attention. As many as 76.8% of patients lack knowledge about fertility preservation [ 13 ] , and 94.2% are unwilling to undergo fertility preservation interventions [ 14 ] . These findings indicate that breast cancer patients of childbearing age in China lack comprehensive and systematic understanding of treatment-related reproductive impairment and fertility preservation. As the primary healthcare providers for patients, nurses play a vital role in providing fertility preservation education, referrals, and information consultation [ 15 ] . The American Society of Clinical Oncology (ASCO) [ 16 ] includes nurses in the clinical practice of discussing and referring childbearing-age cancer patients for fertility preservation.However, the current status of nurses’ involvement in fertility preservation for breast cancer patients in China is far from satisfactory. This is mainly reflected in the significant gaps in nurses’ knowledge of fertility preservation, and such disparities in knowledge directly affect the effectiveness of subsequent clinical practice [ 17 ] . Studies have shown [ 18 ] that most healthcare professionals in China lack clear or adequate understanding of the concept of fertility preservation. Second, the unclear role definition of nurses in fertility preservation practice in China has led them to overlook their important responsibilities [ 19 ] . In addition, there is a lack of unified and standardized fertility preservation protocols and guidelines in nursing practice to direct clinical behaviors [ 20 ] . Therefore, it is crucial to conduct research aimed at improving the knowledge, attitudes, and practices of breast care nurses regarding fertility preservation.Nevertheless, at present, no validated assessment tool specifically targets the knowledge, attitudes, and practices of breast care nurses toward fertility preservation for childbearing-age breast cancer patients. This makes it difficult to identify the root causes of barriers to fertility preservation implementation and thus prevents the development of targeted interventions. Based on the Knowledge-Attitude-Practice (KAP) theory, this study developed a questionnaire to assess the knowledge, attitudes, and practices of breast care nurses regarding fertility preservation in childbearing-age breast cancer patients, and examined its reliability and validity. This questionnaire provides a scientific instrument for evaluating the relevant knowledge, attitudes, and practice levels of breast care nurses in this field. Aims and objectives of study The purpose of this study was to develop and evaluate the validity of a questionnaire assessing knowledge, attitudes, and practices of breast care nurses regarding fertility preservation in breast cancer patients of childbearing age. Design and methods Design This study adopted a standardized questionnaire development procedure [ 21 ] , which was divided into two phases: development and validation (Fig. 1 ).The first phase included item pool generation, expert consultation, and a pilot survey. The item pool was constructed through a literature review, and the questionnaire was developed using the Delphi method. The initial draft was revised via expert consultation to evaluate content validity, and face validity was assessed by conducting a pilot test of the revised questionnaire.In the second phase, the questionnaire was further refined, and its validity and reliability were evaluated based on results from item analysis, exploratory factor analysis, reliability testing, and confirmatory factor analysis. Phase1: development of the questionnaire The establishment of the research group The research team consisted of 8 members, including 2 head nurses (both vice chief nurse specialists), 2 nurse specialists in breast surgery, 2 clinicians in breast surgery (1 chief physician and 1 associate chief physician), and 2 nursing postgraduate students. All participants were from Henan Provincial People’s Hospital.One head nurse and one chief physician were responsible for study design and quality control. The other head nurse and one associate chief physician were in charge of constructing the initial questionnaire item pool, as well as selecting and contacting the experts for consultation.Two nurse specialists were responsible for reviewing and calibrating the initial questionnaire, including evaluating the clinical applicability of the item pool, ensuring linguistic consistency and compliance with hospital guidelines, and administering questionnaire distribution and collection.Two nursing postgraduate students performed literature analysis, developed the expert consultation questionnaire, and conducted data organization and statistical analysis. Development of item pool Theoretical basis Based on the Knowledge-Attitude-Practice (KAP) theory, this study proposes that knowledge serves as the foundation, positive attitude as the intrinsic motivation, and the generation and transformation of practice as the goal [ 22 ] . According to this theory, the research team clarified the three components of KAP within the framework and initially defined the three dimensions of the questionnaire.1) Knowledge: including the basic concept of fertility preservation, the impact of breast cancer treatment on fertility, factors associated with pregnancy success rates, target populations and contraindications, potential risks, and the optimal timing of interventions;2) Attitude: referring to breast care nurses’ attitudes toward learning relevant theoretical knowledge and their beliefs in the effective implementation of fertility preservation;3) Practice: referring to breast care nurses actively learning knowledge related to fertility preservation under the guidance of their existing knowledge and positive attitudes, and conducting clinical practice consistently and proficiently in accordance with standardized procedures.This reflects their ability to translate knowledge and attitudes into effective practice, thereby ensuring that breast cancer patients of childbearing age can make optimal fertility preservation decisions.This dimension aims to evaluate nurses’ ability to translate knowledge and attitudes into effective practice so as to support breast cancer patients of childbearing age in making optimal fertility preservation decisions. Literature review Using “Breast Specialist Clinic/Breast Surgery”, “Nurses/Nursing Personnel/Medical Staff”, and “Fertility Preservation/assisted reproductive/reproductive protection” as English search terms, databases including CNKI, Wanfang, VIP, PubMed, Web of Science, and Embase were searched from their inception to July 2025.Through literature synthesis, theoretical analysis, and group discussion, the item pool was initially screened and refined, consisting of 21 items for knowledge, 9 items for attitude, and 10 items for practice, with a total of 40 items. Delphi expert consultation Selection of experts From August to September 2025, a total of 18 experts in relevant fields were selected using the purposive sampling method.The inclusion criteria for experts were as follows:(1) Bachelor’s degree or above;(2) Intermediate professional title or higher;(3) At least 10 years of clinical practice, nursing work, or research experience in breast surgery or reproductive medicine;(4) Familiar with fertility preservation and questionnaire development;(5) Voluntary participation in this expert consultation. Preparation of expert consultation questionnaire The expert consultation questionnaire comprised three parts:(1) Questionnaire instructions: introducing the research background, research purpose, content and guidance for completion;(2) Consultation content: a 5-point Likert scale was used to score the importance of each item, ranging from 1 (not important at all) to 5 (extremely important). A 4-point Likert scale was applied for relevance, ranging from 1 (totally irrelevant) to 4 (highly relevant). Sections for “revision suggestions” and “item addition or deletion” were included to invite experts to provide comments for revision or supplementation, and to evaluate the comprehensiveness of the questionnaire, so as to ensure it fully covered all elements of the three dimensions (knowledge, attitude and practice) of breast care nurses regarding fertility preservation for breast cancer patients of childbearing age.(3) Expert general information: including demographic data, experts’ familiarity with the research field and their judgment basis. Implementation of expert consultation After obtaining informed consent from the experts, the research team distributed the first-round consultation questionnaire via email and requested a response within two weeks.Following the first round of consultation, the research team summarized, discussed, and revised the experts’ comments to develop the second-round questionnaire, which was then sent to the same experts.After two rounds of expert consultation, a consensus was reached among the experts, and the consultation process was concluded.Items with a mean importance score ≥ 3.50 and a coefficient of variation < 0.25 were retained [ 23 ] .The research team revised the questionnaire content based on the experts’ suggestions. Expert enthusiasm, judgment coefficient, familiarity coefficient, authority coefficient, and content validity Expert enthusiasm was used to evaluate the degree of active participation and the level of attention experts paid to the study. The authority of expert consultation was determined by the judgment coefficient (Ca), familiarity coefficient (Cs), and authority coefficient (Cr). Generally, a Cr value ≥ 0.7 indicates high authority of the questionnaire [ 24 ] . The concentration of expert opinions was expressed by the coefficient of variation (CV) and Kendall’s concordance coefficient. A value of P < 0.05 was considered statistically significant.The scale-level content validity index (S-CVI) and item-level content validity index (I-CVI) were calculated based on experts’ ratings for each item. An S-CVI and I-CVI both greater than 0.8 indicated satisfactory content validity of the questionnaire [ 25 ] . Pilot survey In October 2025, 30 nurses from the Department of Breast Surgery at Henan Provincial People's Hospital were randomly selected to conduct a pilot survey to test whether the questionnaire content was clear and easy to understand. The inclusion criteria were as follows:①holding a valid nursing practice license; ②working as a nurse in the Department of Breast Surgery;③providing informed consent and voluntarily participating in this study. Exclusion criteria were: ①nurses not currently employed at this hospital; ②inability to complete the questionnaire for any reason. Phase2: evaluation and validition of the questionnaire Setting and sample Using convenience sampling, a survey was conducted among breast surgery nurses from tertiary grade A hospitals in Henan Province from October 2025 to December 2025. The initial questionnaire was subjected to item analysis, reliability testing, exploratory factor analysis, and confirmatory factor analysis. The inclusion and exclusion criteria were the same as those used in the pilot survey. The sample size for the two rounds of surveys should be 5–10 times the number of questionnaire items [ 26 ] . The initial questionnaire consisted of 38 items. Considering a 20% sample attrition rate, the required sample size ranged from 238 to 475 cases. A total of 350 and 455 questionnaires were distributed in the two rounds, respectively, and 330 and 420 valid questionnaires were returned, yielding effective response rates of 94.29% and 92.31%, respectively. Instruments data collection tools The first-round questionnaire consisted of a general information sheet (age, sex, education level, professional title, years of work experience) and the initial questionnaire on breast surgery nurses' knowledge, attitude, and practice regarding fertility preservation for young breast cancer patients of childbearing age. The second-round questionnaire included a general information sheet and the formal questionnaire on breast surgery nurses' knowledge, attitude, and practice regarding fertility preservation for young breast cancer patients of childbearing age.Each item was rated using a 5-point Likert scale. For the knowledge dimension, scores ranged from 1 (completely unaware) to 5 (completely aware), with total scores ranging from 17 to 85. Higher scores indicated a better level of knowledge among breast surgery nurses regarding fertility preservation for young breast cancer patients of childbearing age. For the attitude dimension, scores ranged from 1 (strongly disagree) to 5 (strongly agree), with total scores ranging from 11 to 55. The following items were reverse-scored (with the scoring order reversed): "I think fertility preservation seriously interferes with breast cancer treatment"; "I think fertility counseling can be omitted when time for treatment is limited"; "I think fertility preservation should not be offered to breast cancer patients with a poor prognosis"; and "I think fertility preservation is the responsibility of doctors and has nothing to do with nurses." Higher total attitude scores indicated a more positive attitude toward fertility preservation for young breast cancer patients of childbearing age. For the practice dimension, scores ranged from 1 (never) to 5 (always), with total scores ranging from 10 to 50. Higher scores indicated a higher level of practice regarding fertility preservation for young breast cancer patients of childbearing age. Data collection After uniformly trained research team members explained the study purpose to nursing managers at each hospital and obtained their consent, the questionnaire link was sent to participants via a questionnaire platform. The first page of the questionnaire included information on the study purpose, completion instructions, and privacy protection. The questionnaire was set so that each participant could only complete it once, and submission was allowed only after all items had been filled out. After data collection was completed, the data were exported promptly and checked by two researchers. Questionnaires were excluded if the completion time was less than one minute, the responses showed an obvious pattern, or there were logical errors. Data analysis Data entry and analysis were performed using Excel 2019, IBM SPSS v27.0, and AMOS 26.0. Categorical data were described as frequencies and percentages. Normally distributed continuous data were presented as mean ± standard deviation, while non‑normally distributed data were presented as median and interquartile range. The critical ratio method was used to sort the questionnaires collected in the first round from highest to lowest total score; the top 27% were assigned to the high‑score group and the bottom 27% to the low‑score group. An independent samples t‑test was used to compare the differences between the two groups, and items with P ≤ 0.05 or a critical ratio > 3 were retained [ 27 ] . Pearson correlation analysis was performed to calculate the correlation coefficient between each item and the total score; items with a correlation coefficient < 0.4 were considered to have unsatisfactory correlation and were deleted [ 27 ] . For exploratory factor analysis, principal component analysis with varimax orthogonal rotation was used. Factors with eigenvalues > 1 and cumulative variance contribution rate > 50% were retained, and items with factor loadings 0.45. Model fit was evaluated using the following criteria: chi‑square/degrees of freedom (χ 2 /df) < 5, root mean square error of approximation (RMSEA) 0.9, indicating acceptable model fit. Convergent validity was assessed using average variance extracted (AVE) > 0.5 and composite reliability (CR) > 0.7 [ 30 ] . Internal consistency of the questionnaire was evaluated using Cronbach's α coefficient, with α ≥ 0.7 indicating good internal consistency [ 31 ] . Split-half reliability for each dimension and the total questionnaire was calculated using the first-half and second‑half method. After the first round of data collection, 50 breast specialty nurses were selected to complete the questionnaire again after a two-week interval; the test-retest reliability for each dimension and the total questionnaire was calculated to assess the stability of the questionnaire. Ethical and research approvals with the date This study was approved by the Ethics Committee of Henan Provincial People's Hospital on May 30, 2024 (approval No. (2024) Lun Shen No. (116)). The study complied with the principles of the Declaration of Helsinki. All participants provided written informed consent and participated anonymously. Results Delphi expert consultation results A total of 18 experts participated in the final expert consultation, including 8 physicians from breast surgery and reproductive medicine, and 10 nurses from breast surgery and reproductive medicine. Among them, 5 were male and 13 were female, with ages ranging from 38 to 55 (43.78 ± 5.07 )years. Their years of work experience ranged from 10 to 28 (17.11 ± 5.66 )years. Among the experts, 3 held a bachelor's degree, 12 held a master's degree, and 3 held a doctoral degree. Regarding professional titles, 7 had intermediate titles, 8 had associate senior titles, and 3 had senior titles. The effective response rates for both rounds of expert consultation questionnaires were 100%. For the two rounds of expert consultation, the Cs values were 0.93 and 0.94, the Ca values were 0.91 and 0.93, and the Cr values were 0.92 and 0.94, respectively. Kendall's coefficients were 0.218 and 0.236 ( P < 0.001), respectively. In the first round of expert consultation, the mean importance scores of the items ranged from 3.06 to 4.94, and the coefficients of variation ranged from 0 to 0.38. Based on the results of the expert consultation and the experts' comments, the research team discussed and revised the draft questionnaire. Four items were added: "I know that endocrine therapy does not directly damage ovarian reserve, but a treatment course of 5–10 years may lead to a natural decline in fertility due to increasing age"; "I think fertility preservation should not be offered to breast cancer patients with a poor prognosis"; "I believe that actively referring young breast cancer patients of childbearing age to reproductive medicine is the responsibility of breast specialty nurses"; and "I will assess the patient's need for fertility preservation and document it in the nursing records." Three items were deleted: "I know that fertility‑preserving treatment should not pose additional risks or interfere with breast cancer treatment"; "I think that when time for breast cancer treatment is limited, it is unnecessary to communicate with patients about fertility"; and "I will introduce ethical and legal knowledge related to fertility preservation to patients." Nine items were merged. Specifically, the items "I know that fertility preservation techniques for breast cancer include embryo cryopreservation, oocyte cryopreservation, and ovarian tissue cryopreservation; protective measures include ovarian function suppression", "I know that embryo cryopreservation is a technique of ovulation induction, oocyte retrieval, in vitro fertilization, embryo freezing, and then thawing and transferring into the uterus when needed", "I know that oocyte cryopreservation is a technique of ovulation induction, oocyte retrieval, oocyte freezing, and then thawing, fertilization, embryo formation, and transfer into the uterus when needed", "I know that ovarian tissue cryopreservation is a technique of surgically obtaining ovarian tissue, cryopreserving it, and then thawing and transplanting it when needed", and "I know that ovarian function suppression involves monthly injections of GnRHa starting 7 days before chemotherapy and continuing for ≥ 3 months to suppress ovarian function to protect fertility, but it does not replace mature cryopreservation techniques" were merged into one item: "I know that embryo cryopreservation, oocyte cryopreservation, and ovarian tissue cryopreservation are fertility preservation techniques, while ovarian function suppression is a fertility protection measure." The items "I know that embryo cryopreservation is suitable for married women aged < 40 years (for those with normal ovarian reserve, full informed consent, and strong fertility intention, the age limit may be extended to 42 years)" and "I know that oocyte cryopreservation is suitable for women of childbearing age aged < 40 years (for those with normal ovarian reserve, full informed consent, and strong fertility intention, the age limit may be extended to 42 years)" were merged into: "I know that embryo cryopreservation is suitable for married women, and oocyte cryopreservation is suitable for unmarried/married women of childbearing age; the age limit is generally < 40 years, but may be extended to 42 years for those with normal ovarian reserve, full informed consent, and strong fertility intention." The items "Before the cancer treatment plan is determined, I will discuss the importance, benefits, and risks of fertility preservation with patients or family members who have medical indications and willingness for fertility preservation" and "Before the cancer treatment plan is determined, I will provide preliminary information on available fertility preservation options to patients or family members who have medical indications and willingness for fertility preservation" were merged into: "Before treatment, I will discuss the importance, benefits, risks, and available options for fertility preservation with eligible and willing patients/family members." The wording of four items was modified. For example, "I know that radiotherapy and chemotherapy can damage the fertility of breast cancer patients" was changed to "I know that chemotherapy and pelvic/abdominal radiotherapy can damage the fertility of breast cancer patients"; "I know that the hormone receptor status of breast cancer patients does not affect the choice of fertility preservation options" was changed to "I know that the hormone receptor status of breast cancer patients does not affect whether they can use mature cryopreservation techniques"; "I know that the risks of embryo and oocyte cryopreservation include vaginal bleeding, infection, elevated estrogen levels, and ovarian hyperstimulation syndrome" was changed to "I know that during embryo and oocyte cryopreservation, ovulation induction and oocyte retrieval may cause vaginal bleeding, infection, elevated estrogen levels, and ovarian hyperstimulation syndrome"; and "I know that the optimal timing for fertility preservation in breast cancer patients is before surgery, chemotherapy, radiotherapy, or endocrine therapy" was changed to "I know that fertility preservation for breast cancer patients is preferably completed before the start of chemotherapy, radiotherapy, or endocrine therapy; if ovarian reserve is still adequate after treatment, attempts can still be made; fertility preservation can be performed before or after surgery." In the second round of expert consultation, the mean importance scores of the items ranged from 4.11 to 5.00, and the coefficients of variation ranged from 0 to 0.23. Based on the consultation results and expert comments, no items were added, deleted, merged, or modified. After two rounds of expert consultation, the final questionnaire on knowledge, attitude, and practice of breast specialty nurses regarding fertility preservation for young breast cancer patients of childbearing age consisted of 3 dimensions and 39 items, including 17 items in the knowledge dimension, 11 items in the attitude dimension, and 11 items in the practice dimension. Pilot survey A total of 25 questionnaires were distributed in the pilot survey, and all were returned, yielding a 100% effective response rate. The nurses reported that they fully understood the questionnaire content, and the completion time ranged from 6 to 10 minutes. Therefore, no items were deleted, added, or modified. Participants’ characteristics A total of 330 breast specialty nurses were enrolled in the first-round survey, all of whom were female. Their ages ranged from 23 to 46 (31.08 ± 4.56)years. Regarding educational level, 88 nurses (26.70%) had an associate degree or below, 227 (68.80%) held a bachelor's degree, and 15 (4.50%) had a master's degree or above. In terms of professional titles, 59 nurses (17.90%) held primary titles (nurse), 91 (27.60%) held junior titles (nurse practitioner), 166 (50.30%) held intermediate titles (supervisor nurse), and 14 (4.20%) held associate senior or above titles (deputy supervisor nurse or higher). Their years of work experience ranged from 2 to 15 (6.51 ± 3.54 )years. A total of 420 breast specialty nurses were enrolled in the second-round survey, all of whom were female. Their ages ranged from 23 to 45 (30.79 ± 4.41)years. Regarding educational level, 122 nurses (29.00%) had an associate degree or below, 280 (66.70%) held a bachelor's degree, and 18 (4.30%) had a master's degree or above. In terms of professional titles, 90 nurses (21.40%) held primary titles (nurse), 127 (30.20%) held junior titles (nurse practitioner), 194 (46.20%) held intermediate titles (supervisor nurse), and 9 (2.10%) held associate senior or above titles (deputy supervisor nurse or higher). Their years of work experience ranged from 2 to 17(6.21 ± 3.51)years. Item analysis The critical ratio values for each item ranged from 11.506 to 19.930, with statistically significant differences in scores ( P < 0.001), indicating good discrimination. The correlation coefficients between each item and the total questionnaire ranged from 0.546 to 0.750 ( P < 0.01), indicating high homogeneity. Construct validity Content validity The item-level content validity index (I-CVI) ranged from 0.800 to 1.000, and the average I-CVI was 0.932, indicating good content validity of the questionnaire. Construct validity Construct validity was tested on the 39 items retained after item analysis. Two rounds of exploratory factor analysis (EFA) were conducted in this study. (1) In the first EFA, the Kaiser–Meyer–Olkin (KMO) value was 0.969, and Bartlett's test of sphericity yielded a χ² value of 8392.583 (P 1 were extracted, with a cumulative variance contribution rate of 59.678%. The item "I will introduce fertility preservation options to breast cancer patients" had a factor loading 0.5 on their respective factors, with no double or multiple loadings. The remaining 38 items were subjected to a second EFA. In the second EFA, the KMO value was 0.969, and Bartlett's test of sphericity yielded a χ² value of 8392.583 (P 1 were extracted, with variance contribution rates of 25.998%, 17.753%, and 16.286%, respectively, and a cumulative variance contribution rate of 60.038%. Based on the content of the items, the three factors were named the knowledge dimension, attitude dimension, and practice dimension. The factor loadings of each item on the corresponding factors are shown in Table 1 . (2) Confirmatory factor analysis (CFA) results showed a χ²/df of 1.256, GFI of 0.910, AGFI of 0.900, CFI of 0.983, and RMSEA of 0.025, indicating good model fit (Fig. 2 ). Reliability analysis results The Cronbach's α coefficient for the total questionnaire was 0.956, and the Cronbach's α coefficients for the dimensions ranged from 0.924 to 0.956. Deleting any single item did not result in a notable increase in the Cronbach's α coefficient. The split-half reliability coefficient for the total questionnaire was 0.745, and the split-half reliability coefficients for the dimensions ranged from 0.922 to 0.958. The test-retest reliability coefficient for the total questionnaire was 0.936, and the test-retest reliability coefficients for the dimensions ranged from 0.864 to 0.922. Table 1 Factor loadings of EFA Items Knowledge Attitude Practice K1. I know that fertility protection refers to taking early intervention against factors that damage fertility, protecting or preserving fertility to achieve genetically related offspring. 0.825 K2. I know that chemotherapy and pelvic/abdominal radiotherapy can damage the fertility of breast cancer patients. 0.784 K3. I know that endocrine therapy does not directly damage ovarian reserve, but a treatment course of 5–10 years may lead to a natural decline in fertility due to increasing age. 0.734 K4. I know that the success rate of fertility preservation is influenced by factors such as patient age, ovarian reserve function, and whether the patient has received alkylating agent‑containing chemotherapy before preservation. 0.711 K5. I know that fertility preservation must be carried out by medical institutions for medical purposes and comply with national laws and regulations. 0.700 K6. I know that embryo cryopreservation, oocyte cryopreservation, and ovarian tissue cryopreservation are fertility preservation techniques, while ovarian function suppression is a fertility protection measure. 0.746 K7. I know that embryo cryopreservation is suitable for married women, and oocyte cryopreservation is suitable for unmarried/married women of childbearing age; the age limit is generally < 40 years, but may be extended to 42 years for those with normal ovarian reserve, full informed consent, and strong fertility intention. 0.786 K8. I know that ovarian tissue cryopreservation is suitable for breast cancer patients aged ≤ 35 years, with the best indications being prepubertal patients, those who cannot delay radiotherapy or chemotherapy, and patients with hormone-sensitive tumors. 0.771 K9. I know that ovarian tissue cryopreservation does not require ovulation induction and does not delay breast cancer treatment. 0.732 K10. I know that ovarian function suppression is suitable for postpubertal women and is used only as an alternative when mature techniques such as embryo cryopreservation, oocyte cryopreservation, or ovarian tissue cryopreservation are not feasible, and it cannot replace mature cryopreservation techniques. 0.720 K11. I know that contraindications for assisted reproductive technology include active tumors and any medical conditions unsuitable for pregnancy. 0.725 K12. I know that the hormone receptor status of breast cancer patients does not affect whether they can use mature cryopreservation techniques. 0.700 K13. I know that during embryo and oocyte cryopreservation, ovulation induction and oocyte retrieval may cause vaginal bleeding, infection, elevated estrogen levels, and ovarian hyperstimulation syndrome, among others. 0.734 K14. I know that the disadvantages of ovarian tissue cryopreservation include a low pregnancy rate after transplantation and the risk of malignant cell reimplantation. 0.707 K15. I know that ovarian function suppression can cause menopausal symptoms and a reversible reduction in bone mineral density. 0.685 K16. I know that fertility preservation for breast cancer patients is preferably completed before the start of chemotherapy, radiotherapy, or endocrine therapy; if ovarian reserve is still adequate after treatment, attempts can still be made; fertility preservation can be performed before or after surgery. 0.690 K17. I know that contraception is required during breast cancer treatment. 0.741 A1. I think fertility preservation is an important part of improving the quality of life of breast cancer patients. 0.698 A2. I think fertility preservation seriously interferes with the breast cancer treatment process. 0.811 A3. I think that when treatment time is pressing, fertility communication can be omitted. 0.745 A4. I think fertility preservation should not be offered to breast cancer patients with a poor prognosis. 0.699 A5. I think fertility preservation is the responsibility of doctors and has nothing to do with nurses. 0.755 A6. I think nurses should participate in fertility preservation work for breast cancer patients. 0.730 A7. I think nurses should proactively discuss fertility preservation topics with patients. 0.704 A8. I think actively referring young breast cancer patients of childbearing age to reproductive medicine is the responsibility of breast specialty nurses. 0.747 A9. I think the department should establish a multidisciplinary team for fertility preservation involving doctors, nurses, and other healthcare professionals. 0.727 A10. I think nurses should master the relevant knowledge about fertility preservation for breast cancer patients. 0.739 A11. I think hospitals should strengthen systematic training for nurses on fertility preservation knowledge. 0.754 P1. I will pay attention to the fertility wishes of breast cancer patients. 0.771 P2. I will assess the patient's need for fertility preservation and document it in the nursing records. 0.724 P3. I will inform patients of the risk of infertility that treatment may cause. 0.781 P4. Before treatment, I will discuss the importance, benefits, risks, and available options for fertility preservation with eligible and willing patients/family members. 0.697 P5. I will provide patients with educational materials and information access channels related to fertility preservation. 0.727 P6. When patients inquire, I will answer their questions and refer them to the reproductive medicine department if necessary. 0.723 P7. I will refer patients who have fertility preservation needs to the reproductive medicine department. 0.734 P8. I will follow up on the referral status of patients and update the nursing records. 0.710 P9. I will participate in the long‑term follow‑up of patients who undergo fertility preservation. 0.730 P10. I will provide psychological counseling to patients with fertility needs who are at risk of infertility. 0.749 Eigenvalues 9.879 6.746 6.189 Variance Explained (%) 25.998 17.753 16.286 Cumulative variance explained(%) 25.998 43.752 60.038 Discussion Guided by the KAP theory and focusing on breast specialty nurses, this study developed a measurement tool suitable for investigating the knowledge, attitude, and practice of breast specialty nurses in China regarding fertility preservation for young breast cancer patients of childbearing age. Through literature analysis, two rounds of Delphi expert consultation, and repeated discussions within the research team, an initial questionnaire was formed, which included 38 items covering the definition of fertility protection, the impact of breast cancer treatment on fertility, indications and contraindications of fertility preservation techniques, risks and timing, role responsibilities, risk disclosure, and psychological support, making the content relatively comprehensive. The 18 consulting experts were experienced in relevant fields and possessed certain authority and representativeness. In the two consultation rounds, the expert positive coefficients and authority coefficients were both ≥ 0.9, Kendall's coefficients of concordance were 0.218 and 0.236 ( P < 0.001), and the coefficients of variation ranged from 0 to 0.38 and 0 to 0.23, respectively, indicating good consistency and coordination of expert opinions. The questionnaire was repeatedly revised based on expert comments, and a pilot survey ensured the readability of the items. Furthermore, two rounds of questionnaire surveys were conducted in this study, including item analysis, reliability testing, exploratory factor analysis, and confirmatory factor analysis, resulting in the final version of the questionnaire. The questionnaire development process was rigorous, standardized, and scientifically sound. The results of item analysis showed that the critical ratio values for each item ranged from 11.506 to 19.930 ( P < 0.001), and the correlation coefficients between each item and the total questionnaire ranged from 0.546 to 0.750 ( P < 0.01), indicating good discrimination and differentiating power of all items. The Cronbach's α coefficient for the total questionnaire was 0.956, and the Cronbach's α coefficients for the dimensions ranged from 0.924 to 0.956. The split-half reliability and test-retest reliability were 0.745 and 0.936, respectively, indicating good reliability and stability of the questionnaire. The average I-CVI was 0.932, and the I-CVI values ranged from 0.800 to 1.000, indicating good content validity. Exploratory factor analysis extracted three common factors with a cumulative variance contribution rate of 60.038%, and the factor loadings of each item on the corresponding factors ranged from 0.685 to 0.825. Confirmatory factor analysis showed that all model fit indices were within acceptable ranges. The average variance extracted (AVE) values for the dimensions ranged from 0.551 to 0.570, and the composite reliability (CR) values ranged from 0.925 to 0.955, indicating good convergent validity. The relationships between the dimensions and their corresponding items were consistent with the expected design, demonstrating good construct validity. In summary, this questionnaire has good reliability and validity and can accurately and truthfully reflect the levels of knowledge, attitude, and practice of breast specialty nurses regarding fertility preservation for young breast cancer patients of childbearing age. During the decision-making process regarding fertility preservation for young breast cancer patients of childbearing age, the lack of relevant information support results in low levels of awareness about fertility protection, short decision-making time, and a heavy decision-making burden. These patients often experience decision conflict and may even miss the critical window for fertility preservation, which seriously affects their physical and mental health as well as their quality of life [ 32 – 33 ] . As the primary providers of education, referral, and information consultation regarding fertility protection for young breast cancer patients of childbearing age, breast specialty nurses' knowledge, attitude, and practice regarding fertility protection directly influence the delivery of fertility preservation services [ 34 – 35 ] . Few studies in China have focused on the knowledge, attitude, and practice of breast specialty nurses regarding fertility protection, and no relevant assessment tools have been identified. Based on the Knowledge-Attitude-Practice (KAP) theoretical framework, this questionnaire focuses specifically on assessing breast specialty nurses' level of knowledge, attitude tendencies, and clinical practice performance regarding fertility preservation for young breast cancer patients of childbearing age. Furthermore, the participants in this study completed the questionnaire within 6–10 minutes, indicating that the number of items is appropriate, the content is relatively comprehensive, and the questionnaire is easy to understand. Therefore, this KAP questionnaire developed on the basis of the KAP theory has strong clinical practicality and feasibility and is suitable for investigating the knowledge, attitude, and practice levels of breast specialty nurses regarding fertility preservation for young breast cancer patients of childbearing age. Using this questionnaire, nursing managers can assess the current levels of breast specialty nurses, analyze factors influencing the knowledge, attitude, and practice related to fertility protection, and implement targeted interventions based on these influencing factors. Limitations This study only surveyed breast specialty nurses from some tertiary hospitals in Henan Province, which has certain geographical limitations. Future research could expand the sample scope and conduct multi-region, multi-center surveys to further improve the scientific rigor, reliability, and practicality of the questionnaire. Conclusion The questionnaire developed in this study consists of 38 items and demonstrates good reliability and validity, all meeting the measurement standards. This questionnaire can be used to assess the levels of knowledge, attitude, and practice of breast specialty nurses regarding fertility preservation for young breast cancer patients of childbearing age, providing a basis for nursing managers to develop personalized training programs for breast specialty nurses. Declarations Acknowledgements The authors express their sincere gratitude to all participants involved in this study. Author contributions Qi Wang and Pei Zhao contributed to the study’s conception and design, acquisition of data, analysis, and interpretation of data, drafted the article and revised it for content. Hongmei Zhang and Pilei Si reviewed it and approved the final version for publication. Funding 2024 Annual Project of Medical Science and Technology Research Program of Henan Province (SBGJ202403005); Open Project of Henan Provincial Key Laboratory of Nursing Medicine in 2025 (HNSYHLKT202503) Open Project of Henan Provincial Key Laboratory of Nursing Medicine in 2023 (HNSYHLKT202302) Data availability The datasets generated and analyzed during the current study are not publicly available due to privacy and ethical restrictions, but are available from the corresponding author on reasonable request. Ethics approval and consent to participate The study was reviewed and approved by the Henan Provincial People's Hospital. The study followed the ethical guidelines, protocol, and regulations stated in the Declaration of Helsinki. Informed consent was obtained from all participants. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Author details 1 Henan Provincial People's Hospital, Zhengzhou, China References BRAY F, LAVERSANNE M. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229–63. Ruan XY. Expert consensus on fertility preservation in patients with breast cancer occurring during pregnancy.GYNECOLOGICAL ENDOCRINOLOGY.2022;38 (10): 797–802. SUN LEVN, FENTON J. Impact of the 21-Gene Recurrence Score Assay on the Treatment of Estrogen Receptor-Positive, HER2-Negative, Breast Cancer Patients With 1–3 Positive Nodes: A Prospective Clinical Utility Study. Clin Breast Cancer. 2022;22(1):e74–9. Ju J, Zhang RX, Yue J, et al. Investigation on the current situation of fertility needs of young breast cancer patients. Chin J Oncol. 2020;42(5):408–12. Chemerinski A, Cameron K,Sammel M, et al. Relationship of menopausal symptoms and ovarian reserve in reproductive-aged cancer survivors. J Cancer Surviv. 2020;14(5):607–13. 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Paluch-Shimon S, Cardoso F, ,Partridge A, et al. ESO–ESMO 4th International Consensus Guidelines for Breast Cancer in Young Women (BCY4). Ann Oncol. 2020;31(6):674–96. KIEU V, STERN C. Australian fertility preservation guidelines for people with cancer 2022: review and recommendations. Med J Aust. 2022;217(11):564–9. Shi YB, Shao XG. Investigation on the Current Awareness of Both Patients and Doctors in Dalian Regarding Fertility Preservation for Young Cancer Patients. J Reprod Med. 2019;28(01):80–4. Liu YX, Ma JR, Chen HL et al. Analysis of the current situation and intervention effects of fertility preservation in young breast cancer patients. Shanghai Med. 1–14 [2026-01-03]. King L, Quinn GP, Vadaparampil ST, et al. Oncology nurses'perceptions of barriers to discussion of fertility preservation with patients with cancer.Clin. J Oncol Nurs. 2008;12(3):467–76. Loren AW, Mangu PB, Beck LN, et al. Fertility preservation for patients with cancer:American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2013;31(19):2500–10. Qu P. Investigation on the Knowledge, Attitude and Practice of Oncology Nurses Regarding Cancer Patients' Fertility Preservation and Construction of Training Program. Anhui University of Chinese Medicine; 2025. Ye Y, Chen A, Liu Z. Investigation on the Awareness of Sperm Preservation among Hospital Staff and Its Influencing Factors. J Reprod Med. 2020;29(12):1603–9. Chen YF, Zhang JZ, Bao HJ, et al. Research Progress on Nurses' Participation in Protecting the Fertility of Cancer Patients. Nurs Res. 2023;37(14):2581–4. Zhang HF, Jiang QH, Fang YH, et al. Perceptions of Oncology Nurses Regarding Fertility Preservation and Providing Oncofertility Services for Men of Childbearing Age with Cancer. J Cancer Educ. 2023;38(1):16–23. Rattray J, Jones MC. Essential elements of questionnaire design and development. 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Development and validation of the nursing information security questionnaire. Appl Clin Inf. 2025;16(1):44–55. Marsh HW, Morin AJ, Parker PD, Kaur G. Exploratory structural equation modeling: an integration of the best features of exploratory and confirmatory factor analysis. Annu Rev Clin Psychol. 2014;10:85–110. Mendez-Civieta A, Wei Y, Diaz KM, Goldsmith J. Functional quantile principal component analysis. Biostatistics. 2024;26(1):10. Zheng WZ, Wu WY. Evaluation of structural equation modeling fitting:the overall fitting,the internal fitting and crossvalidation testing. Psychol Explor. 2014;34(1):57–61. Welk B, Morrow S, Madarasz W, Baverstock R, Macnab J, Sequeira K. The validity and reliability of the neurogenic bladder symptom score. J Urol. 2014;192(2):452–7. Leproux C, Seegers V, ,Patsouris A, et al. Success and risks of pregnancy after breast cancer. Breast Cancer Res Treat. 2021;188(3):593–600. An A, Wang H, Wu KJ, Ding Y. Inner Experiences of Young Female Patients with Early Breast Cancer Regarding Fertility Preservation Decisions. China Nurs Manage. 2022;03:354–8. Ye Y. Chen A,Liu Z.Investigation of present situation and influence factors of fertility preservation cognition in hospital staffs. J Reproductive Med. 2020;29(12):1603–11. Lewin J, Ma JMZ,Mitchell L, et al. The positive effect of a dedicated adolescent and young adult fertility program on the rates of documentation of therapy-associated infertility risk and fertility preservation options. Support Care Cancer. 2017;25(6):1915–22. Additional Declarations No competing interests reported. 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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-9328430","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":633512168,"identity":"5a04ab13-48dd-4018-aef2-3d08ee42ba4a","order_by":0,"name":"Qi Wang","email":"","orcid":"","institution":"Henan Provincial People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Qi","middleName":"","lastName":"Wang","suffix":""},{"id":633512169,"identity":"936e40a0-d9c1-4e30-9086-e1d89387be90","order_by":1,"name":"Pei Zhao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1ElEQVRIie3ROwoCMRCA4ZFAqrjbbhDiCYRIQLDRqxgEz7BlRMg2Fh5gDyEI1gkD2gi2tjZWNtYKPjqtEjvB/P3HzDAAqdQPloOvrjdJRU6IiyN8iqZgZaZ4RUdxROL2SXZCL/dMRm628UZy21MS2eVwhoHomIBozL0Zde1EcGyu+jWMVc8FCCm8cdpuVIbNdYuB0+sQoe3j1Hh71wbZKY4w8LOG2VG9QEbjSAHeEiip4jOq+rWMuGXoticCr1fmeDycy4EIks+R0a95I9+KVCqV+oseAwZEWNwyvJcAAAAASUVORK5CYII=","orcid":"","institution":"Henan Provincial People's Hospital","correspondingAuthor":true,"prefix":"","firstName":"Pei","middleName":"","lastName":"Zhao","suffix":""},{"id":633512170,"identity":"11afa7fa-1276-4133-9ae2-cb54891d9831","order_by":2,"name":"Hongmei Zhang","email":"","orcid":"","institution":"Henan Provincial People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hongmei","middleName":"","lastName":"Zhang","suffix":""},{"id":633512171,"identity":"da1dea8a-539d-4dd0-959c-60b6fd9122ee","order_by":3,"name":"Pilei Si","email":"","orcid":"","institution":"Henan Provincial People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Pilei","middleName":"","lastName":"Si","suffix":""}],"badges":[],"createdAt":"2026-04-05 20:53:33","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9328430/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9328430/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108725714,"identity":"f92c70a8-f565-4524-af97-bb0e1c5e26ba","added_by":"auto","created_at":"2026-05-07 16:57:30","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":48816,"visible":true,"origin":"","legend":"\u003cp\u003eQuestionnaire development and validation flow chart\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-9328430/v1/5d51bd177a856415ad61efea.png"},{"id":108806672,"identity":"d42a2902-4701-498c-ad30-716755a58345","added_by":"auto","created_at":"2026-05-08 15:29:13","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":170035,"visible":true,"origin":"","legend":"\u003cp\u003eConfirmatory factor analysis (CFA) results\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-9328430/v1/392a309a846eb51fc2a7fe46.png"},{"id":108809776,"identity":"fb3e2d58-77d3-4d3f-a091-93656a24f6ee","added_by":"auto","created_at":"2026-05-08 15:55:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":526325,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9328430/v1/b6c2f1c1-6d01-4167-b14b-6d392b9e8148.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Development and Validation of a Questionnaire on Knowledge, Attitudes, and Practices of Breast Specialist Nurses Regarding Fertility Preservation in Breast Cancer Patients of Childbearing Age","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAccording to GLOBOCAN 2022 global cancer statistics, of nearly 20\u0026nbsp;million new cancer cases, approximately 2.3\u0026nbsp;million were breast cancer, accounting for 11.60% of all new cancer cases\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e, ranking as the most common malignant tumor among women. Furthermore, breast cancer is showing a trend toward younger onset, with more than 60% of cases occurring in women of childbearing age\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. The 5‑year survival rate of breast cancer patients of childbearing age is as high as 87.1%\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e, and about 40% of them still express fertility desires after diagnosis and treatment of breast cancer\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e.Although survival outcomes have improved, comprehensive treatments including surgery, chemotherapy, and endocrine therapy can lead to ovarian dysfunction, which directly impairs patients\u0026rsquo; fertility\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. Research has indicated\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e that the pregnancy rate among breast cancer patients of childbearing age is the lowest among all cancer populations, at only 3%, which is 40% lower than that in the general population. Fertility has become a core component affecting the quality of life of breast cancer patients of childbearing age\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e.Against this background, fertility preservation (FP), as an important intervention, aims to prevent and address infertility risks through various therapeutic approaches. It helps adults and children at risk of infertility preserve their reproductive endocrine function and reproductive potential, enabling them to have genetically related offspring\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eReproductive health has been listed as a key strategic goal in the Healthy China 2030 Blueprint\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. However, during the diagnosis and treatment of breast cancer patients of childbearing age, both healthcare providers and patients mostly focus on the treatment of the disease itself, often neglecting the damage of cancer therapy to the reproductive system and patients\u0026rsquo; long-term fertility needs\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e.To meet the fertility needs of this population, the 4th ESO-ESMO International Consensus Guidelines for Young Women with Breast Cancer\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e and the clinical guidelines on fertility preservation for cancer patients\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e clearly recommend that clinical healthcare professionals discuss the potential risk of infertility with patients as early as possible before treatment initiation and introduce available fertility preservation options.Nevertheless, fertility preservation for breast cancer patients in China has not received sufficient attention. As many as 76.8% of patients lack knowledge about fertility preservation\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e, and 94.2% are unwilling to undergo fertility preservation interventions\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. These findings indicate that breast cancer patients of childbearing age in China lack comprehensive and systematic understanding of treatment-related reproductive impairment and fertility preservation.\u003c/p\u003e \u003cp\u003eAs the primary healthcare providers for patients, nurses play a vital role in providing fertility preservation education, referrals, and information consultation\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. The American Society of Clinical Oncology (ASCO)\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e includes nurses in the clinical practice of discussing and referring childbearing-age cancer patients for fertility preservation.However, the current status of nurses\u0026rsquo; involvement in fertility preservation for breast cancer patients in China is far from satisfactory. This is mainly reflected in the significant gaps in nurses\u0026rsquo; knowledge of fertility preservation, and such disparities in knowledge directly affect the effectiveness of subsequent clinical practice \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. Studies have shown \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e that most healthcare professionals in China lack clear or adequate understanding of the concept of fertility preservation. Second, the unclear role definition of nurses in fertility preservation practice in China has led them to overlook their important responsibilities \u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. In addition, there is a lack of unified and standardized fertility preservation protocols and guidelines in nursing practice to direct clinical behaviors \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. Therefore, it is crucial to conduct research aimed at improving the knowledge, attitudes, and practices of breast care nurses regarding fertility preservation.Nevertheless, at present, no validated assessment tool specifically targets the knowledge, attitudes, and practices of breast care nurses toward fertility preservation for childbearing-age breast cancer patients. This makes it difficult to identify the root causes of barriers to fertility preservation implementation and thus prevents the development of targeted interventions. Based on the Knowledge-Attitude-Practice (KAP) theory, this study developed a questionnaire to assess the knowledge, attitudes, and practices of breast care nurses regarding fertility preservation in childbearing-age breast cancer patients, and examined its reliability and validity. This questionnaire provides a scientific instrument for evaluating the relevant knowledge, attitudes, and practice levels of breast care nurses in this field.\u003c/p\u003e\n\u003ch3\u003eAims and objectives of study\u003c/h3\u003e\n\u003cp\u003eThe purpose of this study was to develop and evaluate the validity of a questionnaire assessing knowledge, attitudes, and practices of breast care nurses regarding fertility preservation in breast cancer patients of childbearing age.\u003c/p\u003e \u003c/div\u003e"},{"header":"Design and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003ch2\u003eDesign\u003c/h2\u003e \u003cp\u003eThis study adopted a standardized questionnaire development procedure\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e, which was divided into two phases: development and validation (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).The first phase included item pool generation, expert consultation, and a pilot survey. The item pool was constructed through a literature review, and the questionnaire was developed using the Delphi method. The initial draft was revised via expert consultation to evaluate content validity, and face validity was assessed by conducting a pilot test of the revised questionnaire.In the second phase, the questionnaire was further refined, and its validity and reliability were evaluated based on results from item analysis, exploratory factor analysis, reliability testing, and confirmatory factor analysis.\u003c/p\u003e\u003c/div\u003e \n\u003ch3\u003ePhase1: development of the questionnaire\u003c/h3\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eThe establishment of the research group\u003c/h2\u003e \u003cp\u003eThe research team consisted of 8 members, including 2 head nurses (both vice chief nurse specialists), 2 nurse specialists in breast surgery, 2 clinicians in breast surgery (1 chief physician and 1 associate chief physician), and 2 nursing postgraduate students. All participants were from Henan Provincial People\u0026rsquo;s Hospital.One head nurse and one chief physician were responsible for study design and quality control. The other head nurse and one associate chief physician were in charge of constructing the initial questionnaire item pool, as well as selecting and contacting the experts for consultation.Two nurse specialists were responsible for reviewing and calibrating the initial questionnaire, including evaluating the clinical applicability of the item pool, ensuring linguistic consistency and compliance with hospital guidelines, and administering questionnaire distribution and collection.Two nursing postgraduate students performed literature analysis, developed the expert consultation questionnaire, and conducted data organization and statistical analysis.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eDevelopment of item pool\u003c/h3\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eTheoretical basis\u003c/h2\u003e \u003cp\u003eBased on the Knowledge-Attitude-Practice (KAP) theory, this study proposes that knowledge serves as the foundation, positive attitude as the intrinsic motivation, and the generation and transformation of practice as the goal\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. According to this theory, the research team clarified the three components of KAP within the framework and initially defined the three dimensions of the questionnaire.1) Knowledge: including the basic concept of fertility preservation, the impact of breast cancer treatment on fertility, factors associated with pregnancy success rates, target populations and contraindications, potential risks, and the optimal timing of interventions;2) Attitude: referring to breast care nurses\u0026rsquo; attitudes toward learning relevant theoretical knowledge and their beliefs in the effective implementation of fertility preservation;3) Practice: referring to breast care nurses actively learning knowledge related to fertility preservation under the guidance of their existing knowledge and positive attitudes, and conducting clinical practice consistently and proficiently in accordance with standardized procedures.This reflects their ability to translate knowledge and attitudes into effective practice, thereby ensuring that breast cancer patients of childbearing age can make optimal fertility preservation decisions.This dimension aims to evaluate nurses\u0026rsquo; ability to translate knowledge and attitudes into effective practice so as to support breast cancer patients of childbearing age in making optimal fertility preservation decisions.\u003c/p\u003e \u003c/div\u003e"},{"header":"Literature review","content":"\u003cp\u003eUsing \u0026ldquo;Breast Specialist Clinic/Breast Surgery\u0026rdquo;, \u0026ldquo;Nurses/Nursing Personnel/Medical Staff\u0026rdquo;, and \u0026ldquo;Fertility Preservation/assisted reproductive/reproductive protection\u0026rdquo; as English search terms, databases including CNKI, Wanfang, VIP, PubMed, Web of Science, and Embase were searched from their inception to July 2025.Through literature synthesis, theoretical analysis, and group discussion, the item pool was initially screened and refined, consisting of 21 items for knowledge, 9 items for attitude, and 10 items for practice, with a total of 40 items.\u003c/p\u003e\n\u003ch3\u003eDelphi expert consultation\u003c/h3\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSelection of experts\u003c/h2\u003e \u003cp\u003eFrom August to September 2025, a total of 18 experts in relevant fields were selected using the purposive sampling method.The inclusion criteria for experts were as follows:(1) Bachelor\u0026rsquo;s degree or above;(2) Intermediate professional title or higher;(3) At least 10 years of clinical practice, nursing work, or research experience in breast surgery or reproductive medicine;(4) Familiar with fertility preservation and questionnaire development;(5) Voluntary participation in this expert consultation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003ePreparation of expert consultation questionnaire\u003c/h2\u003e \u003cp\u003eThe expert consultation questionnaire comprised three parts:(1) Questionnaire instructions: introducing the research background, research purpose, content and guidance for completion;(2) Consultation content: a 5-point Likert scale was used to score the importance of each item, ranging from 1 (not important at all) to 5 (extremely important). A 4-point Likert scale was applied for relevance, ranging from 1 (totally irrelevant) to 4 (highly relevant). Sections for \u0026ldquo;revision suggestions\u0026rdquo; and \u0026ldquo;item addition or deletion\u0026rdquo; were included to invite experts to provide comments for revision or supplementation, and to evaluate the comprehensiveness of the questionnaire, so as to ensure it fully covered all elements of the three dimensions (knowledge, attitude and practice) of breast care nurses regarding fertility preservation for breast cancer patients of childbearing age.(3) Expert general information: including demographic data, experts\u0026rsquo; familiarity with the research field and their judgment basis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eImplementation of expert consultation\u003c/h2\u003e \u003cp\u003eAfter obtaining informed consent from the experts, the research team distributed the first-round consultation questionnaire via email and requested a response within two weeks.Following the first round of consultation, the research team summarized, discussed, and revised the experts\u0026rsquo; comments to develop the second-round questionnaire, which was then sent to the same experts.After two rounds of expert consultation, a consensus was reached among the experts, and the consultation process was concluded.Items with a mean importance score\u0026thinsp;\u0026ge;\u0026thinsp;3.50 and a coefficient of variation\u0026thinsp;\u0026lt;\u0026thinsp;0.25 were retained\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e.The research team revised the questionnaire content based on the experts\u0026rsquo; suggestions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eExpert enthusiasm, judgment coefficient, familiarity coefficient, authority coefficient, and content validity\u003c/h2\u003e \u003cp\u003e Expert enthusiasm was used to evaluate the degree of active participation and the level of attention experts paid to the study. The authority of expert consultation was determined by the judgment coefficient (Ca), familiarity coefficient (Cs), and authority coefficient (Cr). Generally, a Cr value\u0026thinsp;\u0026ge;\u0026thinsp;0.7 indicates high authority of the questionnaire\u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e. The concentration of expert opinions was expressed by the coefficient of variation (CV) and Kendall\u0026rsquo;s concordance coefficient. A value of P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.The scale-level content validity index (S-CVI) and item-level content validity index (I-CVI) were calculated based on experts\u0026rsquo; ratings for each item. An S-CVI and I-CVI both greater than 0.8 indicated satisfactory content validity of the questionnaire\u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003ePilot survey\u003c/h2\u003e \u003cp\u003eIn October 2025, 30 nurses from the Department of Breast Surgery at Henan Provincial People's Hospital were randomly selected to conduct a pilot survey to test whether the questionnaire content was clear and easy to understand. The inclusion criteria were as follows:①holding a valid nursing practice license; ②working as a nurse in the Department of Breast Surgery;③providing informed consent and voluntarily participating in this study. Exclusion criteria were: ①nurses not currently employed at this hospital; ②inability to complete the questionnaire for any reason.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003ePhase2: evaluation and validition of the questionnaire\u003c/h2\u003e \u003cdiv id=\"Sec17\" class=\"Section3\"\u003e \u003ch2\u003eSetting and sample\u003c/h2\u003e \u003cp\u003eUsing convenience sampling, a survey was conducted among breast surgery nurses from tertiary grade A hospitals in Henan Province from October 2025 to December 2025. The initial questionnaire was subjected to item analysis, reliability testing, exploratory factor analysis, and confirmatory factor analysis. The inclusion and exclusion criteria were the same as those used in the pilot survey. The sample size for the two rounds of surveys should be 5\u0026ndash;10 times the number of questionnaire items \u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e. The initial questionnaire consisted of 38 items. Considering a 20% sample attrition rate, the required sample size ranged from 238 to 475 cases. A total of 350 and 455 questionnaires were distributed in the two rounds, respectively, and 330 and 420 valid questionnaires were returned, yielding effective response rates of 94.29% and 92.31%, respectively.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eInstruments data collection tools\u003c/h2\u003e \u003cp\u003eThe first-round questionnaire consisted of a general information sheet (age, sex, education level, professional title, years of work experience) and the initial questionnaire on breast surgery nurses' knowledge, attitude, and practice regarding fertility preservation for young breast cancer patients of childbearing age. The second-round questionnaire included a general information sheet and the formal questionnaire on breast surgery nurses' knowledge, attitude, and practice regarding fertility preservation for young breast cancer patients of childbearing age.Each item was rated using a 5-point Likert scale. For the knowledge dimension, scores ranged from 1 (completely unaware) to 5 (completely aware), with total scores ranging from 17 to 85. Higher scores indicated a better level of knowledge among breast surgery nurses regarding fertility preservation for young breast cancer patients of childbearing age. For the attitude dimension, scores ranged from 1 (strongly disagree) to 5 (strongly agree), with total scores ranging from 11 to 55. The following items were reverse-scored (with the scoring order reversed): \"I think fertility preservation seriously interferes with breast cancer treatment\"; \"I think fertility counseling can be omitted when time for treatment is limited\"; \"I think fertility preservation should not be offered to breast cancer patients with a poor prognosis\"; and \"I think fertility preservation is the responsibility of doctors and has nothing to do with nurses.\" Higher total attitude scores indicated a more positive attitude toward fertility preservation for young breast cancer patients of childbearing age. For the practice dimension, scores ranged from 1 (never) to 5 (always), with total scores ranging from 10 to 50. Higher scores indicated a higher level of practice regarding fertility preservation for young breast cancer patients of childbearing age.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003eAfter uniformly trained research team members explained the study purpose to nursing managers at each hospital and obtained their consent, the questionnaire link was sent to participants via a questionnaire platform. The first page of the questionnaire included information on the study purpose, completion instructions, and privacy protection. The questionnaire was set so that each participant could only complete it once, and submission was allowed only after all items had been filled out. After data collection was completed, the data were exported promptly and checked by two researchers. Questionnaires were excluded if the completion time was less than one minute, the responses showed an obvious pattern, or there were logical errors.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eData entry and analysis were performed using Excel 2019, IBM SPSS v27.0, and AMOS 26.0. Categorical data were described as frequencies and percentages. Normally distributed continuous data were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, while non‑normally distributed data were presented as median and interquartile range. The critical ratio method was used to sort the questionnaires collected in the first round from highest to lowest total score; the top 27% were assigned to the high‑score group and the bottom 27% to the low‑score group. An independent samples t‑test was used to compare the differences between the two groups, and items with P\u0026thinsp;\u0026le;\u0026thinsp;0.05 or a critical ratio\u0026thinsp;\u0026gt;\u0026thinsp;3 were retained \u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e. Pearson correlation analysis was performed to calculate the correlation coefficient between each item and the total score; items with a correlation coefficient\u0026thinsp;\u0026lt;\u0026thinsp;0.4 were considered to have unsatisfactory correlation and were deleted\u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e. For exploratory factor analysis, principal component analysis with varimax orthogonal rotation was used. Factors with eigenvalues\u0026thinsp;\u0026gt;\u0026thinsp;1 and cumulative variance contribution rate\u0026thinsp;\u0026gt;\u0026thinsp;50% were retained, and items with factor loadings\u0026thinsp;\u0026lt;\u0026thinsp;0.4 were removed \u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e. Confirmatory factor analysis was conducted using the maximum likelihood method, with a standardized factor loading threshold\u0026thinsp;\u0026gt;\u0026thinsp;0.45. Model fit was evaluated using the following criteria: chi‑square/degrees of freedom (χ\u003csup\u003e2\u003c/sup\u003e/df)\u0026thinsp;\u0026lt;\u0026thinsp;5, root mean square error of approximation (RMSEA)\u0026thinsp;\u0026lt;\u0026thinsp;0.08, and comparative fit index (CFI), incremental fit index (IFI), and normed fit index (NFI) all \u0026gt;\u0026thinsp;0.9, indicating acceptable model fit. Convergent validity was assessed using average variance extracted (AVE)\u0026thinsp;\u0026gt;\u0026thinsp;0.5 and composite reliability (CR)\u0026thinsp;\u0026gt;\u0026thinsp;0.7\u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e. Internal consistency of the questionnaire was evaluated using Cronbach's α coefficient, with\u003cem\u003eα\u003c/em\u003e\u0026thinsp;\u0026ge;\u0026thinsp;0.7 indicating good internal consistency\u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e. Split-half reliability for each dimension and the total questionnaire was calculated using the first-half and second‑half method. After the first round of data collection, 50 breast specialty nurses were selected to complete the questionnaire again after a two-week interval; the test-retest reliability for each dimension and the total questionnaire was calculated to assess the stability of the questionnaire.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eEthical and research approvals with the date\u003c/h2\u003e \u003cp\u003e This study was approved by the Ethics Committee of Henan Provincial People's Hospital on May 30, 2024 (approval No. (2024) Lun Shen No. (116)). The study complied with the principles of the Declaration of Helsinki. All participants provided written informed consent and participated anonymously.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003ch2\u003eDelphi expert consultation results\u003c/h2\u003e \u003cp\u003eA total of 18 experts participated in the final expert consultation, including 8 physicians from breast surgery and reproductive medicine, and 10 nurses from breast surgery and reproductive medicine. Among them, 5 were male and 13 were female, with ages ranging from 38 to 55 (43.78\u0026thinsp;\u0026plusmn;\u0026thinsp;5.07 )years. Their years of work experience ranged from 10 to 28 (17.11\u0026thinsp;\u0026plusmn;\u0026thinsp;5.66 )years. Among the experts, 3 held a bachelor's degree, 12 held a master's degree, and 3 held a doctoral degree. Regarding professional titles, 7 had intermediate titles, 8 had associate senior titles, and 3 had senior titles. The effective response rates for both rounds of expert consultation questionnaires were 100%. For the two rounds of expert consultation, the Cs values were 0.93 and 0.94, the Ca values were 0.91 and 0.93, and the Cr values were 0.92 and 0.94, respectively. Kendall's coefficients were 0.218 and 0.236 (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), respectively.\u003c/p\u003e \u003cp\u003eIn the first round of expert consultation, the mean importance scores of the items ranged from 3.06 to 4.94, and the coefficients of variation ranged from 0 to 0.38. Based on the results of the expert consultation and the experts' comments, the research team discussed and revised the draft questionnaire. Four items were added: \"I know that endocrine therapy does not directly damage ovarian reserve, but a treatment course of 5\u0026ndash;10 years may lead to a natural decline in fertility due to increasing age\"; \"I think fertility preservation should not be offered to breast cancer patients with a poor prognosis\"; \"I believe that actively referring young breast cancer patients of childbearing age to reproductive medicine is the responsibility of breast specialty nurses\"; and \"I will assess the patient's need for fertility preservation and document it in the nursing records.\" Three items were deleted: \"I know that fertility‑preserving treatment should not pose additional risks or interfere with breast cancer treatment\"; \"I think that when time for breast cancer treatment is limited, it is unnecessary to communicate with patients about fertility\"; and \"I will introduce ethical and legal knowledge related to fertility preservation to patients.\" Nine items were merged. Specifically, the items \"I know that fertility preservation techniques for breast cancer include embryo cryopreservation, oocyte cryopreservation, and ovarian tissue cryopreservation; protective measures include ovarian function suppression\", \"I know that embryo cryopreservation is a technique of ovulation induction, oocyte retrieval, in vitro fertilization, embryo freezing, and then thawing and transferring into the uterus when needed\", \"I know that oocyte cryopreservation is a technique of ovulation induction, oocyte retrieval, oocyte freezing, and then thawing, fertilization, embryo formation, and transfer into the uterus when needed\", \"I know that ovarian tissue cryopreservation is a technique of surgically obtaining ovarian tissue, cryopreserving it, and then thawing and transplanting it when needed\", and \"I know that ovarian function suppression involves monthly injections of GnRHa starting 7 days before chemotherapy and continuing for \u0026ge;\u0026thinsp;3 months to suppress ovarian function to protect fertility, but it does not replace mature cryopreservation techniques\" were merged into one item: \"I know that embryo cryopreservation, oocyte cryopreservation, and ovarian tissue cryopreservation are fertility preservation techniques, while ovarian function suppression is a fertility protection measure.\" The items \"I know that embryo cryopreservation is suitable for married women aged\u0026thinsp;\u0026lt;\u0026thinsp;40 years (for those with normal ovarian reserve, full informed consent, and strong fertility intention, the age limit may be extended to 42 years)\" and \"I know that oocyte cryopreservation is suitable for women of childbearing age aged\u0026thinsp;\u0026lt;\u0026thinsp;40 years (for those with normal ovarian reserve, full informed consent, and strong fertility intention, the age limit may be extended to 42 years)\" were merged into: \"I know that embryo cryopreservation is suitable for married women, and oocyte cryopreservation is suitable for unmarried/married women of childbearing age; the age limit is generally\u0026thinsp;\u0026lt;\u0026thinsp;40 years, but may be extended to 42 years for those with normal ovarian reserve, full informed consent, and strong fertility intention.\" The items \"Before the cancer treatment plan is determined, I will discuss the importance, benefits, and risks of fertility preservation with patients or family members who have medical indications and willingness for fertility preservation\" and \"Before the cancer treatment plan is determined, I will provide preliminary information on available fertility preservation options to patients or family members who have medical indications and willingness for fertility preservation\" were merged into: \"Before treatment, I will discuss the importance, benefits, risks, and available options for fertility preservation with eligible and willing patients/family members.\" The wording of four items was modified. For example, \"I know that radiotherapy and chemotherapy can damage the fertility of breast cancer patients\" was changed to \"I know that chemotherapy and pelvic/abdominal radiotherapy can damage the fertility of breast cancer patients\"; \"I know that the hormone receptor status of breast cancer patients does not affect the choice of fertility preservation options\" was changed to \"I know that the hormone receptor status of breast cancer patients does not affect whether they can use mature cryopreservation techniques\"; \"I know that the risks of embryo and oocyte cryopreservation include vaginal bleeding, infection, elevated estrogen levels, and ovarian hyperstimulation syndrome\" was changed to \"I know that during embryo and oocyte cryopreservation, ovulation induction and oocyte retrieval may cause vaginal bleeding, infection, elevated estrogen levels, and ovarian hyperstimulation syndrome\"; and \"I know that the optimal timing for fertility preservation in breast cancer patients is before surgery, chemotherapy, radiotherapy, or endocrine therapy\" was changed to \"I know that fertility preservation for breast cancer patients is preferably completed before the start of chemotherapy, radiotherapy, or endocrine therapy; if ovarian reserve is still adequate after treatment, attempts can still be made; fertility preservation can be performed before or after surgery.\"\u003c/p\u003e \u003cp\u003eIn the second round of expert consultation, the mean importance scores of the items ranged from 4.11 to 5.00, and the coefficients of variation ranged from 0 to 0.23. Based on the consultation results and expert comments, no items were added, deleted, merged, or modified. After two rounds of expert consultation, the final questionnaire on knowledge, attitude, and practice of breast specialty nurses regarding fertility preservation for young breast cancer patients of childbearing age consisted of 3 dimensions and 39 items, including 17 items in the knowledge dimension, 11 items in the attitude dimension, and 11 items in the practice dimension.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003ePilot survey\u003c/h2\u003e \u003cp\u003eA total of 25 questionnaires were distributed in the pilot survey, and all were returned, yielding a 100% effective response rate. The nurses reported that they fully understood the questionnaire content, and the completion time ranged from 6 to 10 minutes. Therefore, no items were deleted, added, or modified.\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eParticipants\u0026rsquo; characteristics\u003c/h2\u003e \u003cp\u003eA total of 330 breast specialty nurses were enrolled in the first-round survey, all of whom were female. Their ages ranged from 23 to 46 (31.08\u0026thinsp;\u0026plusmn;\u0026thinsp;4.56)years. Regarding educational level, 88 nurses (26.70%) had an associate degree or below, 227 (68.80%) held a bachelor's degree, and 15 (4.50%) had a master's degree or above. In terms of professional titles, 59 nurses (17.90%) held primary titles (nurse), 91 (27.60%) held junior titles (nurse practitioner), 166 (50.30%) held intermediate titles (supervisor nurse), and 14 (4.20%) held associate senior or above titles (deputy supervisor nurse or higher). Their years of work experience ranged from 2 to 15 (6.51\u0026thinsp;\u0026plusmn;\u0026thinsp;3.54 )years.\u003c/p\u003e \u003cp\u003eA total of 420 breast specialty nurses were enrolled in the second-round survey, all of whom were female. Their ages ranged from 23 to 45 (30.79\u0026thinsp;\u0026plusmn;\u0026thinsp;4.41)years. Regarding educational level, 122 nurses (29.00%) had an associate degree or below, 280 (66.70%) held a bachelor's degree, and 18 (4.30%) had a master's degree or above. In terms of professional titles, 90 nurses (21.40%) held primary titles (nurse), 127 (30.20%) held junior titles (nurse practitioner), 194 (46.20%) held intermediate titles (supervisor nurse), and 9 (2.10%) held associate senior or above titles (deputy supervisor nurse or higher). Their years of work experience ranged from 2 to 17(6.21\u0026thinsp;\u0026plusmn;\u0026thinsp;3.51)years.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003eItem analysis\u003c/h2\u003e \u003cp\u003eThe critical ratio values for each item ranged from 11.506 to 19.930, with statistically significant differences in scores (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), indicating good discrimination. The correlation coefficients between each item and the total questionnaire ranged from 0.546 to 0.750 (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01), indicating high homogeneity.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section3\"\u003e \u003ch2\u003eConstruct validity\u003c/h2\u003e \u003cdiv id=\"Sec28\" class=\"Section4\"\u003e \u003ch2\u003eContent validity\u003c/h2\u003e \u003cp\u003eThe item-level content validity index (I-CVI) ranged from 0.800 to 1.000, and the average I-CVI was 0.932, indicating good content validity of the questionnaire.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003eConstruct validity\u003c/h2\u003e \u003cp\u003eConstruct validity was tested on the 39 items retained after item analysis. Two rounds of exploratory factor analysis (EFA) were conducted in this study. (1) In the first EFA, the Kaiser\u0026ndash;Meyer\u0026ndash;Olkin (KMO) value was 0.969, and Bartlett's test of sphericity yielded a χ\u0026sup2; value of 8392.583 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), indicating that the data were suitable for factor analysis. The results showed that three common factors with eigenvalues\u0026thinsp;\u0026gt;\u0026thinsp;1 were extracted, with a cumulative variance contribution rate of 59.678%. The item \"I will introduce fertility preservation options to breast cancer patients\" had a factor loading\u0026thinsp;\u0026lt;\u0026thinsp;0.5 and was therefore deleted. All other items had factor loadings\u0026thinsp;\u0026gt;\u0026thinsp;0.5 on their respective factors, with no double or multiple loadings. The remaining 38 items were subjected to a second EFA. In the second EFA, the KMO value was 0.969, and Bartlett's test of sphericity yielded a χ\u0026sup2; value of 8392.583 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), again indicating suitability for factor analysis. The results showed that three common factors with eigenvalues\u0026thinsp;\u0026gt;\u0026thinsp;1 were extracted, with variance contribution rates of 25.998%, 17.753%, and 16.286%, respectively, and a cumulative variance contribution rate of 60.038%. Based on the content of the items, the three factors were named the knowledge dimension, attitude dimension, and practice dimension. The factor loadings of each item on the corresponding factors are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. (2) Confirmatory factor analysis (CFA) results showed a χ\u0026sup2;/df of 1.256, GFI of 0.910, AGFI of 0.900, CFI of 0.983, and RMSEA of 0.025, indicating good model fit (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eReliability analysis results\u003c/h3\u003e\n\u003cp\u003eThe Cronbach's α coefficient for the total questionnaire was 0.956, and the Cronbach's α coefficients for the dimensions ranged from 0.924 to 0.956. Deleting any single item did not result in a notable increase in the Cronbach's α coefficient. The split-half reliability coefficient for the total questionnaire was 0.745, and the split-half reliability coefficients for the dimensions ranged from 0.922 to 0.958. The test-retest reliability coefficient for the total questionnaire was 0.936, and the test-retest reliability coefficients for the dimensions ranged from 0.864 to 0.922.\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\u003eFactor loadings of EFA\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKnowledge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAttitude\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePractice\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK1. I know that fertility protection refers to taking early intervention against factors that damage fertility, protecting or preserving fertility to achieve genetically related offspring.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.825\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK2. I know that chemotherapy and pelvic/abdominal radiotherapy can damage the fertility of breast cancer patients.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.784\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK3. I know that endocrine therapy does not directly damage ovarian reserve, but a treatment course of 5\u0026ndash;10 years may lead to a natural decline in fertility due to increasing age.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.734\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK4. I know that the success rate of fertility preservation is influenced by factors such as patient age, ovarian reserve function, and whether the patient has received alkylating agent‑containing chemotherapy before preservation.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.711\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK5. I know that fertility preservation must be carried out by medical institutions for medical purposes and comply with national laws and regulations.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.700\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK6. I know that embryo cryopreservation, oocyte cryopreservation, and ovarian tissue cryopreservation are fertility preservation techniques, while ovarian function suppression is a fertility protection measure.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.746\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK7. I know that embryo cryopreservation is suitable for married women, and oocyte cryopreservation is suitable for unmarried/married women of childbearing age; the age limit is generally\u0026thinsp;\u0026lt;\u0026thinsp;40 years, but may be extended to 42 years for those with normal ovarian reserve, full informed consent, and strong fertility intention.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.786\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK8. I know that ovarian tissue cryopreservation is suitable for breast cancer patients aged\u0026thinsp;\u0026le;\u0026thinsp;35 years, with the best indications being prepubertal patients, those who cannot delay radiotherapy or chemotherapy, and patients with hormone-sensitive tumors.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.771\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK9. I know that ovarian tissue cryopreservation does not require ovulation induction and does not delay breast cancer treatment.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.732\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK10. I know that ovarian function suppression is suitable for postpubertal women and is used only as an alternative when mature techniques such as embryo cryopreservation, oocyte cryopreservation, or ovarian tissue cryopreservation are not feasible, and it cannot replace mature cryopreservation techniques.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.720\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK11. I know that contraindications for assisted reproductive technology include active tumors and any medical conditions unsuitable for pregnancy.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.725\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK12. I know that the hormone receptor status of breast cancer patients does not affect whether they can use mature cryopreservation techniques.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.700\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK13. I know that during embryo and oocyte cryopreservation, ovulation induction and oocyte retrieval may cause vaginal bleeding, infection, elevated estrogen levels, and ovarian hyperstimulation syndrome, among others.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.734\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK14. I know that the disadvantages of ovarian tissue cryopreservation include a low pregnancy rate after transplantation and the risk of malignant cell reimplantation.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.707\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK15. I know that ovarian function suppression can cause menopausal symptoms and a reversible reduction in bone mineral density.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.685\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK16. I know that fertility preservation for breast cancer patients is preferably completed before the start of chemotherapy, radiotherapy, or endocrine therapy; if ovarian reserve is still adequate after treatment, attempts can still be made; fertility preservation can be performed before or after surgery.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.690\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK17. I know that contraception is required during breast cancer treatment.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.741\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA1. I think fertility preservation is an important part of improving the quality of life of breast cancer patients.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.698\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA2. I think fertility preservation seriously interferes with the breast cancer treatment process.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.811\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA3. I think that when treatment time is pressing, fertility communication can be omitted.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.745\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA4. I think fertility preservation should not be offered to breast cancer patients with a poor prognosis.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.699\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA5. I think fertility preservation is the responsibility of doctors and has nothing to do with nurses.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.755\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA6. I think nurses should participate in fertility preservation work for breast cancer patients.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.730\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA7. I think nurses should proactively discuss fertility preservation topics with patients.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.704\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA8. I think actively referring young breast cancer patients of childbearing age to reproductive medicine is the responsibility of breast specialty nurses.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.747\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA9. I think the department should establish a multidisciplinary team for fertility preservation involving doctors, nurses, and other healthcare professionals.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.727\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA10. I think nurses should master the relevant knowledge about fertility preservation for breast cancer patients.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.739\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA11. I think hospitals should strengthen systematic training for nurses on fertility preservation knowledge.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.754\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP1. I will pay attention to the fertility wishes of breast cancer patients.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.771\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP2. I will assess the patient's need for fertility preservation and document it in the nursing records.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.724\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP3. I will inform patients of the risk of infertility that treatment may cause.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.781\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP4. Before treatment, I will discuss the importance, benefits, risks, and available options for fertility preservation with eligible and willing patients/family members.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.697\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP5. I will provide patients with educational materials and information access channels related to fertility preservation.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.727\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP6. When patients inquire, I will answer their questions and refer them to the reproductive medicine department if necessary.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.723\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP7. I will refer patients who have fertility preservation needs to the reproductive medicine department.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.734\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP8. I will follow up on the referral status of patients and update the nursing records.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.710\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP9. I will participate in the long‑term follow‑up of patients who undergo fertility preservation.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.730\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP10. I will provide psychological counseling to patients with fertility needs who are at risk of infertility.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.749\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEigenvalues\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9.879\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.746\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.189\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariance Explained (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25.998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17.753\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.286\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCumulative variance explained(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25.998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43.752\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e60.038\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e Guided by the KAP theory and focusing on breast specialty nurses, this study developed a measurement tool suitable for investigating the knowledge, attitude, and practice of breast specialty nurses in China regarding fertility preservation for young breast cancer patients of childbearing age. Through literature analysis, two rounds of Delphi expert consultation, and repeated discussions within the research team, an initial questionnaire was formed, which included 38 items covering the definition of fertility protection, the impact of breast cancer treatment on fertility, indications and contraindications of fertility preservation techniques, risks and timing, role responsibilities, risk disclosure, and psychological support, making the content relatively comprehensive. The 18 consulting experts were experienced in relevant fields and possessed certain authority and representativeness. In the two consultation rounds, the expert positive coefficients and authority coefficients were both \u0026ge;\u0026thinsp;0.9, Kendall's coefficients of concordance were 0.218 and 0.236 (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and the coefficients of variation ranged from 0 to 0.38 and 0 to 0.23, respectively, indicating good consistency and coordination of expert opinions. The questionnaire was repeatedly revised based on expert comments, and a pilot survey ensured the readability of the items. Furthermore, two rounds of questionnaire surveys were conducted in this study, including item analysis, reliability testing, exploratory factor analysis, and confirmatory factor analysis, resulting in the final version of the questionnaire. The questionnaire development process was rigorous, standardized, and scientifically sound.\u003c/p\u003e \u003cp\u003eThe results of item analysis showed that the critical ratio values for each item ranged from 11.506 to 19.930 (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and the correlation coefficients between each item and the total questionnaire ranged from 0.546 to 0.750 (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01), indicating good discrimination and differentiating power of all items. The Cronbach's α coefficient for the total questionnaire was 0.956, and the Cronbach's α coefficients for the dimensions ranged from 0.924 to 0.956. The split-half reliability and test-retest reliability were 0.745 and 0.936, respectively, indicating good reliability and stability of the questionnaire. The average I-CVI was 0.932, and the I-CVI values ranged from 0.800 to 1.000, indicating good content validity. Exploratory factor analysis extracted three common factors with a cumulative variance contribution rate of 60.038%, and the factor loadings of each item on the corresponding factors ranged from 0.685 to 0.825. Confirmatory factor analysis showed that all model fit indices were within acceptable ranges. The average variance extracted (AVE) values for the dimensions ranged from 0.551 to 0.570, and the composite reliability (CR) values ranged from 0.925 to 0.955, indicating good convergent validity. The relationships between the dimensions and their corresponding items were consistent with the expected design, demonstrating good construct validity. In summary, this questionnaire has good reliability and validity and can accurately and truthfully reflect the levels of knowledge, attitude, and practice of breast specialty nurses regarding fertility preservation for young breast cancer patients of childbearing age.\u003c/p\u003e \u003cp\u003eDuring the decision-making process regarding fertility preservation for young breast cancer patients of childbearing age, the lack of relevant information support results in low levels of awareness about fertility protection, short decision-making time, and a heavy decision-making burden. These patients often experience decision conflict and may even miss the critical window for fertility preservation, which seriously affects their physical and mental health as well as their quality of life \u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/sup\u003e. As the primary providers of education, referral, and information consultation regarding fertility protection for young breast cancer patients of childbearing age, breast specialty nurses' knowledge, attitude, and practice regarding fertility protection directly influence the delivery of fertility preservation services \u003csup\u003e[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/sup\u003e. Few studies in China have focused on the knowledge, attitude, and practice of breast specialty nurses regarding fertility protection, and no relevant assessment tools have been identified. Based on the Knowledge-Attitude-Practice (KAP) theoretical framework, this questionnaire focuses specifically on assessing breast specialty nurses' level of knowledge, attitude tendencies, and clinical practice performance regarding fertility preservation for young breast cancer patients of childbearing age. Furthermore, the participants in this study completed the questionnaire within 6\u0026ndash;10 minutes, indicating that the number of items is appropriate, the content is relatively comprehensive, and the questionnaire is easy to understand. Therefore, this KAP questionnaire developed on the basis of the KAP theory has strong clinical practicality and feasibility and is suitable for investigating the knowledge, attitude, and practice levels of breast specialty nurses regarding fertility preservation for young breast cancer patients of childbearing age. Using this questionnaire, nursing managers can assess the current levels of breast specialty nurses, analyze factors influencing the knowledge, attitude, and practice related to fertility protection, and implement targeted interventions based on these influencing factors.\u003c/p\u003e \u003cdiv id=\"Sec32\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study only surveyed breast specialty nurses from some tertiary hospitals in Henan Province, which has certain geographical limitations. Future research could expand the sample scope and conduct multi-region, multi-center surveys to further improve the scientific rigor, reliability, and practicality of the questionnaire.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe questionnaire developed in this study consists of 38 items and demonstrates good reliability and validity, all meeting the measurement standards. This questionnaire can be used to assess the levels of knowledge, attitude, and practice of breast specialty nurses regarding fertility preservation for young breast cancer patients of childbearing age, providing a basis for nursing managers to develop personalized training programs for breast specialty nurses.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors express their sincere gratitude to all participants involved in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQi Wang and Pei Zhao contributed to the study\u0026rsquo;s conception and design, acquisition of data, analysis, and interpretation of data, drafted the article and revised it for content. Hongmei Zhang and Pilei Si reviewed it and approved the final version for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e2024 Annual Project of Medical Science and Technology Research Program of Henan Province (SBGJ202403005);\u003c/p\u003e\n\u003cp\u003eOpen Project of Henan Provincial Key Laboratory of Nursing Medicine in 2025 (HNSYHLKT202503)\u003c/p\u003e\n\u003cp\u003eOpen Project of Henan Provincial Key Laboratory of Nursing Medicine in 2023 (HNSYHLKT202302)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analyzed during the current study are not publicly available due to privacy and ethical restrictions, but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was reviewed and approved by the Henan Provincial People\u0026apos;s Hospital. The study followed the ethical guidelines, protocol, and regulations stated in the Declaration of Helsinki. Informed consent was obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1 Henan Provincial People\u0026apos;s Hospital, Zhengzhou, China\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBRAY F, LAVERSANNE M. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRuan XY. 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Psychol Explor. 2014;34(1):57\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWelk B, Morrow S, Madarasz W, Baverstock R, Macnab J, Sequeira K. The validity and reliability of the neurogenic bladder symptom score. J Urol. 2014;192(2):452\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeproux C, Seegers V, ,Patsouris A, et al. Success and risks of pregnancy after breast cancer. Breast Cancer Res Treat. 2021;188(3):593\u0026ndash;600.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAn A, Wang H, Wu KJ, Ding Y. Inner Experiences of Young Female Patients with Early Breast Cancer Regarding Fertility Preservation Decisions. China Nurs Manage. 2022;03:354\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYe Y. Chen A,Liu Z.Investigation of present situation and influence factors of fertility preservation cognition in hospital staffs. J Reproductive Med. 2020;29(12):1603\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLewin J, Ma JMZ,Mitchell L, et al. The positive effect of a dedicated adolescent and young adult fertility program on the rates of documentation of therapy-associated infertility risk and fertility preservation options. Support Care Cancer. 2017;25(6):1915\u0026ndash;22.\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":"Breast specialty, Nurses, Fertility preservation, Reliability, Validity, Nursing","lastPublishedDoi":"10.21203/rs.3.rs-9328430/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9328430/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe pregnancy rate among breast cancer patients is the lowest among all cancer populations, at only 3%, which is 40% lower than that in the general population. In China, breast cancer patients of childbearing age lack comprehensive and systematic knowledge about treatment-related reproductive impairment and fertility preservation. As the primary healthcare providers for these patients, breast care nurses play a crucial role in providing education, referrals, and information consultation regarding fertility preservation. However, the current status of clinical practice involving breast care nurses in fertility preservation for breast cancer patients in China is far from satisfactory.\u003c/p\u003e\u003ch2\u003eAims\u003c/h2\u003e \u003cp\u003eThis study aimed to develop a questionnaire on knowledge, attitudes, and practices of breast care nurses regarding fertility preservation in childbearing-age breast cancer patients, and to evaluate the validity of this questionnaire among breast care nurses.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe initial draft of the questionnaire was developed through literature review and two rounds of expert consultation. From October 2025 to December 2025, a total of 330 breast care nurses from tertiary Class A hospitals in Henan Province were enrolled for the survey, followed by item analysis, reliability testing, and exploratory factor analysis. Another 420 breast care nurses were recruited for a separate survey to conduct confirmatory factor analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe final questionnaire comprised 3 dimensions and 38 items. For the overall questionnaire, the Cronbach's α coefficient was 0.956, the split-half reliability was 0.745, the test-retest reliability was 0.936, and the average content validity index was 0.932. Three common factors were extracted by exploratory factor analysis, with factor loadings of individual items ranging from 0.546 to 0.750, and the cumulative variance contribution rate was 60.038%. Results of confirmatory factor analysis indicated that the model fit was acceptable and the questionnaire structure was stable.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe questionnaire assessing knowledge, attitudes, and practices of breast care nurses regarding fertility preservation in childbearing-age breast cancer patients is valid and reliable. It is recommended for use in clinical practice and research to evaluate the level of knowledge, attitudes, and practices of breast care nurses toward fertility preservation for this patient population.\u003c/p\u003e","manuscriptTitle":"Development and Validation of a Questionnaire on Knowledge, Attitudes, and Practices of Breast Specialist Nurses Regarding Fertility Preservation in Breast Cancer Patients of Childbearing Age","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-07 16:57:26","doi":"10.21203/rs.3.rs-9328430/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"40715661885339204195658906947634196377","date":"2026-04-28T03:43:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"129614372088132233362730734386401095937","date":"2026-04-26T05:49:47+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-23T04:37:36+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-23T04:33:14+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-20T16:44:03+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-15T02:40:32+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2026-04-15T02:34:18+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":"45fd4544-7893-4754-8067-7369d0288301","owner":[],"postedDate":"May 7th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-07T16:57:27+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-07 16:57:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9328430","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9328430","identity":"rs-9328430","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}