Finding the comfort zone: Physicians' perspectives on addressing infertility with adolescent bone marrow transplant patients and their parents

The objective of this study is to understand physicians' perspectives on addressing treatment-related infertility and fertility preservation with adolescent bone marrow/stem cell transplantation (BMT/HSCT or transplant) patients and their parents. Twelve attending transplant physicians were selected, representing ten pediatric BMT/HSCT centers nationwide.; Using semi-structured interviews, this study examined when and how the topic of infertility was raised, what was most challenging about such discussions for physicians, and physicians' observations of patient and parents' emotional response. The study also identified ethical and legal issues considered by physicians when talking about infertility and fertility preservation.; Results of this study indicated the following. Legal reasons (hospital informed consent forms) compelled physicians to discuss fertility related issues with their adolescent patients and parents prior to the transplant procedure. Invariably the fertility preservation conversation moved into a discussion of patient sexuality which most physicians experienced as uncomfortable. Physician discomfort in these discussions about the treatment effects on fertility can be attributed to the shift in their role from a medical advisory role that is focused on reproductive issues to a more psychosocial advisory role that is focused on issues of sexuality and sex education. Physicians provided differing responses regarding the degree of importance they give to infertility issues prior to transplant, given that competing life-threatening issues were of immediate primary concern.; Results from the study suggest that transplant adolescents would psychologically benefit from having physicians be more definitive about their role as sex educators. Physicians themselves would benefit from more training and collaborative opportunities with other health professionals in addressing issues of infertility and sexuality with their adolescent patients and parents. An outline for a training workshop for transplant physicians addressing fertility and sexuality issues with adolescent transplant patients is provided.