Multilevel factors related to fertility preservation decision-making among women of reproductive age with breast cancer: A mixed-methods systematic review.
4 affiliations
- 1School of Medicine, Lishui University, Lishui, Zhejiang, China.
- 2School of Nursing, Shanghai Jiao Tong University, Shanghai, China.
- 3Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Lishui University, Lishui People's Hospital, Institute of Breast Oncology, Lishui University Medical College, Lishui, Zhejiang, China.
- 4Operating Theatres, Evelina Children's Hospital, London, UK.
Abstract
To synthesize quantitative and qualitative evidence on multilevel factors related to fertility preservation (FP) decision-making among women of reproductive age with breast cancer. Eight databases were searched from inception to June 20, 2026: Ovid MEDLINE, Embase, CINAHL Complete, APA PsycINFO, SinoMed, CNKI, Wanfang Data, and VIP. Studies were appraised using Joanna Briggs Institute (JBI) tools; synthesis followed the JBI convergent integrated approach, with findings organized and interpreted using the socio-ecological model. Thirty-one reports (19 quantitative and 12 qualitative) representing 30 studies were included. The synthesis distinguished FP consideration/intention, actual uptake/completion, and decisional conflict, with service-pathway factors analyzed separately. Evidence spanned four socio-ecological levels. Individual-level factors included sociodemographic and clinical characteristics; reproductive history and intentions; knowledge and self-efficacy; perceived benefits, risks, and burdens; and emotional responses. Interpersonal and organizational factors included family involvement, relationships with clinicians, communication, decision support, referral, service access, and care coordination. Sociocultural and policy factors included reproductive norms, funding, and eligibility rules. Four cross-level themes emerged: financial feasibility; information, communication, and decision support; time for pretreatment FP; and reproductive history and intentions within family and policy contexts. No community-level evidence was identified. FP decision-making is related to reproductive goals, fertility-related knowledge and concerns, clinical circumstances, family involvement, service organization, and sociocultural and policy conditions. Oncology nurses and multidisciplinary teams may support decisions through early fertility discussions, tailored information, psychological support, and timely referral and coordination. Costs and eligibility requirements may pose access barriers largely beyond clinical teams' control. PROSPERO (CRD420251054968).
Related
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BibTeX
@article{fang2026multilevel,
title = {{Multilevel factors related to fertility preservation decision-making among women of reproductive age with breast cancer: A mixed-methods systematic review.}},
author = {Xiaolin Fang and Xiaoling Yuan and Yong Shi and Xuefeng Yan and Zhen Fang and Jiawen Xu and Lihong Jin and Jingdan Li},
journal = {Asia-Pacific journal of oncology nursing},
year = {2026},
month = sep,
doi = {10.1016/j.apjon.2026.101039},
url = {https://europepmc.org/article/MED/42999861},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Multilevel factors related to fertility preservation decision-making among women of reproductive age with breast cancer: A mixed-methods systematic review.
AU - Xiaolin Fang
AU - Xiaoling Yuan
AU - Yong Shi
AU - Xuefeng Yan
AU - Zhen Fang
AU - Jiawen Xu
AU - Lihong Jin
AU - Jingdan Li
PY - 2026
DA - 2026/09/29
JO - Asia-Pacific journal of oncology nursing
DO - 10.1016/j.apjon.2026.101039
UR - https://europepmc.org/article/MED/42999861
AB - To synthesize quantitative and qualitative evidence on multilevel factors related to fertility preservation (FP) decision-making among women of reproductive age with breast cancer. Eight databases were searched from inception to June 20, 2026: Ovid MEDLINE, Embase, CINAHL Complete, APA PsycINFO, SinoMed, CNKI, Wanfang Data, and VIP. Studies were appraised using Joanna Briggs Institute (JBI) tools; synthesis followed the JBI convergent integrated approach, with findings organized and interpreted using the socio-ecological model. Thirty-one reports (19 quantitative and 12 qualitative) representing 30 studies were included. The synthesis distinguished FP consideration/intention, actual uptake/completion, and decisional conflict, with service-pathway factors analyzed separately. Evidence spanned four socio-ecological levels. Individual-level factors included sociodemographic and clinical characteristics; reproductive history and intentions; knowledge and self-efficacy; perceived benefits, risks, and burdens; and emotional responses. Interpersonal and organizational factors included family involvement, relationships with clinicians, communication, decision support, referral, service access, and care coordination. Sociocultural and policy factors included reproductive norms, funding, and eligibility rules. Four cross-level themes emerged: financial feasibility; information, communication, and decision support; time for pretreatment FP; and reproductive history and intentions within family and policy contexts. No community-level evidence was identified. FP decision-making is related to reproductive goals, fertility-related knowledge and concerns, clinical circumstances, family involvement, service organization, and sociocultural and policy conditions. Oncology nurses and multidisciplinary teams may support decisions through early fertility discussions, tailored information, psychological support, and timely referral and coordination. Costs and eligibility requirements may pose access barriers largely beyond clinical teams' control. PROSPERO (CRD420251054968).
SN - 2347-5625
SN - 2349-6673
ER -