Barriers and facilitators of shared decision-making for pregnancy after breast cancer: A qualitative study of patients and healthcare professionals.

Abstract

35 Background: As survival rates for young women with breast cancer (BC) improve, pregnancy after treatment has become an increasingly important survivorship issue. Shared decision-making (SDM) is a collaborative approach in which patients and healthcare professionals work together, but little is known about how pregnancy-related decisions are addressed and supported in oncology care. This study explored barriers and facilitators to SDM for pregnancy after BC from both patient and healthcare professional perspectives. Methods: Through purposive sampling, we conducted a qualitative interview study involving women aged 18 to 49 years who completed active BC treatment and healthcare professionals with experience in pregnancy counseling. Following IRB approval, data were collected from November 2022 to October 2023 via in-depth, semi-structured interviews. Data were analyzed using inductive thematic analysis to identify patterns related to initiation, progression, and support needs for SDM. Results: Fifteen patients (Mean age = 36.00 ± 4.17) and six healthcare professionals (specializing in breast surgery, gynecology, and medical oncology) participated. Eight sub-themes emerged and were categorized into three themes: (a) SDM not initiated: Failure of dialogue to emerge, (b) SDM constrained: Clinical and structural limits to progress, and (c) Facilitating SDM: Desired supports to enable SDM. The analysis revealed that these themes represent a linear trajectory of barriers and facilitators within the SDM process for pregnancy planning. Conclusions: Pregnancy-related SDM after BC often fails to be initiated and, when it occurs, is difficult to sustain within current oncology care delivery models. These findings underscore the need for proactive agenda-setting and structured, multidisciplinary SDM pathways to better integrate reproductive decision-making into oncology survivorship care. Themes and subthemes of barriers and facilitators to shared decision-making for pregnancy after breast cancer. Themes Subthemes SDM not initiated: Failure of dialogue to emerge Unrecognized need for agenda-settingTime pressure and limited opportunity SDM constrained: Clinical and structural limits to progress Oncology-focused clinical encountersInsufficient evidence and individualized informationInadequate multidisciplinary coordination Facilitating SDM: Desired supports to enable SDM Integration of reproductive health into oncology careProfessional counseling including psychosocial supportDevelopment and provision of comprehensive decision aids SDM = shared decision-making.