title: Cancer and fertility preservation in Puerto Rico: a qualitative study of healthcare provider perceptions.
abstract: This study aims to examine healthcare provider perceptions of cancer-related infertility and fertility preservation (FP) in an underserved population and to highlight cognitive and structural barriers to use.
  
  
  
  In-depth, semi-structured interviews were conducted with a sample of 16 healthcare providers participating in a larger ethnographic study on cancer survivorship and cancer-related infertility in Puerto Rico, an unincorporated US territory. Interviews were conducted in-person, audio-recorded, transcribed verbatim, and coded using the constant comparative method.
  
  
  
  Providers identified several barriers to FP in Puerto Rico: high cost in relation to income levels, lack of insurance coverage, gaps in provider knowledge of fertility clinics and financial assistance, lower prioritization of quality-of-life needs leading to inconsistent physician disclosure of fertility risks, geographical location of fertility clinics, and logistical challenges to maintaining FP offerings. Two factors act as facilitators: a high value placed on patient-provider communication and relationships and the formation of local alliances between the oncology and reproductive medicine fields, potentially leading to increased cross-specialty communication and referral.
  
  
  
  Infertility is a continuing source of distress for cancer patients and survivors, and barriers to FP vary cross-culturally. In Puerto Rico, context-specific factors indicate potential areas of intervention. Greater awareness of fertility risks and options can be fostered through physician training in conjunction with organizational measures targeting cost barriers.
authors.affiliation: Department of Anthropology, University of South Florida, Tampa, FL, USA. karen.dyer@vcuhealth.org.|Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, P.O. Box 980149, Richmond, VA, 23298, USA. karen.dyer@vcuhealth.org.
authors.forename: Karen E
authors.initials: KE
authors.lastname: Dyer
authors.affiliation: Health Outcomes and Behavior Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.|Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
authors.forename: Gwendolyn P
authors.initials: GP
authors.lastname: Quinn
mesh_terms: D000328:Adult; D005260:Female; D059247:Fertility Preservation / Q000379:methods*; D006282:Health Personnel; D006801:Humans; D007246:Infertility / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology / Q000628:therapy*; D010465:Perception; D011647:Puerto Rico; D036301:Qualitative Research
keywords: Cancer; Fertility preservation; Healthcare providers; Infertility; Puerto Rico