'Swimming against the tide' : an exploratory study of the experiences of growing up with fertility concerns following cancer treatment

This thesis considers the impact on growing up among young people diagnosed in their teens with cancer and told that fertility impairment may result. The exploratory study informed by grounded theory recruited seventeen males and twenty-one females (overall take-up 35 per cent). Single in-depth interviews were conducted in two age groups - 13 to 21; 21 and over. Five were parents. Findings were considered theoretically within lifespan approaches and resilience theory. Protective or risk factors were Identified within the approach of participants or those around them - including professionals and services, family members, friends and romantic partners. Reactions ranged from being little troubled to deep distress. Strength of desire to parent and the stigma of infertility heightened concerns as did feelings of having little control over fertility outcome. Concerns were eased - but not removed - with the provision of regular, unambiguous information, access to help with strategy building, presence of stored gametes, hope of retention of reproductive function, availability of confidantes including friends and romantic partners, positive experience of disclosure and achievement of parenthood. Across all spheres, fertility matters were· raised less frequently than were other cancer matters by participants or those around them. This was only helpfUl when it reflected protective communication or low concern. The personal and social meaning of fertility matters, including fertile identity implications, appeared more influential than age and life stage and was .dynamic across time and context. Gender too carried social as well as biological challenges, including around fertility analysis. Where return to 'normality' wasprioritised, fertility concerns were marginalised but presented periodic threats. Although many reported gaining strength through having had cancer none did so in relation to fertility matters. For some, fertility concerns overtook those associated with cancer. Preferred professional attributes and suggestions for service developments across disciplines and agencies were identified.

Clinical encounters and culturally competent practice : the challenges of providing cancer and infertility care

This qualitative paper compares how practitioners respond to adults from two ethnic groupings (defined for analytical purposes as South Asian and White), whose fertility is threatened by cancer. Our findings suggest practitioners, in their struggle to offer culturally sensitive care, negotiate various competing ideas, reflecting wider cultural assumptions underpinning notions of ethnicity, gender, fertility and responsible parenthood within the context of premature death posed by a diagnosis of cancer. Wider social and political responses to minority ethnic groups often intersect with personal and professional judgements in influencing what practitioners regard as appropriate care. Our conclusion explores the need for a more pluralistic response to facilitating culturally competent care