What factors influence sexual and reproductive health care among adolescent and young adult cancer patients?: a novel serial focus group study.
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BACKGROUND: Disparities in sexual and reproductive health care at diagnosis and during treatment for adolescent and young adult (AYA, ages 15-39) cancer patients may be linked to various factors, including those at the patient- and system-level. We conducted serial focus groups to explore how AYA cancer patients' experiences with sexual and reproductive health and its care are influenced by their identities (patient factors) and contextual enablers (healthcare factors). METHODS: We recruited individuals aged ≥ 18 years, diagnosed with cancer as an AYA, and residing in Canada. Participants were grouped into cohorts based on identity factors (e.g., gender, cancer stage) with each cohort taking in three serial focus groups mimicking support groups (e.g., sharing information, fostering community). Patient research partners contributed to topic guide development and co-facilitated focus groups. We used framework analysis guided by the PROGRESS-Plus (Place of residence, Race/ethnicity/culture/language, Occupation, Gender, Religion, Education, Social capital, Socioeconomic status, and Plus) framework on health inequity factors and Andersen's model of access to medical care. RESULTS: Altogether, 48 participants (age 33 (21-48)) were assigned into eight cohorts. Each cohort took part in three serial focus groups, resulting in a total of 24 focus groups. Among participants, there was representation based on gender (e.g., nonbinary and gender fluid, n = 4), non-heterosexual sexual orientation (n = 14), and race (n = 12). Themes indicate AYA cancer patients' experiences with lack of sexual and reproductive health information and support, and lack of consideration of experiences and beliefs when providing sexual and reproductive health care. Findings reveal eight identity (patient-level) factors (place of residence, self-advocacy (occupation, education, and plus), socioeconomic status, social capital (plus), gender and sex, age (plus), relationship status (plus), sexual orientation (plus)) and two contextual enablers (health care system-level factors) (inefficiencies and interactions) that influence access to appropriate and available sexual and reproductive health care. CONCLUSION: AYA cancer patients experiences with sexual and reproductive health care are influenced by their identity factors and contextual enablers. Treatment plans, research studies, and care programs should account for these to ensure that care is both inclusive and responsive to their unique needs.