Disparities in Counseling Female Cancer Patients for Fertility Preservation.

BACKGROUND: Female cancer patients who are exposed to gonadotoxic chemotherapy are at risk of future infertility. Research suggests that disparities in fertility preservation counseling (FPC) may exist. Previous research is limited by recall bias; therefore, this study examined objective electronic medical chart data regarding FPC at an academic medical center. MATERIALS AND METHODS: This study included reproductive-aged women (18-45 years old) with a diagnosis of breast, gynecological, or hematological cancer and who were exposed to a gonadotoxic chemotherapeutic agent from 2009 to 2013. Chi-square and logistic regression analyses were utilized to analyze disparities in FPC. RESULTS: Two hundred fifty-nine women met the study criteria. One hundred eighty-one women were diagnosed with breast cancer, 52 with hematological cancer, and 26 with gynecological cancer. 160/259 (62%) women had documented counseling for fertility preservation (FP), 60 (23%) women were not counseled as counseling was determined to be "not applicable," 16 (6%) women were not counseled and no explanation was given for the lack of counseling, and counseling was not documented in 23 (9%) charts. Age, marital status, and racial/ethnic background were related to counseling status. Patients with gynecological or hematological cancer were more likely to be counseled than other patients. Logistic regression results demonstrated that FPC was largely driven by cancer diagnosis. CONCLUSIONS: Although cancer diagnosis was the greatest predictor of FPC, disparities were evident in the counseling of female cancer patients for FP treatment. Equality in counseling female patients for FP treatment is imperative to reduce the risk of emotional harm and future infertility.

Social and Environmental Barriers to Nutrition Therapy for Diabetes Management Among Underserved Pregnant Women: A Qualitative Analysis.

OBJECTIVE: To identify social and environmental barriers to nutrition therapy for diabetes management during pregnancy among a population of low-income, minority pregnant women. DESIGN: Prospective, in-depth, semi-structured interviews performed serially during pregnancy and continued until thematic saturation was reached. SETTING: Urban academic medical center. PARTICIPANTS: Ten pregnant low-income, minority women with gestational diabetes and type 2 diabetes mellitus. PHENOMENON OF INTEREST: Social and environmental barriers to nutrition therapy for diabetes management during pregnancy. ANALYSIS: Qualitative analysis of interview data using electronic coding software was performed using theme analysis. RESULTS: Participants perceived limited ability and self-efficacy to adopt nutrition recommendations. Specific themes identified as barriers included (1) feeling overwhelmed by the unfamiliar; (2) using and decoding nutrition labels; (3) managing nutrition choices and seeking control in the setting of food insecurity; (4) experiencing lack of control and motivation, and limited self-efficacy; (5) balancing recommendations with taste preferences and cultural food norms; (6) maintaining a healthy eating schedule; and (7) accommodating diabetes in family and social life. CONCLUSIONS AND IMPLICATIONS: Pregnant women with diabetes encounter a number of knowledge-based, attitudinal, and resource-related barriers that reduce capacity for nutrition therapy adherence. Provision of culturally informed, practical nutrition support that addresses the needs of women in low-resource communities is an important component of comprehensive diabetes care during pregnancy.

"I Was Tired of All the Sticking and Poking": Identifying Barriers to Diabetes Self-Care Among Low-Income Pregnant Women.

OBJECTIVE: Diabetes in pregnancy is a significant problem for low-income, minority women. We sought to evaluate barriers to diabetes self-care during pregnancy in an underserved population. METHODS: Twenty-nine in-depth, semi-structured interviews were performed over 10 women's pregnancies to identify barriers to successful diabetes management, using cognitive load theory to frame interview questions. Qualitative analysis of interview data used grounded theory techniques. RESULTS: Fifty percent of this cohort of minority, low-income, public aid-supported women had pregestational diabetes. Six barrier domains were identified: diabetes novelty; social and economic chaos; nutrition challenges; psychological stressors; burden of disease management; and outcome expectation inability to promote behavior change. CONCLUSIONS: Low-income women face multiple barriers to successful diabetes self-care during pregnancy. Ability to achieve diabetes goals in pregnancy is influenced by several social, cognitive, and knowledge-based factors. Understanding this complex interplay of factors impacting diabetes management may help providers work with patients in achieving healthy pregnancies.