What factors influence sexual and reproductive health care among adolescent and young adult cancer patients?: a novel serial focus group study.

AYA cancer patients reported a pervasive lack of sexual and reproductive health information and support during cancer diagnosis and treatment.

• 48 participants aged 18 and older (median age 33, range 21-48) who were diagnosed with cancer as an AYA participated across 24 focus groups
• Participants were assigned into eight cohorts based on identity factors such as gender and cancer stage
• Each cohort participated in three serial focus groups designed to mimic support groups, including sharing information and fostering community
• The theme of lack of sexual and reproductive health information and support emerged across cohorts as a central finding

AYA cancer patients reported a lack of consideration of their personal experiences and beliefs when receiving sexual and reproductive health care.

• This theme emerged alongside the lack of information theme as one of the two major qualitative themes identified through framework analysis
• Analysis was guided by the PROGRESS-Plus framework on health inequity factors and Andersen's model of access to medical care
• Patient research partners contributed to topic guide development and co-facilitated focus groups, strengthening the patient-centeredness of findings
• Participants included those with non-heterosexual sexual orientation (n=14), nonbinary and gender fluid individuals (n=4), and participants of various racial backgrounds (n=12), suggesting diverse experiences were captured

Eight patient-level identity factors were identified as influencing access to sexual and reproductive health care for AYA cancer patients.

• The eight identity factors identified were: place of residence, self-advocacy (encompassing occupation, education, and plus factors), socioeconomic status, social capital (plus), gender and sex, age (plus), relationship status (plus), and sexual orientation (plus)
• These factors were mapped using the PROGRESS-Plus framework, which includes Place of residence, Race/ethnicity/culture/language, Occupation, Gender, Religion, Education, Social capital, Socioeconomic status, and Plus categories
• The study recruited participants residing in Canada with representation across multiple identity dimensions
• These factors were identified as influencing both the appropriateness and availability of sexual and reproductive health care received

Two healthcare system-level contextual enablers — inefficiencies and interactions — were identified as influencing AYA cancer patients' access to sexual and reproductive health care.

• Contextual enablers were categorized as health care system-level factors, distinct from the patient-level identity factors
• The two enablers were labeled 'inefficiencies' and 'interactions,' reflecting structural and interpersonal dimensions of the healthcare system
• These findings were derived from framework analysis applied to data from 24 focus groups across 8 cohorts totaling 48 participants
• Andersen's model of access to medical care was used alongside PROGRESS-Plus to guide the analytical framework

The study used a novel serial focus group methodology, with each cohort participating in three sequential focus groups designed to mimic support groups.

• 48 participants were assigned to 8 cohorts, and each cohort completed 3 serial focus groups, resulting in 24 total focus groups
• Cohorts were grouped based on identity factors such as gender and cancer stage
• The serial format was intended to foster community and information sharing similar to a support group structure
• Patient research partners were involved in topic guide development and co-facilitation of focus groups, reflecting a participatory research design

The study sample included representation from gender minorities, sexual minorities, and racial minorities among AYA cancer patients.

• Of 48 participants, 4 identified as nonbinary or gender fluid
• 14 participants identified as non-heterosexual sexual orientation
• 12 participants identified as belonging to a racial minority group
• Participants ranged in age from 21 to 48 years with a median age of 33, and all were diagnosed with cancer during the AYA period (ages 15-39)