Factors influencing fertility preservation communication and decision support for cancer patients: a qualitative evidence synthesis of healthcare professionals’ perspectives

Background Cancer treatments threaten fertility in reproductive-age patients. Although fertility preservation (FP) is an effective option, its communication and decision support remain inconsistently implemented in clinical practice. Objective To identify factors influencing FP communication and decision support from the perspective of healthcare professionals (HCPs). Methods A qualitative evidence synthesis of qualitative and mixed-methods studies from six databases was conducted. Influencing factors were mapped using the Consolidated Framework for Implementation Research (CFIR). Study quality was appraised using the Joanna Briggs Institute (JBI) critical appraisal checklist for qualitative research and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting standards, and the confidence in the evidence was graded using the Confidence in the Qualitative Evidence (ConQual) scale. Results Factors influencing FP communication and decision support were identified across three CFIR domains. Outer setting: local fertility attitudes, geographic barriers, and policy shaped access to and engagement in FP communication and decision support. Inner setting: poor structural characteristics, survival-focused culture, limited FP knowledge, weak relational connections, and suboptimal multi-level communication hindered effective implementation. Individual: family support facilitated engagement, whereas patients’ capacity and emotional state influenced their participation. Four constructs landed at a moderate confidence level, and six constructs landed at a low confidence level. Conclusions Effective FP communication and decision support require multi-level, tailored strategies targeting domain-specific barriers and facilitators. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/ , identifier CRD42024600847.