In a groundbreaking advancement at the intersection of oncology and reproductive health, researchers at Hiroshima University have devised a novel nursing practice scale designed to systematically evaluate and enhance support for fertility preservation (FP) decision-making in women battling cancer. This pioneering scale emerges in response to a critical gap in oncology nursing: standardizing and improving care practices that assist women in making informed, timely choices about their reproductive futures amidst the profound psychological and medical upheaval cancer diagnosis precipitates.
Every year, approximately 20 million individuals worldwide receive a cancer diagnosis, with survival rates improving due to advances in medical treatments. Despite this progress, cancer therapies—particularly chemotherapy and radiation—often jeopardize fertility in women of reproductive age. This potential loss adds a complex layer of urgency and distress to an already challenging diagnosis. Optimal support during FP decision-making is pivotal, as psychological distress commonly hinders women’s capacity to process information and make considered choices about preserving fertility options.
Historically, despite growing recognition of fertility preservation as integral to comprehensive cancer care, standardized frameworks and tools to guide nursing support in this domain have been lacking. Addressing this unmet need, the Hiroshima University team undertook an exhaustive literature review in both Japanese and English to distill best practices in nursing support for FP decision-making. Special attention was paid to synthesizing international perspectives while remaining sensitive to the unique sociocultural context of Japanese healthcare.
Their research culminated in the creation of an initial survey tool encompassing various nursing interventions and communication strategies related to fertility preservation. This draft scale underwent rigorous expert scrutiny: panels composed of clinicians and educators with extensive experience working with female cancer patients meticulously evaluated scale items to enhance clarity, relevance, and respondent ease. Subsequent revisions ensured the tool’s robust applicability across diverse healthcare settings.
To validate the scale’s reliability and factor structure, the researchers conducted a comprehensive cross-sectional study involving 450 cancer care institutions designated under Japan’s national cancer control framework. The large-scale survey targeted nursing staff and yielded significant participation, with 282 valid responses for exploratory factor analysis (EFA) and 318 for confirmatory factor analysis (CFA). These complementary statistical techniques elucidated the latent dimensions underpinning effective nursing practices in FP decision-making support.
The final, 12-item scale distilled nursing support into three critical factors that underpin successful fertility preservation care. First, “professional decision-support” encompasses individualized patient education, provision of timely, relevant information, and guidance tailored to the patient’s oncologic and reproductive context. Second, “facilitation of communication between patients and families” recognizes that family dynamics and shared decision-making influence fertility choices profoundly and that nurses play a pivotal role in bridging these perspectives. Third, “system- and team-based collaboration” highlights the necessity of coordinated multidisciplinary approaches and institutional support structures that operationalize fertility preservation options within oncology care pathways.
Each item on the scale is rated on a Likert scale from 1 to 5, culminating in scores ranging from 22 to 110, wherein higher scores reflect more comprehensive, patient-centered, and collaborative nursing practices in FP. This metric not only quantifies practice quality but also provides actionable feedback to healthcare teams aiming to refine support mechanisms for women confronting the dual challenge of cancer and reproductive uncertainty.
According to Kazuaki Tanabe, the study’s principal investigator and a professor at Hiroshima University’s Graduate School of Biomedical and Health Sciences, this scale marks a paradigm shift. By concretely defining and measuring nursing contributions to fertility preservation decisions, the tool empowers clinical teams to identify gaps and implement targeted educational and systemic improvements. He emphasizes the scale’s utility in fostering “shared decision-making” that respects patient values and preferences—a cornerstone of contemporary patient-centered oncology.
The study underscores the complex interplay between individual nursing competence and broader organizational factors in delivering effective FP support. Nurses serve not only as frontline caregivers but also as communicators and coordinators within multidisciplinary teams. Their ability to navigate both clinical information and psychosocial dynamics decisively influences patients’ opportunities to preserve fertility without delay or regret.
Looking ahead, Hiroshima University researchers envisage deploying this scale as a standard evaluative and educational instrument across oncology nursing curricula and clinical settings. Through iterative application and feedback, they aim to elevate nursing practice consistency nationally and potentially internationally. Beyond Japan, this validated scale offers a replicable framework adaptable to varied cultural and healthcare environments, providing a scaffold for global improvements in FP decision support.
This innovation arrives amid increasing recognition that fertility-related quality of life is a paramount concern for many cancer patients, particularly younger women. Providing reliable, proactive nursing support mitigates distress and empowers patients to make decisions congruent with their long-term life goals. The interdisciplinary, team-based ethos reflected in the scale’s structure further promotes holistic oncologic care that integrates reproductive health as a vital component.
The Hiroshima University team behind this research includes esteemed scholars Mikako Yoshihara, Chie Teramoto, Hiroyuki Sawatari, Ruxin Lei, and Hisae Nakatani. Their collective expertise spans oncology nursing, biostatistics, and reproductive health, fostering a nuanced approach to scale development that bridges theory, clinical insights, and patient needs.
Recognition of this work’s significance is underscored by its publication in the December 2025 issue of the Asia-Pacific Journal of Oncology Nursing. Supported by the Yasuda Medical Foundation, the project exemplifies rigorous, clinically relevant research that promises to transform patient care paradigms in oncology nursing.
In sum, the creation and validation of this nursing practice scale represent a pivotal advance in aligning fertility preservation support with evidence-based, systematic care models. As this tool enters wider clinical use, it offers the promise of more informed, collaborative, and patient-centered fertility decision-making for women confronting the arduous journey of cancer treatment—ultimately preserving not only reproductive potential but also hope and agency.
Subject of Research: People
Article Title: Development and validation of a nursing practice scale for supporting fertility preservation decision-making in women with cancer
News Publication Date: 2-Dec-2025
Web References:
- Asia-Pacific Journal of Oncology Nursing: https://www.sciencedirect.com/science/article/pii/S2347562525001568
- Hiroshima University: https://www.hiroshima-u.ac.jp/en
References:
- DOI: 10.1016/j.apjon.2025.100808
Image Credits: Kazuaki Tanabe
Keywords: fertility preservation, nursing practice, cancer care, decision-making, oncology nursing, scale development, patient-centered care, shared decision-making, reproductive health, Japan, validity, reliability
