Table II.

Qualitative studies included in the review.

Study, origin	Aims	Inclusion criteria	Sample	Study design, data collection	Relevant findings
Gorman et al. (2011), USA	To explore how young women make cancer treatment decisions and role of fertility concerns in that process	(i) Early-stage BC survivors (stage I or II); (ii) ≤40 years at diagnosis	n = 20 Age range: 26–38 years (means, SD, medians not stated) 7 women <30 years 10 women 30–34 3 women ≥35 Length time since diagnosis: range 1–13 years (means, SD, medians not stated) Participants recruited from the WHEL study and YSC To ensure the inclusion of women interested in fertility, half of those in the sample had at least 1 biological child after treatment Race/ethnicity: 17 (85%) White 3 (15%) Hispanic	Cross sectional In dept telephone semi-structured interviews Cross-case analysis	Fertility largely viewed as secondary to the importance of survival/preventing future recurrence Most women interested in possibility of having children post-treatment At the time of interview: 2 unable to have children; 1 trying pregnancy; 4 open to a possible pregnancy; 3 decided against having children due to older age, life circumstances, concerns about recurrence, the baby's health and passing on genetic risk; 2 considering adoption Themes: ‘I was young, I wanted to do everything possible to move forward with my life and not have the cancer come back’, ‘fertility concerns are different for every woman’, ‘my oncologist was great … a huge part of my survivorship’, ‘they did not tell me about my options, and I didn't think about fertility until it was too late’
Lee et al. (2011), UK	Women's reactions to finding out that cancer treatment could affect fertility and how interactions with health services impacted on their ability to deal with this effectively	(i) History of early-stage BC; (ii) ≤40 years at diagnosis; (iii) fluency in English	n = 24 Median age: 32 years (range: 23–39) Median length time since diagnosis: 32 months (range 7–72 months) No women of ethnic minorities recruited (although researchers approached some)	Cross sectional 3 focus groups using flexible interview structure Thematic analysis	Fertility was important; however; survival was priority over having children With the exception of 3 women, not having children would be better than the detrimental effects of a child not having a mother The majority of women thought fertility choices affected their risk of recurrence Themes: ‘survival a priority’, ‘perceived risks to survival’, ‘advice from health professionals’, ‘denial of choice’, ‘women with children neglected’, ‘role of services’, ‘written information provision’, and ‘timing of discussions’
Connell et al. (2006), Australia	Explore young women's issues and concerns over time Focus on changing views of reproductive issues over a period of 12–18 months	(i) Adult female with BC; (ii) ≤40 years at diagnosis; (iii) English speaking; (iv) diagnosis ≤4 years ago; (v) not suffering extreme distress or not in palliative care or not all of these	Phase I (baseline): n = 35 FU women: n = 13 Median age diagnosis (FU) = 37 years (range 29–40 years) Median time since diagnosis = 26 months (range 5–37 months) Ethnicity not specifically recorded. Authors stated that participants were representative of mainstream Australia (i.e. 80% of Australian population's ancestry is Australian, English and Irish)	Longitudinal study (data collected 3 times over a 12–18 months period) Home or telephone one-to-one semi-structured interviews (∼6 months apart) Analytical analysis	Women's perspectives on fertility change over time Mixed desire about pregnancy/wanting children Some women expressed fear of recurrence after pregnancy
Siegel et al. (1997), USA	Women's perceptions of the possible risks and benefits of having a baby after breast cancer Gain insights into factors that influenced women's decision-making concerning pregnancy	(i) Completed treatment for BC ≥ 6 months before study; (ii) <46 years; (iii) black or white non-Hispanic; (iv) be currently deciding whether to attempt pregnancy (or had actively consider it and had made a decision within the previous 3 years); (v) believe that they still have capacity to become pregnant	n = 50 Median age: 33.4 years at diagnosis (range: 22–44 years) Median length of time since diagnosis: 33 months (range: 8 months-8 years) Race/ethnicity: 42 (84%) White non-Hispanic 8 (16%) Black	Cross sectional In-depth focused interview, most interview questions open-ended Content analysis	7 women pregnant since diagnosis (10 pregnancies in total) Most of sample contemplating pregnancy after BC, but not yet attempted to conceive Longer length time since treatment, more women were willing to get pregnant Deterrents for pregnancy (risks/dangers): ‘Fear their disease would recur’, ‘Fear the child would have birth defect because of the cancer treatment’, ‘Fear their child would be born with a greater susceptibility to cancer’; ‘Concerns that caring for a child would be too stressful’ Incentives for pregnancy: ‘Having a baby is a cherished part of a life plan’; ‘Having a baby is life affirming’; ‘Having a child will promote a feeling of normalcy’, ‘Having a baby would give her husband something that would make him very happy’; ‘Having a child would improve their quality of life’
Dow (1994), USA	Identify reasons why young women with BC decide to become pregnant Describe concerns about subsequent pregnancy Describe helpful behaviours in decision-making Explore the meaning of having children after BC	(i) Early-stage BC; (ii) pregnancy after breast-conserving surgery and radiation therapy	n = 16 Mean age at diagnosis: 29.6 years at diagnosis (SD not stated) (range: 25–35 years) Mean age at interview: 38.8 years at diagnosis (SD not stated) (range: 32–45 years) Race/ethnicity: 15 (94%) White 1 (6%) Greek	Cross sectional Semi-structured interview Content analysis	Reasons for pregnancy related to women's developmental age Concerns related to disease recurrence, breast self-examination and mammography during pregnancy and about surviving to see their children grow up 3 themes related to future children: ‘anchoring’, ‘getting well again’, ‘feeling complete’

BC, breast cancer; SD, standard deviation; RCT, randomized control study; SPIRIT, Sisters Peer Counselling in Reproductive Issues after Treatment; WHEL, Women's Healthy Eating and Living; YSC, Young Survival Coalition; FU, follow-up.