Table 2.

Major Themes and Related Representative Quotations

Theme	Representative quotations
Pregnancy avoidance and early pregnancy diagnosis conflated to contraception
Importance of avoiding pregnancy during treatment	“For most of our treatments, it would be for us in hematology … treatments, I think it would really be a huge problem [if a patient got pregnant] and I don't know that a lot of the patients would be able to continue their standard therapy” PR2, physician, medical oncology “I mean their care with us would go on hold until after their pregnancy …. We've already diagnosed them with cancer. They've decided to continue with the pregnancy and we don't operate, we don't get imaging, so we counsel them on again what stage and what type of cancer they have, what they can expect of that.” PR4, APC, surgical oncology “I think it helps us complete all of the treatment in the smoothest way possible, if they avoid pregnancy, yeah. I think it helps get through them fastest and most expeditious cancer care that we can provide.” PR12, physician, surgical oncology
Advising to avoid intercourse	“Honestly, usually, I limit it to like, you shouldn't be having sex while you're neutropenic and that's just a tiny part of the conversation about like, don't eat undercook meat and ham like—it's like once and sandwiched in there with all of these other things.” PR3, physician, medical oncology
Warning to avoid pregnancy	“… during the consent of radioactive iodine, we do talk about the fact … You shouldn't- again, you shouldn't get pregnant for a minimum of three months.” PR10, physician, medical oncology “I just tell them that it's very important not to get pregnant on treatment.” PR18, physician, medical oncology
Focus on early diagnosis of pregnancy	“We check pregnancy tests multiple times along the treatment path, but I don't actually tell them what to use” PR10, physician, medical oncology “[I] will say to them, ‘Is there any chance you can be pregnant?’ … most times it's brought up beforehand. …In radiation, before they start radiation, before they start chemo, before they start most tests, women between childbearing ages are supposed to have a negative pregnancy test.” PR15, nurse, medical oncology
Inaccurate contraceptive recommendations for specific clinical scenarios	“Our breast cancer patients, we try to make sure they do not get pregnant during treatment … So we usually try to keep on that and make sure they are getting either [leuprolide acetate] injections here or using some kind of birth control at home and really stressing to them that this is not the time to get pregnant.” PR15, nurse, medical oncology “We make patients aware that if they're given antibiotics that they're oral contraceptives may not be as effective … if patients are using oral contraceptives, I think we have to tell them it may not be as effective during antibiotics.” PR5, physician, surgical oncology
Lack of clear roles and responsibility for contraception discussions	“I think honestly though, as in the surgical field, we probably would either consciously or subconsciously turf that off to like the person that's administering the chemo or radiation.” PR8, APC, surgical oncology “Honestly, we defer a lot of that stuff onto the pharmacist … pharmacists are the ones that tend to deal with it.” PR3, physician, medical oncology “I think the doctors for the breast cancer patients, at least I think they discussed that in their initial meetings with their patients.” PR15, nurse, medical oncology “I do not make sure [a patient uses contraception] before the surgery, but … I feel like I'm the responsible person after surgery. So, that first month, that first return visit … that's when I assume care and that's when we start having conversations about pregnancy.” PR10, physician, medical oncology “It starts with the doctor, but the nurses see the patients the most. So as much as it starts with the doctor and the NP, I think it should become a little more focused, not as the nurse should be responsible but at least responsible for asking if they're [using birth control].” PR15, nurse, medical oncology “We defer to PCPs … We can help them get into PCP … It doesn't come up all that often … Honestly, most patients when they come in were pretty focused on … their cancer.” PR4, APC, surgical oncology
Inconsistent education about contraception
Lack of formal education	“Nothing in my training. I know, internal medicine, we really didn't learn anything about it. I think in my fellowship, we learned more about the different types of birth controls … so it was sort of by association … in terms of cancer management, no one taught me any of this … there was no education.” PR10, physician, medical oncology “Interviewer: Have you had any education about birth control during cancer treatment, during any of your fellowship or residency? Interviewee: In internal medicine training just in general … information but never, to be honest, never cancer-related contraceptive information.” PR2, physician, medical oncology “Interviewer: Tell me about any education that you've had about birth control during cancer treatment. Have you had any education? Interviewee: Formally? … No.” PR6, APC, medical oncology “No.” PR8, APC, surgical oncology “No.” PR15, nurse, medical oncology “Interviewer: Tell me about any specific education you've had around birth control during cancer treatment? Interviewee: Not birth control. No, we had one segment on fertility preservation in cancer patients, but not specifically on birth control … I think it's a topic that is missed.” PR13, physician, surgical oncology
Lack of comfort initiating conversations due to lack of education	“I suppose I'd feel more comfortable if I had more knowledge leading into these conversations about how to answer specific questions, doesn't come up a lot, so I think that this is definitely an area where I could learn and grow.” PR7, APC, medical oncology
Informal education (clinical or personal experiences) in place of formal education	“You learn from other oncologists about stuff and that's where I learned … you need to teach people not to have penetrative sex while neutropenic … you just … learn it as you go, nothing formal.” PR3, physician, medical oncology “Well I think we would want to know the most current … I mean a lot of us here in this clinic, out of the women here, are over 50. So lot of us are not of reproductive years anymore. So we're probably out of the loop on the lot of the newest IUDs or injections or whatever it is they are using. A lot of us are out of the loop on that … Years ago it was the pill. It's not the pill anymore.” PR15, nurse, medical oncology

APC, advanced practice clinician; PCP, primary care provider.