Fertility Concerns and Decision-Making Influences Among Young and Middle-Aged Patients with Colorectal Cancer: A Multi-Center Mixed-Methods Study

Abstract Background The increasing incidence of colorectal cancer among younger individuals has made fertility concerns a significant issue requiring clinical and psychosocial support for middle-aged and young patients. Fertility anxieties not only lead to psychological distress but also influence reproductive decision-making. Current systematic research remains limited, particularly lacking mixed-method studies combining quantitative and qualitative approaches to elucidate the complex psychological mechanisms and influencing factors. Methods Employing a mixed-methods design, this study systematically examined the prevalence and influencing factors of fertility concerns among young and middle-aged colorectal cancer patients. A cross-sectional questionnaire survey was first conducted. Based on quantitative findings, representative cases were selected for semi-structured in-depth interviews. Descriptive statistics were combined with thematic analysis to gain deeper insights into patients' fertility anxieties and decision-making challenges. Results Fertility concerns among young and middle-aged colorectal cancer patients correlated with age, educational attainment, and tumour stage. They exhibited a significant positive correlation with fertility intentions and a significant negative correlation with social support. Qualitative analysis identified three themes: causes, manifestations, and impacts. Conclusion This mixed-methods study indicates that clinicians should enhance fertility knowledge dissemination, implement early psychological interventions, and facilitate the establishment of family and social support networks to alleviate fertility pressures and reduce fertility concerns among young and middle-aged colorectal cancer patients.