In recent decades, an increasing number of evidence-based patient decision aids have been developed to assist patients in the decision-making process of (complex) medical decisions. They have been proven effective in improving decision quality while enhancing, not replacing, the traditional process of patient counselling by practitioners [
1]. However, decision aids usually do not automatically fit into routine care and are often not routinely used in daily practice [
2,
3]. To optimize the impact of patient decision aids, it is therefore of great importance to focus on the active implementation after proven effectiveness [
4,
5]. Significant gaps have been indicated between the number of patients eligible, the number of patients actually provided successfully with the decision support tool, and those who actually used the tool [
6‐
8]. Although the implementation phase is considered to be a complex process, it is important to optimize this process of providing eligible patients with the tool to optimize the overall reach.
Research efforts with regard to decision support in the area of hereditary cancer are lagging behind compared to applications in non-hereditary cancer (e.g. treatment options), prenatal testing and in pregnancy care in general [
1]. There have been some initiatives to support persons with a predisposition to hereditary cancer in their decision-making regarding genetic testing [
9,
10] and communicating genetic test results with family members and children [
11]. However, no initiatives to support couples with a predisposition to hereditary cancer in the decision-making regarding their wish to have children have been reported in the literature. The present study is part of a larger study on the development, evaluation, and implementation of an online decision aid with the aim of supporting persons having a genetic predisposition to cancer and their partners in making an informed reproductive decision [
12‐
14]. The decision aid is meant for couples who have a high genetic risk, mostly 50%, due to autosomal dominant inheritance, of transmitting a pathogenic variant to offspring with a high risk of a future malignancy (e.g. Hereditary Breast and Ovarian Cancer, Lynch syndrome, and Familial Adenomatous Polyposis coli). Consequently, these couples face complex reproductive decisions [
15‐
20]. Some couples may decide to refrain from having children, while others choose for donor gametes or to adopt children. Most couples, however, pursue their wish to have genetically related children [
21]. Therefore, the decision aid focuses on the options to fulfil the wish for a child that is genetically related to both partners, namely; (1) natural conception without genetic testing, implying acceptance of the risk of passing on the pathogenic variant; (2) natural conception with prenatal diagnosis (PND), offering the choice to terminate the pregnancy if the fetus has the pathogenic variant [
22]; (3) preimplantation genetic diagnosis (PGD), offering couples the option to obtain embryos by in vitro fertilization (IVF) and examine them for the familial pathogenic variant. Only embryos without the pathogenic variant will be transferred into the uterus [
22].
The decision aid was developed as a tool to be used in the home environment and has been proven to be effective in supporting couples during their reproductive decision-making process. A reduction in mean decisional conflict and decisional self-efficacy scores, an increase in knowledge levels, levels of deliberation and improved realistic expectations were found [
13,
14,
23]. This study aims at developing the optimal implementation strategy for the decision aid by investigating the preferences of health professionals involved in oncogenetic consultations in the Netherlands. Engaging these health professionals, who will be the primary sources of referral during the implementation phase, is important to understand potential barriers and find solutions on how to overcome these barriers. We used a mixed methods approach with a questionnaire, focus groups, and individual interviews.