BACKGROUND:
Oncofertility—addressing fertility preservation during cancer treatment—is a critical but still underdeveloped area of women's care. Midwives, with their holistic approach and expertise in reproductive health, are ideally positioned to support cancer patients, yet their role in oncofertility remains unrecognized and undefined.

OBJECTIVES:
To explore the knowledge, attitudes, and perceived competencies of Italian midwives regarding oncofertility, and to identify structural and educational barriers preventing their integration into oncofertility pathways.

METHODS:
A cross-sectional survey was distributed to all 61 Provincial Orders of Midwives in Italy, reaching registered members nationwide. Since no validated assessment tool existed, the questionnaire focused on perceived barriers as proxy indicators of competency gaps. It was based on literature-informed domains and included Likert-scale items addressing seven thematic factors.

RESULTS:
164 midwives responded. The most common answer across all items was "uncertain," indicating a widespread lack of knowledge and confidence. Over 70% of participants did not feel able to provide clear information or navigate referral processes. The vast majority (89%) agreed that workplace training on oncofertility was severely lacking. Several biases and rigid beliefs regarding patient characteristics, prognosis, and reproductive choices were also identified.

CONCLUSIONS:
Midwives in Italy are currently unprepared to support oncofertility due to systemic, cultural, and educational gaps. A validated assessment tool and standardized competency framework are urgently needed. Specific postgraduate training should be implemented to empower midwives to act as patient navigators within interdisciplinary teams for fertility preservation.

KEY MESSAGE:
Midwives have great potential to contribute to oncofertility care, but their integration requires urgent educational, institutional, and policy-level actions to overcome existing barriers. Poster session 2 (Group A)