A promising disclosure tool could help close pediatric provider knowledge gaps about donor conception
Parent and pediatric nurse practitioner views on integrating the digital TELL tool intervention into clinical practice (Hershberger, 2025)
Hershberger, P.E., Adlam, K., Driessnack, M., Gruss, V., Grotevant, H.D., Klock, S.C., Pasch, L., & Gallo, A.M. (2025). Parent and pediatric nurse practitioner views on integrating the digital TELL tool intervention into clinical practice. Journal of Pediatric Nursing, 39(2), 175-188. https://doi.org/10.1016/j.pedn.2025.02.009
Geographic Region: United States
Research Question: How do parents and pediatric nurse practitioners view the Tool to Empower Parental TeLling and TaLking (TELL Tool), a digital psychoeducational decision-support intervention?
Design: Qualitative descriptive study using rigorous and accelerated data reduction (RADaR) technique. In-depth, semi-structured interviews conducted via Zoom. Data collection from May to July 2023. The study was part of a larger pilot randomized controlled trial to evaluate the feasibility, accessibility, and preliminary effects of the TELL Tool intervention among parents with children 1-16 years of age.
Sample:
10 parents who participated in the larger pilot study. Most were White (90%), married/partnered (70%), female (90%), heterosexual/straight (80%), college-educated (70%). Parents used donor sperm (60%), eggs (30%), or embryos (10%). Children conceived via donation ranging in age from 1-12 years.
10 pediatric nurse practitioners. All female (100%), mostly White (80%), all employed full-time (100%). Practice experience ranged from 1-43 years (average 16 years)
Key Findings
Parents found the TELL Tool increased their confidence about sharing information with their children and appreciated its age-appropriate approach and language.
Pediatric nurse practitioners perceived the tool as supporting their ability to provide anticipatory guidance and counseling to families about genetic origins discussions.
All parents recommended early access to the TELL Tool during fertility treatment or pregnancy, with ongoing access as children grow.
Both parents and pediatric nurse practitioners agreed that multiple providers should be involved in guiding the disclosure process, with fertility providers offering initial guidance and pediatric providers providing ongoing support.
Pediatric nurse practitioners identified knowledge gaps about donor conception as a key challenge to providing counseling on disclosure.
Limitations: Limited ethnic and racial diversity among participants. Parent sample did not include those with children over 12 years of age. Study conducted only in the US, limiting global understanding. Small sample size typical of qualitative research.
Applications: The TELL Tool supports early, age-appropriate disclosure, which is associated with better family relationships and emotional wellbeing. The tool offers an evidence-based resource to support education, anticipatory guidance, and counseling for families using donor gametes/embryos. It could be integrated into clinical practice at multiple points from fertility treatment through pediatric care.
Funding Source: National Institutes of Health, National Institute of Nursing Research (Award R34NR019278)
Lead Author: Patricia Hershberger is a researcher at the Department of Health Behavior and Clinical Sciences, School of Nursing, University of Michigan, and College of Nursing, University of Illinois Chicago, who specializes in fertility and family formation research.
Regulatory Context
In the US, there is no comprehensive federal regulation of gamete donation or donor conception
The leading fertility professional organization in the US (American Society for Reproductive Medicine) endorsed telling children about their genetic origins in 2004 and reinforced this recommendation in 2018.