Presenter Status
Fellow
Abstract Type
QI
Primary Mentor
Dr. Joy Fulbright
Start Date
10-5-2021 11:30 AM
End Date
10-5-2021 1:30 PM
Presentation Type
Poster Presentation
Description
Background/Project Intent (Aim Statement): As treatment for pediatric malignancies improves long term survival, physicians are shifting focus to late effects of therapy such as infertility. Currently, options for fertility preservation include cryopreservation of mature oocytes, sperm, and gonadal tissue, although barriers remain present. Within our division, we lacked a standard approach to discussing fertility preservation options prior to initiation of treatment.
Methods (include PDSA cycles): Records from 474 pediatric patients with new oncologic diagnoses at CMH from 2014- 2020 were retrospectively reviewed. We evaluated the frequency that reproductive health discussions were documented in pubertal males and females requiring chemotherapy or radiation treatment. We first implemented a standard fertility preservation note and patient handouts, then surveyed our department to identify barriers to formalized fertility consultations and diagnoses that place patients at risk for infertility. We then provided educational sessions to address these barriers with pre- and post-evaluation using a 5-level Likert scale (1=strongly disagree, 5=strongly agree) to measure efficacy. Our longitudinal assessment, encompassing multiple points of intervention, was compared to results from previous chart review (2010-2013).
Results: Of 474 patients, 175 (36.9%) warranted a fertility discussion per inclusion criteria. Following implementation of an electronic fertility consult process and standardized fertility preservation documentation, there was an increase in documented fertility discussions from 30% in 2014 to 63.6% in 2020. Internal department survey responses identified a lack of comfort with knowing fertility preservation options available and diagnoses that should prompt this conversation. Education sessions with pre- and postprovider assessment demonstrated more comfort discussing fertility preservation (average score increase from 3.44 to 4.33) and knowledge regarding diagnoses at higher risk of infertility (average score increase from 3.67 to 4.33). Before the educational talk, 85.7% of providers were aware how to contact the fertility team compared to 100% afterward.
Conclusions: Integration of a standardized fertility preservation process and addressing barriers identified within our division have led to a 33.6% increase in fertility discussions over the last 6 years. Further steps include incorporation of an automated fertility consultation order into electronic chemotherapy orders, hospital-wide identification of other high-risk patient populations, and continued education of patient, families, and the health care team.
MeSH Keywords
oncology; fertility
Additional Files
Standardization of Fertility Preservation Discussion Amongst Pedi.pdf (239 kB)Abstract
Included in
Higher Education and Teaching Commons, Medical Education Commons, Oncology Commons, Pediatrics Commons, Science and Mathematics Education Commons
Standardization of Fertility Preservation Discussion Amongst Pediatric Oncology and Bone Marrow Transplant Patients: A Single Institution Experience
Background/Project Intent (Aim Statement): As treatment for pediatric malignancies improves long term survival, physicians are shifting focus to late effects of therapy such as infertility. Currently, options for fertility preservation include cryopreservation of mature oocytes, sperm, and gonadal tissue, although barriers remain present. Within our division, we lacked a standard approach to discussing fertility preservation options prior to initiation of treatment.
Methods (include PDSA cycles): Records from 474 pediatric patients with new oncologic diagnoses at CMH from 2014- 2020 were retrospectively reviewed. We evaluated the frequency that reproductive health discussions were documented in pubertal males and females requiring chemotherapy or radiation treatment. We first implemented a standard fertility preservation note and patient handouts, then surveyed our department to identify barriers to formalized fertility consultations and diagnoses that place patients at risk for infertility. We then provided educational sessions to address these barriers with pre- and post-evaluation using a 5-level Likert scale (1=strongly disagree, 5=strongly agree) to measure efficacy. Our longitudinal assessment, encompassing multiple points of intervention, was compared to results from previous chart review (2010-2013).
Results: Of 474 patients, 175 (36.9%) warranted a fertility discussion per inclusion criteria. Following implementation of an electronic fertility consult process and standardized fertility preservation documentation, there was an increase in documented fertility discussions from 30% in 2014 to 63.6% in 2020. Internal department survey responses identified a lack of comfort with knowing fertility preservation options available and diagnoses that should prompt this conversation. Education sessions with pre- and postprovider assessment demonstrated more comfort discussing fertility preservation (average score increase from 3.44 to 4.33) and knowledge regarding diagnoses at higher risk of infertility (average score increase from 3.67 to 4.33). Before the educational talk, 85.7% of providers were aware how to contact the fertility team compared to 100% afterward.
Conclusions: Integration of a standardized fertility preservation process and addressing barriers identified within our division have led to a 33.6% increase in fertility discussions over the last 6 years. Further steps include incorporation of an automated fertility consultation order into electronic chemotherapy orders, hospital-wide identification of other high-risk patient populations, and continued education of patient, families, and the health care team.
