Improving the clinical practice for fertility preservation

Abstract

The consequences of cancer and treatment on fertility can be a continuing source of distress for adolescents and young adults. The study aims were to assess the effects of bundled interventions on clinical practice concerning fertility in young people aged 14-25 years with cancer. Methods: Bundled interventions, including development of quality indicators, resources and targeted education, were introduced during 2015 across five cancer centres. Data prior to interventions (2012-2014) was compared with data prospectively collected during 2015-2016. Relative risks (RR) with 95% confidence intervals (CI) were calculated to assess effects of interventions. Results: Compared with the pre-intervention cohort (n = 260), the post-intervention cohort (n = 216) were 1.47 times more likely to have documented discussion of risk of infertility (95% CI 1.12-1.63, P = <0.001). Similarly, documented referral to fertility specialists was more likely in the post-intervention cohort (RR 1.53, 95% CI 1.26-1.87, P = <0.001) as was documented fertility preservation outcomes (RR 2.56, 95%CI 1.91-3.44, P=<0.001). These differences were significant across age, gender and diseases. Females had greater improvement in documented risk of infertility discussion between cohorts (RR 1.70, 95%CI 1.19-2.08, P = <0.001). Among diseases, the greatest improvements were seen in those with brain cancers (RR 2.15, 95% CI 1.28-3.62, P = 0.004) and soft tissue sarcoma (RR 2.60, 95% CI 1.17-5.78, P = 0.02). Conclusions:We have demonstrated the effects of bundled interventions to improve clinical practice associated with fertility preservation in young people with cancer. Interventions were successful for reducing disparities identified in the pre-intervention cohort associatedwith gender and certain diseases. Assessment of the quality of patient care is not possible without accurate, consistent documentation.L6193513422017-11-27 <br />