Improvements in Clinical Practice for Fertility Preservation Among Young Cancer Patients: Results from Bundled Interventions

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Bradford, Natalie K
Walker, Roderick
Henney, Roslyn
Inglis, Po
Chan, Raymond J
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2018
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Abstract

Aims: 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 centers. Data before interventions (2012-2014) were 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) was 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 associated with gender and certain diseases. Assessment of the quality of patient care is not possible without accurate, consistent documentation.

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Journal of Adolescent and Young Adult Oncology

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7

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1

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This is a copy of an article published in Journal of Adolescent and Young Adult Oncology. Copyright 2018 Mary Ann Liebert, Inc. Final publication is available from Mary Ann Liebert, Inc., publishers https://doi.org/10.1089/jayao.2017.0042

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Subject

Nursing

Oncology and carcinogenesis

Health services and systems

Public health

Science & Technology

Life Sciences & Biomedicine

Oncology

fertility preservation

oncofertility

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Bradford, NK; Walker, R; Henney, R; Inglis, P; Chan, RJ, Improvements in Clinical Practice for Fertility Preservation Among Young Cancer Patients: Results from Bundled Interventions, Journal of Adolescent and Young Adult Oncology, 2018, 7 (1), pp. 37-45

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