Improving Oncofertility Discussions and Referrals: Implementation of a Formal Fertility Preservation Program

BACKGROUND: Impaired fertility is a risk of life-saving cancer treatment in adolescents and young adults (AYAs). Despite this known risk and clinical practice guidelines that stress their importance, treatment-associated fertility risk education and preservation referrals are often neglected in this population. LOCAL PROBLEM: The site of this evidence-based practice improvement project is an outpatient hematology-oncology clinic serving adults with varying cancer diagnoses. The site did not have a standardized approach to ensure treatment-associated fertility risk education and fertility preservation referrals were provided to AYAs with newly diagnosed cancer. The purpose of this project was to implement a formal fertility preservation program with the aim of increasing both fertility preservation discussions and referrals by 50% within three months. METHODS: The planning and implementation of the project were guided by the Evidence-Based Practice Improvement (EBPI) process model. Clinical workflow for implementation of the fertility preservation program was developed using PDSA cycles. Pre- and post-implementation data was collected to measure outcomes related to the project aims and compliance with the intervention. INTERVENTIONS: Implementation of a formal fertility program with an EMR flowsheet to guide documentation and fertility specialist referrals and make available patient and provider education handouts. RESULTS: There was no change in education and referral rates post-implementation. This was largely impacted by a lack of provider adherence with the use of the fertility preservation flowsheet. CONCLUSIONS: AYAs diagnosed with cancer want treatment-associated fertility risk education and specialty referrals to understand their fertility preservation options before beginning treatment. While this project didn’t create the intended change in fertility preservation education and referral, important lessons were learned. Using additional PDSA cycles, intentional attention to buy-in, strengthening interdepartmental teamwork, and frequent process data monitoring and feedback would support more successful implementation in the future