Measures to Preserve Fertility

Cancer patients are often at risk for impaired fertility related to their treatments. A quality improvement initiative at Memorial Sloan-Kettering Cancer Center (MSKCC) in New York City showed that education, developing an algorithm for discussions with patients, documenting those discussions, and supplying patients and providers with a list of referrals for fertility preservation specialists are an important aspect of oncology nursing that can improve the quality of care provided to patients.

The study included 26 patients with sarcoma or melanoma between the ages of 18 and 45 years treated at MSKCC over a 12-month period. All patients were eligible for fertility preservation options. Meetings were conducted with physicians and nurses to identify barriers to discussing fertility, which included a lack of knowledge, undefined roles, the absence of a standardized work flow, no documentation system, and the difficulty of discussing fertility with patients with a poor prognosis.

At baseline, 69% of the oncologists discussed fertility risks associated with treatment, 54% explained fertility preservation options, and 54% referred interested patients to fertility specialists. Among the nurses, 0% discussed fertility, 0% discussed fertility preservation options, and 17% referred patients in response to an oncologist’s direction.

The research team provided education for oncologists and nurses regarding the need for discussion of fertility with the patient and options and referrals for interested patients. The team developed an algorithm for oncologists and nurses to use in discussions with patients, a method of data collection, and strategies for implementing improvements, as well as a list of fertility preservation resources and processes for making referrals and documenting care provided.

After a 3-month evaluation and follow-up of this initiative, dramatic improvement was seen among the nurses: 57% discussed fertility with patients, 71% discussed options, and 80% provided referrals. Among the oncologists, after the education initiative, 60% gave patients referrals for fertility preservation options.

Reference
Clark R, Baldwin A, Frankel Kelvin J. Fertility preservation: standardizing education and patient referral. Presented at: 38th Annual Congress of the Oncology Nursing Society; April 25-28, 2013; Washington, DC. Poster 193.

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