Kemertzis Matthew A, Ranjithakumaran Harene, Hand Meredith, Peate Michelle, Gillam Lynn, McCarthy Maria, Super Leanne, McQuillan Sarah, Drew Sarah, Jayasinghe Yasmin, Orme Lisa
Department of Gynaecology.
Department of Obstetrics & Gynaecology, Royal Women's Hospital.
J Pediatr Hematol Oncol. 2018 Apr;40(3):e133-e139. doi: 10.1097/MPH.0000000000001103.
Fertility preservation (FP) discussions in children with cancer presents unique challenges due to ethical considerations, lack of models-of-care, and the triadic nature of discussions. This study evaluated a fertility toolkit for clinicians involved in FP discussions with pediatric, adolescent, and young adult patients and parents.
A survey-based, longitudinal study of clinicians at The Royal Children's Hospital Melbourne involved in FP discussions undertaken at 3 time-points: 2014, alongside an education session for baseline assessment of oncofertility practices (survey 1); after each toolkit use to evaluate case-specific implementation (survey 2); 2016, to evaluate impact on clinical practice (survey 3).
Fifty-nine clinicians completed survey 1. Over 66% reported baseline dissatisfaction with the existing FP system; 56.7% were not confident in providing up-to-date information. Only 34.5% "often" or "always" provided verbal information; 14.0% "often" or "always" provided written information. Survey 2 was completed after 11 consultations. All clinicians were satisfied with the discussions and outcomes using the toolkit. Thirty-nine clinicians completed survey 3. Over 70% felt confident providing up-to-date FP knowledge, 67.7% "often" or "always" provided verbal information, and 35.4% "often" or "always" provided written information.
Clinicians desire improvement in FP practice. The toolkit provided significant perceived and actual benefits.
由于伦理考量、缺乏护理模式以及讨论的三元性质，癌症患儿的生育力保存（FP）讨论面临独特挑战。本研究评估了一种生育力工具包，供参与与儿科、青少年及青年患者及其父母进行FP讨论的临床医生使用。
对墨尔本皇家儿童医院参与FP讨论的临床医生进行一项基于调查的纵向研究，研究在3个时间点进行：2014年，在一次关于肿瘤生育力实践基线评估的教育课程期间（调查1）；在每次使用工具包后评估具体病例实施情况（调查2）；2016年，评估对临床实践的影响（调查3）。
59名临床医生完成了调查1。超过66%的人报告对现有的FP系统基线不满意；56.7%的人对提供最新信息没有信心。只有34.5%的人“经常”或“总是”提供口头信息；14.0%的人“经常”或“总是”提供书面信息。11次咨询后完成了调查2。所有临床医生对使用工具包进行的讨论和结果都感到满意。39名临床医生完成了调查3。超过70%的人对提供最新的FP知识感到有信心，67.7%的人“经常”或“总是”提供口头信息，35.4%的人“经常”或“总是”提供书面信息。
临床医生希望改进FP实践。该工具包带来了显著的感知和实际益处。
