Kids Cancer Centre, Sydney Children's Hospital, High Street Randwick, Randwick, Sydney, NSW, Australia.
Nelune Cancer Centre, Prince of Wales Hospital, Barker Street, Randwick, Sydney, NSW, Australia.
Hum Reprod Update. 2019 Mar 1;25(2):159-179. doi: 10.1093/humupd/dmy038.
Fertility preservation (FP) is an important quality of life issue for cancer survivors of reproductive age. Despite the existence of broad international guidelines, the delivery of oncofertility care, particularly amongst paediatric, adolescent and young adult patients, remains a challenge for healthcare professionals (HCPs). The quality of oncofertility care is variable and the uptake and utilization of FP remains low. Available guidelines fall short in providing adequate detail on how oncofertility models of care (MOC) allow for the real-world application of guidelines by HCPs.
The aim of this study was to systematically review the literature on the components of oncofertility care as defined by patient and clinician representatives, and identify the barriers, facilitators and challenges, so as to improve the implementation of oncofertility services.
A systematic scoping review was conducted on oncofertility MOC literature published in English between 2007 and 2016, relating to 10 domains of care identified through consumer research: communication, oncofertility decision aids, age-appropriate care, referral pathways, documentation, training, supportive care during treatment, reproductive care after cancer treatment, psychosocial support and ethical practice of oncofertility care. A wide range of electronic databases (CINAHL, Embase, PsycINFO, PubMed, AEIPT, Education Research Complete, ProQuest and VOCED) were searched in order to synthesize the evidence around delivery of oncofertility care. Related citations and reference lists were searched. The review was undertaken following registration (International prospective register of systematic reviews (PROSPERO) registration number CRD42017055837) and guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).
A total of 846 potentially relevant studies were identified after the removal of duplicates. All titles and abstracts were screened by a single reviewer and the final 147 papers were screened by two reviewers. Ten papers on established MOC were identified amongst the included papers. Data were extracted from each paper and quality scores were then summarized in the oncofertility MOC summary matrix. The results identified a number of themes for improving MOC in each domain, which included: the importance of patients receiving communication that is of a higher quality and in different formats on their fertility risk and FP options; improving provision of oncofertility care in a timely manner; improving access to age-appropriate care; defining the role and scope of practice of all HCPs; and improving communication between different HCPs. Different forms of decision aids were found useful for assisting patients to understand FP options and weigh up choices.
This analysis identifies core components for delivery of oncofertility MOC. The provision of oncofertility services requires planning to ensure services have safe and reliable referral pathways and that they are age-appropriate and include medical and psychological oncofertility care into the survivorship period. In order for this to happen, collaboration needs to occur between clinicians, allied HCPs and executives within paediatric and adult hospitals, as well as fertility clinics across both public and private services. Training of both cancer and non-cancer HCPs is needed to improve the knowledge of HCPs, the quality of care provided and the confidence of HCPs with these consultations.
生育力保存（FP）是生殖年龄癌症幸存者生活质量的一个重要问题。尽管存在广泛的国际准则，但生育力保存的提供，特别是儿科、青少年和年轻成人患者，仍然是医疗保健专业人员（HCP）面临的挑战。生育力保存的质量存在差异，FP 的接受和利用仍然很低。现有的指南在提供足够的细节方面存在不足，说明生育力保存模式如何允许 HCP 在现实世界中应用指南。
本研究的目的是系统地审查文献中关于生育力保存护理的组成部分，这些组成部分是由患者和临床医生代表定义的，并确定障碍、促进因素和挑战，以改善生育力保存服务的实施。
对 2007 年至 2016 年间发表的英文生育力保存模式文献进行了系统的范围审查，这些文献涉及消费者研究确定的 10 个护理领域：沟通、生育力保存决策辅助、适合年龄的护理、转诊途径、文件记录、培训、治疗期间的支持性护理、癌症治疗后的生殖护理、心理社会支持和生育力保存护理的伦理实践。为了综合生育力保存护理提供方面的证据，检索了各种电子数据库（CINAHL、Embase、PsycINFO、PubMed、AEIPT、教育研究完整、ProQuest 和 VOCED）。检索了相关引文和参考列表。该审查是在注册（国际前瞻性系统评价注册（PROSPERO）注册号 CRD42017055837）和系统评价和荟萃分析的首选报告项目（PRISMA）的指导方针之后进行的。
在去除重复项后，共确定了 846 项潜在相关研究。由一名评审员筛选所有标题和摘要，然后由两名评审员筛选最后 147 篇论文。在纳入的论文中确定了 10 篇关于既定模式的论文。从每篇论文中提取数据，然后汇总生育力保存模式总结矩阵中的质量评分。结果确定了每个领域改进模式的一些主题，包括：患者需要接受更高质量的沟通，以不同的格式了解其生育风险和 FP 选择；及时提供生育力保存护理；改善获得适合年龄的护理；确定所有 HCP 的角色和实践范围；以及改善不同 HCP 之间的沟通。发现不同形式的决策辅助工具有助于帮助患者了解 FP 选择并权衡选择。
该分析确定了提供生育力保存模式的核心组成部分。提供生育力服务需要进行规划，以确保服务具有安全可靠的转诊途径，并确保服务适合年龄，包括医疗和心理生育力护理进入生存期间。为了实现这一点，需要在儿科和成人医院以及公共和私人服务的生育诊所之间进行临床医生、辅助 HCP 和管理人员之间的合作。需要对癌症和非癌症 HCP 进行培训，以提高 HCP 的知识、提供的护理质量以及 HCP 对这些咨询的信心。
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