Moores Cancer Center, University of California San Diego, La Jolla, California, USA.
Rady Children's Hospital-San Diego, San Diego, California, USA.
J Adolesc Young Adult Oncol. 2021 Oct;10(5):512-520. doi: 10.1089/jayao.2020.0156. Epub 2021 Jan 19.
Oncofertility care at cancer diagnosis remains underimplemented across oncology and fertility care settings, with limited tools to scale up effective implementation strategies. Using implementation science theory, we systematically assessed factors that influence oncofertility care implementation and mapped scalable strategies, particularly electronic health record (EHR)-enabled ones, that fit adult and pediatric oncology care contexts. Using purposeful sampling, we recruited health care providers and female, reproductive-aged survivors of adolescent and young adult (AYA) cancers (AYA survivors) from a comprehensive cancer center and a freestanding children's hospital to semistructured interviews and focus groups. Using thematic analysis combining inductive codes with deductive codes using the Consolidated Framework for Implementation Research (CFIR), we characterized barriers and facilitators to care and designed responsive strategies. Two coders independently coded each transcript. We recruited 19 oncology and fertility providers and 9 cancer survivors. We identified barriers and facilitators to oncofertility care in the CFIR domains of individual, inner setting, outer setting, and process, allowing us to conceptualize oncofertility care to encompass three core components (screening, referral, and fertility preservation counseling) and map five strategies to these components that fit an adult and a children's context and bridge oncology and fertility practices. The strategies were screening using a best practice advisory, referral order, telehealth fertility counseling, provider audit and feedback, and provider education. All but provider education were EHR tools with embedded efficiencies. An implementation science approach systematically assessed oncofertility care and mapped strategies to provide a theory-based approach and scalable EHR tools to support wider dissemination.
在肿瘤学和生育护理环境中，癌症诊断时的生育力保护仍然实施不足，缺乏扩大有效实施策略的工具。我们使用实施科学理论系统地评估了影响生育力保护实施的因素，并绘制了可扩展的策略，特别是电子健康记录（EHR）支持的策略，这些策略适用于成人和儿科肿瘤护理环境。我们使用有目的的抽样方法，从一家综合性癌症中心和一家独立的儿童医院招募了肿瘤学和生育护理提供者以及青少年和年轻成人（AYA）癌症的女性、生殖年龄幸存者（AYA 幸存者），进行半结构化访谈和焦点小组讨论。我们使用主题分析，结合使用整合实施研究框架（CFIR）的归纳代码和演绎代码，对护理的障碍和促进因素进行了特征描述，并设计了响应策略。两位编码员独立对每个转录本进行编码。我们招募了 19 名肿瘤学和生育护理提供者和 9 名癌症幸存者。我们在 CFIR 的个体、内部环境、外部环境和过程领域确定了生育力保护的障碍和促进因素，使我们能够将生育力保护概念化，涵盖三个核心组件（筛查、转介和生育力保存咨询），并将这五个策略映射到适合成人和儿童环境的组件上，并连接肿瘤学和生育学实践。这些策略是使用最佳实践咨询进行筛查、转介医嘱、远程生育咨询、提供者审核和反馈以及提供者教育。除了提供者教育外，所有策略都是 EHR 工具，具有嵌入式效率。实施科学方法系统地评估了生育力保护，并绘制了策略，为更广泛的传播提供了基于理论的方法和可扩展的 EHR 工具。
