学员主导的质量改进项目，以改善癌症患者的生育力保存咨询。
Trainee-Led Quality Improvement Project to Improve Fertility Preservation Counseling for Patients With Cancer.
机构信息
The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD.
Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
出版信息
JCO Oncol Pract. 2022 Mar;18(3):e403-e411. doi: 10.1200/OP.21.00479. Epub 2021 Sep 25.
PURPOSE
Oncofertility counseling regarding the reproductive risks associated with cancer therapy is essential for quality cancer care. We aimed to increase the rate of oncofertility counseling for patients of reproductive age (18-40 years) with cancer who were initiating systemic therapy at the Johns Hopkins Cancer Center from a baseline rate of 37% (25 of 68, June 2019-January 2020) to 70% by February 2021.
METHODS
We formed an interprofessional, multidisciplinary team as part of the ASCO Quality Training Program. We obtained data from the electronic medical record and verified data with patients by phone. We surveyed patients, oncologists, and fertility specialists to identify barriers. After considering a prioritization matrix, we implemented Plan-Do-Study-Act (PDSA) cycles.
RESULTS
We identified the following improvement opportunities: (1) oncologist self-reported lack of knowledge about counseling and local fertility preservation options and (2) lack of a standardized referral mechanism to fertility services. During the first PDSA cycle (February 2020-August 2020, disrupted by COVID-19), we introduced the initiative to increase oncofertility counseling at faculty meetings. From September 2020 to November 2020, we implemented a second PDSA cycle: (1) educating and presenting the initiative at Oncology Grand Rounds, (2) distributing informative pamphlets to oncologists and patients, and (3) implementing an electronic medical record order set. In the third PDSA cycle (December 2020-February 2021), we redesigned the order set to add information (eg, contact information for fertility coordinator) to the patient after-visit summary. Postimplementation (September 2020-February 2021), counseling rates increased from 37% to 81% (38 of 47).
CONCLUSION
We demonstrate how a trainee-led, patient-centered initiative improved oncofertility care. Ongoing work focuses on ensuring sustainability and assessing the quality of counseling.
目的
癌症治疗相关生殖风险的生育力保存咨询对于癌症的高质量治疗至关重要。我们旨在提高约翰霍普金斯癌症中心接受系统治疗的育龄期（18-40 岁）癌症患者的生育力保存咨询率，从基线的 37%（2019 年 6 月至 2020 年 1 月的 25 例）提高到 2021 年 2 月的 70%。
方法
我们作为 ASCO 质量培训计划的一部分，组建了一个跨专业、多学科团队。我们从电子病历中获取数据，并通过电话与患者核实数据。我们对患者、肿瘤学家和生育专家进行了调查，以确定障碍。在考虑了优先排序矩阵后，我们实施了计划-执行-研究-行动（PDSA）循环。
结果
我们确定了以下改进机会：（1）肿瘤学家自我报告缺乏咨询和当地生育力保存选择方面的知识，以及（2）缺乏向生育服务机构的标准化转诊机制。在第一个 PDSA 循环（2020 年 2 月至 2020 年 8 月，因 COVID-19 而中断）期间，我们在教员会议上介绍了提高生育力咨询的倡议。从 2020 年 9 月至 2020 年 11 月，我们实施了第二个 PDSA 循环：（1）在肿瘤学大查房中进行教育和介绍该倡议，（2）向肿瘤学家和患者发放信息手册，以及（3）实施电子病历医嘱集。在第三个 PDSA 循环（2020 年 12 月至 2021 年 2 月）中，我们重新设计了医嘱集，在患者就诊后总结中为患者添加了信息（例如，生育协调员的联系信息）。实施后（2020 年 9 月至 2021 年 2 月），咨询率从 37%提高到 81%（47 例中的 38 例）。
结论
我们展示了如何通过学员主导、以患者为中心的举措来改善生育力保存护理。正在进行的工作重点是确保可持续性和评估咨询质量。
Zotero 插件