School of Medicine, University of California San Diego, La Jolla, California, USA.
Department of Obstetrics and Gynecology, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA.
J Adolesc Young Adult Oncol. 2023 Dec;12(6):843-850. doi: 10.1089/jayao.2022.0187. Epub 2023 May 12.
Oncofertility counseling of female cancer patients lacks efficient access to tailored and valid infertility risk estimates to support shared decision-making on fertility preservation treatments. The objective was to develop, conduct user-centered design, and plan clinic-based implementation of the Cancer Related Infertility Score Predictor (CRISP), a web-based tool to support infertility risk counseling. Using a mixed methods design, literature review was undertaken to abstract data on infertility, primary ovarian insufficiency, and amenorrhea risks of common cancer treatments. The CRISP website was programmed to take user input about patient ages and cancer treatments and generate a risk summary. Using user experience methodology and semistructured interviews, usability testing and implementation assessment were conducted with 12 providers recruited from 5 medical centers in Southern California. The web-based CRISP tool encompasses infertility risk data for 60 treatment regimens among 10 cancer types. Usability testing demonstrated that the tool is intuitive and informed minor modifications, including adding crowd-sourced submission of additional cancer treatments. Participants rated the tool as credible, advantageous over current provider methods to ascertain infertility risks, and useful for tailoring treatment planning and counseling patients. A key barrier was lack of information on some cancer treatments. Fit within clinical workflow was feasible, particularly with electronic health record integration. The novel, web-based CRISP tool is a feasible, acceptable, and appropriate tool to address provider knowledge gap about cancer related infertility risks and use for patient counseling. CRISP has significant potential to support tailored oncofertility counseling in the heterogeneous young cancer patient population.
女性癌症患者的生育力保存咨询缺乏获取针对性和有效不孕风险评估的有效途径，难以支持对生育力保存治疗的共同决策。本研究旨在开发、进行以用户为中心的设计，并计划在临床实施基于网络的癌症相关不孕评分预测器（Cancer Related Infertility Score Predictor，CRISP），以支持不孕风险咨询。采用混合方法设计，对癌症治疗相关不孕、原发性卵巢功能不全和闭经风险的相关文献进行了综述，以提取不孕风险数据。CRISP 网站根据用户输入的患者年龄和癌症治疗方案，生成风险总结。通过用户体验方法学和半结构化访谈，在加利福尼亚州南部的 5 家医疗中心招募了 12 名提供者进行可用性测试和实施评估。该网络工具涵盖了 10 种癌症类型的 60 种治疗方案的不孕风险数据。可用性测试表明，该工具直观易用，并根据测试结果进行了一些小的修改，包括添加了来自大众的癌症治疗方案的提交。参与者认为该工具具有可信度，在确定不孕风险方面优于当前的提供者方法，对于制定治疗计划和为患者提供咨询很有用。一个关键障碍是缺乏某些癌症治疗的信息。该工具在临床工作流程中的适应性较好，特别是与电子病历集成。新型基于网络的 CRISP 工具是一种可行、可接受和适当的工具，可以解决提供者在癌症相关不孕风险方面的知识差距，并用于患者咨询。CRISP 具有支持针对异质性年轻癌症患者群体的生育力咨询的巨大潜力。
