A quality improvement initiative to improve fertility counseling and referral procedures for cancer patients at a university cancer center.

Abstract

e23210 Background: Fertility counseling is crucial in cancer care as treatments can impair fertility, causing emotional distress and reducing quality of life. Early discussions about infertility risks and referrals to reproductive specialists are vital. Despite guidelines like ASCO 2018, fertility counseling and referral rates remain low, 43.5% and 4-30%, respectively. This quality improvement (QI) project aims to enhance fertility counseling and referrals by addressing barriers to these processes. Methods: We conducted a retrospective chart review of cancer patients (ages 18-45) newly diagnosed or with recurrence requiring systemic therapy at Ellis Fischel Cancer Center between 1/1/2020 and 8/31/2024. We also distributed anonymous surveys to patients [ages 18-45, newly diagnosed with cancer between 2/1/2024 and 7/31/2024] and providers [attendings, fellows, and advanced practice practitioners] at the cancer center. Results: The chart review found that 43.5% (40 of 92) of patients had documented discussions on infertility risks before systemic therapy with only 18.5% receiving referrals for fertility counseling. The age distribution was similar between patients who did or did not receive counseling. 66.7% of surveyed patients reported that their provider discussed infertility risks, suggesting under-documentation of these discussions. Despite a low documented counseling rate, 89% of patients reported feeling confident in their fertility preservation decisions. However, only 22% of patients answered all fertility knowledge questions correctly, indicating a potential gap in awareness of available options. These findings highlighted infertility risk discussion and fertility counseling documentation as potential areas of improvement. In response, we created a patient education pamphlet and a Smart Phrase to improve documentation. Of the surveyed providers, 58.8% were female, with experience ranging from 1 to 16 years. While 58.8% of providers felt comfortable discussing fertility preservation, only 29.4% believed their knowledge was sufficient for effective counseling. Most providers (88.2%) agreed that written educational materials would be beneficial. Key barriers identified included the urgency of cancer treatment, limited access to fertility preservation services, and the lack of an efficient referral system. In response, we compiled a list of local fertility preservation clinics with urgent referral guidelines and developed provider education resources. We also plan to advocate for this initiative at oncology meetings and grand rounds within the institution. Conclusions: Our baseline data above highlighted key quality metrics and informed the development of targeted interventions. These interventions are currently being implemented. We plan to collect post-intervention data after 6 months to assess their impact.