P2.267: A Quality Improvement Initiative to Standardize Fertility Preservation Practices in Pediatric Hematology & Oncology

Purpose/Objectives: Fertility preservation is an important indicator of long-term quality of life in the pediatric oncology population. Prior to initiating chemotherapy or radiation, many adolescents view discussions on fertility preservation and treatment-associated risks as a priority. Most female patients and their parents report significant anxiety surrounding infertility in survivorship. However, national studies indicate that the impact of oncologic treatment on fertility is addressed by healthcare providers in fewer than 50% of initial patient encounters.

The primary objective of this project is to ensure that all children with newly diagnosed cancer necessitating chemotherapy or radiation at the Children’s Hospital at Montefiore Einstein (CHAM) receive fertility preservation education. From July 2024 to January 2025, we aim to increase the occurrence of fertility preservation counseling during chemotherapy consent encounters to 90% from a baseline of 17%. Our secondary goal is a 20% increase from baseline in healthcare provider comfort when discussing methods of fertility preservation.

Design/Methods: This initiative included all pediatric oncology fellows, attendings and nurse practitioners at CHAM. Baseline data was collected via retrospective chart review and a standardized survey of all pediatric oncology providers to assess baseline comfort in fertility preservation counseling.

Upon project initiation, the project coordinator identified new diagnoses and sent standardized reminder emails to the patient’s care team that included educational and referral resources for gold-standard fertility treatment. Additionally, the standard medical record chemotherapy consent dotphrase was modified to include mandatory fields about fertility preservation discussion. An in-person education session was held as well.

The survey was re-administered after 6 months. Data was analyzed using two-proportion Z-Test for paired data, t-testing, chi-square analyses and Fisher’s exact testing.

Results: Among the oncology providers, twenty-six responded to the baseline survey. An overlapping twenty-three providers responded to the post-intervention survey.

Medical record documentation about fertility preservation discussions with newly diagnosed pediatric oncology patients increased from 17% (n=39) to 56% (n=24) after the intervention (p=0.008).

There was an increase in the proportion of providers who responded “always” and “mostly” to the question “'Do you discuss fertility preservation options with patients at the time of chemotherapy or treatment consents?” after implementation of the intervention (15/26 pre-intervention, 15/23 post-intervention; p=0.09). When filtering for only “always” responses, there was a statistically significant improvement (3/26 pre-intervention versus 10/23 post-intervention, p=0.02).

Self-reported median comfort level in discussing fertility preservation with post-pubertal males increased from '4' (mostly comfortable) before the intervention to '5' (very comfortable) post-intervention (p=0.06).

Conclusion/Discussion: Dedicated focus and education of providers regarding fertility preservation options for newly diagnosed oncology patients can increase provider comfort and therefore the frequency of fertility preservation counseling. Future directions include expansion of a new, dedicated fertility preservation team for the study’s second cycle and studying this team’s long-term impact on patients and families.