IDENTIFYING BEST FIT IMPLEMENTATION STRATEGIES FOR IMPROVING FERTILITY CARE FOR ADOLESCENT AND YOUNG ADULT (AYA) CANCER SURVIVORS

Abstract

Oncofertility care remains under-implemented with limited tools to scale up effective implementation strategies. Guided by the Consolidated Framework for Implementation Research (CFIR), the objective was to systematically assess factors that influence implementation of oncofertility care and map strategies, particularly electronic health record (EHR) enabled ones, that fit adult and pediatric oncology care contexts. Sequential mixed methods study. Using purposeful sampling, we recruited healthcare providers (HCPs) and female AYA cancer survivors from a comprehensive cancer center and a freestanding children’s hospital. Participants underwent semi-structured interviews and focus groups based on CFIR. Thematic analysis was used to develop inductive codes and CFIR provided deductive codes to characterize barriers and facilitators to oncofertility care and implementation strategies. Two coders independently coded each transcript with a third coder resolving discrepancies by consensus. Developed strategies were evaluated quantitatively by HCPs for acceptability, appropriateness and feasibility. Score range for each measure was 1-5; higher scores indicate more acceptability, appropriateness and feasibility. We recruited 19 oncology and fertility HCPs and 9 AYA survivors. We identified barriers and facilitators to fertility care in the CFIR domains of individual, inner setting, outer setting and process, allowing us to conceptualize oncofertility care in three necessary stages: oncofertility needs screen, referral and fertility preservation counseling. To fit an adult and pediatric contexts, five implementation strategies were mapped: fertility needs screen using a Best Practice Advisory (BPA), fertility referral order, televideo fertility counseling, provider audit & feedback (A&F) and a provider educational session. Mean acceptability, appropriateness and feasibility scores across strategies were high (Table). Six additional strategies were designed but did not fit our contexts.Tabled 1BPAA&FEducational SessionAppropriateness Score Mean (95% CI)4.4 (4.1, 4.7)4.0 (3.5, 4.6)4.7 (4.5, 4.9)Acceptability Score Mean (95% CI)4.4 (4.0, 4.7)4.0 (3.4, 4.6)4.7 (4.5, 5.0)Feasibility Score Mean (95% CI)4.4 (4.2, 4.7)4.2 (3.7, 4.6)4.7 (4.5, 4.9) Open table in a new tab Access to oncofertility care remains a challenge for young cancer patients, in part due to unaddressed barriers and facilitators across clinical settings. An implementation science approach systematically assessed oncofertility care, mapped strategies and explored their acceptability, appropriateness and feasibility, providing a theory-based approach and scalable EHR tools to support wider dissemination.