Trainee-Led Quality Improvement Project to Improve Fertility Preservation Counseling for Patients With Cancer

Laura A. Sena; Ramy Sedhom; Susan Scott; Amanda Kagan; Andrew H. Marple; Jenna V. Canzoniero; Melinda Hsu; Syed M.Qasim Hussaini; Amin S. Herati; Lauren Reschke; Maria Facadio Antero; Mindy S. Christianson; Adam F. Binder; Allen R. Chen; Ross C. Donehower; Kristen A. Marrone; Arjun Gupta

doi:10.1200/OP.21.00479

Trainee-Led Quality Improvement Project to Improve Fertility Preservation Counseling for Patients With Cancer

Laura A. Sena, Ramy Sedhom, Susan Scott, Amanda Kagan, Andrew H. Marple, Jenna V. Canzoniero, Melinda Hsu, Syed M.Qasim Hussaini, Amin S. Herati, Lauren Reschke, Maria Facadio Antero, Mindy S. Christianson, Adam F. Binder, Allen R. Chen, Ross C. Donehower, Kristen A. Marrone, Arjun Gupta

Medicine - Hematology, Oncology, Transplant

Research output: Contribution to journal › Article › peer-review

Abstract

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.

Original language	English (US)
Pages (from-to)	E403-E411
Journal	JCO Oncology Practice
Volume	18
Issue number	3
DOIs	https://doi.org/10.1200/OP.21.00479
State	Published - Mar 1 2022

Bibliographical note

Funding Information:
Supported by the ASCO Quality Training Program and NIH training grant 2T32CA009071-39 awarded to L.A.S. A.G. and R.S. were supported by individual Conquer Cancer, the ASCO Foundation Young Investigator Awards.

Funding Information:
With support from SKCCC and fellowship leadership, Hematology Oncology fellows assembled an interprofessional, multidisciplinary team and participated in the 2020 ASCO Quality Training Program. Other team members included the Quality Training Program coach, fertility experts (reproductive endocrinology and urology), a patient representative, an information technology designer, social workers, a graphic art designer, and fellowship and SKCCC leadership. This study was undertaken as a Not Human Subjects Research/QI initiative, and so as per institutional policy, Institutional Review Board approval was not required.

Publisher Copyright:
© 2021 by American Society of Clinical Oncology.

PubMed: MeSH publication types

Journal Article
Research Support, N.I.H., Extramural

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Sena, L. A., Sedhom, R., Scott, S., Kagan, A., Marple, A. H., Canzoniero, J. V., Hsu, M., Hussaini, S. M. Q., Herati, A. S., Reschke, L., Antero, M. F., Christianson, M. S., Binder, A. F., Chen, A. R., Donehower, R. C., Marrone, K. A., & Gupta, A. (2022). Trainee-Led Quality Improvement Project to Improve Fertility Preservation Counseling for Patients With Cancer. JCO Oncology Practice, 18(3), E403-E411. https://doi.org/10.1200/OP.21.00479

Sena, LA, Sedhom, R, Scott, S, Kagan, A, Marple, AH, Canzoniero, JV, Hsu, M, Hussaini, SMQ, Herati, AS, Reschke, L, Antero, MF, Christianson, MS, Binder, AF, Chen, AR, Donehower, RC, Marrone, KA & Gupta, A 2022, 'Trainee-Led Quality Improvement Project to Improve Fertility Preservation Counseling for Patients With Cancer', JCO Oncology Practice, vol. 18, no. 3, pp. E403-E411. https://doi.org/10.1200/OP.21.00479

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title = "Trainee-Led Quality Improvement Project to Improve Fertility Preservation Counseling for Patients With Cancer",

abstract = "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.",

author = "Sena, {Laura A.} and Ramy Sedhom and Susan Scott and Amanda Kagan and Marple, {Andrew H.} and Canzoniero, {Jenna V.} and Melinda Hsu and Hussaini, {Syed M.Qasim} and Herati, {Amin S.} and Lauren Reschke and Antero, {Maria Facadio} and Christianson, {Mindy S.} and Binder, {Adam F.} and Chen, {Allen R.} and Donehower, {Ross C.} and Marrone, {Kristen A.} and Arjun Gupta",

note = "Funding Information: Supported by the ASCO Quality Training Program and NIH training grant 2T32CA009071-39 awarded to L.A.S. A.G. and R.S. were supported by individual Conquer Cancer, the ASCO Foundation Young Investigator Awards. Funding Information: With support from SKCCC and fellowship leadership, Hematology Oncology fellows assembled an interprofessional, multidisciplinary team and participated in the 2020 ASCO Quality Training Program. Other team members included the Quality Training Program coach, fertility experts (reproductive endocrinology and urology), a patient representative, an information technology designer, social workers, a graphic art designer, and fellowship and SKCCC leadership. This study was undertaken as a Not Human Subjects Research/QI initiative, and so as per institutional policy, Institutional Review Board approval was not required. Publisher Copyright: {\textcopyright} 2021 by American Society of Clinical Oncology.",

year = "2022",

month = mar,

day = "1",

doi = "10.1200/OP.21.00479",

language = "English (US)",

volume = "18",

pages = "E403--E411",

journal = "JCO Oncology Practice",

issn = "2688-1527",

publisher = "American Society of Clinical Oncology",

number = "3",

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TY - JOUR

T1 - Trainee-Led Quality Improvement Project to Improve Fertility Preservation Counseling for Patients With Cancer

AU - Sena, Laura A.

AU - Sedhom, Ramy

AU - Scott, Susan

AU - Kagan, Amanda

AU - Marple, Andrew H.

AU - Canzoniero, Jenna V.

AU - Hsu, Melinda

AU - Hussaini, Syed M.Qasim

AU - Herati, Amin S.

AU - Reschke, Lauren

AU - Antero, Maria Facadio

AU - Christianson, Mindy S.

AU - Binder, Adam F.

AU - Chen, Allen R.

AU - Donehower, Ross C.

AU - Marrone, Kristen A.

AU - Gupta, Arjun

N1 - Funding Information: Supported by the ASCO Quality Training Program and NIH training grant 2T32CA009071-39 awarded to L.A.S. A.G. and R.S. were supported by individual Conquer Cancer, the ASCO Foundation Young Investigator Awards. Funding Information: With support from SKCCC and fellowship leadership, Hematology Oncology fellows assembled an interprofessional, multidisciplinary team and participated in the 2020 ASCO Quality Training Program. Other team members included the Quality Training Program coach, fertility experts (reproductive endocrinology and urology), a patient representative, an information technology designer, social workers, a graphic art designer, and fellowship and SKCCC leadership. This study was undertaken as a Not Human Subjects Research/QI initiative, and so as per institutional policy, Institutional Review Board approval was not required. Publisher Copyright: © 2021 by American Society of Clinical Oncology.

PY - 2022/3/1

Y1 - 2022/3/1

N2 - 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.

AB - 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.

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Trainee-Led Quality Improvement Project to Improve Fertility Preservation Counseling for Patients With Cancer

Abstract

Bibliographical note

PubMed: MeSH publication types

UN SDGs

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