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

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


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 languageEnglish (US)
Pages (from-to)E403-E411
JournalJCO Oncology Practice
Issue number3
StatePublished - 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.


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