Critical appraisal:Allingham C, Gillam L, McCarthy M, Zacharin M, Jayasuriya S, Heloury Y, Orme L, Sullivan M, Peate M, Jayasinghe Y 2018

From Cancer Guidelines Wiki

Critical Appraisal

Article being appraised

Allingham C, Gillam L, McCarthy M, Zacharin M, Jayasuriya S, Heloury Y, Orme L, Sullivan M, Peate M, Jayasinghe Y. Fertility Preservation in Children and Adolescents With Cancer: Pilot of a Decision Aid for Parents of Children and Adolescents With Cancer. JMIR Pediatr Parent 2018 Nov 28;1(2):e10463.


Applicable clinical question

Key Facts

Study Design

cross sectional study

Study aims:

To assess the acceptability, usability and feasibility of a Web-based fertility perservation (FP) decision aid (DA) in parents of children and adolescents with cancer, and clinicians.

Number of Patients:

26

Participant Population (parents):

74 eligible
34 consented and completed the pre-DA questionnaire (19 parents then withdrew)
15 reviewed the DA and completed the post-DA questionnaire

Clinician Population (involved in oncofertility):
24 invited

11 consented to participate
Reported outcome(s):

Comparison of fertility knowledge and decision regret in families that have reviewed the DA compared to those who did not.

Clinical acceptance of the DA by its perceived usefulness and whether they would recommend its use in clinical practice post-DA review survey.

Results of outcome(s):

Participants:
- Increase in parents' fertility-related knowledge
- Expectations of FP had changes post-review
- No increase in decision regret

Clinicians:
- Reported satisfaction with DA design and would recommend the DA to parents facing fertility perservation decision
- Valid and relevant
- Useful plain language resource for clinician before meeting with patient to improve fertility-preservation counselling

Comments on results:

- High dropout rate, resulting in a small sample size that may not be generalizable.
- Decision regret was measured shortly after DA review. However, regret may increase months or years later.
- Retrospective sample cannot measure decisional conflict and decisional regret. Further evaluation in prospective study is warranted.
- Only 8/15 completed the Web-based Values Clarification Exercise (VCE), which was designed to clarify the importance of their child's fertility in the context of cancer diagnosis and treatment planning: not a priority; neutral; and priority.
- DA shown to be acceptable and relevant by parents who have previously made a FP decision, without causing distress.

Includes an economic evaluation

no

Evidence ratings

Level of evidence

IV

Risk of bias
High risk of bias Comments: Participants were recruited from the same tertiary hospital.

Parents were asked to reflect on FP decision-making process, which could have been up to 5 years ago. - May have recall bias


Size of effect
2 Reason for decision: There appears to be a statistically significant improvement in fertility preservation knowledge post-DA. However, results must be interpreted with care due to the small numbers (n=15).
Relevance of evidence
1 Additional comments: Assessment post-DA included survey questions relating to satisfaction with DA design, satisfaction with content, expectations of the DA, emotional impact of the DA, perceived usefulness as a decision-making tool and so on, which directly assess participant-relevant outcomes.


There was a small sample size. However, previous pilot DA studies have shown that such sample sizes are sufficient in testing acceptability and usability of these tools, prior to prospective evaluation.

Result of appraisal

Jutta's tick icon.png Included




Completed by

Dr Michelle Peate

Jutta's tick icon.png This appraisal has been completed.


Article
Allingham C, Gillam L, McCarthy M, Zacharin M, Jayasuriya S, Heloury Y, Orme L, Sullivan M, Peate M, Jayasinghe Y. Fertility Preservation in Children and Adolescents With Cancer: Pilot of a Decision Aid for Parents of Children and Adolescents With Cancer. JMIR Pediatr Parent 2018 Nov 28;1(2):e10463.
Assigned to
User:Michelle.peate
Topic area
Guidelines:COSA:Cancer fertility preservation guidelines/Oncofertility service development
Clinical question
Form
Form:Critical appraisal


Section below only relevant for Cancer Council Project Officer

Edit appraisal assignment