Critical appraisal:Blough K, Mansfield C, Kondapalli LA 2014

Critical Appraisal

Article being appraised

Blough K, Mansfield C, Kondapalli LA. Seamless integration of clinical care and research in an innovative fertility preservation program: the Colorado Oncofertility Program model. J Cancer Surviv 2014 Dec;8(4):533-8 Available from: http://www.ncbi.nlm.nih.gov/pubmed/24806262.

Applicable clinical question

What is the best practice approach for developing and implementing oncofertility services in relation to referral pathways and models of care?

Key Facts

Study Design

case series

Study aims:

1. monitoring baseline referral process
2. Exploring the baseline FP program
3. Setting up a new FP program
4. Evaluating the new FP program

Number of Patients:

126

126 women aged (mean age 1-42)
Patients were predominately cancer patients ( breast, brain and lymphoma) Cohort also included patients who had fertility issues unrelated cancer treatment

Reported outcome(s):

1. information about FP for patients was developed, detailed information about FP should be available in the cancer and fertility centre
2 several measures taken to inform and potential referring process - letters to all GP, information about FP, information sessions for HCP's, review of national guidelines
3. several organisational tools were reviewed or developed to reduce time for consultations, patients asked to complete 4 pre consultation questions to assess this referral pathway

Results of outcome(s):

Identified strengths and weakness of implementation:

Strengths 2011 and 2013
1. good lab capacity
2. acceptance of self referrals
3. Swift dealing of referrals
4. motivation of the staff
New strengths in 2013
1. FP questionnaires and information leaflets available
2. Checklist during first FP consultation FP has become more common care
3. Oncologic centres are team players in FP

Weakness in 2011 now resolved
1. Patients informed in sufficiently
2. Limited clinical information completed for patients
3. Unstructured first FP consultation

Weakness in 2013
1. adequate follow - up after FP required
2. FP could not be done in evenings or weekends

Comments on results:

This quality management project describes the logistic steps that have led to incorporation of acute FP into general reproduc- tive care.

The analysis showed that it was deemed important to develop information for patients and doctors who prescribe fertility threatening treat- ment to facilitate good time management at time of first FP consultation.

Also, FP consultation was improved by introducing a FP- questionnaire for patients and a checklist for doctors to use during consultation.

Includes an economic evaluation

no