Critical appraisal:Bradford NK, Walker R, Henney R, Inglis P, Chan RJ 2018

Critical Appraisal

Article being appraised

Bradford NK, Walker R, Henney R, Inglis P, Chan RJ. Improvements in Clinical Practice for Fertility Preservation Among Young Cancer Patients: Results from Bundled Interventions. J Adolesc Young Adult Oncol 2018 Feb;7(1):37-45 Available from: http://www.ncbi.nlm.nih.gov/pubmed/28934554.

Applicable clinical question

What is the effect of providing onco-fertility services or referral pathways on the referral of cancer patients to fertility specialists?

Key Facts

Study Design

case series

Study aims:

To assess the effects of bundled interventions on clinical practice concerning young people (14-25yo) with cancer in five tertiary cancer centres in Queensland, Australia.

Interventions included:
1. Establishment of quality indicators for youth cancer fertility
2. Delivery of targeted education sessions for medical and senior nursing clinicians
3. Provision of gender-specific patient resource packs to newly diagnosed patients
4. Development of fertility referral pathways, procedures and work instruction forms

Number of Patients:

476

Only post-pubertal patients included.

Reported outcome(s):

- Whether the patient was provided with written and verbal information regarding FP options
- Whether the patient was referred to a fertility specialist
- Whether the patient underwent FP
- If FP was undertaken, what the procedure was
Study describes characteristics of groups, pre- and post-intervention

Results of outcome(s):

Post-intervention, patients were significantly more likely to have evidencee of risk of infertility discussion in their medical records documented (RR 1.47, 95% CI 1.12-1.63, p=<0.001), documented referral to fertility specialist (RR 1.53, 95% CI 1.26-1.87, p+<0.00), and documented FP outcomes (RR 2.56, 95% CI, 1.19-3.44, p+<0.001).

Greatest increase in documentation of infertility discussion occurred for females post-interventions (RR 1.7, 95% 1.39-2.08, p=<0.001).

Males were more likely to have documented risk of internality discussion prior to intervention (RR1.37, 95% CI, 1.11-1.68, p=0.003). This changed with intervention, when no significant differences between the genders was documented (RR 1.04, 95%CI 0.95-1.15, p=.037), but males were more likely to be referred to fertility specialists (RR1.83, 95%CI 1.37-2.46, p=0.001) and have documented outcomes of FP (RR 2.06, 95% CI, 1.44-2.96, p=0.001) even after intervention.

Comments on results:

Fertility discussions, fertility referrals and fertility procedures increased after the implementation of bundled interventions.

Includes an economic evaluation

no