Critical appraisal:Bradford NK, Walker R, Henney R, Inglis P, Chan RJ 2018 2

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 oncofertility programs or health professional education on the number of clinician-patient discussions about fertility preservation following a cancer diagnosis?

Key Facts

Study Design

case series

Study aims:

The study aims were to assess the effects of bundled interventions on clinical practice concerning fertility in young people aged 14–25 years with cancer.

Number of Patients:

476

Youth cancer service in Queensland, 5 cancer centres. Patients aged between 14 and 25yrs old.

Reported outcome(s):

1. Was the patient provided with written and verbal information regarding fertility preservation options? (Yes/No)
�2. Was the patient referred to a fertility specialist? (Yes/No)
3. � Did the patient undergo fertility preservation (Yes/No)
�4. If Yes—what preservation method.

Results of outcome(s):

Compared to patients in the pre-intervention cohort, patients in the post-intervention cohort were significantly more likely to have: (a) evidence of risk of infertility discussion (RR 1.47, 95% CI 1.12–1.63 p=<0.001); (b) documented referral to fertility specialist (RR 1.53, 95% CI 1.26–1.87, p=<0.001); and (c) documented fertility preservation outcomes (RR 2.56, 95% CI 1.19–3.44, p=<0.001).
Post intervention, documented rates of referrals to fertility specialists were significantly higher for patients with bone sarcoma (RR 1.84, 95% CI 1.12–3.01, p = 0.015) and carcinoma (RR 2.37, 95% CI 1.15–4.88, p = 0.019).
Also significant improvements for gender disparity. After interventions, there was no significant difference between male and female discussion documentation (RR 1.04, 95% CI 0.95–1.15, p = 0.37). Males were still males were still significantly more likely to be referred to fertility specialists (RR 1.83, 95% CI 1.37– 2.46, p = 0.001), and to have documented fertility preservation outcomes (RR 2.06, 95% CI 1.44–2.96, p = 0.001).

Comments on results:

Significant improvements in discussion rates after program implementation. Disparity still present post-intervention in fertility specialist referral and uptake of fertility. This could reflect the ease of access to sperm banking for males, or uncertainty/cost/invasive procedures for females.

Includes an economic evaluation

no