Critical appraisal:Buske D, Sender A, Richter D, Brähler E, Geue K 2016

Critical Appraisal

Article being appraised

Buske D, Sender A, Richter D, Brähler E, Geue K. Patient-Physician Communication and Knowledge Regarding Fertility Issues from German Oncologists' Perspective-a Quantitative Survey. J Cancer Educ 2016 Mar;31(1):115-22 Available from: http://www.ncbi.nlm.nih.gov/pubmed/25934223.

Applicable clinical question

What is the level of awareness among health professionals of the need to discuss the risk of infertility with cancer patients?

Key Facts

Study Design

cross sectional study

Study aims:

To investigate German oncologists’ perspective on physician-patient communication in the field of adult haemato-oncology regarding family planning, fertility, and fertility preservation in young adults.

Number of Patients:

120

121 oncologists from 37 of the 76 facilities - one excluded for not seeing pts with fertility issues.
Final sample n=120): 51 female, 69 male; 27-63 yrs old (mean: 37.6); ave 10yrs experience; 51 still in specialty training, 80% worked in university hospitals

Reported outcome(s):

Importance of oncofertility
Discussions about oncofertility
Awareness about oncofertility
Knowledge about oncofertility

Results of outcome(s):

IMPORTANCE: 89.2 % rated fertility, 85.5% the desire to have a child, and 92.5% fertility preservation as important.

DISCUSSION: 65.8% always discuss possible fertility impairment; 65.3% FP.
27.5% mentioned fertility impairment resulting from treatment, and 26.3% FP, in most cases.
59.2% mentioned fertility once during the course of treatment, 24.2% twice.
84.2% discussed possible fertility impairment during the informed consent discussion (before 1st Tx).
Most likely no to discuss if palliative (n=11), urgent indication for therapy (N=9), strong anticipated psychological stress (N=5), and chemotherapy already taken place.
42.9% reported discussion to be difficult, 25.2% felt it was a burden.

AWARENESS:
94.1% felt it important to discuss and 67.2% considered discussions to be successful.

KNOWLEDGE:
All familiar with sperm cryo - with 94.39% having some knowledge (49.6% claimed good knowledge about this method).
54.7% know about TTCP - with 42.2% having some knowledge (8.3% good knowledge).
95% know about GnRH analogues - with 1.3% having some knowledge (47% claiming good knowledge)
97.5% know about oocyte cryo - with 86.3% having some knowledge (19.7% claiming good knowledge)
87.2% know about ovarian tissue - with 69% having some knowledge (15.5% claiming good knowledge)
55.1% know about relocation of ovaries - with 40.9% with come knowledge (10.9% with good knowledge)
37.3% felt well-informed about FP methods

Comments on results:

This also reported on patient factors around discussion (from the oncologist POV):
Less likely when:
-patients >35 (47 %)
-poor prognosis (62.7 %).
More likely when:
-patients <35 (81.5 %),
-good prognosis (64.4 %),
-high risk of infertility (61.9 %).

Also reported on referal patterns:
96.6 % referred to other departments about FP
75% happy with cooperation accross departments (but could be improved)
Also consulted with other deparmtents.

Includes an economic evaluation

no