Critical appraisal:Hariton E, Bortoletto P, Cardozo ER, Hochberg EP, Sabatini ME 2016 2

Critical Appraisal

Article being appraised

Hariton E, Bortoletto P, Cardozo ER, Hochberg EP, Sabatini ME. The Role of Oncofertility Clinics in Facilitating Access to Reproductive Specialists. J Patient Exp 2016 Dec;3(4):131-136 Available from: http://www.ncbi.nlm.nih.gov/pubmed/28725849.

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:

To determine the impact of the establishment of a dedicated oncofertility clinic on the frequency of patient referrals for fertility preservation (FP) consultation and the time from patient referral to consultation.

Number of Patients:

150

female patients aged 18 to 44 years at the time of initial Cancer Center evaluation who were referred for FP consultation at the MGH Vincent Center for Fertility and IVF from December 2010 to August 2015.

Reported outcome(s):

A total of 6895 female patients eligible for FP were seen at the Massachusetts General Hospital (MGH) Cancer Center. Of those eligible, a total of 209 patients were referred for FP consultation with 150 included in the final analysis. Since the establishment of the oncofertility clinic, the mean time to nonemergent consultation with a reproductive endocrinologist decreased by 27%, from 10.4 to 7.6 days (P 1⁄4 .03). Furthermore, the proportion of reproductive-aged females seen at the MGH Cancer Center referred for FP consultation increased from 1.7% to 3.0% (P < .01).

Results of outcome(s):

A dedicated onco- fertility clinic increases physician referrals for FP and decreases the mean time to consultation, improving access to FP consultation for reproductive-aged women with cancer.

Comments on results:

There were no significant differences in the types of cancer between the patient seen prior to the establishment of the clinic and after.
Per month the average number of patients seen per major disease type increased as follows— breast 0.94 prior and 1.13 after, gynecology 0.47 and 1.04, and hematologic 0.34 and 0.43 before and after, respectively. Three (4.05%) patients prior and 1 (1.32%) patient after the establishment of the clinic were self-referred.
Since the establishment of the oncofertility clinic, the mean time to consult decreased by 2.81 days, from 10.38 to 7.57 days (P 1⁄4 .034), a 27% decline.
The median time to consult decreased from 6 to 5 days.
The mean number of patients seen per month increased from 2.31 to 3.30 (P < 0.01, see Table 1) and the median increased from 3 to 4.
Furthermore, there was a near doubling in the percentage of patients referred for fertility evaluation, from 1.69% to 3.01% (w2 1⁄4 12.95, P < .01, see Figure 2).

Includes an economic evaluation

no

Evidence ratings

Level of evidence

IV

Risk of bias

High risk of bias

Comments: N/A

Size of effect

1	Reason for decision: The mean number of patients seen per month increased from 2.31 to 3.30 (P < 0.01) Near doubling in the percentage of patients referred for fertility evaluation, from 1.69% to 3.01% (w2 1⁄4 12.95, P < 0.01)

Relevance of evidence

2	Additional comments: Evidence of an effect on a surrogate outcome - 1. access to FP clinic 2. time to access clinic 3. change in practice with implementation

Result of appraisal

Included