Standardizing Fertility Preservation Counseling for Pediatric Hematology–Oncology and Transplant and Cellular Therapy Patients: A Quality Improvement Initiative

Abstract

BACKGROUND: Infertility following gonadotoxic chemotherapy is among the most distressing late effects experienced by childhood cancer survivors, highlighting the importance of fertility preservation (FP) counseling at the time of diagnosis. We aimed to improve the frequency and consistency of FP counseling and provider comfort with infertility-related discussions through implementation of a standardized multidisciplinary workflow. PROCEDURE: Interventions were implemented through two sequential Plan-Do-Study-Act (PDSA) cycles to standardize fertility counseling practices. The first focused on provider education, workflow reminders, and standardized documentation. The second established a multidisciplinary FP team (FPT) to provide individualized patient counseling and facilitate FP. Documented FP counseling was assessed through chart review, and provider comfort regarding infertility and FP discussions was evaluated through anonymous surveys. RESULTS: Documented fertility counseling improved from 43% at baseline to 65% following the first PDSA cycle and to 93.2% following implementation of the FPT in PDSA Cycle 2. Provider comfort improved most notably when counseling pubertal patients. Provider self-reported comfort with fertility-related discussions increased from 70% to 82% for pubertal male patients and from 56% to 82% for pubertal female patients. Comfort discussing FP with prepubertal patients remained comparatively lower throughout the study. CONCLUSION: A multidisciplinary FPT with standardized workflow resulted in sustained improvement of documented fertility counseling, while also improving provider comfort with fertility-related discussions. These interventions were also associated with increased utilization of FP services. This represents an effective strategy to reduce missed opportunities for FP, ensuring timely counseling and access to FP options to all patients undergoing gonadotoxic therapy.