ANAHEIM, CALIFORNIA—Cancer patients need to receive timely information and counseling regarding oncofertility issues, and oncology nurses involved in their treatment can play a major role in providing this type of care, according to research presented at the Oncology Nursing Society (ONS) 39th Annual Congress.
Unfortunately, fertility effects from cancer treatment are not often discussed before treatment begins. However, research indicates that patients who receive information and have an opportunity to preserve their fertility at the time of diagnosis experience a better quality of life and less regret.
Guidelines updated by the American Society of Clinical Oncology (ASCO) in 2013 have three major recommendations regarding fertility for cancer patients. First, discussion of fertility risk should occur early, referral to a reproductive endocrinologist should be prompt, and clinical trials should be promoted to advance knowledge.
The Educating Nurses about Reproductive Issues in Cancer Healthcare (ENRICH) program—a 10-week, Web-based educational program developed by two doctors—aims to improve oncofertility care by developing action plans for participants’ institutions.
One participant, Jean Ellsworth-Wolk, MS, RN, AOCNS, of the Cleveland Clinic Cancer Center at Fairview Hospital, shared her experience as an ENRICH participant during a poster session.
At her institution, a baseline assessment, which included a chart audit for documentation of pretreatment discussion of fertility and evaluation of physician and nurse knowledge, was conducted.
Several issues that prevented effective oncofertility care were identified. For health care professionals, major barriers included perception of inadequate time for fertility intervention before treatment initiation and a resistance to discuss fertility with patients with late-stage cancer, those with mental or developmental issues, or those already with children.
Health care professionals also expressed discomfort with the subject due to a lack of knowledge, and some felt there was inadequate time to discuss the subject during an office visit.
Patients experienced barriers to receiving effective oncofertility care as well. They cited distress level at the time of treatment planning discussion and lack of patient education materials as two specific problems.
An action plan to improve oncofertility was then formed. To enhance nurse education, a nurse grand round presentation was performed with a total of 75 participants across the health care system and within the community. Nurses also received a Fertile Hope Professional Education Booklet.
Physician education included medical grand rounds on oncofertility by reproductive endocrinologists; distribution of the Fertile Hope Professional Education Booklet; review of the ASCO guidelines and the chart audit results during a meeting; development of smart text for electronic health records; and scripting of a screening question: “Have you completed your family?”
Patient education included distribution of Fertile Hope brochures and pretreatment chemotherapy education classes with information on fertility.
Additionally, a referral system in which the advanced practice nurse functioned as a second line of information and counseling after discussion with a physician was developed. Also, development of a liaison with the reproductive endocrinology offices occurred. Finally, an oncofertility resource folder was shared on the cancer center’s computer drive.
The chart audit showed that, after implementation of the action plan, the number of patients as well as the number of those receiving fertility discussions increased.
“Addressing fertility in the oncology population by the health care team can positively impact a patient’s quality of life in long-term cancer survivorship,” Ellsworth-Wolk wrote in the study’s conclusion.
“Oncology nurses as patient advocates have a responsibility to ensure that appropriate patients have timely information and counseling surrounding oncofertility issues.”
Researchers plan to continue evaluating the interventions via ongoing audits until the practice becomes standard.
Ellsworth-Wolk J. Oncofertility practice in a community cancer center: Fertile ground for improvement. Poster presented at: Oncology Nursing Society (ONS) 39th Annual Congress; May 1-4, 2014; Anaheim, CA.