Discussion
In this pilot pre-post medical education interventional study, we
demonstrated a significant improvement in participants’ knowledge on
topics related to infertility risk and fertility preservation options
among pediatric hematology and oncology providers. Participants’
interactivity was likely slightly limited by the virtual nature of this
education session, and in- person session may have led to a more dynamic
discussion. However, even in a virtual format, we believe that this
one-hour educational intervention session has increased awareness
regarding the importance of discussing infertility risk and fertility
preservation options with all our patients and their families.
Prior studies have emphasized the need for increased education on
treatment- related infertility risk and fertility preservation options
for pediatric oncology patients [10, 11]. Overbeek et al conducted a
nationwide cross-sectional study where a survey was sent to 64
registered pediatric oncologists in the Netherlands. Of the 37
oncologists who participated, < 25% reported a moderate or
high confidence in their knowledge on fertility preservation techniques
[12]. Further, Murphy et al developed a fertility preservation
brochure that was evaluated by patients, parents and healthcare
providers, and later optimized based on this feedback [13]. In
support, Kemertzis et al conducted a survey-based longitudinal study of
clinicians involved in fertility preservation discussions which included
baseline assessment as well as a follow-up survey administered after
each toolkit use. The fertility preservation toolkit resulted in
significant perceived and actual benefits [14]. Similarly, Takeuchi
et al conducted a 4-hour educational program for non-physician health
care providers focused on risk of cancer treatment, fertility
preservation, and psychosocial support. The study reported significant
improvement in in confidence and knowledge among participants, but not
in counseling skills [15]. This lack of improvement of counseling
skills emphasizes the importance of having a dedicated fertility
preservation team in the pediatric hematology-oncology department that
can provide adequate counseling for the patients and their families.
Moreover, a recent publication involved conducting a cross-sectional
survey of information and resources related to fertility preservation on
websites from top ranked pediatric cancer programs[16]. The authors
showed that a fertility team was referenced on the website of 36% of
programs and only 32% provided fertility preservation educational
resources for patients. In addition, information was particularly
limited for prepubertal males and Spanish-speaking patients. This study
emphasizes the need for continued fertility preservation education and
resources.
In conclusion, our one-hour educational intervention session led to
statistically significant improvement in participants’ knowledge on
topics related to infertility risk and fertility preservation among
pediatric hematology and oncology providers. We plan to continue this
study on an annual basis and include more participants over time with
pre-/post assessments and educational session intervention being
completed in one setting to optimize participation.
Table 1 . Key educational points related to significantly
increased risk of infertility adapted from Meacham et al [5]
and fertility preservation options for pre and post pubertal patients
based on the 2019 ASRM guidelines[9]. CED: cyclophosphamide
equivalent dosing.