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.