Purpose A cancer and fertility program was established at a large cancer center to support clinicians in discussing treatment-related fertility risks and fertility preservation (FP) options with patients and in referring patients to reproductive specialists. The program provides resources, clinician education, and fertility clinical nurse specialist consultation. This study evaluated the program's impact on patient satisfaction with information received. Patients and MethodsRetrospective cross-sectional surveys assessed satisfaction before (cohort 1 [C1]) and after (cohort 2 [C2]) program initiation. Questionnaires were investigator-designed, gender-specific, and anonymous. ResultsMost C1 (150 males, 271 females) and C2 (120 males, 320 females) respondents were 2 years postdiagnosis; the most frequently reported cancers were testicular, breast, and lymphoma. A significant difference in satisfaction with the amount of information received was seen between C1 and C2. For males, satisfaction with information on fertility risks was high in both cohorts but significantly greater in C2 for information on sperm banking (x 2 = 9.3, P = .01) and finding a sperm bank (x 2 = 13.3, P = .001). For females, satisfaction with information was significantly greater in C2 for information on fertility risks (x 2 = 62.1, P , .001), FP options (x 2 = 71.9, P , .001), help with decision making (x 2 = 80.2, P , .001), and finding a reproductive endocrinologist (x 2 = 60.5, P , .001). Among patients who received and read information materials, 96% of males and 99% of females found them helpful. Among C2 females, fertility clinical nurse specialist consultation was associated with significantly greater satisfaction with information on FP options (x 2 = 11.2, P = .004), help with decision making (x 2 = 10.4, P = .006), and finding a reproductive endocrinologist (x 2 = 22.6, P , .001), with 10% reporting lack of knowledge as a reason for not pursuing FP. ConclusionImprovements in patient satisfaction with information received demonstrate the potential for fertility programs in cancer care settings to improve the quality of clinician-patient discussions about fertility.
Purpose: To improve the care of head and neck cancer survivors, we developed the Head and Neck Survivorship Tool: Assessment and Recommendations (HN-STAR). HN-STAR is an electronic platform that incorporates patient-reported outcomes into a clinical decision support tool for use at a survivorship visit. Selections in the clinical decision support tool automatically populate a survivorship care plan. We aimed to refine HN-STAR by eliciting and incorporating feedback on its ease of use and usefulness. Methods: Human-computer interaction (HCI) experts reviewed HN-STAR using think-aloud testing and the Nielsen Heuristic Checklist. Nurse practitioners (NPs) thought aloud while reviewing the clinical decision support tool and survivorship care plan and responded to an interview. Survivors used HN-STAR as part of a routine visit and were interviewed afterward. We analyzed themes from the feedback. We described how we addressed each theme to improve the usability of HN-STAR. Results: Five HCI experts, ten NPs, and ten cancer survivors provided complementary usability insight that we categorized into themes of improvements. For ease of use, themes included technical design considerations to enhance user interface, ease of completion of a self-assessment, streamlining text, disruption of the clinic visit, and threshold for symptoms to appear on the survivorship care plan. The theme addressing usefulness was efficiency and comprehensiveness of the clinic visit. For each theme, we report revisions to HN-STAR in response to feedback. Conclusion: HCI experts provided key technical design insights to HN-STAR, while NPs and survivors provided usability feedback and clinical perspectives. We incorporated feedback in preparation for further testing of HN-STAR. This method can inform and improve ease of use and usefulness of survivorship applications.
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