Hematology and oncology fellow education about sexual and reproductive health: A survey of program directors in the United States.

Abstract

11029 Background: Sexual and reproductive health (SRH) concerns are important areas of health and quality of life for patients with cancer that should be included in routine cancer care, according to clinical guidelines. Yet, oncologists often hesitate to raise SRH with their patients due to lack of training. We conducted a national survey of hematology/oncology fellowship program directors (PDs) in the U.S. to understand the state of current fellowship education on three key SRH subjects: fertility, sexual health, and safe sex practices. We assessed rates of provision of formal/informal instruction and endorsement of barriers to formal instruction. Methods: A 13-item survey of education on fertility, sexual health, and safe sex practices in adult hematology/oncology programs was sent to all PDs in the U.S. via an online link or paper survey. PD’s received a $5 gift card for participating. Descriptive statistics and McNemar tests were used. Results: One hundred-twelve PDs responded to the survey (63% response rate). Of these, 75% of PDs reported their programs offered >1 hour of formal instruction on fertility, 42% on sexual health, and 31% on safe sex practices; formal instruction was more common for fertility than either other subject (p’s < .001). Male and female fertility preservation was addressed in 62% and 59% of programs, respectively. Cancer-related sexual side effects for women and men were covered in less than one-quarter of programs (23% and 20%, respectively). Regarding informal instruction, > 73% of programs reported using clinical experience to train fellows in SRH; other informal instruction methods (i.e., case-based methods, webinars, journal clubs, grand rounds) were less common. Lack of experts/resources was the most widely endorsed barrier to providing education about fertility (55%), sexual health (75%), and safe sex practices (69%) and was more widely endorsed for sexual health and safe sex practices compared to fertility (p’s < .01). Lack of space in the curriculum and the topic not being required were also commonly endorsed barriers. Conclusions: Data from this national survey of fellowship program directors show that training in SRH is rare, particularly for sexual health. Barriers to training, especially difficulties in finding content experts, may be leading to a heavy reliance on informal methods of instruction, which are both variable and incomplete. Concerted efforts to integrate SRH into fellowship training, including novel educational curricula, are needed if SRH is to be addressed in routine cancer care.