| Sumario: | Adolescents and Young Adults (AYAs) ages 15-39 account for 70,000 new cancer diagnoses in the U.S. annually. Many AYAs have not yet begun or completed building families; thus the reproductive consequences of treatment have potentially life-altering effects. Fertility related discussions are crucial, yet multiple barriers exist. Previously identified barriers include lack of time, potential delay in treatment, lack of knowledge about fertility preservation procedures, perception of cost burden, and poor fertility specialist referral network. Nurses specifically cite a lack of familiarity with fertility risk and preservation options as well as a lack of institutional guidelines. The purpose of the project was to eliminate barriers for AYAs regarding fertility discussions by implementing several strategic programmatic changes. The primary intervention was providing a discussion regarding fertility risks and fertility preservation options with all patients in the AYA clinic. A collaboration with a reproductive endocrinologist and infertility (REI) specialist was established. Their collaboration with the AYA patient navigator has allowed earlier referral of female AYA patients interested in fertility preservation. An AYA consult service was created to address the urgent fertility needs for male inpatient and a cryobank was identified willing to coordinate inpatient banking. Financial concerns are a frequent barrier to fertility preservation. Philanthropic funds were secured to support financial needs and reduced pricing was negotiated. An Oncofertility Best Practice Advisory (BPA) was developed for use in the institution-wide electronic medical record. It alerts the oncology team to discuss fertility and place a consult to the AYA service when placing a new chemotherapy treatment plan. Implementation of an AYA patient navigator, development of an inpatient consult service, and financial relief improved sperm banking access. Addressing fertility at all AYA visits and embedding a reproductive endocrinologist in our AYA clinic facilitated fertility preservation counseling. An institution wide Best Practice Advisory in the electronic medical record increased AYA/Oncofertility awareness. Collaboration and strategic planning are key to eliminate potential barriers regarding fertility discussions faced by AYAs. Oncology nurses must lead in programmatic changes to reduce the gap in fertility discussions with AYAs. Nurses will need to be able to leverage not only technology to maximize standardization of care but also establish intradisciplinary collaboration.
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