Understanding facilitators and barriers to contraceptive screening and referral in young adults with cancer
Contraception
Awarded 2017
Complex Family Planning Fellowship Research
Sarah Lindsay, MD
Boston Medical Center
$75,347

Background: Young women diagnosed with cancer face unique reproductive health needs. Commonly, providers and patients focus on fertility preservation, but an unplanned pregnancy during cancer treatment can lead to negative consequences, including treatment delays and fetal exposures to treatment. However, available research suggests oncology providers infrequently discuss contraception for pregnancy prevention during treatment. Little is known about the barriers to contraception screening and referral in the cancer setting. National oncology guidelines recently expanded contraception recommendations for this demographic, however these recommendations offer little guidance for implementation of contraception screening and referral in the oncology setting.
Statement of purpose: The goal of this study was to evaluate current practices and perceived barriers to contraception screening and referral for young women with cancer.
Methodology: We used the Promoting Action on Research Implementation in Health Services (PARiHS) framework to design this pre-implementation study as the first step in the implementation process. We performed semi-structured interviews with providers and patients who offered or received oncology care at an urban academic medical center in the northeast. We used standard qualitative techniques, including directed content analysis based on the PARiHS framework, to analyze transcripts from the interviews.
Important findings: We identified several major barriers to contraception screening and referral at this institution. These barriers included: variations in insufficient contraceptive care among oncology providers, lack of clear roles and responsibilities for contraception screening among oncology providers, and providers’ perceived lack of education and expertise precluding contraception discussions. Patient interviews reflected these variations in care and lack of clear roles and responsibilities for contraception among their providers. In addition to these barriers, providers and patients also identified a variety of resources that may support successful implementation of contraception screening and referral. These resources included: provider education about contraception, development of a brief screening tool for contraception in the oncology setting, a streamlined referral process to a qualified reproductive health provider, and the development of patient-facing resources.
Conclusion/Summary: Many barriers exist to contraception screening and referral in the oncology setting. Ultimately, we plan to use the results of this study to implement a contraception screening and referral program at our cancer center. The implementation process must address each of these barriers in order to successfully implement appropriate contraception screening and referral for young women with cancer.

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