Table 2.

Specification of Oncofertility Care Implementation Strategies

Strategy	Actor	Action	Action target(s)	Temporality	Dose	Implementation and services outcomes	Justification
Mandate change	Cancer center leadership	Select fertility counseling as cancer center quality goal	Oncology teams	Once	Once	Uptake of fertility counseling by AYA survivors at diagnosis and in survivorship	(1) Prioritizes implementation; (2) access to quality improvement team and resources
Automate fertility needs screen: remind clinicians	EHR system EPIC	BPA pops up to (1) remind clinicians about fertility counseling, (2) shortcut to referral order	Physicians, APPs	Trigger criteria: new oncology visit, age (<42 females, <50 males), cancer diagnosis in EHR	Each provider will see BPA maximum of one time; after referral, no other providers will see BPA for 2 years	Screen all newly diagnosed and 2-year post-treatment AYA survivors for fertility needs	(1) Compatible with EHR; (2) addresses oncology provider content and operational knowledge gap
Automate fertility referral between clinics	EHR system EPIC	Fertility specialist referral order with cancer treatment plan automatically placed in a STAT fertility scheduler queue for insurance authorization and contacting patient within 72 hours	Oncology physicians and APPs; fertility clinic schedulers ownership of insurance authorization and patient contact; fertility specialists know proposed cancer treatments	Each referral order	Once per referral	Fewer patients lost to care between two clinics; insurance authorization and scheduling efficiency; more precise fertility risk counseling by fertility specialists	(1) Compatible with EHR; (2) addresses oncology providers operational knowledge gap
Fertility counseling: add service sites	Fertility specialist, EHR system and patient portal	Televideo fertility counseling using EHR provider tool and EHR patient portal	AYA survivors at diagnosis and post-treatment	Offered to patient by fertility scheduler after fertility referral order placed	An initial 30- to 60-minute fertility counseling visit on treatment-related reproductive risks and fertility preservation options	Uptake of fertility counseling by AYA survivors; patient-centered, timely visits	(1) Compatible with EHR; (2) addresses geographic and time (multiple visits to multiple providers) barriers
Audit and feedback	EHR system, quality team	Metrics on screening, referral, counseling	Oncology teams; fertility teams	After initiation of screening and automated referral pathways	Monthly reports by individual provider and by clinic team	Fidelity of BPA screening and referral pathway	(1) Compatible with EHR-based screening and referral; (2) peer pressure
Conduct educational meetings	Implementation team, fertility specialist	20-Minute educational session on fertility content and operationalizing implementation strategies	Cancer center cabinet and quality committee; oncology physicians and APPs at oncology team meeting; fertility clinic schedulers and administrators	After preparation of strategies	Once per group	Increase acceptability of implementation strategies	(1) Addresses oncology provider content and operational knowledge gap

BPA, best practice advisory.