Table 3.
Characteristics of Non-Selected Implementation Strategies
| Fertility care pathway order | Strategy | Facilitators and barriers | Justification |
|---|---|---|---|
| Fertility needs screen | Involve patients: AYA survivors screened through questionnaire sent through EHR patient portal MyChart | Facilitators: | Available resource; compatibility |
| Patient time: not limited by in-person visit time | |||
| EHR patient portal uptake high in adults, low in pediatrics | |||
| Barriers: | Compatibility and available resources; compatibility; external policy and incentives; adaptability; complexity | ||
| Heterogeneity of questionnaires used by providers | |||
| Cannot be used in inpatient setting | |||
| Privacy laws do not allow parents access to patient portal in children ≥ age 12 | |||
| No Spanish version of patient portal | |||
| Wording appropriate to children and adolescents | |||
| Involve patients: Paper questionnaire in waiting room | Facilitators: | Available resource; adaptability | |
| Does not require patient to enroll in patient portal | |||
| Could be given in multiple languages | |||
| Barriers: | Complexity; available Resource; compatibility | ||
| Wording appropriate to children and adolescents | |||
| Available patient time to consider screening questions limited | |||
| Provider may miss the paper questionnaire | |||
| Revise professional roles: Dedicated fertility navigator | Facilitator: | Complexity | |
| One provider that does all the steps: screening and referral | |||
| Barriers: | Available resources; compatibility | ||
| Cost | |||
| Depending on volume, difficult to capture all new diagnoses | |||
| Technical assistance—EHR templates to document screens | Barrier: | Complexity, compatibility | |
| Heterogeneity of note templates limits automation and uniform uptake | |||
| Fertility referral | Remind clinicians: EHR inbox messages on new patients | Barrier: | Compatibility |
| Providers overwhelmed by inbox messages | |||
| Automated referral for all new patients | Facilitator: | Complexity | |
| Has one less step required of oncology providers | |||
| Barrier: | Relative advantage | ||
| Leads to unnecessary consults | |||
| Remind clinicians: added referral order to admission order set | Barrier: | Complexity | |
| Heterogeneity of order sets used by different disease teams | |||
| Would not work in outpatient setting | Compatibility |