Theory-guided development of fertility care implementation strategies for adolescents and young adult cancer survivors

Background Oncofertility care remains under-implemented across oncology and fertility care settings, with limited tools to scale up effective implementation strategies. Guided by the Consolidated Framework for Implementation Research (CFIR), we aimed to systematically assess factors that influence implementation of oncofertility care and map strategies, particularly electronic health record (EHR)-enabled ones, that fit adult and pediatric oncology care contexts. Methods Using purposeful sampling, we recruited healthcare providers and female adolescent and young adult (AYA) cancer survivors from a comprehensive cancer center and a freestanding children’s hospital. Participants underwent semi-structured interviews and focus groups. Using thematic analysis combining inductive codes with CFIR-based deductive codes, we characterized barriers and facilitators to oncofertility care and implementation strategies. Two coders independently coded each transcript, with a third coder resolving discrepancies by consensus. Results We recruited 19 oncology and fertility providers and 9 AYA survivors. We identified barriers and facilitators to fertility care in the CFIR domains of individual, inner setting, outer setting, and process, allowing us to conceptualize oncofertility care in three necessary stages: screening, referral, and fertility preservation counseling. To fit an adult and a children’s context, five implementation strategies were mapped: needs screen using a best practice advisory, referral order, telehealth fertility counseling, provider audit and feedback, and a provider educational session. All but provider education are facilitated by the EHR system. Conclusions An implementation science approach enabled systematic assessment of oncofertility care and co-design of implementation strategies with stakeholders, providing a theory-based approach and scalable EHR tools to support wider dissemination.