(69) Improving Infertility Risk Counseling for Pediatric Oncology Patients Considering New Healthcare Coverage Changes in the State of Texas.

Title: Improving Infertility Risk Counseling for Pediatric Oncology Patients Considering New Healthcare Coverage Changes in the State of Texas.

Abstract : Cancer treatment can pose risks to reproductive health; therefore, it is essential to implement timely and effective infertility risk and fertility preservation (FP) options counseling. Despite guidelines supporting implementation of these discussions at the time of diagnosis, infertility risk counseling remains suboptimal at about 20%, though 44% of survivors report moderate to high overall reproductive concerns. Furthermore, a new Texas’ healthcare coverage mandate was passed in 2023 that increases coverage on FP treatments for oncological patients, which may reduce financial barriers. Therefore, the objective of this study is to improve fertility counseling on insurance coverage options to increase accessibility to FP options.

This quality improvement initiative utilized a mixed-methods approach. We conducted seven virtual qualitative interviews with fertility navigators, physicians, and financial counselors to understand barriers to accessing FP treatments, knowledge on the new health mandate, and resources to support patients. To improve FP counseling, we implemented a PDSA cycle utilizing a patient education handout describing the health mandate, how to access insurance benefits, and financial resources for patients. Quantitative analysis investigated patients receiving FP counseling with the insurance handout.

We identified common barriers to receiving FP counseling and treatment - poor patient literacy, ineffective patient education materials, and lack of physician training. Quantitative analysis of 14 patients counseled with the handout revealed that 13 of 14 (92.86%) of new patients were counseled with the handout at initial consultation, and 3 of 14 (21.43%) patients counseled with the handout pursued FP. Consulted patients reported an average rating of 9.57 out of 10 for ease of understanding the handout, and 9.93 for usefulness of the handout and counseling session.

Qualitative and quantitative analyses support the need for patient education on insurance coverage options. Next steps include implementation of another PDSA cycle focused on pediatric oncological patients with private insurance types.