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. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement NIH UL1TR001442, NIH TL1TR001443 ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study was approved by IRBs at University of California, San Diego and Rady Children Hospital All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes The data that support the findings of this study are available from the corresponding author, [HIS], upon reasonable request.