Fertility Preservation Toolkit: A Clinician Resource to Assist Clinical Discussion and Decision Making in Pediatric and Adolescent Oncology.

PURPOSE: Fertility preservation (FP) discussions in children with cancer presents unique challenges due to ethical considerations, lack of models-of-care, and the triadic nature of discussions. This study evaluated a fertility toolkit for clinicians involved in FP discussions with pediatric, adolescent, and young adult patients and parents. MATERIALS AND METHODS: A survey-based, longitudinal study of clinicians at The Royal Children's Hospital Melbourne involved in FP discussions undertaken at 3 time-points: 2014, alongside an education session for baseline assessment of oncofertility practices (survey 1); after each toolkit use to evaluate case-specific implementation (survey 2); 2016, to evaluate impact on clinical practice (survey 3). RESULTS: Fifty-nine clinicians completed survey 1. Over 66% reported baseline dissatisfaction with the existing FP system; 56.7% were not confident in providing up-to-date information. Only 34.5% "often" or "always" provided verbal information; 14.0% "often" or "always" provided written information. Survey 2 was completed after 11 consultations. All clinicians were satisfied with the discussions and outcomes using the toolkit. Thirty-nine clinicians completed survey 3. Over 70% felt confident providing up-to-date FP knowledge, 67.7% "often" or "always" provided verbal information, and 35.4% "often" or "always" provided written information. CONCLUSIONS: Clinicians desire improvement in FP practice. The toolkit provided significant perceived and actual benefits.

A Clinical Decision Support System to Assist Pediatric Oncofertility: A Short Report.

PURPOSE: Fertility preservation discussions with pediatric and adolescent cancer patients can be difficult for clinicians. This study describes the acceptability of a fertility clinician decision support system (CDSS). METHODS: A cross-sectional study of clinicians at The Royal Children's Hospital, Melbourne. Participants were trained on CDSS purpose, contents, and use. A survey captured the perceived benefits and weaknesses of the CDSS. RESULTS: Thirty-nine clinicians participated. Over 90% felt the CDSS aims and format were clear, and understood the components. Over 80% felt it would enable adherence to clinical pathways, policy, and standards of care. CONCLUSIONS: The CDSS provided significant perceived benefits to oncofertility care.

Fertility Preservation in Pediatric and Adolescent Oncology Patients: The Decision-Making Process of Parents.

PURPOSE: Decisions surrounding fertility preservation (FP) in children, adolescents, and adults can be difficult due to the distress of a cancer diagnosis, time constraints for decision-making, and lack of efficacy data. This review examines the decision-making process of oncology patients and their parents (if patients are in the pediatric or adolescent population) to better understand experiences of decisional conflict and regret. METHODS: Two electronic databases, Embase and Pubmed, were searched using the terms (Decision-making OR Conflict (Psychology) OR Decision regret) AND (Freezing OR Oocyte OR Ovarian tissue OR Semen preservation OR Fertility preservation OR Cryopreservation) AND (Neoplasms OR Cancer OR Chemotherapy OR Drug therapy OR Radiotherapy). Medical Subject Heading terms were utilized where possible. Included articles discussed FP decision-making from the patient's perspective. RESULTS: Thirty-five articles discussing FP decision-making were included (24 in the adult population, 11 in the pediatric and adolescent population). Key themes from these articles included the following: factors considered in FP decision-making, decision-making in established procedures and experimental procedures, decisional conflict and regret, the perceived importance of information, adolescent involvement in decision-making, and ethical considerations in the pediatric population. CONCLUSIONS: Unique ethical issues arise in the pediatric and adolescent population. Considering that the decision to pursue FP is known to be difficult in the adult population, decisional conflict and regret may be greater for parents who are making the decision for their child.

Ankle flexors produce peak torque at longer muscle lengths after whole-body vibration.

INTRODUCTION: Whole-body vibration (WBV) has become a popular training method in recent years. This study investigated the effect of WBV on the length-tension relationship of the ankle dorsi- and plantarflexors as measured by a Biodex dynamometer (Biodex Medical Systems Inc, Shirley, NY). METHODS: Twenty healthy young adult males participated in this study and were exposed to two treatments. The first treatment (nonvibration) involved passive stretching of the plantarflexors at end range of motion (ROM) for five 1-min bouts. The second treatment involved the same passive stretch with superimposed WBV (frequency = 26 Hz) for five 1-min bouts on a rotary vibration plate (Galileo 900; Novotec, Pforzheim, Germany). Voluntary ROM, peak torque, and corresponding joint angle of the plantar- and dorsiflexors were recorded pre- and posttreatment. Within-treatment (before and after) and between-treatment (WBV and nonvibration) outcomes were assessed by repeated-measures MANOVA. RESULTS: No significant changes in the measures of ankle dorsiflexion were found within or between treatments. No significant changes in the measures of ankle plantarflexion were found after the nonvibration treatment. After WBV, however, there was a significant 7.1 degree shift in the angle (P = 0.001) of peak plantarflexor torque production corresponding to a longer muscle length. CONCLUSION: This study shows that stretched human ankle plantarflexors respond to WBV by generating peak voluntary torque at longer muscle lengths. This has possible benefits for the rehabilitation of patients with neuromuscular disorders (e.g., stroke) who experience short ankle flexor resting lengths.