Adaptation and implementation of a web-based Family centered Adolescent Sperm banking decision Tool for adolescent males with cancer

项目总结 儿童癌症治疗的进步使&gt；80%的五年存活率1接近50万 在美国，儿童癌症幸存者越来越需要解决和减轻癌症的晚期影响 治疗。2，3生育力障碍发生在大约一半的男性儿童癌症幸存者中，并可能对 影响生活质量。4，5精子库是一种公认的、广泛可用的生育保护形式 尽管承认未来为人父母的价值和治疗前保存精子的指导方针，但6，7 患有癌症的男性青少年仍未得到充分利用，特别是在资源不足的医院。8-10 研究表明，青春期男性更有可能在癌症治疗前储存精子，条件是：1)他们的机构 有专门的生育服务，他们的提供者推荐银行，12和3)他们的父母推荐 为了改善公平的照顾和获得精子库机会，10个以家庭为中心的决策工具，以及 实施这些工具的战略至关重要。我们团队开发了以家庭为中心的青少年精子 银行工具(FAST)，并在新诊断的青少年男性家庭中进行前瞻性测试 癌症。我们发现，FAST引发了更深层次的思考，并促进了家庭关于为人父母的交流 目标和银行业务，17精子库存率显著增加。19考虑到可行性和公平性 考虑因素(即短时间范围、提供生育咨询的各种环境)、目标 这项建议的目的是将FAST调整为基于Web的工具，可以在住院患者/门诊患者/非 临床设置，确定高资源设置和低资源设置的实施策略，并在 110个新诊断的青春期男性(13~21岁)家庭的三点初步研究 癌症。具体目标是：1)根据患者和护理人员调整FAST(设计和交付) 利益相关者反馈(可用性测试)，这将产生一个基于Web的工具，该工具功能齐全，可接受 家庭，并且实施癌前治疗是可行的；2)使用混合的- 方法与临床医生利益相关者一起确定基于Web的定制实施策略 在高资源和低资源的儿科癌症中心快速进行，为进入临床路径做好准备，以及 确保保真度和可持续性，以及3)试点基于网络的快速和量身定制的实施战略 在当地和另外2个站点(1个高资源和1个低资源)检查可行性、可接受性和对 银行利率(事前/事后设计)，为更大规模的多地点混合实施-效果试验做准备。 调查结果将导致一种创新的决策工具，该工具可以在Web上轻松访问并在 多种多样的高资源和低资源环境，以促进患有以下疾病的青少年男性的银行决策 癌症。这些努力将通过扩大为人父母的机会和 有助于改善越来越多的幸存者的生活质量，包括服务不足的人口。

PROJECT SUMMARY Advances in childhood cancer therapies have resulted in >80% five-year survival rates.1 With nearly 500,000 childhood cancer survivors in the U.S., there is a growing need to address and mitigate late effects of treatment.2,3 Fertility impairment occurs in about half of male childhood cancer survivors and can negatively impact quality of life.4,5 Sperm banking is an established and widely available form of fertility preservation.6 Despite recognizing the value of future parenthood and guidelines to bank sperm before treatment,6,7 banking remains underutilized among male adolescents with cancer, especially at hospitals with low resources.8-10 Studies show adolescent males are more likely to bank sperm prior to cancer treatment if: 1) their institution has dedicated fertility services,11 2) their provider recommends banking,12 and 3) their parents recommend it.13 To improve equitable care and access to sperm banking opportunities,10 family-centered decision tools, and strategies to implement these tools, are critical. Our team developed the Family-centered Adolescent Sperm banking Tool (FAST) and tested it prospectively among families of adolescent males newly diagnosed with cancer. We found the FAST prompted deeper thinking and facilitated family communication about parenthood goals and banking,17 and that sperm banking rates increased significantly.19 Given feasibility and equity considerations (i.e., short time frame, variety of settings in which fertility counseling is delivered), the objective of this proposal is to adapt the FAST to a web-based tool that can be accessed in inpatient/outpatient/non- clinical settings, identify implementation strategies for high and low-resourced settings, and test these in a three-site pilot study among 110 families of adolescent males (13-21 years of age) newly diagnosed with cancer. Specific aims are to: 1) adapt the FAST (design and delivery) based on patient and caregiver stakeholder feedback (usability testing), which will result in a web-based tool that is functional, acceptable to families, and feasible to implement pre-cancer treatment; 2) conduct rapid contextual inquiry using a mixed- methods approach with clinician stakeholders, to identify tailored implementation strategies for the web-based FAST in both high and low-resourced pediatric cancer centers, prepare for adoption into clinical pathways, and ensure fidelity and sustainability, and 3) pilot the web-based FAST and tailored implementation strategies locally and at 2 additional sites (1 high and 1 low-resourced) to examine feasibility, acceptability, and impact on banking rates (pre-/post design) to prepare for a larger multi-site hybrid implementation-effectiveness trial. Findings will result in an innovative decision tool that can be easily accessed on the web and implemented at a wide variety of high and low-resourced settings to facilitate banking decisions among adolescent males with cancer. These efforts will optimize long-term outcomes by expanding opportunities for parenthood and contributing to improved quality of life in a growing population of survivors, including underserved populations.