ideasIdea
Default fertility preservation referral for every patient under 40 before treatment
Many young patients are never told that chemotherapy may end their fertility, or are told too late to do anything. An automatic referral, triggered when treatment is ordered, would make the conversation routine.
Guidelines require discussion of fertility preservation before gonadotoxic therapy, yet documented discussion and referral rates remain well below half in many series, with worse rates for women, minorities, and patients at non-academic centres. An order-set trigger that creates a fertility referral for every patient under 40 unless actively declined, with a fast-track reproductive medicine pathway and funding for preservation, would close this gap.
Hypothesis
Default referral will raise documented fertility counselling to above 90% of eligible patients and double the proportion undergoing preservation, without delaying treatment start by more than a week.
Rationale
Defaults outperform reminders; the time-critical nature of preservation means that a missed conversation is irreversible.
What would test it
Run a stepped-wedge implementation across ten centres with counselling documentation, preservation uptake, treatment delay, and regret at two years.
Maturity
being tested at scale
Who has to act
clinic
Cost to try
Small (under $1M)
Years to first evidence
2
Bottlenecks it attacks
- Survivorship and late effects are neglected · Tens of millions of people live after cancer with heart damage, infertility, second cancers and fear, and few services.
- Fragmented care and guideline gaps · Patients fall between specialists, wait for referrals and often do not get the treatment guidelines say they should.