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Background: Despite international evidence about fertility preservation (FP), several barriers still prevent the implementation of equitable FP practice. Currently, oncofertility competencies do not exist. The aim of this study was to develop an oncofertility competency framework that defines the key components of oncofertility care, develops a model for prioritizing service development, and defines the roles that health care professionals (HCPs) play. Materials and Method: A quantitative modified Delphi methodology was used to conduct two rounds of an electronic survey, querying and synthesizing opinions about statements regarding oncofertility care with HCPs and patient and family advocacy groups (PFAs) from 16 countries (12 high and 4 middle income). Statements included the roles of HCPs and priorities for service development care across ten domains (communication, oncofertility decision aids, age-appropriate care, referral pathways, documentation, oncofertility training, reproductive survivorship care and fertility-related psychosocial support, supportive care, and ethical frameworks) that represent 33 different elements of care. Results: The first questionnaire was completed by 457 participants (332 HCPs and 125 PFAs). One hundred and thirty-eight participants completed the second questionnaire (122 HCPs and 16 PFAs). Consensus was agreed on 108 oncofertility competencies and the roles HCPs should play in oncofertility care. A three-tier service development model is proposed, with gradual implementation of different components of care. A total of 92.8% of the 108 agreed competencies also had agreement between high and middle income participants. Conclusion: FP guidelines establish best practice but do not consider the skills and requirements to implement these guidelines. The competency framework gives HCPs and services a structure for the training of HCPs and implementation of care, as well as defining a model for prioritizing oncofertility service developm

BACKGROUND Fertility preservation (FP) is an important quality of life issue for cancer survivors of reproductive age. Despite the existence of broad international guidelines, the delivery of oncofertility care, particularly amongst paediatric, adolescent and young adult patients, remains a challenge for healthcare professionals (HCPs). The quality of oncofertility care is variable and the uptake and utilization of FP remains low. Available guidelines fall short in providing adequate detail on how oncofertility models of care (MOC) allow for the real-world application of guidelines by HCPs. OBJECTIVE AND RATIONALE The aim of this study was to systematically review the literature on the components of oncofertility care as defined by patient and clinician representatives, and identify the barriers, facilitators and challenges, so as to improve the implementation of oncofertility services. SEARCH METHODS A systematic scoping review was conducted on oncofertility MOC literature published in English between 2007 and 2016, relating to 10 domains of care identified through consumer research: communication, oncofertility decision aids, age-appropriate care, referral pathways, documentation, training, supportive care during treatment, reproductive care after cancer treatment, psychosocial support and ethical practice of oncofertility care. A wide range of electronic databases (CINAHL, Embase, PsycINFO, PubMed, AEIPT, Education Research Complete, ProQuest and VOCED) were searched in order to synthesize the evidence around delivery of oncofertility care. Related citations and reference lists were searched. The review was undertaken following registration (International prospective register of systematic reviews (PROSPERO) registration number CRD42017055837) and guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). OUTCOMES A total of 846 potentially relevant studies were identified after the removal of duplicates

In Australia, 2% of births occur in midwifery-led ‘birth centres’. Place of birth has been shown to impact safety of mothers and babies and is therefore an important public health issue. Research to date has presented methodological challenges and few large studies have examined morbidity and mortality. The purpose of this research is to assess the safety, relevance and sustainability of birth centre care for women and their babies in Australia.Three major studies were undertaken to inform health services policy and practice. Study 1 was a national survey of current characteristics and practices. A definition of a birth centre was developed and types identified. The current situation was compared to a previous study conducted ten years earlier, and showed birth centres to be more varied in terms of interventions and equipment available, but less common.Study 2 examined outcomes by intended place of birth using the National Perinatal Data Collection. It showed that most baby outcomes did not differ between the birth centre and a low-risk, term hospital comparison group. This study demonstrated limitations of national data, particularly regarding the availability and quality of data on maternal risk factors and morbidity. Study 3, using linked health data for New South Wales, is the first comprehensive, population-based study conducted in Australia to examine serious maternal and perinatal morbidity and mortality according to intended place of birth. The Study used a matched-pairs design to control more accurately for differences between women giving birth in birth centres and co-located labour wards. Results showed that maternal and perinatal morbidity and mortality did not significantly differ between the groups, or were significantly different in favour of birth centres: PPH (8.6% vs 10.6%), postpartum infection (1.0% vs 1.4%), admission to NICU/SCN (5.6% vs 8.3%), perinatal mortality (1.05 vs 1.44 per 1,000). These studies provide evidence that birth centres with

Objective: To compare the rate of serious adverse perinatal outcomes of term labour between private and public maternity hospitals in Australia. Design, setting and participants: A population-based study of 789 240 term singleton births in public and private hospitals in 2001-2004, using data from the National Perinatal Data Collection. Main outcome measures: Third- and fourth-degree perineal injury, requirement for high level of neonatal resuscitation, Apgar score < 7 at 5 minutes, admission to neonatal intensive care unit or special care nursery, and perinatal death. Results: 31.4% of the term singleton births occurred in private hospitals. After adjusting for maternal age, Indigenous status, parity, smoking status, diabetes, hypertension, remoteness of usual residence, and method of birth, the rates of all adverse outcomes studied were higher for public hospital births. For women, the adjusted odds ratio (AOR) for third- or fourth-degree perineal injury was 2.28 (95% CI, 2.16-2.40). For babies, the odds of a high level of resuscitation (AOR, 2.37; 95% CI, 2.17-2.59), low Apgar score (AOR, 1.75; 95% CI, 1.65-1.84), intensive care requirement (AOR, 1.48; 95% CI, 1.45-1.51) and perinatal death (AOR, 2.02; 95% CI, 1.78-2.29) were all higher in public hospitals. Conclusion: For women delivering a single baby at term in Australia, the prevalence of adverse perinatal outcomes is higher in public hospitals than in private hospitals.