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    • #33276
      James Klosky

        When working with minors, you occasionally run into situations in which divorced parents have different desires regarding fertility preservation. How would you change or adapt the clinical encounter when parents disagree on whether their child should move forward with sperm banking?

      • #33321

        I don’t have a lot of experience with AYA and can’t offer any new information, but I think this an important question! Whenever family members disagree, trying to find the common ground between all parties can be tricky. Ultimately it is the patient’s decision that is considered the final word on whatever the disagreement, but when that patient is a child, the lines can be gray.

      • #33322

        This is a very necessary question and I do believe should be addressed. In a situation like this one, I think both parents need to be reminded that the choice for fertility preservation in a child will impact the child regardless whether they disagree on the topic or not. Ultimately, making the choice for fertility preservation (of course along with considering the child’s response) should focus on the fact that when the child reaches the age to make their own decisions and can make educated choices for themselves, having to choose to have their own family would only be possible if fertility preservation happens. I do believe that should be a part of the treatment plan for their future and survivorship. If the disagreement between parents is hostile, an ethics consult may be a possibility so the focus remains on what is best for the patient over the moral disagreement of the parents.

      • #33336

        I think it would be important to understand the factors impacting each parent and the teen’s decision-making for whether to proceed with sperm banking or not. It’s possible that each person has different misconceptions, fears, priorities, or other considerations that need to be explored in a safe space first in order to ultimately do what is in the best interest of the teen and the family so that all aspects of the family system can feel confident in an ultimate decision. There is a risk for hurt, resentment, and regret if there is not an opportunity to cohesively come to a decision. Depending on family structure and communication patterns, that may mean meeting separately one-on-one with each parent and independently with the teen to understand their preferences as well as their perceived benefits, burdens (or perceived pros/cons) of choosing to move forward with sperm banking or not. Once an understanding of each person’s priorities and values related to fertility preservation are explored, and any misconceptions or barriers (such as cost) are addressed, a joint conversation may be possible that respects each individual and helps a family ultimately make a decision that everyone is comfortable with.

      • #33337

        Communication barriers with divorced parents can be hard to navigate. This is even more difficult when you have a patient that is below age or developmentally not appropriate for assent. Then you add another factor that time is not always a luxury available when these medical decisions need made. In my experience we have had to really rely on multi person approach. Social work has been a very good resource for follow up discussions after the physician presents the medical component of fertility preservation. Social work and the care team can help the family sort through facts, weigh the risks and benefits and keep the discussion focused on the common goal of making the best decision for the child. Including both parents in all discussions can also help even if this means patching a parent into a phone call while the other parent is at the patient bedside.

      • #33367

        Assent is necessary for a child 7+ years of age, even with consent by the parents.  Family dynamics and maturity level of the teen will definitely factor into the decision. There is typically not a large window of time to debate. Attempting to better understand each parent’s reasoning and also giving the patient a voice in the discussion would be important. If the patient is uncomfortable speaking with the parents’ present, it may be good practice to ask the parents to step out of the room so the patient can feel free to speak his mind. Depending on family dynamics, the patient may not want to contradict one parent over the other and it will be important to stress to the parents that the goal is to provide the patient with the best option possible that align with his goals for his future. If an agreement cannot be reached, it may be necessary to bring in the Bioethics Committee to help navigate what is in the best interest for the patient.

      • #33388

        This is an important topic and i think a difficult one to navigate. I think it would be important to provide the same information to both parents, ideally at the same time and allow the space for them to disagree so long as it is done civilly. Depending what the family’s communication patterns are, the family dynamic, and patient’s age, I may need to speak with each parent and the patient separately thereafter to learn more about their goals with addressing fertility concerns. From my understanding, if both parents share custody, only one parent would need to consent to fertility preservation and the patient provide assent to any procedure needed. If the patient is mature and cognitively able to make informed decisions about fertility preservations, i would focus on what the patient’s goals are with the parents and again allow space for disagreement. If treatment is being postponed due to fertility preservation disagreements I would consider consulting with the ethics team for another perspective

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