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      What I enjoyed most about the psychologists’ approach in this case study was that it engaged the family into an open discussion in which the focus was providing them with information so that they could make an informed decision. As the father said, often times patients and families can feel pressured into making a decision they feel the clinical team wants them to make. Another common sentiment the father expressed (and a very common one) was that fertility was the family’s least concern in context of a cancer diagnosis. As a registered nurse who has done new diagnosis teaching with families, I’ve learned that patients and families can become overwhelmed, emotionally exerted, and have impaired ability to process information that is new, complex, or requires long explanations. Although I understand that there is urgency to start cancer treatment and decisions need to be made right away, I think it is important to give patients and families information in small segments. After the treating physician discusses fertility risks with the patient and family, an interdisciplinary team member should give the patient/family printed written material about the patients fertility preservation options and encourage the family to go over the materials. After a day or two, the subject can be touched on again, investigating how the patient/family feels about fertility preservation and encouraging the patient/family to ask questions they may have. In my own experience, I notice patients/parents are better prepared with questions and more engaged when they have had access to important information.

      Fertility preservation conversations should start off by acknowledging and validating the awkwardness AYA patients may feel having this conversation with their parents and members of the care team. However, the clinician should also emphasize the importance of participating in this conversation as our primary goal is to make sure the patient/family’s goals are supported and that they are collectively content with whatever decision is being made. Hopefully by this early on in the conversation, most AYA’s are able to vocalize whether this is a conversation they want to engage in or not, as some may feel so uncomfortable and overwhelmed that they may defer the decision to their parent/guardian. If the patient is receptive to receiving information about fertility preservation options, it is important to use anatomically correct terms, give time frames, and anticipatory guidance. In giving information to parents, it is important for clinicians to be transparent about the fact that testicular tissue cryopreservation is investigational and no guarantees can be made. While parents are left to consider long-term concepts (i.e. feasibility of testicular tissue cryopreservation), kids and adolescents usually want to know about short-term case scenario (e.g. how fast things will happen, what to expect in the process).

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