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    • #33166

      I think there are several things to be mindful of in having these conversations. As a mental health clinician, I would first allow the family to share about their experiences thus far regarding treatment in general, and then validate and empathize with them in their grief, anxiety, confusion, anger, etc.

      I would then ask the family to share with me what their goals are for the visit and then share with them what my goals are as a clinician. I would let them take the lead in terms of determining when information becomes too much, or if they become too emotional. I would give them the control of the direction of the discussion, while also encouraging timely discussions in the future due to the nature of fertility preservation.

      In terms of pre-pubertal conversations, I think there are some layers that warrant a more mindful approach. I think there is a huge grief component in these conversations- parents are making decisions for children that sometimes don’t even have language yet. The amount of pressure that places on them as parents is anxiety-provoking and scary. I think another component to be mindful of in having a conversation is the fact that parents are in survival mode, thinking of the day to day of treatment at this point, and they are being asked to think about their child’s future when they are old enough to become a parent (likely years from this moment). Thinking that far into the future could cause a lot of distress and conflicting emotion- as their child might not survive even the next year.

      I would be intentional about how I wrapped up the conversation as well. I would try to find the balance of holding on to hope while also remaining realistic. I would encourage them to lean on me as their mental health provider should any distress arise regarding fertility.

    • #33175

      I love the strategy of letting parents take the lead and giving them control of the direction of the discussion. Also, such a great point that they are in survival mode.

    • #33645
      Sally Lang

        You both focus on some very good points regarding how to start the conversation.  From a bedside nurse’s perspective, I have been privvy to some of the chaos and urgency that ensues when a child, especially an adolescent who has been stratified as high-risk.  I think this is where we tend to fall short of some successful conversations and gentle approaches in sensitive topics, such as fertility preservation.  There are times when we are up against the clock, and quick decisions must be made.  In those times, we don’t always have all of our resources available. I am pleased to be a part of this course to learn more about how to improve our implementation and provide some moments of pause to give the families time to process.

      • #33770

        i think these comments really highlight the importance of an interdisciplinary approach and that it doesnt have to be the same person having every conversation at the start of treatment. i appreciate sally’s perspective as a bedside nurse – that the chaos and urgency of the situation may not always leave clinicians in the best position to have a comprehensive discussion of fertility preservation – our resources as clinicians are limited too and the interdisciplinary approach allows space for us to lean on other clinicians (their expertise and their resources) to provide the best care for patients.

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