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      There are a multitude of strategies that can be utilized during these appointments.

      1. Prior to meeting with the patient/ family speak with the primary team to gage what information they have told the family regarding their treatment and how it would affect their future fertility. They typically have a general idea, but are not the specialists, so gaging what the family/ patient might already know about this is useful. Chemo, Radiation therapy, and surgery all have different affects depending on dosage and location.

      2. Prior to appointment also gage if there is a timeline in which if the patient is a candidate for cryopreservation (specifically females for oocyte preservation) as this process is lengthy (up to 2 weeks depending on body response). Depending on the type of cancer and when treatment needs to start as the specialist the family might have heard this can be done but there might not be time for it at the institution, so going in with deadlines in mind.

      3. While in the appointment observe and note the patient’s development status. There are instances where parents strongly advocate for this process for their child, but the the pre-pubertal children might not meet the qualifications, as well as the developmental delayed for their age. Also keep in mind emotional level while during appointment as this might mean a lot for the patient/ family but if they do not meet the qualifications they might need some space before you allow them to leave the area.

      4. While the parents will have a lot of questions and will be communicating with you make sure to engage the patient as well. This is their body and their choice. They have a right to consent to what treatment they want done regarding this aspect of their care.

      5. Always gage education level and ensure that you are using appropriate terminology. Open ended questions are wonderful, explaining thoroughly, handouts with information for reading at home/ re-education, or any appointment reminders (cryopreservation/banking)

      6. Tandem discussion with how the treatment they are going through and how each section could affect or could have affected their fertility helps keep the conversation clear. Fertility is a complex topic and is easy to get confused, so going through step by step is an easy way for discussion. (ex: the chemo could have affected you this way, the radiation could have affected you differently this way, etc.)

      7. If it seems like it is going to be an ethical issue conversation, or ends up diverting that way, use your resources and have your ethics team assist. You do not have to do this alone if you feel like it is not going right.

      These are some of the strategies have aided in my clinic that I see my onco-fertility patients.

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