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    • #33191

      In speaking with patients and families about fertility preservation, I think I would use the following strategies:

      1. Depending on the age of the child, I would begin with asking if the parents want to speak first with the child in the room or outside of the room. I think it can make parents a little more comfortable hearing the information first.
      2. I would ask what the patient and family already have been told about fertility preservation.
      3. I think it is also important in that first visit to make sure to address that the goal is to provide information so that the patient/family can make an informed decision for what is right for them.
    • #33232

      These are all great ideas.  I agree with you, when dealing with a younger child, assessing whether they would like the discussion to be had with parents first is a good idea.  I have found that often parents want to have the information first to process it and then discussion can be had together about how to proceed with discussing with the child.  They know their child best and it’s important to recognize this.

    • #33249

      One of the most important things to remember when you are starting off a conversation regarding fertility preservation for parents and pre-pubertal children is how overwhelmed they might be. A cancer diagnosis in itself is already information overload. When discussing fertility preservation, I think it is super important to ask the family what they know already so that you can have a baseline of their understanding. It is also super important to remember how challenging and awkward it might be for the pre-pubertal child to have their family present for the conversation. As healthcare providers, we need to advocate for our patients and families in this area because a lot of the times, they are so overwhelmed by other information, they might now be thinking of family planning or the importance of it at this age, but later down the line they will.

      Strategies that would be beneficial when these conversations are being held are:

      Offer to speak with the parents first prior to including the child into the conversation. Some parents might feel more comfortable knowing the information that will be discussed before their child hears it. Their child may not know very much about this topic, so it is important for the parents to be informed.

      Providing written material and information is also a great option. As patients and families are on information overload, the conversation might go in one ear and out the other. Providing them with materials to revisit is a great opportunity to make sure they know their options.

      Asking open ended questions is also beneficial to make sure that the patient and family are able to have all of their questions answered as well as the healthcare professional to have an idea of what their understanding is and what areas they still might need some guidance and education about.

    • #33258

      Something else to consider is how much education a pediatric patient and even his/her parents need in regards to normal reproduction. My patient population is AYA 18-39 and I am finding not everyone understands normal reproduction. It is a good idea to assess this understanding in order to know where to begin with how cancer treatment alters these normal functions. And why fertility preservation is important to be discussed prior to starting treatment.

      • #33263

        Margaret, this is such an important consideration to take when initiating these conversations. Assessing what patients and families do or do not understand is critical.

      • #33264
        Emily Cotton

          I agree that assessing basic reproductive health literacy is essential. This can come up in many populations, including immigrant populations. Very important.

      • #33281

        I agree with Margaret that we need to first consider how much education the patient and family will require prior to beginning these difficult discussions. As nurses, we always need to gather how much knowledge the patient/family has about the topic prior to going deeper with new education. I also agree with Emily, that this can be an even bigger issue with immigrant populations and people that do not speak the same language. We have also run into problems where the interpreters that we use for some of the languages that are not as common will be speaking a different dialect when interpreting. Families are already overwhelmed and sometimes do not feel confident enough or do not want to be a burden so they do not speak up that they are not completely understanding. Always important to get good background information about education levels and assess how the patient/family are feeling prior to starting any type of new education.

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