Module 3 Discussion

Topic: The egg retrieval process

Some female patients may be interested in fertility preservation options such as egg retrieval and have questions about the process. Watch as Fertility Nurse Specialist discusses the process of egg retrieval with a breast cancer patient, Susan. If you did not have an in-depth knowledge of the egg retrieval, how would you answer questions about the process?

145 Comments

  1. Eileen Seltzer

    That was helpful explanation of the process. I can see that it could be very overwhelming for people to try to absorb all of the information especially while still absorbing their cancer diagnosis. Introducing the topic of fertility preservation early is important.

    1. Cory Elmore

      Eileen,

      i agree that introducing the topic of fertility preservation is very important. I feel that timing is essential in doing so and I feel that the earlier post-diagnosis a patient can get the ball rolling with fertility preservation, the better.

    2. Annie Huhnerkoch

      I agree – I especially appreciated that she paused and allowed the patient to ask those questions and answered in detail before moving. It would be overwhelming to try to absorb all that info and I think it was helpful she explained some info multiple times.

      1. Rose Miller

        I agree, I like the Fertility Specialist relaxed presentation. She had a calm reassuring presence that I believe help make this young patient feel more at ease to ask likely some very sensitive questions.

        1. Whitney Hadley

          Rose – I thought the same thing! I think having a more relaxed approach helps this kind of conversation flow better and feel less intimidating from the patient’s side as well. I think it also helps patients feel more comfortable if they do have questions they are able to ask them

        2. Sommer Brannan

          Rose, I completely agree about her demeanor and how calmly she approached the topic. She used terms that were appropriate to describe the procedures that can be reassuring for a young adult patient. I liked how the physician used the use of transitioning from one step of the procedure to the next by asking the patient if she had any questions. I can see how the thought of egg retrieval especially after getting a cancer diagnosis could be very overwhelming, but the physicians approach really made it seem like an easy process and that she wasn’t going to have to delay her treatment.

    3. Fred Wilkinson

      Yes, it is a lot of information. While sensitive information, I wonder about encouraging a person to bring a partner (if they have one) or another loved one to help listen and ask questions.

      1. Loraine LLanes

        I agreed will all the comments above. It is a lot of information the Fertility Nurse Specialist is sharing with tha patien. She is expressing some tension, probably because of the doubts she had, but probably too because of the nature of the information she is absorbing during the interview. This information is very detailed and it demads having a basic knowledge about the female biology to be well understood. That is why I think it is so important, to give multiple spaces in the process of communication to express doubts, but to explore possible fears too. Even when the stimulating and the eggs retrieval process is less invasive than other medical procedures, it is too. And the patient could have fears, for example, about feeling pain, about the recovery process after anestessia, and so on. That is why I agree with Fred that for the better understading of this sensitive information, and for the decission process of doing or not this procedure before the cancer treatment, it is important to encourage the patient to bring a partner or a significant person for her. Social and emotional support is one of the main aspect for the success of any stage of the health care services, specially during making decission.

        1. Amy Thompson

          This video was very insightful and demonstrates how complex a discussion it is. The Fertility Nurse Specialist was very calm and maintained a confident and caring demeanor necessary for this type of sensitive discussion. It is evident that the patient is trying to absorb all that she is hearing, which is no doubt very difficult to do. I agree that this type of a discussion would be best with a partner present and most likely will need to happen in two parts or with a follow up session to address lingering questions. There is a lot for the patient to absorb, yet it is imperative that she is getting the accurate information she needs to help her make an educated decision.

      2. Angelica Rodriguez

        Agree. Another presentation such as a video on her desktop would have been helpful. Hopefully she was discharged with a summary of the education provided. Otherwise, it was very informative. I actually had no idea aromatase inhibitors such as letrozole were given during the hormone injection period.

    4. Ashley Van Hill

      I agree, I like the way the provider approached this topic in this particular case. It is so important to allow the patient time to think about what is being said and formulate questions. I think this video also provided us with a good idea of how to begin a challenging discussion.

    5. Caroline Dorfmam

      I agree! I think she did a fantastic job using language that would be easy for a patient to understand. This can be an overwhelming topic for patients, and the pace she used to provide this information was also really helpful.

  2. Cory Elmore

    This Fertility Nurse Specialist did an outstanding job of describing the process to the patient step by step. She detailed to side effect profiles of all of the procedures and highlighted the patient experience as well. She was very thorough and easy to follow. However, I do feel that the FNS could have taken a bit more time to assess the emotional and psychological state of the patient. The patient was clearly nervous AEB her facial expressions and continuous wringing of her hands. I feel that more thoroughly assessing the pt’s emotional state and evaluating her feelings would have made the conversation a bit more holistic. Nevertheless, I do feel that the FNS did a wonderful job.

    1. Lacey Ballew

      I like your observation on the conversation Cory. The FNS seems approachable and like the video in Module 2, you can tell the body language doesn’t match up for the patient. The module lecture hones in on patient-centered and holistic care. To have the psycho-social history and religious affiliation known prior might help with options and if patient is able to consider them. I also wonder what the setting of the clinic is and if Ethical Religious Directives would play a role in the conversation.

    2. Stacy Sanford

      I agree the pts body language suggested she might need to slow down a bit and process with her

    3. Erin Donnelly

      I totally agree with you Cory.

    4. Rose Miller

      Excellent points. Very well said.

    5. Tamar Tenenbaum

      I agree with Cory’s points as well. The FNS did a fantastic job relaying information, but this patient was obviously feeling anxious and possibly not processing the information in full. I think by assessing her emotional state by asking some open ended questions, could possibly help ease some of the anxiety and allow the patient to take in more of the information and education being provided.

  3. Renee Martinez-Epperson

    I noticed through the duration of this video, the patient appeared to be very anxiety moving her hands, facial expressions and deep breaths. At the end of the appointment, I feel this would have been the perfect time to introduce the role of the Clinical Social Worker. The RN did a wonderful job explaining but for a visual learner she could have offered handouts, showed visuals, played a video etc.

    1. Leah Clark

      Yes, the addition of written or visuals would have been very helpful. The patient asked very good questions despite her observed level of anxiety.

      1. Mary Williams

        That was my first thought…having a handout with pictures, steps reiterating what she was saying would be a great addition. I’m definitely a visual learner.

      2. Evelyn Joran-Thiel

        Yes, I also echo the need for visuals, a sample calendar would be helpful and handouts.

    2. Lacey Ballew

      I agree that a video would be great! You can tell that the patient starts to lose focus on minute 3:22.

    3. Laura Petiya

      I actually will do drawing for patients. Sometimes it helps to see it visually even if this is not how you learn best. I think it also allows the patient to have references at home. Google is nice, but can sometimes give the wrong information. Each fertility program is set up differently and searching on the internet can add to the confusion.

      1. Marissa Fors

        That sounds great to do drawings while describing the procedure. What a creative way to help the patient be able to absorb and understand the information better. Visuals in various forms can be a wonderful tool to help educate patients that are more visual learners.

      2. Loraine LLanes

        I agree with my partners above that sharing some other type of written or visual information could help to the better understanding of the information. But it is crucial too, to adapt this information to the cultural and the instruction context of the patient, exploring her possible fears and other barriers that could obstacle her comprenhension.

      3. Mary Williams

        I agree, we have a laminated double-sided document with female anatomy in each of our exam rooms which we frequently reference with each patient encounter.

    4. Joanna Patten

      I agree that she did a wonderful job going slowly and explaining the procedures at length. I also agree with others who observed the patient appearing quite nervous and thinking it might have been helpful for the RN to check in to see how the patient was feeling about hearing all of this information.

      1. Kathy Bugge

        As others have shared, I agree about the patient’s body language giving pause to reflect, as well as having written, and/or videos to share (either at this time, or at the end of the discussion), to supplement and reinforce the significant information presented.

    5. Kathleen Hinkle

      I totally agree with you, Renee. My first thought watching this FNS was that she didn’t assess how the patient learns best. If Susan is a visual learner, some type of diagram or model would have been an excellent tool.

    6. Angela Luna

      Great idea — it could be a great segue into the introduction of the role of the clinical social worker as someone who could help with decision-making process and talk about all the feelings that this conversation will inevitably elicit!

  4. Helen Tackitt

    I think the FNS did a great job at explaining the process. To answer the question about how I would explain the process with out an in depth knowledge; I would not have this conversation without knowing about the procedure. Having a conversation like this without knowing in depth about the process would make the patient even more nervous. I would take the time to see the process and learn as much as possible before attempting this conversation. I would also make sure I had someone who knew the process who could sit in for the first few conversations I had until I felt comfortable.

    1. Laura Petiya

      Helen, I agree. This is too important a conversation to have with a patient without an in depth knowledge of how it works and what to expect to properly prepare a patient.

    2. Raquel Begelman

      I agree that the FNS did a great job as well. She was informative and knowledgeable about the patient’s case. She knew that the patient was post surgical and gave her a timeline that was feasible for her before the start of chemotherapy.

    3. Kathleen Hinkle

      Great points, Helen. If I did not have in-depth knowledge of egg retrieval, I would not attempt to have this conversation with the patient. Coming across as uncertain or misinformed, or providing inaccurate information would have a negative impact for the patient, for sure. It’s important to know our limitations. I would tell the patient that I will refer them to someone with more knowledge who can explain the process more thoroughly. Being able to sit in on an expert having this discussion with a patient would be a great way to learn. I’d also find current research-based articles to expand my knowledge.

  5. Leah Clark

    I can see how this would be very overwhelming for a patient who is dealing with a cancer diagnosis and pressure to start treatment as soon as possible. It seems that if the patient agrees, it would be a good idea to have a supportive friend or family member there for this discussion – not only for support but to help ask questions.

    1. Anna DeVine

      I agree that having another person there with the patient could be very beneficial. Sometimes we only hear half of what is being said, I cannot imagine how little is actually heard during such a traumatic time. Even an opportunity to record the conversation, or a suggestion of taking notes might be helpful. At the same time, this is a very intimate, sensitive topic, so I can also understand that the patient might not want someone there with them. If she has a spouse, that might be a good option But mom, sister or best buddy would work too. Support is incredibly comforting and helpful at this time.

    2. Leigh Hart

      I think this is a great point. Having an advocate with every patient can always offer a support system throughout the medical journey

      1. Vicky Wood

        Having an advocate or someone else present to take notes would be helpful because of the shock related to the new diagnoses. At VHC where I work, during the admission history, we encourage patients to designate someone as a second learner. City of Hope, in their Comfort Communication seminars, recommends a second set of ears stating patients don’t hear or remember much due to the stress of the diagnoses/prognosis.

  6. Lacey Ballew

    Overall, I ultimately agree with Helen that it would be unprofessional to hold this conversation without the proper training. The title of the nurse is “Fertility Nurse Specialist”. I wonder what the training background would require and refer the patient to the appropriate specialist with the required training.

  7. Angela Nicholson

    I don’t think you could answer questions if you did not have an in-depth knowledge of the IVF process. I think this step in the process of decision making is important for a lot of patients as they can get some of their questions answered prior to meeting with an REI. I agree the patient is visibly nervous, but at the end of the discussion the FNS did a great job at giving space for questions.

  8. Tomoko Tsukamoto

    The Fertility Nurse Specialist did an excellent job explaining the process. I am a visual person, and seeing the process in pictures would help me understand the steps better. If I didn’t have anan in-depth knowledge of the egg retrieval, I would inform the patient that when she goes to the REI for fertility preservation consultation, the providers and staff will explain the procedure step-by-step in detail and will answer all the questions the patient would have before she needs to make any decisions.

    1. Stacy Geisert

      Tomoko,

      As you said, I think it is important to not share information regarding the egg retrieval process if you are unfamiliar or not sure of the specifics of the procedure. I think a helpful approach would be to have some key pamphlets and reading resources on hand to provide the patient and/or family with. Perhaps it would be worthwhile to work with a fertility specialist or reproductive endocrinologist to see what materials and resources they would recommend providing the patient with in the event that they had questions prior to their consultation or appointment.

    2. Rebecca DiPatri

      I agree, Tomoko. I think simple visual aids would probably be beneficial, as the patient is receiving complex information. I very much appreciated the FNS approach. She was knowledge and able to introduce a general overview of what to expect with egg retrieval. I felt like she wasn’t in a rush to discuss this important topic with patient. It was her job to introduce the topic of the egg retrieval process and the patient would still continue on to a meeting to discuss specific details with the reproductive endocrinologist.

    3. Vicky Wood

      I agree giving written information and using a few diagrams would reinforce understanding and giving patients an opportunity to ask questions is important. I really appreciated when the counselor explained the time frame and ensured the patient that there was time to complete the egg retrieval without interfering with the timing of her chemo. I also liked that she was honest about the lack of research to prove the safe use of hormones use and that there was a potential negative risk. Honesty is important in building trust and in obtaining informed consent.

  9. Laura Petiya

    It would be extremely difficult to have this type of discussion with a patient without having a lot of knowledge about IVF.

    I do think the FNS did a a good job of explaining. It is overwhelming to hear a cancer diagnosis and then more overwhelming to learn your fertility may be affected by the cancer treatment.

    There is one thing the FNS repeated several times that is actually not true, however. We do not necessarily wait for a period before starting this process. We do what is called “Random Start” which allows us to start the stimulation process in most cases the day the patient comes for their consultation if they are ready to begin and know they want to freeze eggs or embryos.

    There also wasn’t a discussion about the patient having a partner or not. The FNS mentioned she has a 2 year old. If she has a partner, it would be best to include him or her in the discussion and to briefly touch on the slight differences between egg and embryo freezing.

    1. Sarah Vogel

      Laura, you made great points! I especially appreciated your insight about the fact that stimulation can start any time for these patients (I didn’t know that!) and the idea to involve her partner if he is in the picture. That would be super helpful as he will have an important role if freezing embryos is their plan.

    2. Shanna Logan

      good points!

    3. Melanie Baker

      Laura, I agree with your point about bringing a partner into the conversation. Someone else in the thread above had also mentioned that having a second person may have also helped with retaining the needed information. Thank you additional for sharing your knowledge about the timing of stimulation.

      1. Jean Melby

        While a two year old was mentioned, we do not know if the patient is married. If so, her spouse would need to be present at least when consents are signed as the resulting embryos will be his/hers as well. The future use/disposition of those embryos will have future legal implications. In this case, I am assuming this was a first visit, meant to review and discuss options in general.

  10. Marissa Fors

    I agree that the information provided was very thorough and she took the time to explain everything in a caring manner. This is a lot of information to take in and the young patient does look overwhelmed already. She is facing a diagnosis of breast cancer and is now trying to understand her fertility options. I would like to check in with her often in this discussion to assess how she is feeling and her comfort level of the information. I would also like to follow up with a written explanation/education material on what was discussed as it could be very difficult to remember everything, especially if the patient is already nervous, anxious, or scared.

  11. Stacy Sanford

    The nurse did an excellent job explaining the procedures. However,
    she did present quite a lot of detailed information before pausing to ask if the patient had questions. I think pausing to checking in more frequently with the patient would be preferred in a real life scenario. Additionally, the patient was sending obvious nonverbal queue’s that she was anxious which might need to be addressed and could have resulted in suboptimal receipt of the education provided.

    1. Shanna Logan

      agree with this Stacy. I also wonder about how the patient would be able to retain all this information when clearly stressed

      1. Loraine LLanes

        Me too Shanna!!!! It could be very difficult for the patient to retain so much specific information about a fertility retrieval procedure, in the context of having had a breast surgery 10 days ago, of facing a soon quimotherapy treatment, and specially in the context of facing a diagnosis of cancer, that is usually very impacting. I agree tha the Fertility Nurse Specialist has a very good knowledge about the procedure and that he explained it the patient in a clear and a supportive way, but I agree too that it was maiby much information for the patient considering her situation and probable emotional state.

    2. Anastasia Brown

      I absolutely agree. While the RN did a wonderful job explaining the information it was very content heavy and the patient was becoming overwhelmed. Having an advocate in the room to take notes, either a personal relation or member of the healthcare team, along with some visual demonstrations and information for the patient to take home would have been beneficial.

  12. Alisa Barber

    This FNS did a great job explaining step by step but it was to much information at one time. I have had this conversation many times with patients and they are so overwhelmed with just going over medications and scheduling. The other thing is using layman terms, some of this information could be a little to descriptive depending on the age and understanding of the patient. As people have said above, these patients are already overwhelmed with their cancer diagnosis and now they are being overwhelmed with another process.

  13. Sarah Vogel

    Overall, I was impressed by the nurse’s ability to explain the process and answer the patient’s questions. I appreciated when she stopped halfway through to check in with the patient and what questions she had. It probably would have been helpful to ask what the patient knew ahead of time or if she had any immediate concerns/questions before the nurse explained everything. I’ve found that patients/families often come in with a particular question or concern and can’t really focus on what I’m saying until I answer that specific concern. So, for example, if this patient was concerned the entire time about what the hormones might mean for her cancer diagnosis, she may have missed the entire discussion up to that point thinking that it’s a useless discussion given that she has an estrogen sensitive cancer.

    1. Kathy Bugge

      Sarah, that is a great point, and one I have observed also: patients who have a particular item of concern, that can cloud out other issues (even if they ‘appear’ to be listening, or are waiting for that item to be mentioned. That is good to ask, prior to starting on a prepared educational piece.

    2. Amy Thompson

      Sarah, you make such a great point about assessing her initial questions to ensure she can fully focus on the discussion. I realize that we get focused in our individual roles and have so much to cover with patient that we may “over-educate” at times. Such a delicate balance in healthcare, where there is so much to cover in a set period of time.

  14. Shanna Logan

    The nurse has such a lovely manner about her, speaking clearly and slowly, describing the process in medical terms and following up with examples of what the procedures may feel or look like. She has a lovely warmth about her. A lovely balance of medical information with a kind approach. It is such a lot of information for patients to take in at once. I liked that the nurse asked if the patient had any questions, perhaps she could have stopped at a sooner point to ensure that the patient had understood. It is clear that the patient is very nervous, as others have noted. Written information to take with her would be beneficial so that she could continue to absorb the process.

    1. Iam Scott

      I agree with what has been said about the nurse’s calm demeanor and yet it is still a lot for the patient to absorb. While she did stop at the 5:00 minute mark to see if there were questions (and this could have been done a bit earlier), I think it would also be worthwhile to ask how the patient is feeling and coping with the information. The patient appears understandably nervous, so I think it would be worth balancing the technical discussion with more emotional support.

  15. Thresa Jean Mayr

    If I did not have in-depth knowledge of the egg retrieval process, I would explain to the patient that I would be happy to facilitate a meeting a fertility specialist in hopes she can get accurate information. I believe the FNS in this video did a great job describing the process but am in agreement with the majority of the posts that she failed to read the patient’s body language to pause and assess her level of understanding before continuing on with such detailed information.

  16. Michelle Bronzo

    I think that it would be extremely challenging to explain the intricacies of the IVF process without extensive training or a medical background, however I would be comfortable painting a picture of the process in broad strokes and then referring them to a reproductive endocrinologist to go into all of the details/ answer questions. You could tell that she was very anxious, and sometimes having too much information is very anxiety provoking.

  17. VichinsartvichaiP

    Wonderful counseling. The fertility nurse made all the procedure very clear and she’s very knowledgeable with just the right amount input for the half-scared patient.

    1. Jill West

      I definitely agree. It’s a difficult balance between making sure all the information gets covered and making sure the patient’s emotional needs are addressed.

      1. Loraine LLanes

        I completely agree with Jill. This kind of balance between the provided information and the emotional needs of the patient is very delicated. So one usefull strategy, besides an in depth interview with the patient preferibly prior to share this fertility procedure information, is to dosify it, to plann different encounters to be sure that the shared information is been well undertood and to give the opportunity to the patient to process and contrast it with other sources.

  18. Kathleen Hinkle

    I agree with many of the comments that this FNS was extremely knowledgeable and provided lots of excellent information. However, the patient was obviously anxious (taking several deep breaths, fidgeting, wringing her hands, etc.). It might have been nice to stop briefly and acknowledge Susan’s feelings. Also, taking more breaks in the conversation to allow for questions would have been helpful since there was so much information to cover.

  19. Danielle Rogers

    The video was very detailed and provided a thorough explanation of the process of egg retrieval. However, I could not help but notice the patient seemed anxious. I know a diagnosis at such a young age and trying to sort out all of her options can feel overwhelming. I do like how the CNS did ask her about questions, but i feel she should have given her opportunity to ask questions earlier into the conversation. I find if patients are preoccupied with a concern and are unable to ask the question sooner they may not be as focused on what the rest of the conversation is about. Maybe if the CNS was sitting at a couch and had some visual aids for the patient it might have helped some as well. But overall, i did enjoy the video. Very informative as far as technique and procedures required for egg retrieval.

    1. Jill West

      Hi Danielle. Seems like many others have noticed the patient’s anxiety; I certainly did, too! I appreciate that the FNS seemed to stay calm and address the material that needed to cover in an informative and matter-of-fact way, but hope that she acknowledged the patient’s anxiety if we were to have seen the rest of the conversation. I think it is natural to feel anxious when taking in all of the information, so as I am having simliar conversations with patients, I will try to balance making sure the information gets communicated while also validating, acknowledging, and addressing the patient’s emotions.

      1. Kim Keely

        Yes I agree to all that has been said. I think it is common and natural for patients to be nervous the first time we cover a new topic like treatment or fertility preservation. Hopefully, this patient goes home with written information about what they covered, hears it again when she meets with the physician, and gets a card with the phrase that many of us use with patients- “Please call me with any and all questions as they come up. That’s what I hear for!”. Repetition is our friend :).

  20. Jill West

    One thing that I noticed from reviewing this video and from reviewing the slides for this week is that the options for patients with cancer and the options for any woman with infertility issues for any reason are probably 80% the same. For instance, in this video, the only thing that seems to differ from anyone else with infertility is the medication that is taken to keep the estrogen level from getting too high. I wonder if explicitly telling AYA patients this piece of information would help to normalize the process to some degree. The process of going through infertility treatment and weighing different options is undoubtedly anxiety-provoking and challenging, but having the context that many women, not just those with cancer, are going through something simliar could lessen some of that anxiety. It could also potentially expand the network of women with whom AYA patients feel comfortable relying for social support, because the process is largely the same.

  21. Anna DeVine

    I agree the FNS did a good job with her explanation. I like all of the comments about the best learning style for Susan. I know that at our facility, we ask the question about learning style during every admission, but after watching this and truly considering the effects, I think I will pay more attention to the learning styles and adapt my discussion and education accordingly. I think there are so many options, from videos, to podcasts, pamphlets, group opportunities for basic education, one on one options, discussion boards… truly a plethora of choices to assist these patients at such a devastating time in their lives.

    1. Ashley Flynn

      I agree, Anna. While I was watching the video, I was thinking about how helpful images or videos would be while she is explaining the surgeries/procedures.

      1. Alexandra Huffman

        Fully agree on need to assess and customize education to patient’s learning style. The patient’s questions were focused on the efficacy of her cancer treatment and potential impact of FP on her treatment. She is giving information on her goals and focus, and I think a mental health professional could be another good resource along with a support group or peer support.

    2. Erin Donnelly

      Laura: I do drawings too! I also enjoy giving handouts as well. Most patients walk-out of the office after a new patient visit in a daze. By making them a packet with applicable Pt info sheets/step by step instructions/handbook etc… it allows them to revisit all of the information in bite size pieces once they’ve had a chance to get home & “relax”. Also; I encourage them to call me directly prior to their next visit should they have any questions that come-up after reviewing everything.
      I feel continuity of care is also really important & goes a long way with this population.

  22. Amber Lamoreaux

    This was explained so much better than it was explained to me when I went through the egg retrieval process. I believe that had I had some of this information, even though it might have been overwhelming at the time, it would have put me at greater ease since I would know what was going to happen. The way she explained the process was clear within being overly technical/ medical but still included the important terms that need to be understood to truly know what is going to happen.

    1. Lisa Cummings

      Thank you for sharing. I am sorry that you had to go through this process and I hope the outcome was what you desired. I have had no experience with the egg retrieval process. As as professional, I might have only equated the egg retrieval process as exciting and joyful for the patient since it is for something very positive in the future, I would not have necessarily thought about the fear or overwhelming nature of the process for the patient. It does make sense that it could be overwhelming, especially when combined with the cancer diagnosis. Thank you for sharing that simple education as outlined above would have helped decreased your anxiety. Fear of the unknown is often worse than fear of the known.

  23. Ashley Flynn

    If you did not have a lot of knowledge surrounding in vitro fertilization and the egg retrieval process, it would be very difficult to speak with a patient regarding these processes and procedures. In fact, I think it is important to admit that you do not know details about the process, but will have another team member speak with the patient.
    I believe it is important to have some very basic knowledge of the process, however, and state that the reproductive endocrinologist could answer questions more in depth.

    1. Lacey Ballew

      I like your approach Ashley on first admitting you don’t know and then refer to the correct source.

      1. Raquel Begelman

        Alway having a patient baseline understanding is a great thing!
        I alway ask my patients What do you thing is going to happen …with Chemotherapy…or Bone marrow biopsy? They can alway tell me what the doctor said and then I fill in the blanks on how to do it.

        But the video was very informative for me as well…. I watched it twice!

  24. Stacy Geisert

    This was a very thorough description of the entire egg retrieval process and I believe the FNS did a great job answering all of the patient’s questions. I, however, would not be able to share this insightful information with a patient if I had the opportunity simply for lack of knowledge. That being said, I would make let the patient know that I would not want to provide them with any incorrect information so it would be best to speak to a specialist. However, if a specialist were not available to speak to them at that point in time, I would do my best to provide the patient and/or family with reputable resources regarding the process and whatever questions they might have.

    1. Melanie Hericks

      I think that this is spot on. I agree that I personally would not have been able to present the information like the FNS either. However, like you pointed out, if a specialist isn’t available, it would be appropriate to let the patient know that and to make sure resources are given out and referrals to the right people are made.

  25. Fred Wilkinson

    I work at a pediatric hospital wonder how different this conversation would look with a teen or younger adult.

    1. Kelley Johnson

      Hey Fred, I work in pediatrics as well and I don’t think it has to be any different. I think you need to approach the conversation a little differently in terms of parental involvement and appropriate language, but I think every woman as a teen, and especially a younger adult, has the right to be fully informed.

      1. Fred Wilkinson

        Thanks Kelley. I completely agree that they need to be fully informed. I just wondered if the provider would have used any different language or visuals, and how she would have included parents or partner.

        1. Stacy Geisert

          Fred,

          I agree that visual tools would be a great resource in guiding these discussions with both adolescents and young adults. I also think that, as Kelley mentions, the conversation would look different based on who is present for the discussion and any consents required. It is also imperative to make sure to tailor the conversation to the patient’s and or family’s desires and wishes. The patient may not want in-depth details about the egg retrieval at this time. However, perhaps the family would like these details so they can help their child understand if they do have questions regarding the process in the future. I think this brings up another great point about always keeping the conversation about fertility and family building options ongoing as a patient’s perspective may change at any moment.

        2. Patricia Sullivan

          It can be such a challenge to discuss with adolescents who either want to discuss but parents do not want to discuss or parents are interested and patient is not ready.

    2. Giselle Perez

      This is exactly what was going through my mind, Fred. I find myself struggling with envisioning what this conversation would look like with someone who was younger, who hasn’t had any children, or who comes from a different cultural background…

  26. Lisa Cummings

    The question asked how I would address the question regarding egg retrieval if I did not have an in-depth understanding. The truth is that I do not have an in-depth understanding. In fact, the conversation above was very informative and taught me much that I did not know, This was the basic introductory information that would be given to a patient, not a professional that plans to educate patients. Providing information without having a strong background in the subject would not be advised.

    I know my limitations. I would make a referral to a fertility clinic. They in-turn can answer the questions appropriately and completely. They would also have the in-depth knowledge to tailor the answers to the patient’s specific needs.

    I would ensure that the fertility clinic would be able to contact the patient within a suitable time fame. I would ensure the patient had the information to reach out to the clinic in the event the clinic did not reach out to the patient as promised. I would reassure the patient that it would be best to receive the information from the experts. I would follow up to ensure that my patient received the counseling that they desired.

    1. Christina Wilson

      Lisa,
      I agree. I think knowing ones limitations as a provider is very important. These are individuals who make decisions on information and discussions with us as healthcare providers. It is our duty to understand our limits and areas of speciality, If we are unsure of how to answer a patient question we should be honest, and provide them with the resources/referrals to make an informed decision.

    2. Sara Soares

      Lisa, I completely understand where you are coming from…I too have no knowledge of this process and also found the video quite informative. I would not feel comfortable answering questions or teaching a patient about this process at all. I would have to call in the experts; possibly set up the appointment time and provide encouragement to the patient at this very overwhelming time in their live.

  27. Christina Wilson

    Fortunately, as a Women’s Health Nurse Practitioner, I do have some understanding of the egg retrieval process; however, this is very in depth, and I don’t know if I would have explained it as in depth as the nurse in the video. Since this video provided a substantial amount of in depth knowledge, I was very appreciative of it. If I was the provider in the room with the patient and she asked some questions that I was unsure of the answer to, I would first, tell her honestly, that I am not sure of the answer to the question, and I that I would be happy to find out more, and get back to her. I believe one needs to know their limits, and not overreach. As a provider, providing accurate and honest information is crucial to patients to make an informed decision. I also could ensure that if she did want to proceed with the procedure, that during the referral, all of her questions were answered at the visit. One other option, is a team meeting (depending on availability and coordination of schedules) with the patient and her team of providers (oncology, REI, etc.).

  28. Shannon Patterson

    I appreciate the numerous comments that draw attention to the patient’s body language. Many have noted that she looks anxious, and that the nurse in the video could have done a bit more to address this, perhaps assessing the patient’s readiness to hear the information that was presented in great detail. She might have also paused to acknowledge the patient’s discomfort, and checked in. As a psychologist in a primary care setting, I’m aware that medical professionals have varying degrees of comfort with patients’ emotional distress. This might have been an appropriate time to offer mental health services for an additional opportunity to process the events and for the team psychologist to also assess the patient’s understanding and questions during a follow up visit after she’s had time to digest this information.
    I am in agreement that the patient could have used some more visual information, perhaps in the form of an informational handout. given that anxiety can impact our ability to process information, it would be important to also assess the patient’s level of understanding- maybe in the form of a teach back method (i.e., “what have you taken away from our conversation today? what other questions might I be able to address”. Overall, though, I thought the FNS had a warm demeanor and professional approach during this encounter.

  29. Kelley Johnson

    The Livestrong chart, mentioned in the lecture, seems like an excellent tool that I would utilize if I was unsure how to answer a patient’s questions. There are so many different treatments and fertility options and medicine is always advancing. I would refer to this chart to help guide my education and recommendations. I would also reach out to a fertility specialist in addition to my referral, to help inform the patient.

  30. Bishop Chris

    As a long time REI nurse/ nurse practitioner I was reminded that even though this is the “millionth” time I have explained this procedure to someone – it is the first time this particular patient is hearing this information. In addition she is not the “average” infertility patient, she has not visited doctors and read up about how to get pregnant or why she might not be getting pregnant. She is not infertile, she is a patient who has cancer, learning for the first time about treatments that may make her infertile.
    I think regardless of what our role is in guiding a patient through this process- we must always keep in mind that these patients are likely hearing everything each of us says for the very first time.

    1. Loraine LLanes

      I agree with Chris about our role as guides and counselors of the patients. We mustn’t be satisfied just sharing the right information in a kind manner. We must be assure (in different ways and stages) that the patients really understand the given information, and that they are able (considering their specific situation: personal, social, marital, familial, health related, and so on) of using it on their best benefit.
      The patient asked about the possible influences of the hormone treatment over the progression and the control of her cancer, and the FNE was very cleared answering that even when the scientific studies were not definitive about denying absolutely some possible deleterious effects, the general experiences with other women with breast cancer was positive. Considering other alternative ways to give useful information and to take advantage of the benefits of the social support, it was maybe a good moment to connect the patient with other women survivors of cancer who have had the experience of success fertility preservation, in order to know their experiences from themselves. This kind of social support usually has a very positive impact on the health making decision process, because it is provided by other people who have experienced the same challenges.

  31. Bishop Chris

    This may be a better question for a later module, but I am curious as to others thoughts. Egg freezing and embryo freezing were both discussed as options in the module. Why, if egg freezing is no longer experimental and indeed is offered as an option to preserve fertility even for those not facing cancer, would you encourage embryo freezing? Cancer patients, unfortunately, have a high rate of divorce and I would prefer the woman have the ability to use her eggs when she is ready with the partner of her choice. I have never heard of a male patient be encouraged to freeze embryos. This is just one of many issues that make me wonder why embryo freezing is encouraged.

  32. Hayley Shaw

    I was very impressed by the discussion by this FNS. While obviously overwhelming, I do think it is pretty unavoidable to be overwhelming, while also ensuring that all the information is conveyed. I thought she spoke in an understandable language and with a very calm demeanor which is likely comforting to this patient. She was able to describe the processes in a way that most women would be able to visualize and understand. I appreciated her ability to be honest and open with her patient and to also asses her understanding of the topic. As a nurse, the idea of a teach back and assessment of your education is so important. Overall I found this presentation of information to be very impressive.

  33. Erin Donnelly

    I thought the FNS did a good job explaining the process to her patient & felt that though the patient, who was overtly, yet understably, nervous, was reassured a bit by the calm, soft spoken tone & confidence expressed in the nurses voice. Remaining calm & soft spoken despite a patient’s nervous energy can go a long way.
    One thing I would’ve done differently was the explaination of the needle guided probe for the retrieval. You can clearly see how the patient’s nervousness is heightened when the nurse says that they will “insert a needle into her vagina”. That’s not exactly how it’s performed & given this patient’s demeanor, I especially wouldn’t have said it that way, ( I would not ever have explained it that way anyway).
    Additionally, I personally would’ve addressed the patient’s nervousness. I would have asked her how she is feeling as a means to inviting her to share.
    I, too, was surprised that she did not have someone with her, though I know some people do not want a support person in the moment at the office.
    I work as a FNS and though this facility’s protocol seems to be a menses start for GND meds, we do random start for our oncology patients. Most I see are literally diagnosed w/CA and in our office within 48 hours and starting medications.

    1. Beth Corcoran

      Hi Erin,

      Thanks so much for your insight, particularly with your work as a FNS!

      As others and you have noted, the pt did appear to be anxious. I was wondering if you or any one else in the course had any ideas of what could be asked or addressed to the patient to discuss their presentation. To be more specific, if there were certain phrases or lead ins people use to address this.

      As a mental health provider, I have some ideas. But I wanted to take this course to learn further ideas and skills to address these observations without indirectly being insensitive or alienating the patient.

      I thought the FNS did a nice job of explaining the procedure. I sometimes wonder if there is a medium about the amount of information we provide to patients.

      Interested to hear others thoughts,
      Beth

  34. Amanda Chassee

    As others have stated, the FNS did a lovely job presenting so much information in a calm, organized manner. However, due to the clear level of anxiety Susan is expressing, written materials may help clarify the procedure and plan. A calendar including when meds start, when ultrasounds would occur, when the retrieval is etc might minimize Susan’s anxiety and sense of overwhelm.

  35. Rebecca DiPatri

    Although the patient did appear anxious, I wondered why she was alone at this appointment. I think the FNS did a fine job, with a calm and caring demeanor, presenting the process of egg retrieval. For all we know, this may have been the first time the intricacies of the topic have been discussed with the patient and continued reinforcement of the topic may need to be addressed by other providers. I felt as is the FNS appreciated the importance of the information being shared and wanted to make sure details were provided to the patient.

  36. Michelle Broussard

    The FNS did an excellent job describing the process in detail. There is so much information it is difficult to “sum it up” without leaving the patient in the dark. I think making the patient feel comfortable is very important and this FNS displayed that. I do think being able to go home and absorb it is necessary and it would be nice to be able to see a video online. They do have a lot on you tube now so maybe just providing them with some useful sites to look up. I think the FNS did an awesome job even though the patient seemed nervous; I don’t think we can take all of that away considering the circumstances. Cancer is on their mind non-stop and survival. I think letting the patient know that we are going to guide them the entire way and make sure they are taken care of and that they do not have to try and stay on top of everything with everything else they have going on may relieve some of their burden.

  37. Leigh Hart

    The education and details that the FNS provided was excellent. She was to the point and simple in her explanations. Although fertility can be a senistive topic to discuss with a partner or family member present, during the initial phase of therapy having moral support in the eduction session could of offered her somone to lean on and write down important notes as they went along.

  38. Chelsey Strand

    I feel the fans did great, but maybe the conversation would have gone better if she would have prefaced in the beginning that she could stop and ask questions along the way. I thought a lot of info was divulged before she paused to get feedback from the pt. I would hope this visit includes a psycho-social professional to follow up or at least provide their contact info for additional support.

  39. Raquel Begelman

    I agree with many of the comments about the patient appearing anxious. As a visual learners, I would have appreciated a video or handout because that was a very informative discussion. We all know that patients will have a ton of questions after they leave that office.
    As the nurse providing the information, I would encourage note taking for patient and definitely encourage a support person being person. I would also recommend some re-verbalization for her understanding of the procedure as well.

    1. Riki Hirmes

      I agree. Any other visual aids or handouts would help give the patient information to access at a later point, when the information has time to settle in.

  40. Melanie Hericks

    I found that this video was very educational for myself as I don’t know much about the process. I think it would be very difficult to answer questions about the egg retrieval process if one didn’t have in-depth knowledge. I would have disclosed the fact that I’m not an expert and would like to have her speak with a specialist who could explain the process and better answer any questions she would have. We all have our own scope of practice and that is why having a team approach to this is so very important.

    1. Kathleen Culliton

      Yes! This video helped me understand the process better!
      The FNS was very clear in her explanations. Also, yes–The patient could have benefited from a partner/friends/family member present.

    2. Laurel Heath

      I agree, Melanie. I think it’s important to highlight how valuable every team member can be. I would give the patient a very rudimentary explanation of the process and refer them to a fertility nurse specialist. I think patients and families do not mind when you say “I may not be the best person to explain ___ to you, but I know who is. Let me connect you with them.” You’re acknowledging your own strengths and weakness and then supporting other team members and putting them in a position where the patient will trust them.

      1. Ashlea OShea

        Laurel, absolutely! Without this extensive knowledge, it is best to tell the patient the basics and the refer them to the expert. It is so important for us to be able to acknowledge when we don’t have all the answers for the good of our patients!

  41. Melanie Baker

    I know that I am echoing many comments above. In an ideal scenario, I think the FNS would have started by asking the patient what she understands about her cancer and upcoming treatment plan in addition to her current fertility options. I also agree that more pauses to check in on the patient’s emotional state and processing would have been helpful. I however also acknowledge that many times in healthcare we have limited time to meet with patients and think the FNS did a good job of conveying a lot of information in a short amount of time. If I were the patient, visuals would have been key to my ability to absorb this information.

  42. Riki Hirmes

    Wow. What a wonderful explanation of the options for preservation for this newly diagnosed patient. I do think the provider gave a lot of wonderful information, but I think that she could have used a ‘teach back’ method to ask the patient to repeat the information to see what she retained. There was A LOT of information presented with a lot of unfamiliar medical terms and although explained very clearly, it seems difficult to grasp if the patient truly understands the information.

  43. Ashlea OShea

    Prior to this video, I had minimal knowledge of egg retrieval. I knew about the hormone injections, but not much else. Prior to this video, I would have told my patient that egg preservation is the best fertility preservation option for women. I would have given my patient every brochure and bit of information I could find and encouraged her to meet with a fertility specialist before beginning chemotherapy.

    Unfortunately, a huge problem in my hospital unit is the urge for chemo to start the day of or the day after diagnosis, as soon as the central line can be placed. With men, it is far easier to ask them to deposit their specimen in the cup that day because chemo can still start on time. This video used this woman’s specific breast cancer case to show that there is plenty of time to collect eggs before chemo has to start, but what if the oncology team is pushing for immediate chemotherapy upon diagnosis? We may not have those 2-4 weeks. Plus, my patient population is pediatrics. Our teenagers fall into this AYA population, but their menstrual cycles are not always regular. We may not know when their cycle will start next. While we can still try to collect eggs at a random point in their cycle, the lecture explained that doing so is sub-optimal for egg retrieval.

  44. Jean Melby

    As a nurse myself, I felt she did a great job explaining the whole process. I would preface the conversation by stating that I am aware this is a huge and overwhelming process and that she won’t be expected to remember everything. There will be repeated opportunities to communicate and review the process on a day by day basis. I would also slip in my congratulations on her bravery in coming in to learn more about this option. My answer to the original question is that you should only attempt this conversation with a more experienced team mate who does have the expertise.

    1. Carolyn Demsky

      I completely agree!

  45. Mary Caldwell

    THis was a very helpful videi to watch to help perfect my own discussions with patients. The FNS did a great, calming job. At our institution we send the patients to outside REIS where they are also counseled on the process and risks etc. Hearing this info more than once enables the patient o better absorb and process the info. As others have commented, having a partner, or second pair if ears at sessions is always helpful as long as the patient wants that.

  46. Jill Fitzpatrick

    I think the FNS did a great and thorough job explaining the process but agree wtih above comments- visual aids are oftentimes very much appreciated by patients as we forget that patients don’t have the antatomical knowledge that providers do, sometimes even on a very basic level. Even explaining by picture the relationship of the gyn organs could have been very helpful.

  47. Michelle Reising

    I agree with many of the above points. The FNS did a thorough job explaining the process in significant detail, and did a good job taking her time. I agree that this is a lot of information, however, and would benefit from pauses for questions or clarification of understanding. I also think written materials to accompany the conversation (which would also give the pt a place to take notes if they wished) and/or having a partner/family member present if possible would be ideal. I also think it’s sometimes helpful to start the conversation by asking the patient what they DO know about this process. Many women know people who have been through IVF and she may have some preconceived ideas about the process that would be helpful to incorporate into the conversation.

  48. Tiffany Edwards

    I really enjoyed watching this video and thought that the health professional did a great job of describing, in great detail, a process which can be very complicated and confusing for patients. Her rate of speech, body language and tone were appropriate in creating a supportive environment and she took the time to ask if the patient had questions throughout.

  49. Elizabeth Addington

    I’m a health psychologist and often am in the role of helping patients navigate medical information and decisions, along with communication/relationships with medical providers. Depending on the patient’s needs and preferences, sometimes that means taking a more active role in easing the path for them (e.g., making a referral, directly providing information they can understand and use); other times that means helping them engage in the process and build skills or confidence in their own ability to do so. If I don’t know enough about egg retrieval or other topics that are important to a patient, I usually try to help them articulate what’s important to them about the topic, along with their key questions – which I encourage them to write down (especially with complex topics like this). Then I ask if there’s someone they already know of who they could ask about the topic, and/or I make referrals/suggestions for who could be helpful or how to identify someone who can answer the questions.

  50. Carolyn Demsky

    This specialist delivered a tremendous amount of information in the 7+ minute video. I think although the patient was mostly interactive and asking questions, she was visiably overwhelmed. I also think Visual anatomy models would be very helpful and/or paperwork. Does anyone on this list work in pediatric oncology and if so, what do you discuss with patients and families?

    We give a very brief outline of options but is so provider dependent and is not streamlined. Do you have info sheets etc to give prior to referring to REI?

    1. Elise Oberman

      Hi Carolyn, I work in Pediatric Oncology (and we have a lot of AYA patients as well). For our patients who are post-pubertal, we do offer oocyte harvesting/banking and sperm banking. However, in my experience, a lot of our younger patients actually prefer to move forward with OTC. The hormones and medications required for stim, frequent monitoring (including transvaginal ultrasounds) and the harvest are a lot for an adolescent to go through. We always offer this, however, in practice, I have found most of these patients decline and will pursue OTC (or nothing due to finances most often). We have very basic handouts that outline preservation options. Our REI team will go into further depth and provide more detailed information about the options.

  51. Amy Thompson

    If I did not have in depth knowledge of the egg retrieval process, I would explain an overview of the process without going into detail that is beyond my level of knowledge. During that time, I would assure her that the procedure details will be fully reviewed at her consultation with the fertility specialist with time to have questions answered prior to the procedure. I would acknowledge that there is a lot of information to absorb and that our conversation is an overview which ideally will spark thought and questions for her to discuss with the physician. I would offer if she would like access to pamphlets and resources to help her with reliable information prior to her consultation.

    To gain further knowledge about the egg retrieval process, I would consider contacting our local fertility specialist to determine the best ways to increase my knowledge and per

    1. Amy Thompson

      (I apologize, my previous comment posted prematurely): I would consider learning ways to increase my knowledge from local experts and network with the office(s) for shadowing, classes, and other educational opportunities.

  52. Devon Ciampa

    This video provided great information and very detailed in the process. However, it seemed like a lot of information for a patient to absorb while also dealing with a new cancer diagnosis. Maybe having some visual aids (information sheets, diagrams, etc.) might help when first presenting the patient with this amount of information.

  53. Angela Luna

    The provider did a good job of explaining the process in accessible language. However, I echo the concerns of many others here who worry that she did not spend enough time tending to the patient’s reactions, including her obvious anxious body language. I wonder if a shared visit between nurse specialist and clinical social worker could be beneficial, where the social worker could elicit and acknowledge some of the patient’s concerns and address the while the nurse specialist was still in the room to clarify any of the material that is unclear to the patient. Though some may worry that having two providers in the room could be overwhelming, having two caring providers in the room with different approaches and expertise could increase a patient’s sense of being cared for and improve patient experience too. Written information would also be a great way for a patient to review the information after the visit!

    1. Julia Leavitt

      I agree with all of the points Angela raises. I also think that follow-up in this case is needed. If the nurse specialist is not comfortable addressing the psychosocial distress of the patient it would be extremely helpful to have a mental health provider to explore with the patient. Additionally, I think a follow up phone call would be appropriate to assess if the patient has further questions, concerns, or wants help processing the information. I also think she absolutely should have been provided with written information or information on how to access additional information.

  54. Mary Williams

    Another useful document would be a timeline and/or To Do list for the patient after this encounter. Enjoyed the video!

    1. Anastasia Brown

      I love the idea of a to-do list or tracking system for the patient. There are so many things for the patient to do following diagnosis that, particularly for people who do well with checklists, having something to mark off steps can be a rewarding feeling and also help calm fears that they are missing something.

    2. Allison Winacoo

      A to-do list is a great idea and can serve as a visual reminder of what the patient can check off their list, which may help them feel more in control and see evidence that they’re moving forward along their treatment path!

  55. Anastasia Brown

    Having some context with the video of where this discussion falls in the context of the patient learning of their diagnosis would be helpful. The patient was anxious but it’s hard to discern if this is because of the volume of information discussed or a result of the general overwhelming feeling patients often experience at diagnosis. Also I did not hear any discussion of cost of the procedure or storage or the possibility of combining the sedation with port placement.

  56. Allison Winacoo

    Even though the patient seems anxious, I like that the FNS is sitting face-to-face with her. I wonder how much less information the patient retains if they are sitting on an exam table or sitting while the provider is standing. That makes the imbalance in power of sorts between patient and provider so apparent. I really get the feeling that the provider here’s focus on educating Susan is a way of expressing concern and that the patient is on the same level as the members of the care team.

  57. Karen Pallotti

    I thought this discussion was extremely well done. Susan was clearly very anxious (wringing her hands repeatedly) but I thought the nurse did a very good job of speaking clearly and allowing plenty of opportunity for Susan to ask questions. She appeared to have all the time in the world, and did not make Susan feel rushed . This was an extremely important discussion and the nurse did a great job of offering a very detailed explanation, not taking anything for granted. She certainly did not talk down to Susan, but she provided her with a lot of excellent , detailed information. She also did a good job of offering a time table for this fertility preservation.

  58. Ashley Van Hill

    Even if you don’t have an in-depth knowledge of the egg retrieval process, it is important for a provider to at least start the discussion. Many patients get a cancer diagnosis, and that is their main focus. As providers, we need to give them the information that we can, even if it’s just the basics, prior to referring them to a fertility specialist. This way, they aren’t overwhelmed and may have some time to formulate some questions and do some research prior to meeting with the specialist. This also allows them to discuss with their family and/or partners. Possible fertility issues may not even be something they have thought about.

  59. Elise Oberman

    This was a very detailed discussion of oocyte harvest. I think it is important to use visuals to be able to explain the process as well. I have found it to be so important to have this discussion and really explain the process, because I think people have an idea about oocyte harvesting and do not realize all of the monitoring that occurs. I care for mostly pediatric patients and some AYAs. Asking a post-pubertal 14 year old to undergo stimulation (all of the hormones and medications including injections) as well as transvaginal ultrasounds would definitely be a barrier for some of the patients/families. I have also found culturally and spiritually, the monitoring process has been an issue for some families given the adolescent is a virgin, with the thought that having the ultrasounds disrupts this. There are points in the conversation where you see the patient getting anxious in her body language, which I think is always a good time to slow down, take a step back and regroup. Visuals, again, would be helpful!

    1. Jennifer Elvikis

      We also sometimes have pediatric patients that would like to go through egg freezing. I agree that the visuals would help and going into great deal about the monitoring, as this is usually an issue if they are a virgin and have never used tampons before. I think especially for this pediatric patient population, it is important to be aware of where they are at on a maturity level and give them and their parents all of the information to understand the monitoring process. I have also encountered this issue in some of the young adult patient population as well, so I think when obtaining the history for the patient, it is important to be aware if they have ever had sex, used a tampon, or seen a gynecologist in the past, as this may impact their feelings about vaginal ultrasound as well. It would then be important to alert the provider caring for the patient and those doing the ultrasounds as to the patient’s experience level with these things and concerns about their comfort level.

  60. Pam Bolton

    Great over view of the process. Agree that visual aids may be helpful.

  61. Annie Lopez

    Great information, seemed like patient was getting anxious with all the details. I agree having visual aids, pamphlets would be helpful to help patient understand. I have found that when speaking with patients, it is so overwhelming and they do not remember a lot of the information that was given to them. Being able to leave the clinic with written information for them to review on their time.

  62. Jennifer Elvikis

    As a fertility preservation patient navigator, I agree that the patient seemed nervous and as stated above, I would have addressed this throughout the conversation. I would have broken the conversation several times to say, I know this is a lot of information at once, what questions do you have at this time before I proceed? In that way, you give the patient a chance to discuss their concerns before they forget their questions as you move on to the next item. Also, as mentioned by another provider above, we do random cycle starts for our oncology patients in order to allow for a decreased delay to starting treatment. A lot of what I do is also the initial consult prior to the patient coming in to see the REI doc. I would also encourage the patient to write down any additional questions they may think of for their MD visit because although they had already heard the information once, it can be easy to forget what they want to ask in the appointment. If there is ever a question that I don’t know the answer to regarding the treatment plan or anything related to the egg retrieval, I would always tell the patient that I would need to check with the appropriate personnel (IE-MD, finance, etc) to get the correct answer and can call them when I have the information.

  63. Caroline Dorfmam

    Does anyone think there would be value to having a patient read along with printed materials during the discussion? I know there are a lot of components to this process, so I am just wondering if having a step by step outline for them to review during the discussion would be helpful. Has anyone tried this in their clinical practice?

    1. Heather DeRousse

      I think this is such a great idea. I am very visual so having printed materials would help me retain the information.

  64. Heather DeRousse

    The fertility specialist was very knowledgeable and offered all the information in a comfortable manner that allowed the patient to take time to accept all the details.

  65. Joan Coleman

    I think the Fertility Nurse Specialist had a very calming demeanor and explained the process of egg retrieval in a very step-by-step manner. Not surprisingly, the patient seems mildly anxious during the conversation. The FNS allowed time for questions, then proceeded to the next step. I think this encounter was very informative for the patient but most likely needs reinforcement for the patient and a family member or spouse. Very informative for me to relay to patients as well!

  66. Eileen McMahon

    I know this was an example interaction but it’s a little worrisome that at 1:07 she incorrectly identifies antral follicles as mature eggs. She then incorrectly states at 1:45 and again at 3:13 that stim meds start at day 2. We are all doing random starts for onc patients so we don’t delay their treatment and have been for years so if their period falls within a day or two of the consult then great but we certainly don’t wait for a period to start as she implies.
    There are also many centres that do not put patients to sleep but instead use minimal sedation so that doesn’t apply to all practices either. We also don’t use the word “puncture” when speaking about egg retrieval we say we ‘place a needle through the vaginal wall into each follicle to drain the fluid’. Puncture scares people!
    Otherwise I liked that she provided the patient with all of the necessary information (aside from risk of infection, bleeding, injury to surrounding structures and vessels, as well as sedation risk) – but she did not use any adult learning principles such as diagrams, teach back, asking if the patient understood etc which is concerning.

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