Module 5 Discussion

Topic: Addressing religious considerations related to family building options

Romantic partnerships can have an impact on fertility decisions and family building decision making. Watch as he social worker discusses family building options with Jose (survivor) and Cheryl (Jose’s partner). Notice how she addresses their concerns about the use of assisted reproductive technologies and their religion and tailors supportive care needs such as faith based peer support based on those concerns. Think about what resources you have access to that you can share with your patients and provide at least two examples of resources related to reproductive health that are tailored for patients by religion, sexual orientation, gender identity, age, etc.

73 Comments

  1. Joanna Patten

    I appreciate that the provider here is making room for Jose and Cheryl to have complicated reactions to this information. I like how she asked about the support that Cheryl might have access to within her own community and also offered to connect her to female partners who have had similar experiences. Based on Cheryl’s discussions of her faith, if a similar conversation were to occur at our institutions, we might also involve a member of the Spiritual Care team (chaplains) in our discussion to respond directly to Cheryl’s concerns as they relate to her faith and her faith community.

    1. Angelica Rodriguez

      Agree. Chaplains are readily available for most institutions and under utilized in the outpatient scene. That would be an excellent resource to recommend.

      1. Robin Dorman

        I thought it was important that Cheryl’s faith was such a primary factor and that she did not necessarily feel that her community would be the best support for her. I agree that a Chaplain in the medical setting could be very helpful and it would likely help to identify the Chaplain as someone not specific to her church, but to the intersection between medicine and faith.

        1. Christine Calafiore

          I never really though of the use of a Chaplain as part of the fertility preservation team. It is definitely an innovative idea that would serve well for this couple. I think being able to make a Chaplain or other faith leaders involved in the hospital part of treatment teams and informational trainings would be beneficial whenever possible. There are many grey areas with different religious beliefs and types of fertility preservation. Utilizing their faith-based expertise and informing them on how FP procedures work could be very affirming for patients.

          1. Ian Scott

            I agree that chaplains (or spiritual care providers, as they are called in my area) would be very helpful here. However, I think that the social worker could explore this more thoroughly with the couple. I realize it’s only a short clip, but many professionals struggle to hold space for people when spiritual distress arises. Continuing with an open and curious approach, as the social worker in the video is already doing, could go a long way in addressing these faith-based concerns. I think a lot of professionals shy away from these topics, but just because we may not be a chaplain doesn’t mean it’s off-limits. A spiritual care provider could then resume the conversation and lead the couple to a deeper exploration and reflection.

        2. Anna DeVine

          Curious if the medical chaplain might have different views from her own church community? Wondering if it might be a good idea to get her own pastor involved too, as to not make her home life unbearable with decisions that might stray far from her church? Or at least to offer the opportunity to the couple to see if they are interested in their own pastor being a part of the conversation?

          1. Kim Keely

            What I’ve found using experienced chaplains, is that they are able to help the patient frame the issue with respect to their beliefs. They don’t espouse their own beliefs, but with their background on these topics, they might be a richer resource than their church community initially. They can support the patient in talking with their community and think through that process.

          2. Raquel Begelman

            I agree, Anne, that having the couple consult their own pastor is a better idea. The couple is sure to have so many feeling that speaking to someone that they trust with such a personal decision would make them more comfortable. I believe the provider encouraged that.

          3. Susan Stephens

            We often ask the AYA’s and family’s own religious community leader(pastor, rabbi, priest) to help us understand how religious beliefs may impact treatment and end-of-life decisions, so I agree that having the couple consult on fertility options may be beneficial. I also wonder if having the couple here have another consult with the fertility specialist who may be aware of religious and culturally sensitive options relevant for this couple. Jose mentioned that he has his sperm count assessed, but unless I missed it, it did not seem that his partner had spoken with the fertility specialist related to her needs. Having options may help when speaking with other survivors or her minister.

          4. Juliann Kiefer

            I agree that medical chaplains may have a broader view of the topics. From the reading and thinking about so many different religions I feel that having their own pastor/spiritual leader present for discussion would be beneficial. I do worry that their medical understanding may make the conversation a bit difficult, but believe they could still offer some good guidance for the patient.

          5. Loraine LLanes

            I agree in recommending the couple, and specially Cheryl, a medical chaplains or a spiritual counselor in order to help her/them getting clear her/their ideas to make a consented decision, releasing the sense of conflict that an specific believe, faith or religion could arise related to the fertility and reproductive technology options. I think that spirituality is one of the most important aspects and coping resources in the health field, mainly when people are facing chronic illnesses and when they are making key decisions for their lives. Because of that it is so relevant, as a health team, to have information about different religions, and especially about the social and community’ resources that could offer spiritual support for the patients.

          6. Jamie Hillmer

            I think getting the hospital chaplain involved is a great idea. Our chaplain will reach out to each individuals church if needed, so that they may speak with them as well. I work for a Catholic based facility, so we do not have fertility specialists in our system. So I researched the Ethical and Religious Directives for Catholic Health Care services, they do allow some infertility treatments, they recommend counseling and adoption, I found it interesting that they do not allow surrogacy. So part of this is respecting the patient and significant others religion. We may offer fertility specialist referral, but they may defer just based on their religion and faith. Which we need to respect.

      2. Giselle Perez

        I love this – in truth (and sad to admit it), I have not thought about introducing Chaplain services into the care of my patients.

    2. Megan

      I agree. This helped remind me that we have access to Chaplain services here at the hospital. I’m interested to know if any of them ever had discussions about fertility and faith.

    3. Jennifer Bojanowski

      Yes, the suggestion to involve others from Cheryl’s faith community – that spiritual component – is a piece that is often overlooked in many multidisciplinary medical settings. It was great to see the social worker open the questioning to that level, as for Cheryl, the lack of knowledge about how ART would be perceived within her church was central. In my work as a genetic counselor, this situation reminded me a bit of how some Catholic women struggled with considering pregnancy termination when receiving a fatal fetal diagnosis. These women were usually able to find a way to reconcile their personal and religious values through seeking consult with priests and other Church representatives wishing to support women through this issue. In a distinct but similar way, I can really see how important considerations of spirituality would be for some around ART.

  2. Annie Huhnerkoch

    I really respect how the social worker started where the couple was and not starting with her own agenda or plan for the session. She asked them to shared their fears or concerns and then not only explored their own support network but offered an alternative resource to help Jose’s partner and feel supported.

    1. Shanna Logan

      Agree with all of this Annie. I thought she was very responsive to their immediate concerns and allowed a pathway to further information in a way that would aid the decision making process and gain support.

    2. Lacey Ballew

      I too liked the social worker’s approach along with getting their input and helping them with resources that would work for them.

  3. Tomoko Tsukamoto

    I appreciate how the social worker facilitated the difficult conversation with the couple. Jose mentioned that they would not be able to have a child naturally, and were offered alternatives. I would like to know what alternatives were explained to them. However, I think that the social worker did a wonderful job showing the respect for the coupe and helped Jose’s partner feel comfortable to speak about her faith and the religious community she belongs. The social worker asked if there would be someone that she could talk about ART or infertility within her faith community before offering to connect with other couples. Connecting with other couples that experienced the same issue is a great way to support them.

    1. Sara Soares

      I agree, the SW did a great job of offering them to meet with other couples as a means of a support system and to connect with someone that has been in their shoes…..that type of connection would give them firsthand knowledge and an actual human that is going through or has been through what they are experiencing. This type of support system might be a helpful way for the couple to validate their feelings and emotions.

    2. Loraine LLanes

      I totally agree with Annie, Shanna, Lacey and Tomoko about the respectful, gentle and flexible way in which the social worker managed the re-encounter with Jose and Cheryl, and especially their upsetting, conflicting and frustration feelings. I think that it is important, not only for the health assistance made with the oncology patients and their family, but from a general social educational point of view, to work more in questioning the cultural believe that being a father or a mother need (almost as an obligatory requirement) to have a biological link with the descendant. This is a strong believe specially in the Latin-American context, and in my opinion it is one of the main sources of grieve and sense of lost when people or couples are facing infertility, and when they have to choose between reproductive options that don´t guarantee a biological connection between the future baby and the mother and the father (for example: ovodonation, sperm donation, adoption).

  4. Chelsey Strand

    I liked her open dialogue and she did a great job of checking in on their feelings and assessing their beliefs and knowledge. I feel like his concern about the financial burden of ART was overlooked. If was voiced Addressed..I think language is important and when the girlfriend described ART as Sci-fy the SWer replied “totally”and that could have come across like she agreed.

    1. Leah Clark

      Yes, the issue of cost for these therapies is paramount in decision making and accessibility. Addressing this is very important with also provision for resources.

      1. Ian Scott

        Yes, I would “echo” that (get it?! ECHO that? :-)).

        The financial part was overlooked. For many, many AYAs, the prohibitive cost makes fertility preservation discussions almost a non-starter. It is still important to have the conversation to inform patients of their options both before and after treatment, but it absolutely needs to include some mention of the cost, particularly if the patient is not covered for fertility preservation. I think many AYAs receive a disservice if they are told about fertility preservation by their oncology care team and then arrive at a fertility clinic only to find out they can’t afford to proceed.
        As the course literature has demonstrated, there are many possible barriers to pursuing fertility preservation, but I wonder if this is the biggest one. Understandably, many AYA patients I have supported would have done fertility preservation if not for the high costs.

        1. Bishop Chris

          I knwo for a fact that this is a factor in why patient’s do not pursue fertility preservation. Unless you live in a state where some type of a mandate exists. An egg freeze cycle can easily run 8-12K and that may not include storage of eggs or all of the medication. It also does not include time off work for fertility clinical monitoring and the egg retrieval. IF these individuals are looking at high deductibles before their CA treatment is covered then this is a cost they will forgo because they simply don’t have the funds.

        2. Burton Rebecca

          I agree that the financial part has been overlooked throughout many parts of this course. When I asked the person who I wanted to interview what was the biggest issue facing her patients, she immediately said the cost of fertility preservation. I know a friend spent at least 50k on the other side trying to conceive recently. Whether we are talking about preservation or actively trying to conceive, it is a huge issue that will need to be addressed.

        3. Angela Luna

          I agree w/ your comment, Ian, and would take it a step further to add that even when patients are educated about costs associated w/ fertility preservation and maybe even connected w/ funds to defray some of the costs associated w/ preservation, “options” like adoption or surrogacy that are commonly cited in educational materials are not truly accessible to most people because of astronomical costs. I am a social worker and I struggle with this particular challenge because of the lack of resources available to assist with these costs. I wonder if this may be why the social worker didn’t delve more into this topic… because we can raise the issues but we do not have much to offer in terms of answers to these questions.

    2. Beth Corcoran

      Hi Chelsey,

      I agree that language is very important. I think in this context, the SW was attempting to connect with the pt’s partner and validate her feelings with that particular statement. Perhaps a nod of her head and simply saying “sure,” empathically may have been a slightly better route; however, I think their conversation continued on well without any negative connotations.

      Overall, I think the SW did a nice job covering a lot of topics in a short period of time. I personally think to have one person on a team trying to address all different angles can be very difficult and overwhelming. Being able to have an open dialogue and referrals to places where these conversations can continue is so important no matter our role on the healthcare team.

    3. Mary Williams

      Agree, this was one of the first things I thought of after listening to the discussion. The financial burden of ART and adoption is huge; I think very few young people have any idea of costs. Having a good financial understanding from speaking with a Reproductive Specialist and adoption agency would help steer the conversation…maybe the social worker could provide referrals/contacts for the couple prior to the next session.

  5. Robin Dorman

    I very much appreciated that the provided focused on eliciting the couples’ thoughts, feeling, existing support, and discussions they have already had. It would be easy for her to go into education mode about all of the possibilities but this way she was able to elicit the role of faith in both Cheryl’s confusion and decision making.

  6. ChrisostimB

    Indeed religion and one’s belief system are critical components in health care service provision as they form an integral component of the healing process. It is impressive how the social worker maintains a non jidegemental approach to her inquires and gives the couple options for possible exploration. She at the same leaves the couple to make their own decisions

  7. Thresa Jean Mayr

    Sharing a religious or cultural belief with relation to fertility is important for the health care team to consider when talking about ART. This SW did a nice job exploring the couple’s feelings and made appropriate recommendations being mindful of the difficult position the couple is in.

    1. Lacey Ballew

      That’s a good point, Thresa. Depending on a patient’s religious views/practices, it could steer the direction of family building.

  8. Lacey Ballew

    The social worker seemed to do such a great job facilitating this difficult conversation. She had a warm greeting, explored both the patient and partner’s feelings/concerns, acknowledged and normalized and elicited their input on resources that might work. Her approach on building rapport could likely be key in working with the family on family building options.

    Like many other comments, the resource of chaplaincy would be appropriate considering the partner’s discussion on religion/spirituality. Also, an option for a counselor could also be considered as both Jose and his partner state in the beginning of the clip their disappointment of not having a natural pregnancy.

    1. Melanie Hericks

      Lacey, I really like how you point out that a counselor could be beneficial for them too. I think that sometimes healthcare professionals can overlook the fact that patients and their partners face emotional distress with fertility issues and may not always think to refer them to counseling for emotional support and to process what they have been through.

  9. Sara Zargham

    As said previously, the community she surrounds herself in and with seems to be very imperative and important to her. It’s often times hard to worry about yourself while also worrying about other people’s views/opinions. Because this is such a huge discussion, Jose and his girlfriend will need to find the focus to do what’s best for their family and their lives without the outside pressure. Talking to a chaplain or spiritual outreach at the clinic or nearby facility can help address these stressors and some of the extra emotions this couple is facing. Another good idea would be finding a support group, or other couples going through the same fertility issues maybe secondary to chronic and acute diseases. This way, they’ll gain a supportive background while also getting insight into their multiple options.

    1. Kristy Katsetos

      Absolutely agree that it was a great idea for the SW to bring up the importance of connecting to others who have been through a similar experience. I thought that was a wonderful way to connect them to the idea that they are not alone in this process, but still allow them to have their own individual thoughts and feelings on the issue.
      One area I thought would have been important to give leave some conversation for was the piece on cost of using ART and how this would impact their decision.

    2. Sara Soares

      Sara, I appreciate that you addressed the question….”Think about what resources you have access to that you can share with your patients and provide at least two examples of resources” and gave positive alternatives.

  10. Elizabeth Addington

    I agree with others who have mentioned chaplains as helpful resources in this context. In addition, when concerns about faith arise in the health setting, I find that – rather than bringing resources to the patient (which may or may not align with patient values/beliefs) – sometimes the best approach is to help patients use their own resources, and make sure that’s part of our conversation. For example, I would ask about faith advisers they trust and important faith-based texts that might inform their decisions; we’d make plans about how to consult them; then we’d discuss what they learned through those consultations/readings, etc.

  11. Sara Soares

    Prior to Jose’cancer diagnosis, this couple had a perception of their individual social identities and also what an ideal relationship entailed. Now, their perceived norm pertaining to natural reproduction and future children has been disrupted. They have been given a challenge and need to educate themselves and come to grips with what their new reality is. The SW did a great job of allowing them to express themselves and mad sure that everyone was comfortable in talking about the transition they need to make not only mentally and emotionally, but also the optional physical choices of childbearing. All the options for child bearing should be provided and the appropriate resources and or referrals provided, such as mental health professionals, psychologists/counsellors, adoption agencies, fertility specialists, surrogates, donor options, etc. This young couple would also highly benefit from using the Internet and finding applicable Social Networks; they might feel more comfortable, less isolated, discover some alternative coping options, and actually receive true support for their situation.

  12. Cheryl Smith

    I appreciated how she keeps checking in with them throughout the discussion about how they are feeling about this. She attempted to use terms that were not medical jargon and that they could understand. She utilized open ended questions and listened without interrupting. She also normalized and validated their feelings and emotions. I appreciated that she offered information to talk with others who have gone through similar experience and the support they could provide having walked in these shoes.

  13. Anna DeVine

    Although the Social Worker was open, welcoming and good with many aspects of this discussion, I felt at times she would ask 2 questions thus leading to some akwardness. I think offering 1 open ended question would have been more beneficial. I also think pausing and allowing more time might offer the couple additional time to not only think about her questions, but also their own answers. I cannot imagine the difficulty in finding out the news regarding infertility, but I felt the social worker did a nice job of offering assistance for the couple to talk with others in an similar situation. I also wonder if discussing the options, finance options, etc. might have been beneficial in helping this couple to refresh their minds regarding their options. The “Sci Fi” comment made me laugh, I had never really thought about a Petri dish in this light, but moving forward will change my view.

  14. Kim Keely

    I appreciate the ongoing communication between the social worker and the couple together and as individuals. This continues to highlight how guided conversations with professionals can help patients identify their needs and concerns. These videos continue to give me good exposure to all the twists and turns a fertility discussion can have in real life!

  15. Courtney King

    I liked the social workers ease in discussing this topic and felt that this made it easier for this couple to discuss the infertility issue as well ass other options. I think that she could also speak with a fertility specialist to hear what other options there are and that this may help her in decision making.

    1. Leigh Hart

      The aspect of combining 2 people’s past life experiences into a new family is a process now adding in Jose’s medical history and Cheryl’s religious beliefs does not make this conversation any easier related to infertility. A neutral party to guide them such as the fertility specialists seems like a good starting point. At this point there is time to think about these decsions nothing needs to be rushed.

  16. Raquel Begelman

    Fertile options is a sensitivity subject because it brings up feelings of disappointment and sadness. The social worker did a great job with providing opportunity to discuss feelings, ART options and encouraging and supporting them to reach out to their religious leaders.
    The social worker also encouraged to have them speak to other couples that went thru a typical decision making process. I also liked when the social worker confirmed that these are normal feeling, but would have liked if she said something like” the decision you make is the right decision for you”. Everyone has choices and as a healthcare provider, I encourage and support each patient’s individual choice.

  17. Caroline Dorfmam

    I really liked that that social worker offered for them to talk to others who have been in similar situations. I am curious though how she would facilitate this due to HIPAA concerns. Would this be in the form of a support group? Are there specific resources in the community she would recommend? I was disappointed that the video clip ended when it did because I wanted to know how she was going to connect them to others.

    1. Lisa Cummings

      Hi Carolyn: When I have someone who would like to talk with someone in a similar situation, I first ask them if I can provide their name to an individual who is in their similar situation. Once they say yes, I speak to the person that I think is a good match, and I ask if they are willing to connect with this person. If they say yes, then I will give them the contact information. I later reconnect with the patient to see if the connection was helpful.

    2. Krystal Robinson

      Great point Carolyn. At least in my local community, I don’t know of specific support groups for this sensitive topic, but it does make me want to do some research and find out i things are in development. I think the challenge may be how to refer, as you indicated. If its an already established local sport group, perhaps providing them with the information (date, time etc) or if more formal referral measures are required, then HIPAA would definitely need to be considered.

      1. Loraine LLanes

        Thinking on the relevance of having different social support groups, sometimes, in some settings, it could be very useful to connect patients, couples and families with another patients, couples and families who have had the same experiences before, and who are specially sensitive and resilient to share their learnings with others. In my experience, some patients have expressed their wishes to share their learnings in order to help other people, to avoid them to live unnecessary negative situations, and to facilitate them to face their lives in a better way. I think that one important part of the social support is that received from other people who lived the same situation and who have important achievements after that (from a health, psychological and social point of view). They could became in health promotors and, joined with other main resources (religious, social, communities, health care providers), to enhance the health process of people living with cancer and other chronic illnesses.

  18. Lisa Cummings

    I felt the social worker did a nice job working with this couple. The question asks what resources I can provide that are based upon religion, sexual orientation etc. If the couple would like to meet with a spiritual adviser outside of their church, then I could recommend our hospital chaplain. I would encourage a social worker/counselor referral who would hopefully have a list of resources to better advise this person. She may in turn make a psychologcial referral if needed, but that would not be my place to do so. I could provide them with the Imerman Angels website information where they could be matched with another patient/couple experiencing the same issues. Without further investigation in my local resources, I do not know what else may be available to this person.

  19. Angela Yarbrough

    I think the social worker did a nice job of engaging the partner’s feelings while also addressing other options of family building. I agree with those above that a psychologist might be beneficial to work with this couple through all of the feelings and decisions that they will go through.

  20. Leigh Hart

    The times that was taken to support Cheryl and her concerns were refreshing. The social worker equally made this meeting about the survivor, Jose, and his partner. Each were offered their moment to share feelings.

  21. lauren Martino

    I think the SW was very empathetic and offered them good options. I think this scenario highlights that many of these conversations are ongoing and may not be “solved” in one sitting. I think it was a good suggestion to have them speak with a member of their clergy/faith to help with decision making.

    1. Mary Williams

      Agree, would imagine multiple sessions needed as the couple gathers more information regarding their options….including what options may be cost prohibitive

    2. Kathleen Hinkle

      Good point, Lauren. A conversation this complex cannot be accomplished in just one sitting. The social worker does a nice job of laying the groundwork and offering some resources, but there will be more discussion needed as this young couple sorts through this process.

  22. Pam Bolton

    This highlights how challenging and emotional these discussions can be. Directing to others of faith will provide support and offering options to talk to other partners of survivors is important. We ask families if they would be willing to talk with other’s that have had similar experiences and have questions, and if they are willing then we connect the families directly. We have not had good luck with in person “support groups” as attendance is low. We do find that families and patients will use social media support and chat groups, but these need monitoring as information is not always accurate and they can be negative.

  23. Mary Williams

    Liked how the meeting was started with getting the point of view from both the guy and girl…always nice to have a good idea of someone’s thoughts/expectations/bias before launching into a meeting.

  24. Melanie Hericks

    I think that this was a very good module. If I needed to share reproductive health resources in regards to religion, sexual orientation, gender identity, age, etc with one of my patients, one thing I would offer is that they could meet with our outpatient clinic chaplain.She also offers to contact the patient’s personal pastor/priest/spiritual advisor, on behalf of the patient too (if that is something they want help with). We have also had previous patients who have offered to be mentors for current patients going through the same struggles. If that was something the patient and/or sig other are interested in, I would get the appropriate permission from both parties so that they could connect. I would also let them know that we have a outpatient oncology counselor available to speak with them as well.

  25. Linda Rivard

    This was a very good module – it appeared the couple struggled more with religious beliefs and both worried if they reached out to their church that decision may sway them in a direction they may not want to accept. It reinforced the wonderful article on religious beliefs and fertility -and religious beliefs and the AYA population – a growing divide even in the general population. This article really highlighted the struggles with religion and fertility options. Pairing the couple with other survivors who faced similar situation is wonderful – but there is still the underling issue of religion that I picked up that Jose’s partner was afraid to address because she “was afraid of the answer?”

    1. Jennifer Bojanowski

      Linda, your comments reminded me of how important it would be to check back in with Jose and Cheryl after the conversation with clergy was initiated. While such conversations can often be helpful and resolve much for those deeply involved with their church community, sometimes such interactions can go in a disappointing direction. This couple would need both initial support and possibly a referral to receive more in-depth individual or couples’ therapy for bereavement/adjustment to this new reality. Should they choose to pursue a path different from that sanctioned by their church, this couple would need significant support going forward.

  26. Bishop Chris

    I know for a fact that this is a factor in why patient’s do not pursue fertility preservation. Unless you live in a state where some type of a mandate exists, an egg freeze cycle can easily run 8-12K and that may not include storage of eggs or all of the medication. It also does not include time off work for fertility clinical monitoring and the egg retrieval. IF these individuals are looking at high deductibles before their CA treatment is covered then this is a cost they will forgo because they simply don’t have the funds.

  27. Kathleen Hinkle

    This is such a difficult conversation, and the social worker did an excellent job. It’s important to not just jump right in to the discussion, but to take a moment to acknowledge feelings and understand the attitudes and beliefs (cultural and religious) that the patient and their significant other bring to the table. To answer the question, if my patient had concerns related to gender identity, I would refer him or her to our Gender Management Program at my hospital. This program provides medical consultation, psychological support (including a weekly support group facilitated by a psychologist), education, advocacy, and referrals to specialists in the community. Another excellent resource (for all patients) is Imerman’s Angels, an organization that connects patients to matched mentors (who have a similar history) for one-on-one support.

  28. Vogl Stacey

    This one is a difficult one as it addresses the fertility issues, the financial piece related to it and their relationship in general. When you feel strongly about your faith or a belief but you feel as though you may be alone in that thinking it may seem difficult to discern on where to turn for help. In my own practice we have non denominational pastoral care who can meet with the patient or their SO to discuss some of these concerns without them having to discuss it directly with their own parish. I love the above suggestions of Imerman’s Angels as it is an organization that I have used in the past but when things get busy are easy to forget. They do a wonderful job with supportive care to their patients.

  29. Juliann Kiefer

    I felt this module and video did a good job of addressing the often avoided and sensitive topic of fertility issues. I feel the scene did a good job of the social worker letting the couple guide their discussion. She opened up nice letting them say where they were instead of filling in the information. Since faith was a big part of the discussion I believe with the above comments about having the patient rely on their own spiritual resources or offer to provide hospital support as available.

  30. Angela Luna

    Agreed with many of the other comments about the social worker’s skillful handling of this situation, as she does a good job tending to both partners’ reactions and feelings (highlighting that a social worker’s skillset when it comes to talking about fertility should include some comfort working with couples together!). As a social worker myself, I appreciate this very straightforward example of how a conversation like this might go and techniques to facilitate!

  31. Krystal Robinson

    I echo others who expressed that the social worker did a great job allowing the couple to talk freely about their feelings while also offering guided yet supportive discussion of options. With their faith being what appears to be a central part of their day to day lives, naturally It may have some impact on their decision making in this part of their lives. I wonder if it might be helpful to suggest that they also consult their pastor or spiritual leaders at their church, and discuss the options available to them? Basically taking that information and support provided by the social worker and medical team and discussing it with their trusted spiritual leader. Alternatively there may be a medical chaplain on site at the hospital who could help. Definitely a sensitive discussed and its important to factor in both the survivor as well as their partner’s take on planning.

  32. Christopher David

    I think she did very well to open the discussion and validate the couple’s feelings and normative confusion. She allowed for an environment for discussion which I think helped the woman to better question herself and allow herself to learn about options regardless of any possible perceived contradictions with her faith tradition.

  33. Robyn Dillon

    I appreciate that both religion and finances and the impact they these two issues impact decision making was carefully acknowledged and supported as part of the conversation. as too often the emphasis is on the medical intervention only; this shed light on how multidimensional this topic and decision can be.

    1. Amber Lamoreaux

      Robyn Dillon- I totally agree with your assessment. Both religion and finances can have such a big impact on decisions made. By moving away for the treatment side of the cancer journey, both the patient and girlfriend were able to discuss their hopes and fears for the future.

  34. Heather DeRousse

    The social worker did a fantastic job of getting both of them to share their thoughts about fertility.

  35. Elizabeth Arthur

    I agree and appreciate the suggestions to speak with her faith leaders. I picked up on how she said, “I can’t imagine my life without Jose’ twice. That makes me think that she actually has considered whether his inability to have bio kids is a deeper issue. I might recommend a psychologist/couples therapist. I love that the provider recommended peer mentors as well — I think this is very powerful for many survivors.

    1. Jennifer Bojanowski

      All true, Elizabeth, and great observation of the double mention of not being able to imagine life without Jose. I noticed this, as well, which suggested to me that Cheryl’s concerns about Jose’s fertility issues is quite significant and will require time and support to work through. She was quite open in this interview, but I wonder if she would have been able to do even deeper work on her own with a therapist or clergy member – in case she was holding back out of concern for Jose’s feelings.