Difficult conversations

Home Echo Discussions Module 2 Discussion Difficult conversations

  • This topic has 5 replies, 6 voices, and was last updated by sthilges.
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    This topic is often a difficult conversation to have especially with other family members wanting to stay. The intimate details of reproduction is often a delicate subject to conquer with a 19 year old college student who is unsure of there future.  The focus is primarily on starting treatment so quickly due to patient being symptomatic.


    This is a good example of getting the conversation started. I often see that young patients are unaware of options and are so focused on what is right in front of them (cancer and current relationships) that they have a hard time looking to the future. Sometimes it is good to start the conversation and see where it takes you with the patient. A guided discussion can often lead to a very productive meeting.


    There are so many factors to consider such as estimating their approximate psychological age vs chronological age, the presence of any cultural influences, practices, or traditions, respecting their individuality and their cancer experience as their own separate from and in conjunction with their loved ones perceptions, thoughts, feelings, and preferences, and respecting autonomy (to make decisions for themselves and their best interests according to their values, beliefs, etc) .


    I agree with the aforementioned barriers to engaging in conversations around oncofertility. As a provider I try to offer youth one on one time to gauge their readiness for treatment and offer developmentally appropriate discussion around these topics. I will say there are patient provider dynamics that come up during these conversations (i.e. preferring a male provider etc.). I also try to normalize some of the experiences they have and discuss ways for us to address these in upcoming appointments. I have heard from may teens that they were “not expecting” to deal with these procedures as 15-25 year olds and this is where psychosocial support is so key.


    Are there any resources for clinicians to learn more about cultural and religious differences that pertain to sexual health/infertility, and responses to different treatment options for infertility?  It would be helpful to have some background information before approaching a patient/couple/family.  It would guide some of the questions for the interview toward getting more information.



    I second (or third) the inquiry into any frameworks or guidance available on cultural and religious perspectives on sexuality and family planning. Not only are these conversations nuanced in variance between chronological and emotional age but also with the family or social systems in which they are living.

    Making these difficult challenges are more challenging is that I imagine at many centers (as it as at mine), different providers may be having portions of this conversation at different times. It seems less common to have a provider dedicated to oncofertility who is an expert in the medical/clinical and psychosocial risk factors patients may face during and after treatment. Different providers may solicit different responses from patients which may impact decision making.

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