Module 3: From Fertility RN Perspective

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  • #17339

    I have been a fertility nurse for the past 8 years, and the donor egg IVF coordinator for the past 6 years.  I have worked in depth with Dr Mersereau at UNC Fertility in the care of oncofertility patients, fertility preservation patients, and donor egg recipients who need donor gametes due to previous chemotherapy.  (She is wonderful, BTW!)

    When a fertility center receives the referral for a female, every effort is made to schedule the patient’s visit within 24 hours, even if that means the provider starts their day early, works through lunch, or stays later after clinic.  Generally, when the provider meets with the patient, depending on the age of the patient, the family (parents) and/or spouse/partner are present.  After the provider meets with the patient, they meet with the nursing team (here’s where I come in!).  I like to start with a decompression/venting session – “This is really hard”, “I know you never thought you’d be here”, “My goal is to make this is as easy as possible for you” – and open the conversation for them to emote.  Then, I walk the patient (and others) through what a typical stimulation cycle is like.  This would include programs available to obtain medications for free (Livestrong and Heartbeat), how to start the application, what medications are started when and why, how the cycle typically unfolds (days of stimulation, office visits, working around port placement, etc), and what the retrieval is like.

    During this visit to the fertility center, there is also a meeting with the financial coordinator.  As Dr Mersereau mentioned, some centers provide discounts to oncofertility patients with regards to the procedures and storage of eggs/embryos.  Almost all of the medications can be procured for free, however, there are guidelines and limitations (citizenship, insurance coverage, income restrictions, etc).  Sometimes, if the patient has a larger window from the oncology team, they will skip the session with the nurse, see the provider and the financial, and then meet with nursing if and when they decide to proceed.

    One item that has room for improvement, or how I could navigate this part better with the oncology team, would be the Livestrong application.  There are three components – the REI form, the patient’s forms, and the oncology form.  In order to receive medications for free (and this often needs to happen very quickly), the application needs to be complete.  We are often waiting on the oncology form to get uploaded.  Having a dedicated person as a onco-fertility liaison or have the oncology case manager’s information passed along to the fertility center would be very beneficial!

    I know that was a lot of information and I’m happy to answer any questions that come up!

    Kim

    #17360

    Kim- Thank you so much for your overview of your process and insight from all your years of experience!

    As an oncology social worker working in a rural setting at a comprehensive cancer program we are in the initial stages of assessing our process and identifying best practice. Our closest IVF clinic for fertility preservation discussions is over an hour from our clinic so we have started laying the ground work for time frames for referral in addition to the logistics of the referral process.  I am going to meet with their team next month to connect with the staff to better help our patients with what to expect and knowledge of the staff they will meet.  Your description of  your role and the ability to help clarify what they have heard from the provider and support them through the next steps is such a needed strength as they walk through balancing cancer treatment timeframes and the importance of the opportunity for fertility preservation.

    I greatly appreciate your recognition of the livestrong application process steps- as we on the other side of the application also struggle with receiving the oncology form we need to complete in a timely manner to prevent delays.  This will be on my list to discuss.

    I would love to hear any words of wisdom or practical process recommendations related to your experience with the referrals from oncology and what could improve the process or patient experience with how the discussion from oncology took place.

    Karen

    #17398

    Kim –

    Thanks so much for sharing what your role as a fertility nurse and donor egg IVF coordinator. I love that you have a decompression/venting session. I think this can be really helpful even after a cancer diagnosis. I didn’t know of the Livestrong or heartbeat programs, and thank you for the tips about filling out the Livestrong application completely to avoid delay in free medications – which can certainly be a barrier to care.  Do you have any tips for Nurse Navigators or other members of the healthcare team – anything specific you wish we would communicate with the patient prior to getting to a fertility center?

    Megan

    #17413

    Kim – Thank you so much for the information in your post. It’s so helpful to read this from the real life aspect of the nurse! I found it interesting that you said family/partners are typically present during discussion. Is the patient ever offered the chance to speak without family present? Or is it assumed that if the patient brought these specific people to the appointment, they’re comfortable with sharing in front of them?

    I do see how the live strong would be a barrier. I think it’s an excellent idea to have a liaison responsible for streamlining this aspect.

    Currently, I am an oncology RN on an 18 bed inpatient chemo floor. Our main specialty is sarcoma, so we have a high number of patients who are in their late teens to mid thirties. It is my goal to create a more comfortable environment for fertility preservation to be discussed between nurses and patients. Because we are inpatient chemo, by the time our patients get to their first chemo, they’ve typically already had discussions about fertility preservation when they were initially diagnosed. However, there is no process in place for verifying that, other than checking the chemo consent form (and who knows if anyone really paid attention to every detail when they signed). Additionally, we do rarely have people who come to our ED without any idea that they have cancer. They then get transferred to our floor right away if chemo needs to start ASAP. These patients never get the fertility preservation talk because everything is so rushed and the pressure to begin treatment is on. It is my mission to make sure that these patients, typically diagnosed at stage 4, still have the opportunity to make a choice about their fertility.

     

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