- This topic has 2 replies, 3 voices, and was last updated by ACLARA9791.
January 31, 2020 at 1:03 pm #17412
As a health care provider who cares for patients while they are in the seat for chemotherapy, it is hard conversation to have. As the doctor often wants to get treatment started, as a nursing staff we do not assess if a patient has been counseled about fertility. There is this assumption that it is standard of care and that if patient is in the seat, they’ve chosen their path but I’m not sure that’s always the case. If I was a patient and this was never brought up by any one on my treatment team, I would not handle this conversation very well. It also begs the question, when is the right time to discuss this? Hearing an initial diagnosis and the overwhelming information prior to starting treatment, the actual treatment, it is all so overwhelming. Perhaps a separate mandatory office visit or class to discuss fertility alone would be helpful for patient of child bearing age. I definitely wouldn’t love being told that it was would have been possible that even prior to my treatment there could have been issues. It just seems like an excuse though I do understand there is no easy way to apologize for a patient not being counseled prior to any treatment. I did like the follow through, with the patients options like adoption. Though the false hope of just needing ‘one happy healthy sperm’ might be misleading depending on the specific treatment which also brings up the question, should this be a discussion for a broad teaching from a social worker or should this fall under the doctor who has more insight into the exact effects of their treatment on their fertility?
The one thing is clear, we as caretakers should strive to have well informed patients about their risk and options regarding fertility PRIOR to their treatment and I hope that we can each help our institution get there.February 2, 2020 at 11:26 am #17430
Thank you for your post. As a fellow nurse, I agree with the fact that many times we are facing a CAYA and find out that not all the side effects of the chemotherapy I would be infusing have been fully discussed, such as the topic of this course… fertility. It is very frustrating to be the nurse to break the news and create more stress on the patient. I am now in my career as a study coordinator for clinical trials, I am involved in the early intake process of treatment so that fertility discussions are part of the informed consent when entering a clinical trial. Even then, I find that I am still at a disadvantage as once the patient does find their way to a clinical trial, we are not their first line of therapy and the “damage” has already been done. Enter this module’s case study and discussion, we are in “damage” control mode. I agree with your questions about who’s responsibility is it to lead the discussion after the fact, but I do believe anyone in the multidisciplinary team can assist and lead the question. I believe any health care provider with direct patient care can open a discussion as long as they have the training and stay within their scope of practice.
Jen H. Albert, RNFebruary 2, 2020 at 6:55 pm #17437
@Tsecatero Great point. I agree timing is important, for the patient’s ability to manage the emotions related to the thought of fertility as well as being able to discuss fertility in the shadow of a major medical diagnosis. I’d be curious about other clinics’ flow of patient care around initial cancer diagnosis. I imagine that the acute (review of results, review of prognosis, review of treatment options) aspects are prioritized, while dedication to long-term quality of life factors are secondary. The issue being, a lot of the information we’re getting is suggesting fertility treatments may need to be had immediately. In addition the initial discussion, the flow would need to include space for follow-up questions because many patients don’t think linearly and need time to process their options.
@hsuj I just wanted to acknowledge that I am in also in a “damage control” role. If a patient has reached me after the point of starting treatment and I have this “things you should do before you start” information, what is helpful and what is hurtful to disseminate?
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