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Interdisciplinary Collaboration:Challenges and Successes
Michael S. NealScientific Director, ONE Fertility, 3210 Harvester Rd. Burlington, Ontario
Cancer and Fertility Crossroads
Increasing Cancer Survival Rates(≥ 70% for pediatric oncology)
Increased emphasis on Quality of Life
Advances in Assisted Reproductive Technologies (ART)
+
Greater need for Information and Understandingabout Fertility Risks and Options
=
Oncology banked sperm used for conception is
effective: a) 36.4% clinical PR/IUI
b) 54.5% clinical PR/ET with IVF/ICSI
Only 17.8% (146/821) newly diagnosed AYA cancer patients utilized sperm cryopreservation technology.
Awareness is the key to increased use of sperm banking for oncology purposes.
Awareness of Fertility Preservation Options
Neal et al., Cancer 2007
Interdisciplinary Team Approach to Fertility Preservation
NursingOncologyFertility
ResearchFundamental
Questions
Male•DNA fragmentation study.
•Germ cell regeneration.
Scientific CommunityNew ideas and approaches
Medical TeamCancer Patient
Risk ManagementLegal, ethical.,
government regulations (AHR)
Patient Support
Family of their own in future
ParentsOncologist
REI Physician
ART Lab
Female•Developing reliable ooctye freezing
technology•Ovarian tissue cryopreservation.
•In vitro maturation of oocytes
Patient Centered Research•Improved communication between patients
and Allied Health Professionals•Referrals
Quality of Care Research•Sperm and oocyte banking brochures
•Referral algorithm
SocialWorkFertile Future
www.fertilefuture.ca
NursingHelp a Child Smile
Challenge:
Bridge the gap between oncology and fertility professionals.
Ultimate Goal:
Improve the quality of life of cancer survivors by providingfertility preservation options.
Two pronged Approach:
1. Health Care Professionals2. Patients
Health Care ProfessionalsEmpowering staff to ensure patients are referred
to the Fertility clinic:
Algorithm• designed to aid in the identification of candidates for fertility preservation earlier rather than later to afford the patient the appropriate time to consider options.
Diagnosis
Treatment
Health Care Professionals
Referral Form and Process:• creation of a standard approach.• provides evidence in the health record of informed consent.• educational sessions for all levels of staff (physician, nursing, social work).
Challenges:Who initiates the discussion?
- physician, nurse, social worker
Age of the patient influences:- consent process- who should come to the clinic (Mom/Dad/Partner)- what if no current partner
Patient Information and Awareness
Patients need to make an informed decision at a time when they are inundated with treatment information.
Developed:• plain language educational pamphlet• more effective to provide written material instead of the message being lost amongst verbal information.
Implemention of an educational pamphlet:• became a teaching tool• helped all health care professional to “open the door” to conversations about this sensitive but important topic.
Conclusions
• Awareness and Education is required for not only patients, but, allied health care professionals.
• Oncologists combined with a multi-disciplinary team of health professionals provides hope for the future fertility of oncology patients.
• Increased awareness and a more rigorous clinical approach resulting in a 71% increase in referrals for oncology banking compared with the previous year.
DiscussionDiscussion
Michael S. NealONE Fertility, and Reproductive Biology Division,
Department of Obstetrics and GynecologyMcMaster University, Hamilton, Ontario, Canada