Keys to Building a Successful Interdisciplinary Program-Creating the...

Great, we are back. Everyone is refreshed here on the panel, and we're hoping that all the participants are refreshed as well. We're very excited about the closing segment, which is, uh, keys to building a successful interdisciplinary program, which is key to each of your centers I'm sure for the function of your program as well. We'll start with Doctor Hefkin for this session, creating the fertility team. All right, great. Um, so, uh, we're gonna talk to you a little bit. A lot of questions that we get are about, uh, people who are trying to start and build a fertility preservation program, um, and obviously one of the biggest parts here is how do you start the fertility team and, and how do you grow and, and develop those programs, um, so the team here at Cincinnati Children's is the comprehensive fertility care and preservation program. So the biggest um thing that is important in doing a fertility preservation program is having a collaboration um that of multidisciplinary providers so um from both the providers on the medical and surgical aspects of the patient's care you wanna have people from oncology, from the surgical aspects, um, as well as primary care physicians that can work with the patient, but also from the ancillary care part of the team, so the care managers from oncology working together. With our patient navigator from the fertility team but also a number of other uh staff from both social work psychology, genetics, uh, ethicists that have spoken with you today can help with the with the care working together with the patients and the families to optimize um the decision making and the final outcomes. Um, so this slide is very busy, so you know I, I apologize for that in advance, but this just gives you an idea of what we think of when we get a fertility consult coming in and how we work through the flow of the consultation. Um, I'm not gonna go over, you know, in, in great detail all of this because Olivia will talk to you about the fertility navigator role, um, and what she does, and that, you know, really tends to be one of the most important steps in all of this, and we couldn't survive without her, um, so we'll let her go into that, but she does start, um, with the. Obtaining of the consult kind of reviewing that and then getting the information to us. The oncologist who's on call will then do the risk assessment, um, which we have talked about, um, in some detail already today, um, but, um, we have two oncologists that work as part of the fertility preservation program, um, so instead of the oncologists, um, the primary oncologist, it will be the people on our team who are making that, um, and then that will then go. Uh, they will then provide that information to either the gynecologist or the urologist, um, depending on whether this is a male or a female consultation, and we will utilize that information to discuss with the patient and the family their risk of, uh, infertility or um gonadotoxicity from their previous treatments, their future treatments, and then what type of um uh uh options they would have for fertility preservation moving forward. From that it goes back to the fertility navigator who as Olivia will talk with you also assists us with the consultations and then she'll move forward assisting the patients and she's gonna talk about that in a little bit more detail um but we also have research coordinators who assist us with some of those more experimental techniques that we've talked about throughout the day. Um, so one of the biggest things that we wanna talk about when we're, when we're doing these consultations is we really wanna standardize our approach and we talked about that a little bit in. Um, you know, if we're able to, to do these consults throughout multiple, um, disciplines and we're doing consultations through multiple centers, um, how can we make sure that every patient gets the same information, they're getting equal information, and even though we want to make it so that every patient receives information that is specific to them, we wanna make sure that they get the same, uh, the same level of information and that they're getting evidence-based information. Um, and we also find it's important we want every patient to be consulted, so we have, um, you know, we have a motto here that every patient should receive a fertility preservation consultation regardless of their risk, um, and, you know, one of these is that families are always talking and we wanna make sure that they understand, you know, if, if the person next door was offered this option and my son wasn't offered this option, why is that? And you know they, they need to know maybe that's because your risk is different, maybe that's because your age is different. Um, and so we wanna make sure that everyone is educated and everyone is aware. So there's a few different ways that we're doing that. These are our, uh, patient decision aids or our, uh, shared decision making tools and again this is a very busy slide, um. These are um some educational tools that we have made here as a team um and we basically use these to help guide families through um the decision making process so we take um the options that would be available it talks them through the process through the time frame uh through risks and benefits and the cost of the different procedures and helps to um to let the patients um know what these things are we also at the bottom um have different. Um, considerations that patients and families may utilize in their decision making, such as, um, some of the things. That Michelle had talked about earlier as far as ethical stand ethical considerations, religious considerations that you would think about, but also things like genetics and social services that patients may find, uh, useful, uh, we do have the shared decision making tools available for use at other centers, um, and we can talk about the availability of those, uh, later. Um, finally we have made some, uh, videos that we can utilize for patients and families. At this point we are using the videos to provide a brief introduction to what fertility preservation is, um, that the families can watch prior to seeing us, um, and then gives them an introduction to all of the things that we've talked about today in an easy to understand format, and I'm gonna show you our, uh, initial introductory video now. If you've just been diagnosed with cancer, you might have a lot of things running through your mind. One thing you may not have considered is fertility preservation. This is the process of protecting your child's ability to have children after their cancer therapy. It is important to think about this before cancer treatment begins. The Cincinnati Children's Fertility Preservation team can help walk you through these decisions. Our body's sperm and egg cells are vulnerable to cancer treatment. Fertility preservation is the process of collecting and protecting a few of your sperm or egg cells so they are not damaged during cancer treatment. Many parents might believe that their child is too young to understand what fertility means or feel that they don't need to worry about something like this with a young child. However, most people start from birth with the ability to have children. Information on fertility preservation comes from your fertility preservation team. This team consists of a fertility navigator, a pediatric oncologist, a pediatric gynecologist for girls, or urologist for boys. Their job is to educate their patients and families as well as carry out the different procedures. They're also there to answer any questions before, during, and after your cancer treatment. For young children, the choice to undergo fertility preservation lies with the parent or guardian, but teenagers and young adults can help make the decision after learning all the facts. The fertility preservation team members work closely with families and their primary oncologists to determine the most effective route of treatment. A good way to visualize how treatment will affect a cancer patient's fertility is to imagine fertility as a spectrum. The spectrum includes 4 different factors that all play a role in determining the procedure options and the risk of infertility. Chemotherapy can affect the risk of infertility, depending on which medications are used and how much of each medication is necessary for your child's cancer. The patient's age will play a role because as patients get older, their risk of infertility increases. There are also more procedure options once a patient has gone through puberty. The timing of cancer therapy can affect the different preservation options, and it depends on how much time there is before the cancer patient's first treatment. This is due to the fact that some procedures take longer to complete than others. Whether you are a boy or girl will determine the types of cells needed to be frozen to preserve fertility. For boys, they can freeze sperm cells or testicular tissue, and for girls, they can freeze eggs, embryos, or ovarian tissue. The process of freezing these cells at an extremely cold temperature is called cryopreservation, and the cells can be stored for up to years at a time until they are needed. It's important to plan for life after cancer, and fertility preservation can allow the patient to have a choice on whether or not to have their own children. The whole care team is here to help. Don't be afraid to ask your fertility preservation team members and oncology providers about any concerns you may have. Um, and then, uh, we have, uh, also a website that's dedicated to the, um, program itself. It is not housed in any of the, um, disciplines, um, for which are part of the program, um, where patients and families can come and also providers can come to find information related to the program and also, uh, information about how to consult our team.