Using decision trees to enhance interdisciplinary team work: the case of oncofertility

Abstract

Purpose Oncofertility, an emerging discipline at the intersection of cancer and fertility, strives to give cancer patients options when they are confronting potential infertility as a consequence of cancer treatment. Fertility preservation decisions must be made before treatment begins, adding stress to the decision-making process. Methods Healthcare providers need to be aware of the intricacies involved in oncofertility decision making, and the often tight time line that patients face when making these decisions. Cancer patient's perspectives may also change, as the dual burden of a cancer diagnosis and potential infertility can cause great flux in emotions. Results A provider-facing decision tree was created to enhance patient decision-making capacities and outline the multiple potential intervention points. Conclusions Decision trees, which highlight the important decision points during which providers can approach patients, can be a useful tool to help providers in counseling patients on fertility preservation.

Jatrogeninės menopauzės prevencijos ir vaisingumo išsaugojimo būdai moterims, sergančioms kolorektaliniu vėžiu

“…Po transpozicijos kiaušidės yra pažy-mimos chirurginėmis kabėmis tam, kad būtų žinoma jų vieta planuojant spindulinio gydymo lauką. Pašalinus kiaušides iš radioterapinio lauko, tenkanti jonizuojančiosios spinduliuotės dozė sumažėja iki 90 % [19] Jeigu kiaušidžių transpozicija buvo atlikta prieš radioterapiją, tai tikimybė, kad mėnesinių ciklas po taikyto gydymo normalizuosis, yra 50-90 % [20][21][22]. Dideli tikimybės intervalo svyravimai galimi dėl radioterapijai naudojamų spindulių sklaidos bei dėl galimo kiaušidžių kraujagyslių pažeidimo atliekant transpoziciją.…”

Oncofertility in Canada: An Overview of Canadian Practice and Suggested Action Plan

“…Various health care providers and components of the oncofertility process would be specifically integrated into the referral system, maintaining a multidisciplinaryintegrative trajectory. Not only would such a system help to lessen the burden on oncologists in initiating the process, but it would also ensure that a patient's understanding of fertility preservation comes from multiple different angles, that his or her knowledge is reinforced and complete, and that a decision to pursue or decline fertility preservation is well thought-out, with multiple opportunities to alter decisions 41 . Several studies have already supported the positive effects of a "well-defined" system 31,42,43 .…”

Nonmalignant Diseases and Treatments Associated with Primary Ovarian Failure: An Expanded Role for Fertility Preservation

“…It needs to be explained to patients that the adoption process can be difficult for people with chronic diseases. 116 If patients are interested in fertility preservation, they can be directed to the National Physician Cooperative (NPC), a National Institutes of Health (NIH)-funded initiative that has created a network of specialized centers with reproductive endocrinologists who are trained and aware of the fertility preservation treatments that are currently available. There are limited data on the safety and efficacy of fertility preservation procedures in patients with nonmalignant diseases.…”

“…For example, the addition of psychosocial counseling can be invaluable to ensure that the patient has decision-making capacity and is making a reasonably informed choice about fertility preservation. 116 Patients also should be referred to websites, such as myoncofertility.org and fertilehope.org, for more patientdirected information about fertility preservation options (Table 2). Another key lesson that has been learned through implementation of the NPC is the importance of using a patient navigator to help facilitate various appointments with reproductive specialists and act as a patient advocate.…”