The role of the
Patient Navigator for Fertility Preservation
Olivia Jaworek Frias, MSN, RN III, CNL
Patient Navigator of Fertility Preservation
Comprehensive Fertility Care and Preservation Program
Cincinnati Children’s Hospital Medical Center
3333 Burnet Ave Cincinnati, Ohio, 45229
Outline
• Define the Role
• How the Patient Navigator is integrated into our standardized fertility
process at Cincinnati Children’s Hospital Medical Center (CCHMC)
• Interventions
• Consult
• Post therapy continuation of care
Defining the Role
The Fertility Navigator of Fertility Preservation
Goal: Assist the patient/family through the Oncofertility process and
achieve seamless care
• Malignant and non malignant conditions whose disease/treatment
may impair fertility
• Acuity
• Expedite referral
• Time frame prior to starting gonadotoxic therapy
Defining the Role Con’t
The Fertility Navigator of Fertility Preservation
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Support patient/families through consultation, education, and
coordination
•
Shepherds patients seamlessly through a complex medical system,
providing a single point of contact for patients and the multiple services
involved in a consult.
• Internal and external facilities
•
Act as a resource for the referring primary team
•
Identify programmatic process successes /improvement
•
Research updates within oncofertility realm
Gracia, C., & Woodruff, T. K. (2012)
Integrating Programs
•
Comprehensive Fertility Care and Preservation Program (CFCPP)
Multi-disciplinary effort
Fertility Navigator
Olivia Frias, MSN
Oncology
Karen Burns, MD
Christine Phillips, MD
Kasiani Meyers, MD
Adolescent Gynecology
Holly Hoefgen, MD
Lesley Breech, MD
Gylynthia Trotman, MD
Urology
Andrew Strine, MD
Pramod Reddy, MD
Abbey Franklin, PA
Pathology
David Witte, MD
Jaime Reuss
Bonnie Kelly
REI
Julia Rios, MD
Quality Improvement
Mary Anne Lenk
Research Coordinator
Tara Schafer-Kalkhoff, MA
Outside Resources
Anderson Center
LiveWell Collaborative
Integrating Program
Cancer and Blood Diseases Institute ( CBDI)
CBDI
• Liquids Team
– Leukemia/Lymphoma
• Solids Team
– Solid tumors
• Neuro Onc Team
– CNS tumors
• Bone Marrow Transplant
– Marrow Failures/ Immune Deficiency
Each team is unique in their own way
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Inpatient
Outpatient
Referral Process
Work up
Lateral Integration
• Barriers
– How can we communicate effectively and efficiently?
– How can we identify patients in need of fertility preservation care
through this process?
– How can we ensure patient/family that elect fertility preservation
receive continued care before, during, and after their
intervention?
Interventions
Patient Navigator:
Identified the following interventions
• Attend weekly team meetings (L/L, Solids, Neuro-onc,)
• Receive weekly ONC registry
• Receive weekly BMT calendar
• Monthly BMT meetings
• Attend Tumor Board
Electronic Interventions:
• Email: [email protected]
• Desk phone/ message line
• Pager “On Call”
• EPIC in- basket
• EPIC order set
• Website
Website
The Consult
Work Up
•
New patient presents to CBDI
• Fertility Consult is triggered
• Via page, email, phone, or order set
• Fertility consult process/ chart review initiated
• Acuity – identify urgency of consult
• Timeline – communicate with primary team
• Identify previous treatment & future treatment
Pre Consult
•
•
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Request fertility lab panel
– To be drawn prior to the start of any chemotherapy
Navigator alerts CFCPP team
– Inpatient
– Outpatient CBDI clinic
CFCPP Oncologist will discuss patient with primary oncology team
– Review any prior therapy, current/planned therapy
– Review timeline
– Calculate the risk based on dosing/exposure, literature review
• High: >80%
• Moderate: 20-80%
• Low: <20%
Return to Navigator with low, intermediate, high risk and timeline
The Consult
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Standardized Consult
– Males
– Females
Folders specific to our team
– Team members & contact information
– CCHMC patient education material
– Outside patient education material
Shared Decision Making Tool
LiveWell Videos
– Educate
– Distribute information
– Self promotion
Shared Decision Making Tools
Post-Consult Follow up
Navigator makes contact with family and coordinates next steps (72 hours)
– Sperm banking
– Embryo/Oocyte cryopreservation
– Ovarian Tissue Cryopreservation
• Research Coordinator notified
• OR scheduling
• Pathology notified
• Off site storage facility
Funding/Financial:
• financial burden
• Procedure
• Storage fees
Social Work:
• Collaboration
• Allocate philanthropic funds appropriately
Fertility Consult Workflow
Fertility Navigator
•Obtain initial contact information
•Review records for any previous fertility team contact
•Reach out to the Oncologist on-call to address Gonadotoxic Risk Calculation
•Reach out to the Gynecologist or Urologist on-call to make aware of pending consultation
Oncologist
Gynecologist /Urologist
Fertility Navigator
• Assist with consultations as required and available
• Follow up with primary team
•Contact Research Coordinator for any patients requesting research protocol treatment
•Contact University of Cincinnati for female REI services
•Contact appropriate sources for sperm banking
•Assure patients and families have all required contacts, direct follow-up appointment and assist
with further process steps as required
• ** Follow up with "maybe" patients within 72 hours **
Survivorship
The patient Navigator of Fertility Preservation
1 year post therapy
• Female fertility lab panel
• Make contact with at risk patients in Cancer Survivorship Center
• Re-establish care with current patients at one year off therapy
• Evaluate current status, monitor going forward
• Provide resources for fertility preservation
• Follow as necessary for ongoing discussions regarding risk and fertility
preservation
•
“Window” post therapy
• Fertility preservation option
• Ovarian tissue cryopreservation
• Ooctye cryopreservation
Take Away:
The Patient Navigator of Fertility Preservation
• The Patient Navigator of Fertility Preservation
– Point person
– Liaison
– Lateral integrator
– Fertility preservation advocate
Funding the Navigators
• Immediate team
- Can vary based position
• MA, RN, NP
• FTE flexibility
• Institution
– Academic Research Committee (ARC)
• Grants
References:
Gracia, C., & Woodruff, T. K. (2012). Oncofertility medical practice: Clinical issues and
implementation. New York, NY: Springer