1. 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

2. 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

3. 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

4. Defining the Role Con’t The Fertility Navigator of Fertility Preservation
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)
Gracia, C., & Woodruff, T. K. (2012). Oncofertility medical practice: Clinical issues and implementation. New York, NY: Springer

5. 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

6. Integrating Program Cancer and Blood Diseases Institute ( 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
Inpatient
Outpatient
Referral Process
Work up

7. 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?

8. 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:
Desk phone/ message line
Pager “On Call”
EPIC in- basket
EPIC order set
Website

9. Website

10. The Consult

11. Work Up New patient presents to CBDI Fertility Consult is triggered
Via page, , 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

12. Pre Consult 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

13. The Consult 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

14. Shared Decision Making Tools

15. 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

16. 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 **

17. 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

18. Take Away: The Patient Navigator of Fertility Preservation
Point person
Liaison
Lateral integrator
Fertility preservation advocate

19. Funding the Navigators
Immediate team
Can vary based position
MA, RN, NP
FTE flexibility
Institution
Academic Research Committee (ARC)
Grants

21. References:
Gracia, C., & Woodruff, T. K. (2012). Oncofertility medical practice: Clinical issues and implementation. New York, NY: Springer