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PURPOSE: To characterize the frozen oocyte disposition preferences of patients undergoing medical and planned fertility preservation. METHODS: All oocyte cryopreservation (OC) patients were identified between 2015 and 2018. Demographic information and fertility preservation (FP) indication (medical or planned) were identified for each patient. Oocyte disposition options included disposal, donation to research, or donation to a specified third party, which was decided at the time of initial consent and made available in the electronic medical record. The primary outcome was the disposition selection. Secondary outcomes included differences in demographic variables and disposition selections between medical and planned FP patients using chi-squared analysis. RESULTS: A total of 336 OC patients with a documented oocyte disposition preference were identified in the study timeframe. Patients were on average 34.5 years old (SD = 5.1) and were predominantly White (70.2%), nulliparous (83.0%), with a BMI of 24.7 (SD = 5.4). A total of 101 patients underwent OC for medical FP and 235 for planned FP. In both groups, the most commonly selected disposition option was donation to research (50% planned, 52% medical), followed by donation to a specified third party (30% planned, 30% medical), and finally disposal of oocytes (20% planned, 18% medical). There were no significant differences in disposition selection between each group. When comparing patient variables between groups, medical FP patients were more likely to be under the age of 35 and were less likely to be nulliparous (p < .001). CONCLUSION: This study shows that oocyte disposition choices are similar in patients undergoing OC for medical and planned indications. As donation to research was the most commonly selected option in both groups, it is time to start thinking of streamlining ways to utilize this potential research material in the future.
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Preservação da Fertilidade , Criopreservação , Recuperação de Oócitos , OócitosRESUMO
Women with a history of breast cancer compose the largest group of cancer survivors. Physician assistants and nurse practitioners can play a key role in caring for cancer survivors in primary care settings. This article provides a brief overview and synthesis of current breast cancer guidelines, other resources, and clinical observations that may help primary care providers to translate plans developed by oncology specialists into primary care delivery.
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Neoplasias da Mama/reabilitação , Sobreviventes de Câncer , Atenção Primária à Saúde , Feminino , Humanos , Profissionais de Enfermagem , SobreviventesRESUMO
BACKGROUND: People with atrial fibrillation (AF) have lower reported quality of life and increased risk of heart attack, death, and stroke. Lifestyle modifications can improve arrhythmia-free survival/symptom severity. Shared medical appointments (SMAs) have been effective at targeting lifestyle change in other chronic diseases and may be beneficial for patients with AF. OBJECTIVE: To determine if perceived self-management and satisfaction with provider communication differed between patients who participated in SMAs compared to patients in standard care. Secondary objectives were to examine differences between groups for knowledge about AF, symptom severity, and healthcare utilization. METHODS: We conducted a retrospective analysis of data collected where patients were assigned to either standard care (n = 62) or a SMA (n = 59). Surveys were administered at pre-procedure, 3, and 6 months. RESULTS: Perceived self-management was not significantly different at baseline (p = 0.95) or 6 months (p = 0.21). Patients in SMAs reported more knowledge gain at baseline (p = 0.01), and higher goal setting at 6 months (p = 0.0045). Symptom severity for both groups followed similar trends. CONCLUSION: Patients with AF who participated in SMAs had similar perceived self-management, patient satisfaction with provider communication, symptom severity, and healthcare utilization with their counterparts, but had a statistically significant improvement in knowledge about their disease.
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Fibrilação Atrial/terapia , Satisfação do Paciente , Qualidade de Vida , Consultas Médicas Compartilhadas , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Breast reconstructive surgery has changed significantly over the past decade. The incidence of nipple-sparing procedures and prophylactic mastectomy has also increased significantly as women and their surgeons use shared decision-making strategies. The following case history of two sisters, one with breast cancer and one at elevated risk for breast cancer, highlights the current standard of care with newer gold-standard procedures for mastectomy and subsequent reconstruction. A comparison of types of mastectomies, steps in reconstruction, and reconstruction options are discussed.
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The objectives of this study are to compare the sexual concerns, interest and experiences in discussing these concerns with their doctor for women of "Only Men" and "Some to Only Women" sexual orientation. A survey was mailed to women patients from two military outpatient settings, with 1,196 women responding. Of eligible respondents (N = 1,170), 90% reported "Only Men" and 10% reported "Some to Only Women" sexual orientation. Sexual concerns varied by sexual orientation, while interest and experience in discussing sexual concerns and desire for physicians to initiate the topic differed minimally. Women with "Some to Only Women" sexual orientation have both similar and differing sexual concerns compared to "male-only" oriented women. Larger primary care patient-based studies of sexual health care needs of sexual minorities are needed.
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Assistência Ambulatorial , Necessidades e Demandas de Serviços de Saúde , Heterossexualidade , Homossexualidade Feminina , Hospitais Militares , Militares , Adulto , Demografia , Feminino , Humanos , Pessoa de Meia-Idade , Relações Médico-Paciente , Estados UnidosRESUMO
Advancements in methods of fertility preservation have resulted in more options available to women seeking to postpone reproduction. Preservation of unfertilized oocytes provides women with the possibility for reproduction even after age-related declines in fertility might make conceiving a child difficult to impossible. As oocyte cryopreservation rises in popularity among women, it is crucial for nurses and other clinicians to understand the background, process, ethical issues, and risks involved to help women make informed medical decisions.
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Criopreservação/métodos , Recuperação de Oócitos/métodos , Comportamento Reprodutivo/ética , Criopreservação/economia , Criopreservação/ética , Educação Continuada em Enfermagem/métodos , Prática Clínica Baseada em Evidências/métodos , Feminino , Custos de Cuidados de Saúde , Humanos , Ovário/patologia , Educação de Pacientes como Assunto/métodos , Educação de Pacientes como Assunto/normas , Poder Psicológico , Resultado do TratamentoRESUMO
BACKGROUND: Oncology nurse navigation programs enhance coordination of care and patient satisfaction. â©. OBJECTIVES: The objective was to evaluate the effect of oncology nurse navigation on access to care, patient and provider satisfaction, and clinical trial enrollment of patients with hematologic or gynecologic malignancies.â©. METHODS: A descriptive cohort study with a historic control was undertaken. Data were collected from electronic health records and patient and provider surveys in two disease-specific groups.â©. FINDINGS: A significant decrease in the mean days from first provider visit to first therapy was observed in the hematology population. In both groups, time from contact to first visit and from first visit to initiation of treatment decreased. Mean satisfaction survey scores for both groups were high regarding relationships with the navigator and care received. Providers were highly satisfied with the program, and the navigation program did not increase clinical trials enrollment.
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Institutos de Câncer/organização & administração , Assistência Integral à Saúde/organização & administração , Enfermagem Oncológica , Desenvolvimento de Programas , Estudos de Coortes , Registros Eletrônicos de Saúde , Feminino , Neoplasias dos Genitais Femininos/enfermagem , Acessibilidade aos Serviços de Saúde , Neoplasias Hematológicas/enfermagem , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The process of in vitro fertilization (IVF) causes anxiety, but it is unclear whether this anxiety continues into pregnancy and affects childbirth preparation. This study administered the pregnancy-related anxiety measure to 144 women during their second trimester. Anxiety scores were slightly higher among IVF compared to non-IVF pregnant women. Thirty-one participants provided narrative data about their pregnancy-specific anxiety. Themes emerged from qualitative analysis related to anxiety about the health of their babies, perception of maternal health and safety, and perception of their abilities to fulfill the role of mother. Because of their relationship with patients during pregnancy, nurses and perinatal educators play a critical role in identification of women with pregnancy-specific anxieties and providing relevant care to address these anxieties.
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Innovative group medical visit programs have emerged in an effort to increase efficiency, improve service and quality of healthcare, and better manage high-risk patient populations. A case study program for cancer survivors, adapted from the Centering Healthcare Institute's model, demonstrates how nurse practitioners can lead the implementation and measurement outcomes of group visit models.
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Assistência Ambulatorial/organização & administração , Processos Grupais , Profissionais de Enfermagem , Neoplasias da Mama/enfermagem , Feminino , Humanos , Modelos de Enfermagem , Modelos Organizacionais , Pesquisa em Avaliação de Enfermagem , Estudos de Casos Organizacionais , Inovação Organizacional , Sobreviventes/psicologiaRESUMO
The Centering Cancer Survivorship (CCS) follow-up care program is an innovation in healthcare delivery that meets the needs of cancer survivors and cancer centers. Piloted in a breast cancer clinic, the program provides an avenue for provision of psychological support and health-promotion activities, as well as surveillance for recurrence or late effects. The program empowers each survivor by enlisting her to produce a written breast cancer survivorship care plan for personal use and to share with her primary care provider. Concurrently, this innovation should enhance the viability of the primary cancer center by freeing appointment slots for oncologists who provide expensive therapies to newly diagnosed patients. The CCS program's central feature is the implementation of a multidisciplinary clinic designated specifically for breast cancer survivors in which follow-up care is provided through a group visit medical model. This model of care provides opportunities for health assessment, patient empowerment, and patient education within a framework of social support from peers with similar issues. The group visit model may be well suited to addressing the unique chronic healthcare needs of breast cancer survivors. Further evaluation is needed to verify cost-benefit analysis.