ABSTRACT
Study objective: Multidisciplinary meetings (MDMs) are increasingly implemented in complex care based on the principle that they lead to evidence-based treatment recommendations, foster adherence to clinical guidelines, induce better team performance and improve medical care. In oncofertility, the uncertain outcomes of fertility preservation procedures in children contribute to the complexity of decision-making. There is limited published information on the influence of MDMs on paediatric and adolescent oncofertility care. Aim(s): To describe the implementation, characteristics & outcomes of multidisciplinary meetings (MDMs) in a paediatric oncofertility setting. Method(s): A retrospective medical records review of oncofertility MDMs held between April 2020 and March 2021 at the Royal Children's Hospital Melbourne. Inductive content analysis of the reasons for MDM was undertaken. MDM documentation was scored out of 24, according to a Victorian Paediatric Integrated Cancer Service quality assurance checklist for MDMs, (1)) which included consent for MDM, nature of attendees, quality of discussion and documentation. Result(s): Of the 169 oncology patients treated at the Royal Children's Hospital between 1st April 2020 and 31st March 2021, MDMs were required for 40 patients (23.7%). The median number of clinical attendees was 10, and included craft groups from both paediatric and adult centres (oncology, oncofertility, gynaecology, clinical ethics, endocrinology, paediatric surgery, anaesthetics, haematology, fertility specialists and reproductive scientists). Fifty-four percent (n=22) of MDMs were for male patients (median age 8.4 [0.1-16.5] years) and 46% for females (n=18, median age 8.1[0.4-16.3] years). The commonest diagnoses presented at MDM were brain tumours (27.5%), leukemia (25%), and non malignant conditions (19.5%). Approximately 77% of all MDM patients were going to receive treatment that put them at high infertility risk and 62.5% had co-morbidities. MDMs included the following themes (i) likelihood of successful parenthood: disease progression, prognosis, neurocognitive decline;(ii) certainty or otherwise of planned treatment and infertility risks;(iii) mitigation of anaesthetic and surgical risks;(iv) ethical concerns;(v) organizational capacity and logistics in the face of covid restrictions or high dependent care between centres (vi) child and family of risks, expectations and their values regarding fertility preservation. In 87.5% of cases, it was deemed permissible to offer fertility preservation. The median score for the MDMs derived from the quality assurance checklist was 16. Conclussion: MDMs acted as a valuable educational and communication tool improving situational awareness, building shared mental models, assisting with risk mitigation and oncofertility planning.Copyright © 2023
ABSTRACT
OBJECTIVE: Social media is a popular way to disseminate new information and opinions, perhaps furthered by the COVID-19 pandemic and quarantine. Our objective was to analyze information and sentiments posted regarding the COVID-19 vaccine (VAX) on fertility-related social media. MATERIALS AND METHODS: The search function of Instagram (IG) and Twitter (TW) was used to identify the first fifty accounts with the following terms: fertility doctor, fertility, OBGYN, infertility, TTC, and IVF. Accounts not in English, private, no posts in >1 year, or content unrelated to search terms were excluded. Accounts were evaluated for author type and categorized as physician (PH), individual (ID), or fertility center/fertility-related organization (FCO). Account demographics including number of followers and prior baseline post activity (number of likes/number of followers) were recorded. The VAX was approved on 12/11/2020 and posts dated 12/1/2020 - 2/28/2021 were reviewed. Posts mentioningthe VAX were analyzed for content: sentiment (positive, negative, or neutral), mention of research studies (RS), national guidelines (NG), personal experience (PE), side effects (SE), reproductive related (RR) content and post activity. Statistical analysis included Chi-Squared and Fisher's exact tests, with significance set to <0.05 (∗). RESULTS: 536 accounts were identified and 276 were included (133 IG and 143 TW). There were 104 PH accounts (45 IG, 59 TW), 91 ID accounts (62 IG, 29 TW), and 81 FCO accounts (26 IG, 55 TW). PH accounts were most associated with mention of COVID (83.7%∗) and VAX (68.3%∗), followed by FCO (37% COVID∗, 30.9% VAX∗), and ID (8.8% COVID∗, 6.6% VAX∗). PH was most associated with >1 VAX posts compared to FCO or ID (51.0% v 11.1% v 1.0%∗). Sentiments toward the VAX were largely positive for all groups (PH 90.3%, ID 71.4%, FCO 70%), or neutral (PH 9.7%, ID 28.6%, FCO 30%), with no negative posts identified. Trends in mentions and sentiments were similar on both IG and TW platforms. PH cited NG (24.6%∗) and RS (17.5%) more than ID and FCO, with most cited guidelines from ACOG, ASRM, and SMFM. ID posts were mostly PE (87.5%∗) and SE (57.1%∗). RR posts were most associated with FCO accounts (80%∗) which included pregnancy, infertility, and breastfeeding. Sub-group analysis of IG accounts showed an increase in activity on VAX posts compared to baseline by likes (PH 4.86% v 3.76%, ID 7.5% v 6.37%, FCO 2.49% v 0.52%) as well as comments (PH 0.35% v 0.28%, ID 0.90% v 0.69%, FCO 0.10% v 0.02%). CONCLUSIONS: Overall, the majority of posts expressed positive sentiments toward the VAX with no negative posts identified. PH were most likely to post about COVID-19, the VAX and guidelines. Few ID accounts posted but when present were about personal experiences or side effects and remained positive. IMPACT STATEMENT: There is an active conversation regarding COVID-19 and VAX information on social media, with the majority of posts expressing positive sentiment. Physicians play a large role in circulating information regarding the VAX on social media platforms, and can be influential in discussions of VAX guidelines and dispelling fertility myth.
ABSTRACT
OBJECTIVE: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected millions of people. With the development and administration of the SARS-CoV-2 vaccines, there is growing evidence to suggest that there has been reduced transmission of the virus. However, the novelty of the vaccine has raised many questions for infertility patients due to the lack of research. This study examines the perceived anxiety level of patients at a fertility clinic in Manhattan who are undergoing infertility treatments, such as Timed Intercourse (TIC), Intrauterine Insemination (IUI), and In-Vitro Fertilization (IVF). Understanding the mental state of patients with infertility problems during the COVID-19 pandemic is vital for fertility clinics in their future patient assessments. MATERIALS AND METHODS: Surveys were administered to approximately 100 patients at a fertility clinic in Manhattan during early April 2021 - a few months after the first Covid vaccine was administered in the USA. The questionnaire asked patients to specify their treatment plan (TIC, IUI, IVF, oocyte cryopreservation, or no infertility problem). The survey included a 20-item Spielberger State-Trait Anxiety Inventory (STAI) assessing their current state of anxiety. For the STAI score cutoff, <40 = not anxious;40+ = high anxiety. Continuous variables were measured as mean and standard deviation and compared with a two-sample t-test or ANOVA. Categorical variables were compared with a Fisher test. A p-value <0.05 was considered statistically significant. Statistics were done with R version 4.0.5. RESULTS: There is no statistical significance in which group was more likely to have received at least one dose of the COVID-19 vaccines. However, the ''undecided'' group had the lowest percentage of individuals receiving the vaccine. There is also no statistical significance in the anxiety levels of the different groups of patients. The group with the greatest percentage of anxiety according to the STAI score is the ''undecided'' group. Fear of the COVID-19 virus being greater than the fear of the COVID-19 vaccine is a commonality between all the groups. CONCLUSIONS: The survey found that the greatest cause of apprehension in patients was the virus's unknown effects on their physical health. Majority of the hesitancy in receiving the vaccine was due to the potential side effects posed by the injection on pregnant women and their fetus. Interestingly, patients not in treatment had a trend towards higher fear and anxiety compared to patients undergoing infertility treatment. When broken down even further, patients who are undecided in their treatment are more anxious about both the COVID-19 virus and the vaccine. This indicates that the patient's treatment plan influences their view of the pandemic. IMPACT STATEMENT: Women with infertility issues experience tremendous amount of emotional turmoil, which can further interfere with their fertility. Recognizing the root of this population's anxiety during the COVID-19 pandemic can assist reproductive endocrinologists in forming treatment plans that integrate management of patient's psychological wellbeing.