Chapter 10: Will2Love: A Start-Up to Disseminate and Commercialize Work in Onco-Fertility
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Description
In this chapter, Dr. Schover sketches her work with her start-up company, Will2Love. She explains that after the third business grant from the NCI came to a close, she began to explore how to create a digital health business. In 2015 the Texas medical Center was initiating the TMCx program to enhance innovation and she received special permission to take part. She talks about the process of shifting to an entrepreneurial mindset and explains why hospitals have been resistant to undertaking programs in onco-fertility and sexuality.
Next, she sketches the services that Will2Love offers for both patients and providers. She also talks about work with a provider, Greenville Health System in South Carolina, a innovative, APN-directed fertility program. She talks about the lessons learned in developing both the patient and provider materials. She discusses a possible contract with MD Anderson.
Next, Dr. Schover talks about what is next for Will2Love.
Identifier
SchoverL_02_20181004_C10
Publication Date
10-4-2018
City
Houston, Texas
Interview Session
T.A. Rosolowski, PhD, Oral History Interview, October 04, 2018
Topics Covered
The Interview Subject's Story - The Researcher; MD Anderson Product Development and IP; Discovery, Creativity and Innovation; Finance, Entrepreneur, Biotechnology; The Researcher; Professional Practice; The Professional at Work; Collaborations; Discovery and Success; Definitions, Explanations, Translations; Overview; Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care; Survivors, Survivorship; Patients, Treatment, Survivors
Transcript
Leslie Schover, PhD:
So it was really, as the third grant was coming to an end and I started seriously thinking about commercialization, because Dr. Martinetti decided he didn’t want to go forward with the commercialization process because he had other irons in the fire, of different things he wanted to do. And so I started exploring learning what I could do to learn how to create a digital health business like this. The NIH actually had just kind of like a three-weekend program called the Commercialization Acceleration Program, that I participated in, and started to give some ideas about what it would take to actually create a company. Then, in 2015, the Texas Medical Center started their TMC/X innovation program and we ended up being one of the first 20-some companies that were accepted into that program. That was a real whirlwind education. I got special permission to spend some of my time in that program, since I was still on the faculty.
T.A. Rosolowski, PhD:
Now you said we. Did you have a partner you were working with at the time?
Leslie Schover, PhD:
Well not really at that point, it was more me. I guess I often say we when I talk about the company, but it’s been a very lean company. I have a business consultant now, who is maybe a quarter time with the company, and he’s my major partner, but I also have a Web development company I’ve been working with ever since, for about five years now. We’ve got accountants and lawyers and stuff, but we don’t have a lot of personnel in the company, partly because I’ve been funding it myself and we’re doing what we can afford to do until we get more customers. So.
T.A. Rosolowski, PhD:
Who is the partner you’ve been working with?
Leslie Schover, PhD:
His name is Fard, F-a-r-d, Johnmar, J-o-h-n-m-a-r, and he’s a digital health expert in New York City. We meet once a week by videoconference and if it weren’t for Fard, I’m sure we would have never gotten this far, so he’s been very, very helpful.
T.A. Rosolowski, PhD:
So, tell me more about this whole process. I mean it’s interesting, because there’s so many people who want to become entrepreneurial with discoveries that they’ve made, but that’s a whole different skillset. What was that like for you and how did that process affect kind of what you have ended up presenting?
Leslie Schover, PhD:
Well, you know, it’s been a pretty anxiety laden process. For one thing, when I started with the TMC/X, there were so many things I didn’t really know a lot about, like marketing and how to—and we started out thinking we could sell these things directly to consumers, which we quickly found out was not going to work. That’s been the experience of the great majority of digital health companies. So what you end up doing is trying to get hospitals to license your software and offer it to patients without a cost to the patient. So that’s a whole different issue, because when it comes to sexuality, and to a lesser extent fertility, hospitals have been doing very little, as little as they can. So when we try to sell them on the idea that they should be providing better care and spending some money on it, it’s like persuading them to spend money on something they didn’t have to spend money on before, rather than saving money, which is how most digital health companies try to market themselves. So we can say that we think that we can save oncologists and oncology nurses and social workers some clinic time, because whatever time they are talking to patients, they may not be very well trained and not know how to help patients and what to do. What we offer them instead is just ask one question to identify a problem and then have trained staff who can bill for a visit, instead of giving unbillable clinician time in the clinic, and that helps sustain the program. The other thing that helps financially is for example, in MD Anderson, where we have our benign gynecologists and our urology, sexual medicine clinic, and to a lesser extent oncofertility --because some of that revenue goes to Texas Children’s Hospital. But if we can increase the referrals to those specialty services, then MD Anderson benefits, so whatever the cost of the contract with us may be, hopefully they can earn more back in increased revenue, so it’s not revenue draining, and besides which, it provides much better quality here for patients, on an issue that patients care about. We can also talk to the hospitals about how this is a great marketing tool, since the major cancer centers are all competing nationally for a pool of very well educated, well insured patients, and this is something that those patients care about, is having a program like this.
T.A. Rosolowski, PhD:
Now tell me, kind of take me on a tour of everything that Will2Love offers.
Leslie Schover, PhD:
One thing that we offer, although we can do a contract without it, is consulting in how would you actually structure a reproductive health program in an oncology setting. What kind of staffing would you need and what kinds of professions could bill for assessment visits or specialty visits, what CPT codes would you use to bill. How do you get buy-in from the clinicians, that this is something important enough for them to at least ask a 20-second question and refer people. These aren’t little issues, these are big issues, trying to change people’s practice. We also can help train the professional staff of the program. We have an online training portal called our PRO Portal, that includes a whole section on skills that make it easier to talk to patients about sex and fertility, like what words do you use and how do you normalize and put questions into context so it’s not embarrassing, and outlines of assessment interviews. We also have a very detailed clinician’s manual on how to use our self-help programs to counsel patients, whether you’re doing brief counseling --like maybe you’re an advanced practitioner who is spending a half hour trying to get the patient started off on the right track or maybe you are a mental health professional who has worked with oncology patients a lot but hasn’t had a lot of training in fertility counseling or sexuality counseling. Then we have a lot of information in the PRO Portal that can help people get up to speed. And then we have the men’s and women’s self-help programs, which have evolved considerably over these 17 years, so that we hope they are now more engaging for patients. We know that some patients are going to do better with some clinician contact, in addition to the programs, but we’ve tried to create them as much as we can so that they can be used as a standalone. So, each program includes the sexual and fertility side effects for a whole range of cancer sites and treatments, and explanations of basic things like how reproductive anatomy works for fertility and for sexual response, and how to avoid unwanted pregnancies or sexually transmitted infections during and after cancer treatment, and what about survivors of childhood or young adult cancers. And then we have a section called Sexual Solutions, which goes over all the different common sexual problems that men or women, depending on the program, have after cancer, like loss of desire or erection problems in men or vaginal dryness and pain in women, trouble reaching orgasm, pain problems, incontinence or ostomies affecting sex. We go through the sexual and fertility side effects of special treatments like stem cell or bone marrow transplants, or limb amputation, or you know all kinds of things that are far, far more in depth than anything else that’s out there in terms of a self-help book or Internet. I wrote the original American Cancer Society online information on sexuality and cancer, and the men’s and women’s versions are each between about 50 and 70 pages long, but they’re maybe a tenth of what we have in our self-help programs. Also, each self-help program has seven or eight interviews with real patients that we did here at MD Anderson, with UTTV, and we also wrote scripts and casted them with actors and did kind of a series of vignettes. So there are two in the women’s and two in the men’s, that tell the story of someone going through a particular kind of cancer and their relationship and communication with their partner and things like that, to show common situations. We give self-help strategies that people can use, like how to use lubricants and dilators for women, or different treatments that you can use for erectile dysfunction in men. We also give guidance on what are your medical options and how to choose whether you want to try a certain medical treatment. So it’s very comprehensive.
T.A. Rosolowski, PhD:
Do you find that some patients prefer to access all this information online, rather than sitting down with someone?
Leslie Schover, PhD:
Well, I mean that’s what we’re offering them. It’s essentially a website that you can access online, without any help from a clinician.
T.A. Rosolowski, PhD:
I mean, I’m just thinking that some patients might actually prefer it. I mean first of all, it’s a learning strategy, to absorb all this detail more slowly, and secondly, I mean some of it is pretty stressful to talk to somebody else about and they might want privacy. I’m just curious, if you found this as a preferred mode for people.
Leslie Schover, PhD:
Well, I don’t know if it’s preferred but it definitely—it’s been a little bit difficult to assess that in the kinds of studies that we’ve done. Currently, we have a study with the American Cancer Society, with 289 people enrolled, but in contrast to our smaller studies at MD Anderson, we’ve had a much higher dropout rate. I think that what I came to realize is that our programs at this point, have so much information in them, that even though we’ve got some navigation strategies that have to do with setting specific goals and then getting links to parts of the program where you can learn things or try exercises to complete your goal, that some patients may get bogged down or confused. And so this summer we’re actually creating a new feature where we’re using a very short questionnaire to actually set up a personalized home page for each user. So we ask them, Are you using this as a patient or as a partner. Are you a man or a woman? Is your partner same sex or opposite sex? What kind of cancer and treatments have you had and what kinds of—and do you have advanced disease? Have you had any of these particular special treatments, or what kind of sexual problems are you have, or are you interested in fertility and are you concerned about the health of your children? And depending on what they say, they get links to parts of the program that they can click on, right on their home page. We also take them through the actual process of setting goals, because in our current study, it looks like only about a quarter of people are setting goals, even though we thought that was something that we wanted everybody to do. And so now we’re giving them a whole tour of exactly what’s in the program, how do you find something using our search box or our frequently asked questions that, you know people didn’t seem to be using, so hopefully that will help. People are very impatient when it comes to websites, they just want to get in there. They have one question and they want to get it answered, and then they often miss the richness of what’s in there, where we want them to use this as a comprehensive intervention. So.
T.A. Rosolowski, PhD:
Well, it is an interesting process, you know, and yeah, people are conditioned to think that sites will work pretty automatically, but the services that you’re delivering are really complicated too. So I imagine it’s obviously a learning curve for you, how to menu out everything that you are offering. Stage one is just getting it all down, [laughs] and then kind of creating the map so people can find their way through it. Yeah, a really interesting kind of challenge.
Leslie Schover, PhD:
Yeah. Because people come with so many different agendas; that’s how we got to our goal setting. So we have menus, three menus of goals. We have knowledge goals, which are things you just might want to learn about, and action goals which involve solving or preventing a problem, like I want to stop having pain during sex, or I want to improve my sexual… And then we have relationship goals, which are things like I want to improve sexual or general communication with my partner, or I want to date after cancer, if they’re single. So you know, we have a whole range of things and we ask them to choose their top priority goal in each category, and the program sets up a table for them, with links to the parts of the program where they can do steps to reach their goal. That, we hoped, we had thought that was going to be a big improvement, but then if people don’t use it, it obviously isn’t going to help, so.
T.A. Rosolowski, PhD:
Yeah. Well, that’s the downside of self-directed, right?
Leslie Schover, PhD:
Yeah.
T.A. Rosolowski, PhD:
All of those things are basically self-directed. The person can do the book learning, but are they actually going to do the work of making the changes or rising to the challenges, and that’s basically on the individual. Even if they’re having their hand held by a clinician.
Leslie Schover, PhD:
Right, right.
T.A. Rosolowski, PhD:
That’s the hard work of it.
Leslie Schover, PhD:
Right. Right now it looks to us like at least a third of people are probably going to benefit from using the program, but we sure want to increase that. So currently, if we did a contract with a hospital, it could just be a software licensing contract where they would, you know, have access for all their patients, to either the men’s or women’s self-help program, and the PRO Portal for their staff, or what we prefer is a contract that has those software elements but where we also, certainly in the initial months of the contract, help them set up their program and make sure that it’s sustainable and that people are happy with it, and that the staff is well trained, et cetera.
T.A. Rosolowski, PhD:
So, are you in the point now where you’re searching for contracts with organizations. That’s the next stage of development? Have you worked with some organizations already?
Leslie Schover, PhD:
Well, we have one hospital customer which is the Center for Integrative Oncology and Survivorship, which is part of the Cancer Center in Greenville, South Carolina. It’s Greenville Health System, and they’re a very unusual health system. They’re very forward looking and they’re early adopters of a lot of psychosocial things. They came to us, and we’ve been working with them for about six months, and we’re only working with them on the women’s side of things, for sexuality, but it’s been going well and it’s been definitely a learning curve. It’s an advanced practice nurse kind of directed program, which is exactly the kinds of practitioners that we think may do very well doing these assessment visits. So it’s been very interesting and helpful. I worked with them, I did do one visit, but I’ve been working with them mainly with videoconferencing, and trying to get them to explore these programs in depth, and to modify some of the things they were already doing with patients.
T.A. Rosolowski, PhD:
So what are some of the big learning moments you’ve taken away from this relationship, for you?
Leslie Schover, PhD:
Well one is that I think I’m always very idealistic and I just assume that if we make the PRO Portal available to clinicians, that they’ll just spend hours in there learning all kinds of stuff, like reading a book, and they’ll just go through it and go, Wow, isn’t this amazing. But in fact, people are really busy and it’s very hard to get people to spend more than a few minutes looking at stuff. So one of the things I’ve been doing this summer is creating a series of webinars, to supplement the PRO Portal, that go over some of the major issues of material that’s in it, and hopefully we’ll not only teach people, but stimulate them to go in and learn even more.
T.A. Rosolowski, PhD:
Is there anything else?
Leslie Schover, PhD:
Well one is that when you’re working with people who already have done something a certain way, that there’s always a little bit of a struggle to get them to stop giving written handouts, versus using the online resource or to—and different programs have different resources that they like to use, like maybe they have a compounding pharmacist, or they have a gynecologist who does a kind of treatment that I’m not sure is very beneficial. So having to deal with their local culture of how they do things and try to gently suggest alternatives but know that I may not be able to change some of these things.
T.A. Rosolowski, PhD:
Right. It may be a process of them slowly realizing, Hey wait a minute, we ought to take another look at this.
Leslie Schover, PhD:
Right. And here at MD Anderson, I don’t know if we’ll have an agreement that goes forward. I’m still waiting to hear, but one of the things that worries me is towards the end of the time I was here, I kept trying to get a grant funded to train interdisciplinary teams in different site specific clinics, to do a better job with sexuality and fertility. I had put together this brief training program that --most of which was online and could be done not during working hours, et cetera. I thought that this would be something that clinic chiefs would be very supportive of. But one of the times I was trying to get this grant funded I thought, I’m going to email or call around to a bunch of different clinic chiefs and get some endorsement from them that, Yes, they would love to do this. I discovered there were only three clinics that said they were really interested. That really worried me, so if we do get an agreement to come and work with clinics here, one of the things that may be an uphill battle is just getting the faculty and staff to say, Yes, this is a worthwhile issue and if I only have to spend 30 seconds with a patient to get things started, I can do that, because this is such an incredibly busy, complex place.
T.A. Rosolowski, PhD:
Now when you contacted these people and they said no they weren’t interested, did they give a reason?
Leslie Schover, PhD:
Well, I mean some of them did, that it’s too many hours, or I don’t even care if it’s outside of work time, that’s too much time devoted to this topic, or I don’t think it’s a high priority.
T.A. Rosolowski, PhD:
Right, right, sort of the usual things. People are stressed, for sure. What’s kind of next for you with Will2Love? What’s the immediate evolution you can foresee?
Leslie Schover, PhD:
Well, I’ve been funding it out of my own funds and I can’t keep doing that. So either we will get some reasonably paying customers in the next six months or get some startup seed funds from investors, or I’m going to close the company down, as sad as it would make me to do that, because I just can’t leave myself destitute for the future.
T.A. Rosolowski, PhD:
Right, right.
Leslie Schover, PhD:
I’ve already spent far, far more money than I ever intended. It’s like once you get started, you keep thinking well just a little more and then we’ll be there, and there may not come, so.
T.A. Rosolowski, PhD:
So this you know, obviously, you’ve put literally, your money where your mouth is.
Leslie Schover, PhD:
Yeah. Which may have been one of the stupidest things I’ve ever done.
T.A. Rosolowski, PhD:
Well, knows about that. I think the deeper point is you really believe in this issue. What’s the connection, why—how would you articulate your belief in the importance of doing this?
Leslie Schover, PhD:
You know I think that it may not be so much the issue of sexuality and fertility itself, not that I don’t think that is important. I think it may be more tied up with my own views of myself as a successful person. There have been very few things in my career that I’ve failed at, and I think there’s a little part of me that says, I can’t believe that I can’t be successful doing this too –which, you know, 95 percent of startups fail. My son, who is in the computer science area, said to me, “Mom, why are you doing this?” So.
T.A. Rosolowski, PhD:
Yeah, well that’s interesting, and I think you’ve always been kind of a risk taker or been kind of—you know, you got into a field that was emerging, you took part in research that was very, very new, got involved with oncofertility, which was really new, now these startups. New. You know, I mean you’ve kind of been the person to move into those areas.
Leslie Schover, PhD:
And I guess the thing that’s also been a passion for me is patient communication and education, and feeling like I could make a difference for patients who have—I mean, they have plenty of other problems too, like life or death problems and finances and fatigue and smoking, and all these other things. But it was an area where I felt like I could make a difference in the information that people would get. Maybe help alleviate some suffering along the way, et cetera. I love writing and creating things, and so to me, putting the websites together and picking the photos and writing scripts for the videos and things like that, has been an awful lot of fun. I really enjoy doing a lot of that.
T.A. Rosolowski, PhD:
Well, it is really a comprehensive expression of a huge range of skills too, some of which you may not have had the opportunity to use before, in the other aspects of your job. So it’s been creative it seems, in some way.
Leslie Schover, PhD:
Yeah, yeah, and I like organizing things. I mean that’s one reason it would make me very sad to shut the company down, is that I’m not sure there’s any way to preserve the websites, unless there was a nonprofit that wanted to take them over and there very well may not be, because there’s a lot of costs in maintaining them, like hosting them and maintaining them, et cetera. So we’ll see.
Recommended Citation
Schover, Leslie PhD and Rosolowski, Tacey A. PhD, "Chapter 10: Will2Love: A Start-Up to Disseminate and Commercialize Work in Onco-Fertility" (2018). Interview Chapters. 1501.
https://openworks.mdanderson.org/mchv_interviewchapters/1501
Conditions Governing Access
Open
