Priority assessment for women with recurrent ovarian cancer: a pilot study

Objectives: There is no one best treatment option for women with recurrent ovarian cancer and the treatment plan is usually determined via shared decision-making. The primary objective of this study was to prospectively assess the feasibility of implementing a patient-centered Priorities Assessment Tool (PAT) in gynecologic-oncology clinics. Methods: Inclusion criteria included diagnoses of recurrent ovarian cancer and English language proficiency. Exclusion criteria included cognitive impairment and non-engagement in treatment decision-making. Clinic schedules were reviewed in advance and eligible patients were contacted prior to their gynecologic-oncology appointment about the study. The study team approached interested subjects immediately prior to their visit to complete demographic information, the FACT FOSI-18 and the PAT instrument. Following the visit, patients and providers completed PAT evaluation forms. Feasibility was defined as the proportion of patients who completed all 3 study forms prior to meeting with their physician. A secondary objective was the identification of factors from the demographic form and FACT FOSI-18 associated with priority assessments from the PAT. Institutional review board (IRB) approval was obtained. Results: Between October 2018 and December 2019, 115 women with recurrent ovarian cancer were considered for enrollment. Of these, 63 enrolled, 13 declined, and 39 were ineligible due to being non-English speaking. Reasons for declining included lack of time or interest. A total of 97% (60) of patients completed all three forms prior to their doctor's visit. The median age range was 61-70 years old, 48% (30) were of race or ethnicity other than non-Hispanic white, and 47% (29) had graduated college. A total of 18% (11) had no evidence of disease, and 78% (47) were receiving treatment. Prioritization included “having enough energy to do the things that are important to me” (66%, 41), caring for others (32%, 20), and hobbies (21%, 13). FACT FOSI-18 (Functional Assessment of Cancer Therapy Symptom Index) top concerns are shown in Figure 1. 79% (49), which indicated wanting to be involved in treatment decisions, 39% (24) needed help understanding their disease, and 76% (47) understood their goals of care. When FACT FOSI-18 scores were correlated with PAT responses, quality of life was inversely associated with wanting to be involved in treatment decision-making (Pearson Correlation -.273, p=0.031). In evaluating the tool after their visits, 98% (60) said the PAT was easy to use and 61% (38) reported that it helped to communicate goals and priorities with the medical team. Download : Download high-res image (81KB) Download : Download full-size image Conclusions: Implementation of the PAT was feasible with 97% of enrolled patients completing all study forms prior to their appointment. The PAT allowed participants to share their treatment-related priorities and highlights that the majority of women with ovarian cancer want to engage in shared-decision making with their providers, especially those with diminished quality of life. This finding demonstrates the increasing importance of patient-physician communication over the cancer continuum.