Previous research has documented a communications gap between ovarian cancer patients and their healthcare providers. A new study in JCO Oncology Practice reported on findings from a patient-centered priorities assessment tool that was distributed to women with ovarian cancer in small focus group settings and online. Of 44 women who were offered participation, 36 (81.8%) completed the tool, usually within 10 minutes. Although 31 of the patients (86%) answered that they participated in shared medical decision making with their healthcare team, only five (14%) said that they felt comfortable doing so.
When asked “How satisfied are you now communicating with your medical team?,” six participants (17%) responded feeling satisfied, 16 (44%) said they felt very satisfied, and eight (22%) said they felt neutral. The researchers concluded that completion of the assessment tool helped participants identify their goals and priorities and feel more comfortable in the process of shared decision making, and that it would be useful to complete the tool before making treatment-related decisions.
In the following interview, Melissa K. Frey, MD, of Weill Cornell Medicine in New York City, elaborates on the team’s findings.
What do you take from the 81.8% completion rate of the priorities assessment tool?
Frey: Unfortunately, based on our study design we cannot assess reasons for declining participation. As mentioned in the paper’s limitations, ovarian cancer survivors well enough to attend evening focus groups or respond to online survey invitations represent a limited spectrum of survivors.
How did the direction of the appointments differ with the use of the priorities assessment tool — i.e., did the women focus on areas different from the physicians would have otherwise?
Frey: The patient-centered priorities assessment tool was administered to women with ovarian cancer at focus groups. Twenty-four (68.6%) women reported that the priorities assessment tool would be helpful the next time they needed to make a decision about cancer treatment. A pilot study of this priorities assessment tool in gynecologic oncologists’ offices, including post-activity assessments from survivors and physicians, is ongoing. The results of this study will provide data on the efficacy of this strategy from the patient and healthcare provider perspectives.
How would/could the use of advance practice providers aid in shared decision making?
Frey: In order to accomplish successful physician-patient shared decision making, the physician must understand the patient’s goals, priorities, and concerns. In the setting of ovarian cancer and ovarian cancer treatment, the patient experience is complex and can change along the disease continuum. Completing a patient-centered priorities assessment tool prior to a physician visit offers patients the opportunity to thoughtfully reflect on their goals/priorities/concerns and then effectively communicate these feelings and thoughts with the physician.
What do providers see as the biggest barriers to shared decision making?
Frey: Insufficient consultation time. Successfully communicating with a patient and achieving a broad understanding of her experience to date and goals for the future requires a tremendous amount of work from the ovarian cancer patient and physician. The patient-centered priorities assessment tool was developed with the concern in mind, giving women the opportunity to carefully reflect on their goals and values and providing a method for streamlined communication with the treatment team.
Based on these findings, what do you anticipate/hope for changes, and if so, what type, in office practice?
Frey: Our ongoing pilot study will assess the priorities assessment tool in gynecologic oncologists’ offices. We hope that this study will provide data on the efficacy of this strategy from the patient and healthcare provider perspectives, laying the groundwork for wide-scale implementation in gynecologic oncology office practice.
Last Updated March 09, 2020
Frey reported research funding from Invitae; co-authors reported financial relationships with Johnson & Johnson, Roche, Tesaro, and Merck.