Exploring Patient Treatment Decision Making in the Context of Ovarian Cancer Recurrence

Author: ORCID icon orcid.org/0000-0001-6716-4964
Lothamer, Heather, Nursing - Graduate School of Arts and Sciences, University of Virginia
Epstein, Beth, NR-Nursing: Faculty, University of Virginia

Title of Project: Exploring Patient Treatment Decision Making in the Context of Ovarian Cancer Recurrence
The lifetime risk of developing ovarian cancer (OC) is less than 2%, but ovarian cancer ranks fifth in cancer deaths for women and is the most lethal of the gynecologic malignancies. Stage IV ovarian cancer five-year survival rate is 17%, with most patients diagnosed at Stage III or IV. Approximately 80% of women diagnosed with advanced OC will experience recurrence after first line chemotherapy. Recurrent OC is treated as a chronic condition and few patients diagnosed with recurrence will ever be disease free again. With continued therapy, all patients become resistant to therapy and the duration of response diminishes with each treatment. Depending on the treating institution, patients are given options for the type of treatment they would like to receive, which can be either a clinical trial or one of the FDA approved therapies. Each of the choices may have a different trajectory, side effect profile, and treatment schedule. Regardless of the option chosen, response rates are low, about 20-50%. Because the response rates for treatment are similar but the regimens are vastly different, patient preference in terms of values, knowledge about treatment options, and her expectations for both treatment and quality of life play a major role in the decision.
Specific Aims: The overall goal of this program of research is to improve the shared decision making process for women diagnosed with an OC recurrence through1) Exploring the experiences of women making decisions about treatment for recurrent ovarian cancer 2) Exploring healthcare providers’ experiences of clinical decision making for recurrent ovarian cancer 3) To triangulate the findings of aims 1 and 2 to provide a fuller picture of shared decision making in the context of OC recurrence
Study Design: Design: A descriptive qualitative study with thematic analysis will be used to evaluate the process of decision making as experienced by women with OC recurrence and healthcare providers.
Patient inclusion criteria are: 1) diagnosis of OC recurrence within the past 4-6 weeks, 2) 18 or older, 3) English speaking, 4) Plans to receive treatment, 5) Either platinum sensitive or platinum resistant. Inclusion criteria for healthcare providers are: 1) provide care for patients with OC recurrence, 2) physician, nurse, or advanced practice nurse. A target for patient enrollment is 25 women, and 10 healthcare providers.
Cancer Relevance: Exploration of the treatment decision making process for key stakeholders in an outpatient cancer clinic will provide important foundational knowledge for intervention development to build and support shared decision making for complex treatment decisions such as OC recurrence.

PHD (Doctor of Philosophy)
Shared Decision Making, Ovarian Cancer Recurrence
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