Development and Pilot Test of an Elective BSO Decision Support Guide

描述（由申请人提供）：卵巢癌是一种常见且往往致命的疾病。每年有60多万妇女接受子宫切除术，其中90%是因为非癌性疾病。从历史上看，这些妇女中有许多人接受了双侧输卵管卵巢切除术（BSO），以降低卵巢癌的风险和/或避免可能的发病率和未来与良性卵巢肿瘤，子宫内膜异位症和盆腔疼痛相关的手术。然而，BSO导致卵巢雌激素和雄激素的永久性损失，已知这些雌激素和雄激素与维持心血管健康、骨骼健康、性功能和整体健康相关的生活质量相关。因此，考虑卵巢保留的绝经前妇女谁是不增加卵巢癌的遗传风险一直提倡，虽然没有明确的指导方针已经建立了关于如何决定是否进行选择性BSO和子宫切除术的良性条件的时间。在许多领域，已经开发了决策辅助工具，并鼓励使用这些工具，以帮助患者和提供者共同做出明智的决策，特别是在包括一种以上护理方法、不确定结果以及人们对利益和危害的不同评价的情况下。显然，围绕BSO的决策是一个符合这些标准的领域。因此，我们建议进行形成性研究，并利用它来开发和试点测试BSO决策支持指南，以帮助患者与他们的提供者分享，就是否接受BSO伴随子宫切除术以预防卵巢癌做出明智的，基于偏好的决定。为了实现这些目标，我们将进行一系列的焦点小组和一对一的定性访谈，以评估妇女谁将经历，或谁最近经历了子宫切除术的非癌性条件下查看选修BSO和评估他们的信息需求和愿望在这种情况下共同决策。然后，我们将创建一个草案BSO决策支持指南使用从文献中获得的信息，从我们的形成性研究，和提供者的经验，谁咨询妇女关于这个选择。在62名因良性疾病计划接受子宫切除术的女性中对BSO决策支持指南进行试点测试，以评估其对患者及其提供者的有用性和可用性后，我们将生成最终版本，该版本将准备用于未来研究干预对决策质量和BSO使用的影响。公共卫生相关性：这项研究的结果将有助于妇女的偏好和对BSO的态度的小文献。这项研究将产生一个临床上有用的BSO决策支持指南，不同文化水平和不同文化背景的妇女可以用来帮助他们参与有关使用BSO的共同决定。它还将生成问卷和数据，用于规划未来评估该指南对平均风险女性子宫切除术伴随BSO的知情决策、使用和满意度的影响。

DESCRIPTION (provided by applicant): Ovarian cancer is a common and often fatal condition. Over 600,000 women undergo hysterectomy each year, 90% of which are done for non-cancerous conditions. Historically, many of these women have undergone bilateral salpingo-oophorectomy (BSO) to decrease the risk of ovarian cancer and/or to avoid possible morbidities and future surgery related to benign ovarian neoplasms, endometriosis, and pelvic pain. However, BSO results in a permanent loss of ovarian estrogen and androgens that are known to be associated with maintenance of cardiovascular health, bone health, sexual functioning, and overall health-related quality-of-life. As a result, consideration of ovarian retention for premenopausal women who are not at increased genetic risk of ovarian cancer has been advocated, although no clear guidelines have been established regarding how decisions should be made regarding whether or not to perform elective BSO and the time of hysterectomy for benign condition. Decision aids have been developed and their use has been encouraged, in a number of areas to help patients and providers share in making informed decisions, particularly in situations that include more than one approach to care, uncertain outcomes, and benefits and harms that people value differently. Clearly, decision making around BSO is an area the meets these criteria. We therefore propose to conductive formative research and use it to develop and pilot test a BSO Decision Support Guide, to help patients share with their providers in making informed, preference-based decisions regarding whether or not to undergo BSO concomitant to hysterectomy to prevent ovarian cancer. To accomplish these goals, we will conduct a series of focus groups and one-on-one qualitative interviews to assess how women who will be undergoing, or who have recently undergone, hysterectomy for non-cancerous conditions view elective BSO and to assess their information needs and desires regarding shared decision making in this context. We will then create a draft BSO Decision Support Guide using information obtained from the literature, from our formative research, and the experience of providers who have counseled women about this choice. After pilot testing the BSO Decision Support Guide among 62 women scheduled to undergo hysterectomy for benign conditions to assess its usefulness and usability for patients and their providers, we will generate a final version that will be ready for use in future studies of the impact of the intervention on decision quality and use of BSO. PUBLIC HEALTH RELEVANCE: Results of this study will contribute to the small literature on women's preferences and attitudes toward BSO. This study will generate a clinically useful BSO Decision Support Guide that women of varying literacy levels and diverse cultural backgrounds can use to help them participate in shared decisions about use of BSO. It will also generate questionnaires and data to be used in planning future evaluations of the impact of the guide on informed decision making regarding and use of and satisfaction with BSO concomitant to hysterectomy among average risk women.