Salpingectomy for Ovarian Cancer Risk Reduction: Improving Utilization and Informed Decision-Making

卵巢癌通常被称为“沉默的杀手”，缺乏特定的症状和有效的筛查。病人 诊断多为晚期，预后较差。因此，初级预防特别有益。 传统上，在子宫切除时预防性切除卵巢是为了防止卵巢 癌症，但这会导致外科更年期，损害患者的心血管、骨骼和认知健康。 然而，关于卵巢癌发生的新证据表明，大多数卵巢癌起源于 输卵管而不是卵巢。这揭示了卵巢癌预防的更好机会-- 预防性输卵管切除术(摘除输卵管，保留卵巢)，可有效 降低患卵巢癌的风险，而不会受到荷尔蒙剥夺的不利影响。它还扩大了患者的范围 可以从卵巢癌预防中受益的人口到接受绝育的妇女，在这种情况下 以前没有考虑过癌症预防。然而，输卵管切除术的摄取率在不同的提供者之间差别很大。 原因不明，患者往往不知道与卵巢癌相关的风险降低 输卵管切除术。该项目的总体目标是提高预防保健服务的质量 通过识别提供者和患者相关的使用障碍并促进知情的输卵管切除术 决策。我们的具体目标是：1)确定采取预防措施的不同实践表型 在医生中进行输卵管切除术，并比较这些表型的医生属性；2)检查 医生中的社会传染在影响输卵管切除术接受率中的作用；3)确定医生 输卵管切除术吸收和分享决策的感知障碍；以及4)评估决策的质量- 从患者的角度对预防性输卵管切除术进行探讨，找出影响因素。我们 将重点关注卵巢癌风险处于低到中等水平的女性，在这些女性中，预防性输卵管切除术(与 卵巢保护)带来的好处最多。我们将利用大型医疗保健领域提供的独特数据 数据库，包括高级医疗保健数据库、州住院患者数据库/州非卧床外科 和服务数据库，以及蓝十字蓝盾轴线数据库，辅之以主要数据收集 通过焦点小组、访谈和调查直接从医生和患者那里获得。该项目具有创新性。 因为它研究了一种独特的辅助手术(在已经接受手术的女性中) 在几乎不增加患者负担的情况下预防癌症的机会，采用了一种新的潜在类别增长分析 确定医生采取预防措施的轨迹(水平和斜率)的不同表型 输卵管切除术，并应用新兴的社交网络分析来研究医生和 它如何通过同伴影响影响输卵管切除术的吸收(这是一种以前未被开发的干预机制)。 在美国，每年有超过120万妇女接受子宫切除和绝育手术，这一发现 研究将增强我们利用这一绝佳机会预防卵巢癌的能力。

Often referred to as the “silent killer”, ovarian cancer lacks specific symptoms and effective screening. Patients are often diagnosed at advanced stage with poor prognosis. Thus, primary prevention is particularly beneficial. Conventionally, prophylactic removal of the ovaries at the time of hysterectomy was used to prevent ovarian cancer, but that causes surgical menopause and impairs patients’ cardiovascular, bone, and cognitive health. New evidence on ovarian carcinogenesis, however, shows that most ovarian cancers originate from the fallopian tubes rather than from the ovaries. This reveals a better opportunity for ovarian cancer prevention – prophylactic salpingectomy (removing the fallopian tubes while preserving the ovaries), which can effectively reduce ovarian cancer risk without the detrimental effects of hormonal deprivation. It also expands the patient population that can benefit from ovarian cancer prevention to women undergoing sterilization, a setting where cancer prevention was not considered previously. Yet, salpingectomy uptake varies widely among providers with largely unknown reasons, and patients are often unaware of ovarian cancer risk reduction associated with salpingectomy. The overarching objective of this project is to improve quality of care for prophylactic salpingectomy by identifying provider- and patient-related barriers to utilization and promoting informed decision-making. Our specific aims are: 1) to identify distinct practice phenotypes in adopting prophylactic salpingectomy among physicians and compare physician attributes across these phenotypes; 2) to examine the role of social contagion among physicians in influencing salpingectomy uptake; 3) to ascertain physician perceived barriers to salpingectomy uptake and shared decision-making; and 4) to evaluate quality of decision- making regarding prophylactic salpingectomy from patients’ perspective and identify influencing factors. We will focus on women who are at low to average risk for ovarian cancer where prophylactic salpingectomy (with ovarian conservation) confers the most benefit. We will draw on unique data available in large healthcare databases, including the Premier Healthcare Database, State Inpatient Database/State Ambulatory Surgery and Services Database, and Blue Cross Blue Shield Axis database, supplemented by primary data collection directly from physicians and patients through focus groups, interviews, and surveys. This project is innovative because it studies an adjunctive procedure (among women who are already undergoing surgery) as a unique opportunity for cancer prevention with little added patient burden, employs a novel latent class growth analysis to identify distinct phenotypes of physicians in their trajectory (level and slope) of adopting prophylactic salpingectomy, and applies the nascent social network analytics to study connections among physicians and how it affects salpingectomy uptake via peer influence (a previously untapped mechanism for interventions). With over 1.2 million women undergoing hysterectomy and sterilization in the U.S. each year, findings from this study will enhance our ability to capitalize on this prime opportunity for ovarian cancer prevention.