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。患者 常在晚期确诊，预后差。因此，初级预防特别有益。 传统上，在子宫切除术时预防性切除卵巢是用来防止卵巢癌的。 癌症，但这会导致手术绝经，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卵巢癌。 而不是来自卵巢。这揭示了卵巢癌预防的更好机会- 预防性输卵管切除术（切除输卵管，同时保留卵巢），可以有效地 降低卵巢癌的风险，而不会产生激素剥夺的有害影响。它也扩大了病人 人口可以受益于卵巢癌预防妇女接受绝育，一个设置， 以前没有考虑过癌症预防。然而，输卵管切除术的吸收在提供者之间差异很大 大部分原因未知，患者通常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性保健的质量， 输卵管切除术，通过确定提供者和患者相关的利用障碍， 决策的我们的具体目标是：1）确定不同的实践表型，在采用预防性 输卵管切除术之间的医生，并比较这些表型的医生属性; 2）检查 社会传染在影响输卵管切除术中作用; 3）确定医生 对输卵管切除术吸收和共同决策的感知障碍;以及4）评估决策质量- 从患者的角度制定预防性输卵管切除术的相关政策，并找出影响因素。我们 将重点关注那些处于卵巢癌低至平均风险的女性， 卵巢保护）提供最大的益处。我们将利用大型医疗保健领域的独特数据， 数据库，包括Premier Healthcare Database、State Inpatient Database/State Ambulatory Surgery 和服务数据库，以及蓝十字蓝盾轴心数据库，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。这个项目是创新的 因为它研究了一种预防性手术（在已经接受手术的女性中）， 癌症预防的机会，几乎没有增加病人的负担，采用了一种新的潜在类增长分析 确定医生在采用预防性治疗的轨迹（水平和斜率）中的不同表型 输卵管切除术，并应用新生的社会网络分析研究医生和 它如何通过同伴影响（一种以前未开发的干预机制）影响输卵管切除术的吸收。 在美国，每年有超过120万妇女接受子宫切除术和绝育手术， 研究将提高我们利用这一主要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.