ASPO Abstracts
A qualitative analysis of the pathways to ovarian cancer diagnosis
Category: Behavioral Science & Health Communication
Conference Year: 2022
Abstract Body:
Purpose of the study: Ovarian cancer is often diagnosed at a late stage when survival is poor. Qualitative narratives of patients' pathways to ovarian cancer diagnoses may identify opportunities for earlier cancer interception and, consequently, earlier stage at diagnosis. Methods: We included ovarian cancer patients and survivors diagnosed or treated at the University of Utah (UHEALTH) between 2/5/2018 and 8/6/2020. Trained study staff conducted telephone-based in-depth interviews with 14 study participants from 10/18/2019 to 10/10/2021, focusing on the pathway to diagnosis. Thematic analysis was conducted in Dedoose using a two-phase approach of deductive and inductive coding. Deductive coding was completed by two independent reviewers using a priori codes from the validated Model of Pathways to Treatment (MPT), including self-appraisal and management of symptoms, medical help-seeking, diagnosis, and initiation of treatment. Inductive coding identified emerging themes within each stage of the MPT. Results: The median age at ovarian cancer diagnosis was 61.5 years (range, 29-78 years), and the majority of women (10/14) were diagnosed with advanced stage disease. The median time from first symptoms to diagnosis was 4 months (range, 20 days to 4.5 years). Emerging themes unique to MPT intervals included: symptom normalization and self-management (appraisal), patient-provider relationship and logistics (medical help-seeking), and continuity of care and social connections (diagnosis). Themes common to the help-seeking and pre-treatment intervals included financial concerns and social support, though financial barriers during the help-seeking interval were described only by patients who presented at the emergency department (ED) and referred from the ED to gynecologic oncology. Among patients who presented to an outpatient provider and were referred directly to gynecologic oncology, positive patient-provider relationships and continuity of care acted as facilitators, shortening the diagnostic interval. Conclusion: Findings suggest that some, but not all, patients experience a prolonged pathway to diagnosis. Areas for interception may include patient education on ovarian cancer symptoms and addressing systemic barriers to healthcare access.
Keywords: Ovarian cancer, pathways to diagnosis, early detection of cancer