Charlotte Fisch

Evaluation of a patient decision aid for opportunistic salpingectomy and salpingectomy as sterilization method to prevent ovarian cancer

AbstractIntroductionA patient decision aid on opportunistic salpingectomy and salpingectomy as a sterilization method has been developed to provide uniform counseling and reduce practice variation. The aim of this study was to evaluate the use of the patient decision aid in daily clinical practice to ensure its effectiveness and usability, as well as its influence on the decision‐making process and the decision of opportunistic salpingectomy.Material and MethodsAs part of the STOPOVCA‐implementation study, we conducted a multicenter observational study in 16 hospitals between July 2020 and February 2024. Patients who were eligible for opportunistic salpingectomy were invited to use the decision aid while they considered whether or not to undergo opportunistic salpingectomy. Digital questionnaires were used to evaluate the decision aid, the decision process, and patients' decisions 6–8 weeks post‐surgery.Results425 out of 542 patients participated in the questionnaire. A majority of these 425 patients received (N = 357; 84%) and used the decision aid (N = 347; 82%). Two thirds (N = 234; 67%) of those who used the decision aid stated that it increased their knowledge of opportunistic salpingectomy. Patients considered the decision aid a usable aid, allocating a score of 8.1 out of 10 and would recommend it to other patients facing the decision regarding opportunistic salpingectomy. Patients considered the extent to which they were involved in the decision‐making process as high, and the decisional conflict low. The majority of patients who used the decision aid opted for opportunistic salpingectomy (N = 326; 95%). Main reasons for choosing opportunistic salpingectomy were the risk‐reducing effect of ovarian cancer (N = 311; 90%) and the lack of functionality of the fallopian tubes after childbearing (N = 320; 92%).ConclusionsThe patient decision aid was used by a majority of patients who received it. The decision aid was regarded by patients as user‐friendly, and it was recommended to be used in the decision‐making process for opportunistic salpingectomy. Patients stated that the decision aid provides reliable information and increases patients' knowledge of opportunistic salpingectomy.

Ovarian cancer risk reduction by salpingectomy during non-gynaecological surgery: scoping review

Abstract Background Ovarian cancer is the leading cause of death among gynaecological cancers. The identification of the fallopian tube epithelium as the origin of most ovarian cancers introduces a novel prevention strategy by removing the fallopian tubes during an already indicated abdominal surgery for another reason, also known as an opportunistic salpingectomy. This preventive opportunity is evidence based, recommended and established at the time of gynaecologic surgery in many countries worldwide. To expand interest among surgeons in performing a salpingectomy during non-gynaecological surgery, the aim of this review is to identify knowledge gaps during those surgeries. Methods A scoping review was performed following the PRISMA-Scoping Review (ScR) checklist. PubMed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL) database and Cochrane Library were systematically searched from inception to November 2024. Trial registers were searched for ongoing trials. All studies reporting original data on salpingectomy during non-gynaecological surgery were included. Outcomes were provided narratively. Results Eighteen studies were identified reporting on the implementation, surgical feasibility, patients’ perspectives, physicians’ knowledge and cost-effectiveness of an opportunistic salpingectomy during non-gynaecological surgery. Population-level data indicate that an opportunistic salpingectomy is rarely performed in non-gynaecological surgeries. High success rates and no complications of an opportunistic salpingectomy were observed during bariatric surgery and cholecystectomies. However, performing an additional salpingectomy appeared more time-consuming. Patients had strong interest in information on and willingness to undergo opportunistic salpingectomy. Cost-effectiveness analysis encourages opportunistic salpingectomy use, as models show reduced ovarian cancer incidence and mortality rate while being cost-effective. Conclusions Opportunistic salpingectomy during non-gynaecologic surgery appears to be a promising method to prevent ovarian cancer. Implementing such a strategy will require education of multiple surgical disciplines, training and resolution of organizational issues.

Opportunistic Salpingectomy in Non‐Gynecologic Surgeries: Barriers and Facilitators From a Healthcare Provider Perspective

ABSTRACT Objective This study identifies barriers and facilitators for implementing opportunistic salpingectomy (OS) during non‐gynecological abdominal surgeries from a healthcare provider perspective. Methods From October 2023 to July 2024, a mixed‐method study was conducted. The qualitative phase involved semi‐structured focus group interviews and individual interviews with specialists in surgery (gynecologists, general surgeons, urologists, and residents) and policymakers to identify barriers and facilitators for implementing OS during non‐gynecological surgery. The quantitative phase consisted of a cross‐sectional web‐based survey assessing the importance of these barriers and facilitators. The study utilized the standardized implementation frameworks to categorize the factors into six domains: innovation, patient, healthcare professional, social setting, organization, and economic and financial context. Results In the qualitative phase, 38 healthcare professionals and policymakers identified 38 barriers and 28 facilitators. Barriers were found in all domains and mainly included increased workload, unclear invoicing, and variations in eligible surgeries. Facilitators included the poor prognosis of ovarian cancer, simplicity of OS, and availability of counseling materials. The quantitative survey revealed that 75% of gynecologists, 60% of surgeons, and 61% of urologists supported offering OS during non‐gynecological abdominal surgeries. Barriers identified included the ambiguity regarding which patients are eligible for OS, the perceived complication risks of OS, the increased workload as a result of adding OS, and the unclarity around invoicing an OS. Facilitators included the poor prognosis of ovarian cancer, the availability of uniform counseling materials, education on counseling and technical performance of OS, involvement of a gynecologist during the counseling, and clear agreements between the departments within hospitals. Conclusions Key barriers to OS implementation in non‐gynecological surgeries include unclear invoicing and increased workload, while significant facilitators are the availability of counseling materials and education on counseling and technical performance of OS. Addressing these barriers and leveraging facilitators could enhance OS adoption, potentially reducing ovarian cancer incidence.

Implementation of opportunistic salpingectomy for ovarian cancer prevention: Analyzing clinical practice and key characteristics

AbstractIntroductionOvarian cancer (OC) is the most lethal gynecologic cancer, often diagnosed at an advanced stage due to nonspecific symptoms and lack of effective screening. Over 90% of all ovarian cancer cases are epithelial in origin, which is thought to originate from the fallopian tubes in approximately 70% of cases. Opportunistic salpingectomy (OS), the additional removal of fallopian tubes during abdominal surgery, has emerged as a preventive strategy. Despite growing evidence, the implementation of OS varies widely. This study examines OS counseling and performance trends in the Netherlands from 2019 to 2022 and identifies associated patient, surgical, physician, and institutional characteristics.Material and MethodsA historical cohort study was performed, analyzing electronic medical records from six Dutch hospitals, including two academic, two teaching, and two nonteaching hospitals. Patients undergoing elective gynecologic surgery from January 2019 to December 2022 were considered eligible. Multilevel logistic regression analyses identified characteristics associated with counseling and performance of OS.ResultsOut of 2716 eligible patients, 51% were counseled about OS, of whom 92% opted for the procedure. The counseling rate increased from 38% in 2019 to 57% in 2022, while the performance rate rose from 39% to 56%. OS was more common among patients undergoing hysterectomy, laparoscopic surgery, and treatment at teaching hospitals. OS was less common during vaginal surgery. Physician characteristics accounted for 18% of counseling and 12% of performance variations.ConclusionsAlthough OS implementation improved, substantial variability remains in counseling and performance, largely driven by surgical approach and type of surgery. Targeted interventions to enhance uptake among underutilized surgical types, including vaginal procedures, are necessary to standardize OS practice and ensure wider adoption across all eligible patients.