OBJECTIVES: Multiple randomized controlled trials have recently demonstrated significant benefit of frontline maintenance treatment with PARP inhibitors for patients with newly diagnosed ovarian cancer in complete or partial response to platinum chemotherapy, highlighting a need to both support and shift conversations between patients and their providers about maintenance therapy to occur early after diagnosis, in a manner that is consistent with most current standards of care issued by NCCN. Consensus guidelines highlight an unmet need for “shared decision making” (SDM) for frontline maintenance. SDM is a process in which patients and clinicians discuss the array of treatment options, the associated benefits, and risks and come to a joint treatment decision based on patient preferences and values. This study aims to: 1) develop an SDM guide for frontline maintenance therapy, and 2) to recommend scalable solutions to efficiently implement SDM into clinical practice to create a plan of care personalized to each patient’s needs, values and preferences. This abstract focuses on developing the SDM guide to ensure patients are fully informed about their frontline maintenance treatment options to create a plan of care that takes into account specific patient needs, values, and preferences. Future phases will recommend scalable approaches for efficiently implementing SDM conversations into clinical practice.
METHODS: To develop an SDM guide to facilitate appropriate patientcentered discussions between patients and their oncology providers regarding frontline maintenance therapy, we will perform qualitative interviews with 20 patients and 20 clinicians across a variety of academic and community practices within a large academic health system. Qualitative interviews, lasting approximately 60 minutes, will assess patient and provider preferences, values, optimal timing of discussions regarding frontline maintenance, and barriers to making treatment decisions. Patients with ovarian cancer will be interviewed at specific time points in their treatment course: 1) Recently diagnosed but not yet started treatment (n=5), 2) Actively undergoing upfront chemotherapy (n=5), 3) Taking PARP maintenance (n=5), 4) Actively undergoing treatment for recurrent disease and naïve to frontline PARP maintenance (n=5). Gynecologic oncologists, medical oncologists, and advanced-practice providers who frequently treat ovarian cancer patients will be interviewed about their experiences with decisions regarding frontline maintenance treatment. Thematic analysis will be used to identify, characterize, and summarize patterns found in interview data, and coding of transcripts will be used to develop a priori codebook. Transcripts will be coded using ATLAS.ti version 9.0 (Scientific Software Development GmbH, Germany). Results of patient and clinician interviews will be analyzed separately, and dominant trends will be identified. Patient and clinician desires, preferences, barriers, and needs in frontline maintenance treatment decision-making will be synthesized and provide insight into developing a patient decision aid that will facilitate appropriate patient-centered discussions between patients and their oncology providers.
