Methods: A descriptive qualitative study with thematic analysis of semi structured interviews and field notes related to the interview will be used to evaluate the process of decision making as experienced by women with OC recurrence and healthcare providers. The setting for this study will be the outpatient gynecologic oncology cancer care clinic at the University of Virginia Health System (UVAHS), Emily Couric Cancer Center (ECCC). The UVAHS is a research-intensive academic medical center and regional referral center serving much of central and southwestern Virginia. The ECCC is a National Cancer Institute designated institution with more than 130 researchers from multiple fields dedicated to cancer research. The gynecologic oncology program serves thousands of patients yearly, with approximately 30% being patients with OC recurrence. The clinic provides comprehensive services including laboratory, radiology, chemotherapy infusion, and consultation rooms within a single space. Women with a diagnosis of recurrent OC, including epithelial ovarian, fallopian tube or primary peritoneal cancer, and ECCC gynecologic oncology physicians and nurses will comprise the study sample. A target for patient enrollment is 30 women, although data collection will continue until saturation of findings is reached. Additionally, 8-10 healthcare providers will be recruited.
Qualitative descriptive approach using thematic analysis of semi-structured interviews and field notes will inform the exploration of recurrent ovarian cancer treatment decision-making. Trustworthiness (credibility, transferability, dependability and confirmability) will be ensured through the use of triangulation of data and persistent observation, detailed literature review and inquiry audits of process notes. Interviews will initially be read and re-read and notes written down of initial ideas. The interviews and field notes will be transcribed verbatim and imported into qualitative software to assist with data organization and analysis. Transcripts will be cross-checked for accuracy. Initial coding will be theory driven based on the decision support framework, and will include both semantic and latent codes. Collating and organizing relevant codes will lead to emergent themes. A thematic map will be developed to help visualize the analysis and to organize both candidate and sub-themes, which will then be compared to the overall data set to check for accuracy. Members of the team will cross check codes and emerging themes.
Results: To date, 19 patient participants and 8 provider participants have been interviewed. Early results reveal that patients rely heavily on the expertise of the provider for treatment decision making while maintaining open communication about values and quality of life. Concurrently, providers solicit feedback from patients about short and long term goals to determine next steps for treatment; for example, seeing a child graduate from college, or traveling abroad.
Conclusion: Exploration of the treatment decision making process for key stakeholders in an outpatient cancer clinic will provide important foundational knowledge for intervention development to build and support shared decision making for complex treatment decisions such as OC recurrence.