Background

The discovery of the fallopian tube epithelium as the origin of high-grade serous ovarian cancer has brought a new option for ovarian cancer prevention. The fallopian tubes have no known function after completion of childbearing and can be removed to reduce the lifetime risk of ovarian cancer. Although the lifetime risk in the general population does not justify preventive surgery in itself, salpingectomy can be performed during abdominal surgery for other indications, also known as an opportunistic salpingectomy. The popularity of opportunistic salpingectomy is increasing worldwide; however, the variation between gynecologists and hospitals in their advice on opportunistic salpingectomy occurs because of the remaining uncertainty of evidence. Therefore, whether a woman can make her own decision depends on the hospital or gynecologist she visits. We aimed to lower this practice variation by providing standardized and unbiased counseling material.

Objective

We aimed to develop and test a patient decision aid for opportunistic salpingectomy in women undergoing pelvic gynecologic surgery to either retain the ovaries or opt for sterilization.

Study Design

We followed a systematic development process based on the International Patient Decision Aid Standards. Data were collected between June 2019 and June 2020, using both qualitative and quantitative methods. The development process that occurred in collaboration with patients and healthcare professionals was overseen by a multidisciplinary steering group and was divided into 4 phases: (1) assessment of decisional needs using individual telephone interviews and questionnaires; (2) development of content and format based on decisional needs, current literature, and guidelines; (3) alpha testing and the first revision round; and (4) alpha testing and the second revision round.

Results

An outline of the patient decision aid was developed on the basis of decisional needs, current literature, and guidelines. It became clear that the decision aid should consist of 2 separate paths: one with information specifically for salpingectomy in addition to abdominal surgery and one for salpingectomy as a sterilization method. Both paths contained information on the anatomy and function of ovaries and fallopian tubes, risk reduction of ovarian cancer, and potential benefits and risks of opportunistic salpingectomy. Moreover, the sterilization path contains information on various sterilization methods and risks of unwanted pregnancy. The patient decision aid was developed as an online tool that includes information chapters, a knowledge quiz, consideration statements, and a summary detailing the patient’s preferences and considerations. Adjustments were made following alpha testing round 1. The improved patient decision aid was subjected to usability tests (alpha testing round 2), in which it scored an “excellent” in tests with patients and a “good” in tests with gynecologists. Furthermore, our patient decision aid met the requirements of 45 of 49 applicable items from the International Patient Decision Aid Standards criteria.

Conclusion

In collaboration with patients and healthcare professionals, a patient decision aid was developed on opportunistic salpingectomy and salpingectomy as a sterilization method. Both patients and gynecologists believed it is a useful tool that supports patients in making an informed decision whether to undergo an opportunistic salpingectomy and supports the counseling process by gynecologists.

中文翻译：

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卵巢癌的一级预防：机会性输卵管切除术的患者决策辅助

背景

输卵管上皮细胞作为高级别浆液性卵巢癌起源的发现为卵巢癌的预防带来了新的选择。完成生育后输卵管没有已知的功能，可以将其移除以降低卵巢癌的终生风险。虽然普通人群的终生风险本身并不能证明预防性手术的合理性，但可以在腹部手术期间针对其他适应症进行输卵管切除术，也称为机会性输卵管切除术。机会性输卵管切除术在全球范围内越来越受欢迎；然而，由于证据的不确定性，妇科医生和医院对机会性输卵管切除术的建议存在差异。因此，女性能否做出自己的决定，取决于她就诊的医院或妇科医生。

客观的

我们旨在为接受盆腔妇科手术的女性开发和测试机会性输卵管切除术患者决策辅助工具，以保留卵巢或选择绝育。

学习规划

我们遵循基于国际患者决策辅助标准的系统开发流程。数据是在 2019 年 6 月至 2020 年 6 月期间使用定性和定量方法收集的。与患者和医疗保健专业人员合作的开发过程由一个多学科指导小组监督，分为 4 个阶段：（1）使用个人电话访谈和问卷评估决策需求；(2) 根据决策需要、当前文献和指南开发内容和格式；(3) alpha测试和第一轮修改；(4) alpha 测试和第二轮修订。

结果

在决策需求、当前文献和指南的基础上制定了患者决策辅助的大纲。很明显，决策辅助应包括 2 条不同的路径：一种是针对除腹部手术外的输卵管切除术的专门信息，另一种是针对作为绝育方法的输卵管切除术的信息。两条路径都包含有关卵巢和输卵管的解剖结构和功能、卵巢癌风险降低以及机会性输卵管切除术的潜在益处和风险的信息。此外，绝育路径包含有关各种绝育方法和意外怀孕风险的信息。患者决策辅助工具是作为一种在线工具开发的，其中包括信息章节、知识测验、考虑陈述以及详细说明患者偏好和考虑的摘要。在第 1 轮 alpha 测试后进行了调整。改进的患者决策辅助工具接受了可用性测试（第 2 轮 alpha 测试），其中它在患者测试中得分为“优秀”，在妇科医生测试中得分为“好”。此外，我们的患者决策辅助符合国际患者决策辅助标准标准中 49 个适用项目中的 45 个的要求。

结论

与患者和医疗保健专业人员合作，开发了机会性输卵管切除术和输卵管切除术作为绝育方法的患者决策辅助工具。患者和妇科医生都认为这是一个有用的工具，可以帮助患者做出是否接受机会性输卵管切除术的明智决定，并支持妇科医生的咨询过程。