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Table 2 Barriers and facilitators identified during interviews and focus group by patients and professionals

From: Patients’ and professionals’ perspectives on implementation of opportunistic salpingectomy: a mixed-method study

Domain Barriers Facilitators
Identified by patients
Innovation (OS) • Low life time risk of ovarian cancer in general population
• Insufficient evidence of long-term risks and effects
• Reduction of ovarian cancer risk
• Family history of ovarian cancer
• Fallopian tubes lose function after completion of childbearing
• High lethality rate of ovarian cancer
Patient • Unwillingness to have healthy organs removed
• Lack of insight into the size of surgery
• Worry if OS fails
• Complicated choice whether or not to undergo OS
• Reliable information material such as a decision aid
• Counselled and advised by their gynecologists
• Confidence in treating physician
• A small additional scar in case of sterilization is not a problem
Identified by professionals
Innovation (OS) • Low life time risk of ovarian cancer in general population
• Presence of residual risk of ovarian cancer after OS
• Risk of overtreatment
• Insufficient evidence of long-term risks and effects
• Complicating the surgery, especially in patients with certain medical history
• More difficult during vaginal surgery
• More extensive surgery as sterilization method
• Unclear limits of the eligible population
• Reduction of ovarian cancer risk
• High lethality rate of ovarian cancer
• High success rate for OS
• No increase in complication risk compared to complication risk of the primary procedure
• No extension of surgery in case of a hysterectomy
• Fallopian tubes lose function after completion of childbearing
• Family history of ovarian cancer
Health care professional • Unaware or not convinced of evidence
• Insufficient skills to perform OS
• Experiencing time pressure during consultation due to counselling for OS
• Forgetting to counsel about OS
• Uniform counselling material such as a decision aid
• Performing a national prospective follow up study for OS registration and ovarian cancer
Patient • Unwillingness to have healthy organs removed
• Unwillingness to take unnecessary risks
• Fear of earlier menopause
• Lack of knowledge concerning the disadvantages
• Lack of insight into the size of surgery
• Lack of knowledge concerning the difference between ovaria and fallopian tubes
• Complicated choice
• High acceptance among patients
• High awareness of OS
• Not worrying if performing OS fails
Organization • Limited time to provide counselling
• Increased surgical time, especially for sterilization
• More time and pathologists needed for analysis of the Fallopian tubes
• Additional (telephone) consultation required
• Counselling for OS possible during regular consultation
• No additional surgical instruments are required
Social   • National consensus on OS
• Communal policy about OS in gynecological department
• Inclusion of OS in the guidelines of the Dutch society for Obstetrics and Gynecology (NVOG)
• Inclusion of OS in the guideline of the Dutch College of General Practitioners (NHG)
• Inclusion of the recommendation to discuss OS in several guidelines of international societies
Economic and Financial • Higher costs due to Fallopian tube analysis by pathologists
• Higher costs due to increase in surgical time in case of sterilization
• Invoicing of OS is unclear
• Cost-effectiveness on long term due to opportunistic nature
• No extra costs in case of additional intervention