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