Assessment of distress and impact on shared decision-making in new gynecologic oncology patients (478)

Abstract

<b>Objectives:</b> This study aimed to characterize the severity and sources of patient distress at first presentation to a gynecologic oncologist and assess the relationship between distress throughout the visit and patient perceptions of shared decision-making (SDM). <b>Methods:</b> Patients were offered participation in a quality improvement project at the start of their first visit to the gynecologic oncologist. Participants (<i>n</i>=58) had a new diagnosis of cancer, a clinical suspicion of cancer, or another high-risk condition requiring care from a gynecologic oncologist. Upon arrival, participants selfreported demographics, the reason for visit, and distress using the NCCN Distress Thermometer (DT) and Problem List. At the conclusion of the visit, patients repeated the Distress Thermometer and completed the collaboRATE questionnaire, a 3-item patient-reported experience measure of shared decision-making. The collabo-RATE score was calculated as a mean of scores on the three items. Descriptive statistics and Chi-square tests were used to characterize distress. Paired sample t-test was used to measure the change in distress during the visit. Pearson's correlations were used to assess the relationship between distress and SDM. <b>Results:</b> At the start of the visit, the mean distress score (DT) was 5.12 out of 10, and 67% of participants endorsed severe distress (DT >4). Main sources of distress were worry (<i>n</i>=39), nervousness (<i>n</i>=35), sleep disturbances (<i>n</i>=25), sadness (<i>n</i>=24), and fatigue (<i>n</i>=23). At the end of the visit, mean distress had decreased significantly to 4.16 (p=0.02), but the decrease in the percentage of patients with severe distress did not reach significance (p=0.07). There was no relationship between pre- or post-visit distress and shared decision-making (p=0.53 and p=0.70, respectively). Patients at all distress levels reported high levels of shared decision-making, with a mean collaboRATE score of 8.6 out of 9. <b>Conclusions:</b> Initial distress at presentation to a gynecologic oncologist is high, even among patients without a cancer diagnosis. Distress decreased after meeting with the gynecologic oncologist, and patients at all levels of distress perceived high levels of shared decision-making. These findings support the need for psychosocial support among patients facing a possible or confirmed gynecologic malignancy. Gynecologic oncologists should prioritize shared decision-making even when caring for severely distressed patients.