Evaluating root causes contributing to real-world disparities in ovarian cancer care: Insights from an implementation science initiative utilizing tethered patient-provider surveys and chart reviews.

Abstract

e18665 Background: Quality ovarian cancer care is significantly impeded by racial disparities in treatment and survival outcomes for black women with ovarian cancer. In this implementation science (IS) initiative, we evaluated root causes for disparities in care among patients with ovarian cancer at 3 diverse health systems and implemented focused action plans to facilitate improved care quality and promote health equity. Methods: Between 11/2020 and 3/2021, we surveyed oncology team members (n = 53) and ovarian cancer patients (N = 41), and performed randomized and retrospective baseline chart audits (N = 100) at 3 health systems to assess current practices, challenges/barriers, and areas for improvement in equitable care of ovarian cancer patients. Providers then participated in audit/feedback (AF) educational sessions and developed and implemented action plans to address identified gaps. Follow-up chart audits measured practice change following the educational initiative. Results: Significant differences were found between Black and non-Black patients in chart documentation patterns and self-reported survey responses. For example, Black patients were significantly less likely to have chart-documented practices of biomarker testing (BRCA testing 47% of Black patients, and 70% on non-Black patients), assessments for treatment-related adverse events and supportive care (40% vs 70%), fertility counseling (4% vs 17%) and shared decision-making (57% vs. 81%). Patient survey and data suggest racial/cultural differences in the emphasis placed on different treatment decision-making factors, as well as differences in the time/extent to which treatment risks and benefits are discussed with patients. Oncology team members participating in AF sessions developed action plans to improve equitable ovarian cancer care, including increasing education and patient counseling, increasing use of patient navigators, and improving documentation. After implementing action plans, follow-up chart audits showed improvement in the provision of patient education, shared decision-making, biomarker testing, and supportive care for both Black and non-Black patients with ovarian cancer. Conclusions: These findings reveal important factors contributing to racial disparities in ovarian cancer outcomes. The identified gaps may inform future IS initiatives and represent key opportunities for improvement in equitable ovarian cancer patient care. Study Sponsor Statement: The study reported in this abstract was funded by an educational grant from AstraZeneca, GlaxoSmithKline, and Merck & Co. Inc., who had no role in the study design, execution, analysis, or reporting.