September is Ovarian Cancer Awareness Month and Gynecologic Cancer Awareness Month, an excellent time to celebrate the progress made toward the prevention and treatment of ovarian cancer and other gynecologic cancers.
Screening for ovarian cancer remains difficult. When cases are detected, they are often advanced, with limited treatment options – making prevention especially crucial for this disease.
While in recent decades, we have made great strides in the fight against ovarian cancer through the development of highly effective interventions like opportunistic salpingectomy (OS) (the removal of the fallopian tubes during a pelvic surgery, with patient consent), the ability to perform a preventive procedure doesn’t necessarily guarantee uptake. Though OS has been recommended by the Society of Obstetricians and Gynecologists of Canada (SOGC) since 2015, the rate of uptake across Canada is quite variable, and is notably lower in rural and remote areas.
Patient education is important for increasing the uptake of interventions, but so is provider education; providers who understand when and why an intervention is recommended, and who can weigh the risks and benefits for each patient, are better equipped to counsel patients and ensure preventive treatments are implemented where they will have the greatest impact. Effective care is built on trust, and for some patients and patient communities, there are bigger gaps that need to be bridged in building – or rebuilding – trust.
Indigenous communities have faced, and continue to face, discrimination and mistreatment at the hands of healthcare providers. Indigenous women’s experiences of forced sterilization and other involuntary medical procedures are a likely contributor to lower uptake of OS in rural and remote communities – both from the perspective of patients reluctant to engage with the health system due to past negative experiences, and providers reluctant to begin conversations with patients out of caution against retraumatizing those patients. To ensure equitable access to ovarian cancer prevention in rural and remote communities, a culturally safe, trauma-informed approach to both patient and provider education is required.
Led by Dr. Brittany Bingham (Indigenous Equity Lab) and Dr. Gillian Hanley (Executive Director, WHRI), and involving collaboration with researchers (including Dr. David Huntsman, Dr. Justin McGinnis, Dr. Dawn Cochrane, Dr. Lesa Dawson, Chelsey Perry, Dr. Alexandra Lukey, Dr. Alicia Tone), physicians, Indigenous leaders, and patient partners, the Ovarian Cancer Equity, Access & Navigation (OCEAN) project proposes a study looking specifically at the rural and remote healthcare regions in Canada where there is the greatest opportunity to increase rates of opportunistic salpingectomy. The goal is to gain a more detailed understanding of the barriers at play and empower rural and remote healthcare providers to have safe conversations with their patients about the procedure, thus enabling patients to make informed decisions about their care.
Aim 1: To understand the barriers to uptake of OS in rural and remote healthcare regions
Aim 1 will be achieved through a mixed-method explanatory research design. This will take the form of quantitative data collection followed by a qualitative questionnaire intended to expand on the quantitative data and provide further insights.
Data will be collected from healthcare providers who self-select as practicing in rural and remote communities – and who perform a minimum of 5 relevant pelvic surgeries each year. The study team will focus especially on recruiting clinicians from the prairies, Ontario, and Atlantic Canada to ensure cross-Canadian representation of communities with lower uptake of OS.
Aim 2: To develop tools to support clinicians in having culturally safe conversations about OS with Indigenous patients.
Information gleaned through the methods supporting aim 1 will allow the study team to pinpoint the most pressing barriers to access and develop tools to support clinicians in overcoming these barriers. Tool development will take place in 3 phases and will be guided by engagement with an Indigenous Guiding Group, consisting of Elders, Indigenous and non-Indigenous allied healthcare practitioners in remote settings, and Indigenous midwives, birth workers, nurse practitioners, and OBGYN residents.
Research like this often focuses on barriers as experienced by patients, and though patient partners are involved, focusing the conversation primarily on healthcare providers will help to avoid potentially traumatic interactions for Indigenous patients while still working to improve patient access to care. Future research will bring tools designed to be culturally safe and trauma-informed to patients in the healthcare setting for further refinement and improvement.