A Qualitative Study on Using Telemedicine for Precepting and Teaching in the Academic Setting.

PURPOSE: To examine the impact of telemedicine use on precepting and teaching among preceptors and patients during the COVID-19 pandemic. METHOD: The authors conducted a secondary analysis of a qualitative study focusing on providers' and patients' experiences with and attitudes toward telemedicine at 4 academic health centers. Teaching and precepting were emergent codes from the data and organized into themes. Themes were mapped to domains from the 2009 Consolidated Framework for Implementation Research (CFIR), a framework that assists with effective implementation and consists of 5 domains: intervention characteristics, outer settings, inner settings, characteristics of individuals, and process. RESULTS: In total, 86 interviews were conducted with 65 patients and 21 providers. Nine providers and 3 patients recounted descriptions related to teaching and precepting with telemedicine. Eight themes were identified, mapping across all 5 CFIR domains, with the majority of themes (n = 6) within the domains of characteristics of individuals, processes, and intervention characteristics. Providers and patients described how a lack of prepandemic telemedicine experience and inadequate processes in place to precept and teach with telemedicine affected the learning environment and perceived quality of care. They also discussed how telemedicine exacerbated existing difficulties in maintaining resident continuity. Providers described ways communication changed with telemedicine use during the pandemic, including having to wear masks while in the same room as the trainee and sitting closely to remain within range of the camera, as well as the benefit of observing trainees with the attending's camera off. Providers expressed a lack of protected structure and time for teaching and supervising with telemedicine, and a general view that telemedicine is here to stay. CONCLUSIONS: Efforts should focus on increasing knowledge of telemedicine skills and improving processes to implement telemedicine in the teaching setting in order to best integrate it into undergraduate and graduate medical education.

Substance Use Disorders in the Geriatric Population: a Review and Synthesis of the Literature of a Growing Problem in a Growing Population.

Purpose of review: Substance use disorders are becoming increasingly prevalent in the geriatric population, necessitating an updated understanding of the existing literature. This review aims to describe the epidemiology, special considerations, and management of substance use disorders in older adults. Recent findings: PubMed, Ovid MEDLINE, and PsychINFO databases were searched from their inception through June 2022 using the following keywords: "substance use disorder," "substance abuse," "abuse," "illicit substances," "illicit drugs," "addiction," "geriatric," "elderly," "older adults," "alcohol," "marijuana," "cannabis," "cocaine," "heroin," "opioid," and "benzodiazepine." Our findings suggest an increasing trend in substance use in older adults despite medical and psychiatric consequences when using such substances. The majority of older patients admitted to substance abuse treatment programs were not referred by healthcare providers, suggesting room for improvement in the screening and discussion of substance use disorders. Our review also suggests that there should be careful consideration of COVID-19 and racial disparities when screening, diagnosing, and treating substance use disorders in the older population. Summary: This review provides updated information on epidemiology, special considerations, and management of substance use disorders in older adults. As substance use disorders become more prevalent in older adults, primary care physicians must be prepared to recognize and diagnose substance use disorders as well as collaborate with and refer patients to geriatric medicine, geriatric psychiatry, and addiction medicine.

The Telemedicine Experience in Primary Care Practices in the United States: Insights From Practice Leaders.

PURPOSE: The need to rapidly implement telemedicine in primary care during the coronavirus disease 2019 (COVID-19) pandemic was addressed differently by various practices. Using qualitative data from semistructured interviews with primary care practice leaders, we aimed to report commonly shared experiences and unique perspectives regarding telemedicine implementation and evolution/maturation since March 2020. METHODS: We administered a semistructured, 25-minute, virtual interview with 25 primary care practice leaders from 2 health systems in 2 states (New York and Florida) included in PCORnet, the Patient-Centered Outcomes Research Institute clinical research network. Questions were guided by 3 frameworks (health information technology evaluation, access to care, and health information technology life cycle) and involved practice leaders' perspectives on the process of telemedicine implementation in their practice, with a specific focus on the process of maturation and facilitators/barriers. Two researchers conducted inductive coding of qualitative data open-ended questions to identify common themes. Transcripts were electronically generated by virtual platform software. RESULTS: Twenty-five interviews were administered for practice leaders representing 87 primary care practices in 2 states. We identified the following 4 major themes: (1) the ease of telemedicine adoption depended on both patients' and clinicians' prior experience using virtual health platforms, (2) regulation of telemedicine varied across states and differentially affected the rollout processes, (3) visit triage rules were unclear, and (4) there were positive and negative effects of telemedicine on clinicians and patients. CONCLUSIONS: Practice leaders identified several challenges to telemedicine implementation and highlighted 2 areas, including telemedicine visit triage guidelines and telemedicine-specific staffing and scheduling protocols, for improvement.

Web-based tool for cancer family history collection: A prospective randomized controlled trial.

OBJECTIVES: Approximately 1% of individuals have a hereditary cancer predisposition syndrome, however, the majority are not aware. Collecting a cancer family history (CFH) can triage patients to receive genetic testing. To rigorously assess different methods of CFH collection, we compared a web-based tool (WBT) to usual care (clinician collects CFH) in a randomized controlled trial. METHODS: New gynecologic oncology patients (seen 9/2019-9/2021) were randomized to one of three arms in a 2:2:1 allocation ratio: 1) usual care clinician CFH collection, 2) WBT completed at home, or 3) WBT completed in office. The WBT generated a cancer-focused pedigree and scores on eight validated cancer risk models. The primary outcome was collection of an adequate CFH (based on established guidelines) with usual care versus the WBT. RESULTS: We enrolled 250 participants (usual care - 110; WBT home - 105; WBT office - 35 [closed early due to COVID-19]). Within WBT arms, 109 (78%) participants completed the tool, with higher completion for office versus home (33 [94%] vs. 76 [72%], P = 0.008). Among participants completing the WBT, 63 (58%) had an adequate CFH versus 5 (5%) for usual care (P < 0.001). Participants completing the WBT were significantly more likely to complete genetic counseling (34 [31%] vs. 15 [14%], P = 0.002) and genetic testing (20 [18%] vs. 9 [8%], P = 0.029). Participant and provider WBT experience was favorable. CONCLUSIONS: WBTs for CFH collection are a promising application of health information technology, resulting in more comprehensive CFH and a significantly greater percentage of participants completing genetic counseling and testing.

Provider and Patient Experiences of Delays in Primary Care During the Early COVID-19 Pandemic.

BACKGROUND: The necessary suspension of nonacute services by healthcare systems early in the COVID-19 pandemic was predicted to cause delays in routine care in the United States, with potentially serious consequences for chronic disease management. However, limited work has examined provider or patient perspectives about care delays and their implications for care quality in future healthcare emergencies. OBJECTIVE: This study explores primary care provider (PCP) and patient experiences with healthcare delays during the COVID-19 pandemic. METHODS: PCPs and patients were recruited from four large healthcare systems in three states. Participants underwent semistructured interviews asking about their experiences with primary care and telemedicine. Data were analyzed using interpretive description. RESULTS: Twenty-one PCPs and 65 patients participated in interviews. Four main topics were identified: (1) types of care delayed, (2) causes for delays, (3) miscommunication contributing to delays, and (4) patient solutions to unmet care needs. CONCLUSIONS: Both patients and providers reported delays in preventive and routine care early in the pandemic, driven by healthcare system changes and patient concerns about infection risk. Primary care practices should develop plans for care continuity and consider new strategies for assessing care quality for effective chronic disease management in future healthcare system disruptions.

Telemedicine Impact on the Patient-Provider Relationship in Primary Care During the COVID-19 Pandemic.

BACKGROUND: The COVID-19 pandemic has necessitated a rapid uptake of telemedicine in primary care requiring both patients and providers to learn how to navigate care remotely. This change can impact the patient-provider relationship that often defines care, especially in primary care. OBJECTIVE: This study aims to provide insight into the experiences of patients and providers with telemedicine during the pandemic, and the impact it had on their relationship. RESEARCH DESIGN: A qualitative study using thematic analysis of semistructured interviews. SUBJECTS: Primary care providers (n=21) and adult patients (n=65) with chronic disease across primary care practices in 3 National Patient-centered Clinical Research Network sites in New York City, North Carolina, and Florida. MEASURES: Experiences with telemedicine during the COVID-19 pandemic in primary care. Codes related to the patient-provider relationship were analyzed for this study. RESULTS: A recurrent theme was the challenge telemedicine posed on rapport building and alliance. Patients felt that telemedicine affected provider's attentiveness in varying ways, whereas providers appreciated that telemedicine provided unique insight into patients' lives and living situations. Finally, both patients and providers described communication challenges. CONCLUSIONS: Telemedicine has altered structure and process aspects of primary health care such as the physical spaces of encounters, creating a new setting to which both patients and providers must adjust. It is important to recognize the opportunities and limits that this new technology has to help providers maintain the type of one-on-one attention that patients expect and that contributes to relationship building.

Association of Vaccination with the Persistence of Post-COVID Symptoms.

BACKGROUND: Patients who have had COVID-19 often report persistent symptoms after resolution of their acute illness. Recent reports suggest that vaccination may be associated with improvement in post-acute symptoms. We used data from a prospective cohort to assess differences in post-acute sequelae of COVID (PASC) among vaccinated vs. unvaccinated patients. METHODS: We used data from a cohort of COVID-19 patients enrolled into a prospective registry established at a tertiary care health system in New York City. Participants underwent a baseline evaluation before COVID-19 vaccines were available and were followed 6 months later. We compared unadjusted and propensity score-adjusted baseline to 6-month change for several PASC-related symptoms and measures: anosmia, respiratory (cough, dyspnea, phlegm, wheezing), depression, anxiety, post-traumatic stress disorder (PTSD; COVID-19-related and other trauma), and quality-of-life domains among participants who received vs. those who did not receive COVID-19 vaccination. RESULTS: The study included 453 COVID-19 patients with PASC, of which 324 (72%) were vaccinated between the baseline and 6-month visit. Unadjusted analyses did not show significant differences in the baseline to 6-month change in anosmia, respiratory symptoms, depression, anxiety, PTSD, or quality of life (p > 0.05 for all comparisons) among vaccinated vs. unvaccinated patients. Similar results were found in propensity-adjusted comparisons and in secondary analyses based on the number of vaccine doses received. CONCLUSIONS: Our findings suggest that COVID vaccination is not associated with improvement in PASC. Additional studies are needed to better understand the mechanisms underlying PASC and to develop effective treatments.

Web-based tools for family cancer history and cancer risk modeling: what are the barriers to successful implementation?

More than 80% of individuals with hereditary cancer syndromes are unaware of and, therefore, cannot take advantage of strategies for cancer prevention. The COVID-19 pandemic has resulted in a revolution in healthcare clinical workflows, moving away from the face-to-face model and towards digital strategies. Collection of family health history (FHH) and automated generation of disease risk models is a powerful digital tool that can be performed remotely and safely during a pandemic and help identify those at-risk for hereditary cancer syndromes. We aimed to evaluate barriers to completion of a web-based application (WBA) for FHH and cancer risk models (CRM). Patients scheduled for a gynecologic oncology new patient appointment between 9/2019-9/2020 were offered enrollment in a prospective trial randomizing participants to collection of FHH during the office face-to-face physician interview vs FHH collection via WBA at home or in the office (randomized 1:1:1). The WBA included embedded CRMs (BRCAPRO, Claus, Tyrer-Cuzick, Gail, colorectal and endometrial MMRPRO, MELAPRO, and PANCRO). 66 patients were randomized to utilization of the WBA with median age 60 years (range 22-88). 53 (80.3%) accessed the application and 13 (19.7%) did not for the following reasons: Home arm (11) - forgot (3), WBA was confusing (1), technological issues (1), uncertain of family history (1), concerned about privacy (1), unsure (3), lost to follow-up (1);Office arm (2) - insufficient time to complete (2). Among patients accessing the WBA, 28 (52.8%) successfully input all necessary information to compute the CRM. Thirty-five patients (66%) had at least one validation error including seven patients with two errors and one with three errors. Causes of validation errors included: patient not eligible due to age or cancer history (17, 32.1%), incomplete entry of personal health information (13, 24.5%), incomplete entry of relative(s) health information (10, 18.9%) and user error (misunderstanding questions) (4, 7.5%). Fifty-two patients, 98.1% of those who accessed the application, had at least one successfully generated CRM. There was no difference in completion of CRM between patients competing the web-based application at home versus in the office prior to the appointment. [Display omitted] WBA for collection of FHH and generation of CRM are a promising part of the current health care digital revolution;however, as with all new technology, it is critical to assess usability and efficacy. In our study of WBA FHH collection, 20% of patients did not successfully access the WBA and only 27% of patients randomized to the WBA successfully completed all risk models. Barriers include difficulty accessing the application, concern about privacy, incomplete entry of personal and relative information and user error. Design of future health information collection systems must emphasize clear patient instructions on accessing the digital tool and comprehensively completing included questions. [ABSTRACT FROM AUTHOR] Copyright of Gynecologic Oncology is the property of Academic Press Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Web-based tool to assess breast cancer risk for women presenting to a gynecologic oncology visit

Approximately 40,000 women die from breast cancer each year in the United States, highlighting the importance of identifying high-risk women prior to breast cancer development. Risk models exist, including the Tyrer-Cusick (TC) model but have not been widely implemented due to the time required to perform the risk assessment and interpret results. We aim to report our experience with a web-based application (WBA) to complete the TC model for women prior to a scheduled gynecologic oncology clinic visit. All patients scheduled for a gynecologic oncology new patient appointment between 9/2020-9/2021 were offered enrollment in an institutional review board-approved prospective trial. Patients were randomized to standard of care gynecologic oncology visit versus utilization of a WBA completed either at home or in the office prior to the appointment (randomized 1:1:1). The WBA collects personal and family health history and utilizes this information to generate a TC score. As part of the trial protocol, all women with a TC score reflecting a lifetime risk of breast cancer ≥ 20% were referred to the institution's high risk breast clinic which provides counseling on genetic testing, breast screening and breast cancer prevention. The WBA also generated additional information on personal and family cancer, the results of which are reported separately. Sixty-six patients were randomized to utilization of the WBA which included completion of the TC model. Median patient age was 60 (range 22-88). Twenty-six patients (39.4%) did not complete the model for the following reasons: 13 (50%) were not able to access the application, 11 (42.3%) did not answer all required questions and 4 (15.4%) were ineligible due to prior breast cancer. Forty patients (60.6%) successfully completed the TC model and among those patients, 6 (15%) had a significantly elevated lifetime breast cancer risk score (defined as ≥ 20%), all of whom were referred to a high risk breast clinic. The COVID-19 pandemic has pressed the healthcare system to better utilize technology to provide safe and equitable medical care. A WBA for collection of personal and family health history and generation of cancer risk models completed prior to the physician appointment is an exciting application of such technology. When piloted in a gynecologic oncology practice, 60.6% of patients were able to complete the risk model and 15% of these patients were found to have a significantly elevated breast cancer risk warranting follow-up care. [ABSTRACT FROM AUTHOR] Copyright of Gynecologic Oncology is the property of Academic Press Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Family health history of gynecologic oncology patients: can we do better?

Despite a growing understanding of familial cancer, multiple studies demonstrate that the quality of family health history (FHH) as currently collected in a clinic setting is inadequate to assess disease risk. Proposed challenges in FHH collection include lack of patient preparation, lack of FHH standardization, and time requirement (especially during the COVID-19 pandemic with intentional minimization of office time). Prior to implementation of a web-based application for FHH collection, we aimed to review the quality of collected FHH in a gynecologic oncology clinic and to determine if any patient factors affect FHH collection. This was a single institution retrospective study of FHH collection for new patient appointments at a gynecologic oncology outpatient practice between 4/2019-7/2019. FHH was collected verbally during the patient face-to-face interview. FHH was evaluated for the following, previously published, quality measures on a point system: 1) Three generations, 2) Relative gender, 3) Relative lineage (maternal vs paternal), 4) Pertinent negatives (absence of hereditary cancers), 5) Age of relatives' cancer diagnosis, and for deceased relatives, 6) Age of death and 7) Cause of death. Among the 200 evaluable patients, 185 (92.5%) had FHH documented in the medical record. The median age was 52 years (range 23-93). Eighty-nine (44.5%) included three generations, 154 (77%) relatives' gender, 109 (54.5%) relatives' lineage, and 77 (38.5%) pertinent negatives (Figure 1). Among 147 patients reporting a history of cancer in their family, 23 (15.6%) included age of relatives' cancer diagnosis. Among 75 patients listing deceased relatives, 13 (17.3%) included age of death and 48 (64%) cause of death. Age and personal cancer diagnosis were not associated with quality of FHH. Patients with family history of cancer scored higher in quality of FHH than those without family history (median=3.0 [IQR 3.0;4.0] vs. 1.0 [0.0;2.0], P <0.001) and were more likely to have inclusion of three generations (57.1% vs. 9.4%, P <0.001). Forty-three patients (21.5%) had previously undergone genetic testing and these patients had higher FHH scores than those without prior genetic testing (3.0 [3.0;4.0] vs. 3.0 [1.0;4.0], P=0.01) and were more likely to include age of relatives' cancer diagnosis (27.0% vs. 11.0%, P =0.04), age of relatives' death (35.7% vs. 13.1%, P=0.04), and cause of relatives' death (92.3% vs. 58.1%, P=0.02). Overall, patients with higher quality FHH had increased likelihood of being referred to genetic assessment (4.0 [3.0;4.75] vs. 3.0 [1.0;4.0], P=0.002). [Display omitted] Our data are consistent with the literature suggesting that standard collection of family history may not adequately capture all measures of a high quality oncologic FHH. Patients without prior genetic testing and no family history of cancer had the lowest scores for FHH quality and might benefit from a web-based FHH collection tool, allowing them to contact relatives for more information prior to an office visit and permitting better patient preparation and efficiency. In light of the COVID-19 pandemic, tools that minimize inoffice time are increasingly important. A prospective evaluation of a web-based FHH collection tool to address these issues is ongoing. [ABSTRACT FROM AUTHOR] Copyright of Gynecologic Oncology is the property of Academic Press Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Disparities in genetic testing for women with ovarian cancer: a systematic review

Despite the recommendation for genetic assessment for all women with ovarian cancer, the limited available data suggest significant disparities in referral and uptake of genetic services in minority populations. Additionally, the COVID-19 pandemic has exacerbated many existing health care disparities, making it even more critical that inequalities be identified and addressed. We sought to evaluate differences in genetic counseling and genetic testing among women with ovarian cancer based on race and insurance status. A complete systematic search of online databases (PubMed, EMBASE, MEDLINE, and the Cochrane Library) for studies reporting on genetic testing in ovarian cancer without date restriction was performed. Random effects pooled proportions were calculated using the logit transformation and 95% confidence intervals for individual study proportions were calculated using the Clopper-Pearson exact method. The comprehensive search produced 3026 studies, among which 38 met inclusion criteria. Eight studies included analysis by self-reported race/ethnicity and 6 included analysis by insurance status. Among studies listing mean age of diagnosis, stage, and histology data, the median of the mean age of diagnoses across the studies was 63.3 years. The median proportion of patients with early stage (I/II) ovarian cancer was 14.7%, late stage (III/IV) 68.6%, and unknown stage 9.3%. The median proportion of patients with serous histology was 81.8%, endometrioid 12.6%, mucinous 5%, clear cell 5.8%, mixed 3.7%, carcinosarcoma 3%, and other/unknown histology 81.8%. Among 7,862 patients, 6,469 reported being White, 599 Black, and 794 Asian. Random-effects pooled proportions by race/ethnicity to follow: Among White patients, 43% [CI 26-62%] were referred for genetic counseling and 40% [CI 25-57%] completed testing, and for Black patients, 24% [CI 13-42%] were referred for counseling and 26% [CI 17-38%] completed testing. For Asian patients, 23% [CI 2-83%] were referred for counseling and 14% [CI 2-51%] completed testing, although only two studies included referral and testing proportions in Asian patients, with the majority of patient data coming from one study with referral proportion of 39% and another study with testing proportion of 31%. Among 7,681 patients, 5,320 (69%) had private insurance, 2,078 (27%) had Medicare/Medicaid, and 283 (4%) were uninsured. Random-effects pooled proportions by insurance status to follow: Among patients with private insurance, 39% [CI 26-54%] were referred for genetic counseling and 47% [CI 30-64%] completed testing. Among patients with Medicare/Medicaid, 27% [CI 18-38%] were referred for counseling and 26% [CI 16-40%] completed testing, and among uninsured patients, 24% [CI 13-41%] were referred for counseling and 23% [CI 18-28%] completed testing. Small sample and high study heterogeneity observed in the race and insurance data resulted in large confidence intervals in the pooled proportions of interest. Rates of genetic counseling and genetic testing are below national guidelines for all women with ovarian cancer. Our systematic review of the existing literature on this topic suggests that minority women and patients without private insurance may be disproportionally affected by lower referral rates and more limited access to genetic testing. This disparity is concerning as it can have significant impact on the health of the affected patient and her at-risk relatives. [Display omitted] [ABSTRACT FROM AUTHOR] Copyright of Gynecologic Oncology is the property of Academic Press Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Using health information technology to improve collection of family cancer history: prospective randomized trial of web-based tool in a gynecologic oncology outpatient clinic

In the US there are approximately 4 million individuals with a genetic cancer predisposition syndrome, however, the majority are not aware and cannot benefit from genetically-targeted cancer prevention. Family cancer history (FCH) can identify high risk patients and triage them to genetic assessment, however there is wide variability in accuracy, breadth and strategies for FCH collection. We aim to evaluate whether a web-based tool (WBT) can result in improved quality of FCH versus standard FCH collection via face-to-face interview. All patients scheduled for a gynecologic oncology new patient visit between 9/2019-9/2020 were offered enrollment in an institutional review board-approved prospective trial. Patients were randomized to one of three arms: 1) standard of care FCH collection during the interview, 2) WBT administered at home prior to the visit, 3) WBT administered in the office prior to the visit. The primary endpoint was evaluation of FCH quality based on established quality measures. Chi-square test was used to compare FCH quality between intervention arms and ANOVA test for the number of relatives/generations in the pedigree. A Bonferroni correction was used to account for multiple comparison testing. A total of 100 patients were enrolled. The mean age was 56.2 years (SD 15.2). The WBT was completed successfully by 67% (22) of patients randomized to home administration vs 94% (31) randomized to office administration (P=0.01). Patients cited the following reasons for failure to complete the WBT at home: difficulty with technology, concern about privacy and forgetting about the WBT invitation. In the intention-to-treat analysis, office WBT collection resulted in significantly higher quality FCH vs the control and home arms (Table 1). The WBT resulted in significantly greater mean number of relatives included in the pedigree (Arm 1 - 3.9 [SD 3.0], Arm 2 - 32.4 [SD 16.8], Arm 3 - 29.0 [SD 18.3], P<0.001) and significantly greater number of included generations (2.2 [SD 0.9], 3.9 [SD 0.4], 3.7 [SD 0.6], P<0.001). Patient age, race, ethnicity, and personal/family cancer history were not associated with FCH quality. When excluding patients who could not access the WBT at home, there were no differences in FCH quality when WBT was completed at home vs in the office. A total of 39 patients utilizing the WBT (74%) completed a satisfaction survey following the office visit;38 (97%) reported that the WBT was easy to understand and 30 (77%) reported being satisfied with the tool. [Display omitted] FCH collection is an exciting application of information technology in the current healthcare setting with a growing emphasis on cancer genetics, disease prevention and thoughtful use of WBTs. In our cohort of gynecologic-oncology patients, a WBT resulted in significantly higher quality and more comprehensive family cancer pedigrees. With the COVID-19 pandemic inspired drive to minimize in-office time, future studies must assess strategies to improve patient engagement with WBT at home prior to the visit. [ABSTRACT FROM AUTHOR] Copyright of Gynecologic Oncology is the property of Academic Press Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Adapting and avoiding coping strategies for women with ovarian cancer during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has resulted in unprecedented challenges for people living with cancer, impacting not only physical health but psychological well-being. The psychological response affects the individual as well as the community and can persist long after the outbreak. We aim to assess coping strategies employed by women with ovarian cancer during the COVID-19 pandemic. METHODS: Women with a current or prior diagnosis of ovarian cancer completed an online survey which included a query about coping strategies during the COVID-19 pandemic. The survey was distributed from March 30th through April 13, 2020 through survivor networks and social media. RESULTS: Six hundred and three women visited the survey website during the study period and 555 (92.0%) completed the survey. Four hundred and eight (73.5%) provided information on coping strategies utilized during COVID-19. Among those who responded, the median age was 58 years (range 20-85) and 150 participants (40.8%) were undergoing active cancer treatment. Commonly utilized adaptive coping strategies included emotional support (159, 39.0%), self care (148, 36.3%), hobbies (139, 34.1%), planning (87, 21.3%), positive reframing (54, 13.2%), religion (50, 12.3%) and instrumental support (38, 9.3%). Many participants also relied on avoidance coping strategies including self distraction (111, 27.2%) and substance use (19, 4.7%). CONCLUSIONS: Most ovarian cancer survivors are using adaptive, problem-focused coping strategies during the COVID-19 pandemic, however many are practicing avoidance strategies as well. As coping mechanisms profoundly impact quality of life, oncology providers must assist patients in identifying coping strategies that optimize physical and psychological well-being.