Occupational Needs of Women in the Acute Post-Operative Phase After Gynecologic Oncology Procedures

The primary treatment modality for ovarian cancer is radical surgery. Rates of post-operative morbidity (20-30%) and hospital readmission (10-15%) are high. Low QOL prior to chemotherapy (i.e. after surgery) is associated with delayed chemotherapy start, dose delays, and decreased overall survival. The quality of surgical recovery in this population is high-stakes, with an impact on the costs of hospital readmission, as well as post-operative chemotherapy receipt and survival. For women with ovarian cancer, there is currently no published literature on acute post-operative functional deficits and QOL decrements. Functional deficits and QOL are modifiable and constitute the main goals of OT. This study will be the first in this population to identify post-operative, modifiable, functional deficits. We will collect essential qualitative data to design a population-specific, evidence-based OT intervention. The goals of this work are to improve post-operative recovery in order to decrease readmission, improve QOL and ultimately decrease cost. Objective: To identify and describe the modifiable functional deficits after ovarian cancer debulking surgery at discharge. Specific aims: 1) to identify patient functional deficits; 2) to identify patient perceived functional needs and 3) to collect population-specific QOL data Research question: Do women after ovarian cancer debulking surgery have functional deficits that are modifiable with OT? Hypotheses: (1) Women after ovarian cancer debulking surgery have potentially remedial functional deficits. The proportion is unknown, but it is expected to be high. (2) The main theme of perceived functional need will be post-operative self-care. Participants will undergo OT assessment, COPM administration, and QOL survey administration by OT. The QOL surveys will include: Patient Reported Outcome Measurement Information System (PROMIS)-Global Health, PROMIS – Anxiety, Modified Work Ability Index, NCCN Symptom Distress Management Screening Tool, and the Possibilities for Activity Scale (PActS) – Gynecologic Oncology. This will occur within 24 – 48 hours of planned hospital discharge. Medical information on each patient will be abstracted from the medical record and will include: age, cancer site, procedure type, and plan for adjuvant therapy. The evaluation will also be recorded and transcribed for qualitative analysis. Using Atlas.ti software, the transcripts will be evaluated, categorized, and analyzed through an iterative process of Focused coding, In Vivo coding, Pattern coding, and Theoretical coding. The codes will be aggregated into conceptual categories to identify themes, patterns, and relationships among them. Lastly, a model for interpretation will be developed of the women’s’ post-operative experience and perceived needs. COPM scores for functional performance and satisfaction will be summed separately and reported.