400 Understanding decision-making for risk-reducing surgery: a women choosing surgical prevention (WISP) qualitative study

Introduction/Background We aimed to identify common themes and influential factors in the decision to undergo risk-reducing surgery in patients at genetic high-risk for epithelial ovarian cancer (EOC). Methodology Participants of the Phase II WISP trial investigating risk-reducing salpingo-oophorectomy (RRSO) and interval salpingectomy with delayed oophorectomy (ISDO) were invited to participate. Those who provided informed consent underwent semi-structured interviews that were transcribed and analyzed using a thematic content analysis approach. Results 15 interviews were conducted (ISDO n=8, RRSO n=7) via Zoom. Data were coded and similar codes were grouped into themes by domain. Sentiments that were shared and unique to the RRSO and ISDO groups were identified. (Table 1) Within Domain 1, Decision to Pursue Surgery, decision-making factors were divided into themes of medical/physical, psychological, and social considerations. Important factors for both groups included age, independent research, experiences of others with cancer, and advice from a variety of medical providers. In the ISDO group, patients noted the fallopian tube origin of EOC and the possibility of future fertility as influential; RRSO group considered prior experience with medically induced menopause. In Domain 2, Expectations and Experience, both groups had overall positive experiences and found surgical recovery was easier than expected. Some suggested that they may have pursued surgery sooner if they knew about ISDO. The RRSO group noted negative effects of surgical menopause and feelings of premature aging. In Domain 3, Suggestions for the Future, patients suggested that providers can do a better job of counseling patients on the effects of surgical menopause, and individualize discussions based on patient experiences. Conclusion Patients in the ISDO and RRSO groups shared a number of decision-making factors and overall had positive experiences with risk-reducing surgery. There is a need for more personalized counseling and resources for patients to allow for self-exploration and improve shared decision making with providers. Disclosures None.