Mapping the ovarian cancer diagnostic journey in Israel: Results from a qualitative patient and clinician study.

Abstract

e17570 Background: Ovarian cancer is the most lethal gynecologic malignancy worldwide, with survival declining sharply between early and advanced stages, making timely diagnosis critical. Globally, the median interval from symptom onset to diagnosis remains prolonged (approximately 31 weeks), with substantial variation across countries. Patient journey mapping has improved diagnostic timelines in other disease areas and studies by the World Ovarian Cancer Advocacy Coalition emphasizes both the scarcity of research on ovarian cancer mapping and the variation in patient experiences and outcomes between countries. However, no systematic assessment of the ovarian cancer diagnostic journey has been conducted in Israel. This two-part study aims to identify barriers to timely diagnosis in Israel, with Part 1 qualitative interviews informing the development of a national patient journey questionnaire in Part 2. This abstract reports Part 1 findings. Objective: The overall objective of this study is to characterize the ovarian cancer diagnostic journey in Israel. Part 1, detailed here, uses patient and clinician interviews to develop a diagnostic framework to inform the development of a national patient journey questionnaire used in Part 2. Methods: In-depth semi-structured interviews were conducted with 11 women diagnosed with ovarian cancer (10 without known BRCA mutation at symptom onset; 1 with known BRCA mutation), and a multidisciplinary group of clinicians, including gynecologic oncologists, gynecologists, family physicians, a urogynecologist, and a genetic counselor. Interviews were analyzed using thematic analysis to construct diagnostic trajectories and identify potential deviations. Results: Interviews revealed a typical diagnostic pathway beginning with symptom recognition, followed by evaluation in community-based primary or gynecologic care, preliminary diagnostic testing, hospital referral, and eventual gynecologic oncology consultation. Both patients and clinicians described frequent deviations from this pathway (“diagnostic sidetracks”). Common sidetracks included normalization or minimization of symptoms, misdiagnosis, unclear referral pathways, limited access to diagnostic testing, and delays in appointment availability. Facilitators of faster diagnosis included prior awareness of BRCA mutation status and strong patient persistence in healthcare relationships, suggesting a more direct diagnostic route for women aware of their genetic risk. Conclusions: These Part 1 findings establish a diagnostic journey framework to guide the development of a nationwide ovarian cancer patient journey questionnaire. By identifying common diagnostic deviations and facilitators, this work supports future system-level interventions aimed at reducing diagnostic delays and enabling more efficient detection of ovarian cancer.