title: Identification of the optimal pathway to reach an accurate diagnosis in the absence of an early detection strategy for ovarian cancer.
abstract: OBJECTIVE
  There is a lack of knowledge about the health care events experienced by individual patients that lead to a definitive diagnosis of ovarian cancer (OC). The goal of this study was to describe the various pathways and to identify an optimal path to accurate diagnosis.
  
  
  METHODS
  Women who were referred to gynecologic oncology for a suspected OC were enrolled to this study. Medical records (MRs) from all health care providers were obtained from the time the patient recalled first suspecting a health issue through the time of diagnosis to build a decision tree model. A Monte Carlo simulation was conducted of 83,000 patients to identify the optimal pathway to reach diagnosis.
  
  
  RESULTS
  In the Monte Carlo simulation, gynecologic oncologists and gynecologists accounted for the most efficient diagnosis in over 37.9% and 29.2% of suspected OC cases, respectively, in terms of the least amount of time to reach diagnosis. Gynecologic oncologists were further associated with the fewest health care visits needed to reach diagnosis in 37% of the simulation cases; however, 23% of trials were indifferent to any specific provider.
  
  
  CONCLUSIONS
  The decision tree provides a more comprehensive view of the complexity in reaching an accurate diagnosis of OC. This analysis was able to identify the health care utilization patterns that underlie the events that occur to reach an accurate diagnosis in the setting of a suspected OC, and was able to identify the most efficient pathways that utilize the fewest health care resources in the least amount of time.
authors.affiliation: Indiana University School of Medicine, Department of Obstetrics and Gynecology, Indianapolis, IN 46202, USA. lmhess@iupui.edu
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Hess
authors.forename: Frederick B
authors.initials: FB
authors.lastname: Stehman
authors.forename: Michael W
authors.initials: MW
authors.lastname: Method
authors.forename: Tess D
authors.initials: TD
authors.lastname: Weathers
authors.forename: Paridha
authors.initials: P
authors.lastname: Gupta
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Schilder
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018394:CA-125 Antigen / Q000097:blood; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008875:Middle Aged; D009010:Monte Carlo Method; D010051:Ovarian Neoplasms / Q000175:diagnosis*
chemical_list: D018394:CA-125 Antigen