Table 2.

Proposed Approaches to Improve Models of Care to Increase Gynecologic Care

Author (Year)	Focus of article	Approach	Approach description or focus
Boyd et al. (2011)29	Geographic availability of GOs; factors associated with GO use/non-use; strategies to increase GO care	Centralization/regionalization of carea	Centralize care so patients attending municipal hospitals with fewer specialty services can receive quality care from GO at high-volume specialty health center.
		Sharing of physicians	Sharing of physicians in public and private settings through a shared physician practice model.
		Use of referral systems	Develop and use referral systems to ensure patients with ovarian cancer have the benefits of high-volume surgeons and centers with appropriate ancillary services.
Bristow et al. (2015)37	Geographic availability of GOs; factors associated with GO use/non-use; strategies to increase GO care	Centralization/regionalization of care	Implement a national approach of centralization of care for women with ovarian cancer to improve population-based clinical outcomes. The transplant model used in the United States provides a template that could be used to regionalize ovarian cancer care.
Canadian Partnership Against Cancer (2018)39	Strategies to increase GO care	Centralization/regionalization of care	Regionalize care to ensure access to high-volume cancer centers to reduce health disparities and ensure timely access to care.
		Multidisciplinary care	All women with gynecologic malignancies should have access to multidisciplinary teams and should be operated on and/or have treatment directed by a GO.
		Telemedicine	Ensure access to telehealth to mitigate the risks of geographic isolation and provide care closer to home.
Collins et al. (2014)18	Factors associated with GO use/non-use; facilitators/barriers to GO access; strategies to increase GO care	Use of referral systems	Use of electronic health records to collect data that gives a better picture of care received and identify patient barriers and systemic factors to receiving quality gynecologic cancer care.
Cowan et al. (2016)33	Geographic availability of GOs; geographic use of GOs; factors associated with GO use/non-use; facilitators/barriers to GO access; strategies to increase GO care	Centralization/regionalization of carea	Centralize GO services. Centers and providers with less experience should reach out to more specialized providers/hospitals to ensure patients are receiving appropriate care.
Duska (2018)17	Geographic availability of GOs; geographic use of GOs; factors associated with GO use/non-use; facilitators/barriers to GO access; strategies to increase GO care	Centralization/regionalization of care	Coordination of local and centralized services, with the most complex components of care provided in tertiary settings or centers of excellence.
		Guest operations	Send GO faculty to outreach hospitals to conduct surgery, inpatient consults, and outpatient clinical services.
		Patient navigation	Engage a patient navigator to help patients navigate complex cancer systems.
		Telemedicine	Virtual tumor board with virtual teleconferencing and digital transfer of radiology and pathology images to allow for in-depth review of cases and discussion of treatment recommendations by multidisciplinary group of experts.
Fung-Kee et al. (2015)34	Strategies to increase GO care	Centralization/regionalization of care	Centralize care to ensure multidisciplinary care and surgery by GO to improve survival outcomes for ovarian care patients.
Horvath et al. (2010)42	Strategies to increase GO care	Multidisciplinary carea	Use multidisciplinary care in which physicians from multiple specialties attend to the same patient population. There are many advantages to the model, including reduced time to treatment, coordinated treatment plans, increased patient and physician satisfaction, and increased enrollment into clinical trials.
Keyver-Paik et al. (2016)35	Strategies to increase GO care	Centralization/regionalization of care	Centralize ovarian cancer care to increase the volume of patients being treated in hospitals with adequate infrastructure.
		Multidisciplinary carea	Multidisciplinary practice and centralization of care resulted in improved quality of care received in patients participating in the program.
Minis et al. (2015)28	Facilitators/barriers to GO access; strategies to increase GO care	Centralization/regionalization of care	Centralize care in centers with higher patient volumes and interdisciplinary collaboration and utilize referrals from less-specialized hospitals within a network, region, or defined catchment area to ensure comprehensive care for women with gynecologic cancer.
National Academies of Sciences, Engineering, and Medicine (2016)10	Strategies to increase receipt of care from GO	Patient navigation	Explore patient navigation systems to allow women to be more engaged in their own care.
		Telemedicine	Telemedicine can help remote patients become more involved in their care. Teleoncology can make oncologists more capable of helping care for patients in areas not located near high-volume centers.
Peters et al. (2014)25	Facilitators/barriers to GO access; strategies to increase GO care	Guest operationsa	GOs from oncology centers should travel to community hospitals to perform cancer surgery there, together with local gynecologists.
Ramzan et al. (2018)43	Geographic availability of GOs; factors associated with GO use/non-use; facilitators/barriers to GO access; strategies to increase GO care	Telemedicine	Use of tele-oncology to provide cancer care remotely through virtual tumor boards, video-based intraoperative consults, and remote supervision of chemotherapy administration.
Ricci et al. (2017)31	Geographic availability of GOs; factors associated with GO use/non-use; facilitators/barriers to GO access; strategies to increase GO care	Centralization/regionalization of care	Centralize gynecologic oncology care at high-volume centers with the infrastructure, expertise, and ancillary support services necessary for excellent patient care.
Rim (2016)27	Geographic availability of GOs; geographic use of GOs; factors associated with GO use/non-use; facilitators/barriers to GO access; strategies to increase GO care	Telemedicine	A virtual method of interfacing points of the health care process, telemedicine may be used for both physician-to-physician video-consulting as well as provider-patient post-operative follow-up.
		Patient navigation	Patient navigation is a proven method of improving patient awareness and the patient’s experience with the clinical system. The goal of patient navigation is in improving access to treatment services and ensuring receipt of timely, quality cancer care.
Shalowitz et al. (2015)44	Geographic availability of GOs; geographic use of GOs; facilitators/barriers to GO access; strategies to increase GO care	Telemedicine	Provide remote cancer care to improve access to care in rural or underserved areas through virtual treatment conferences, remote ordering and supervision of chemotherapy, virtual tumor boards, telepathology, communication with local providers for surgeries at remote sites, and inpatient rounding through videoconference.
Sinno et al. (2017)30	Factors associated with GO use/non-use; facilitators/barriers to GO access; strategies to increase GO care	Centralization/regionalization of care	Utilize a centralized care model for women with advanced ovarian cancer to ensure a larger proportion of women receive care at high-volume ovarian cancer centers.
		Use of referral systems	Develop and use referral systems to ensure patients are getting to high-volume, centralized ovarian cancer centers.
Society of Gynecologic Oncology (2013)41	Strategies to increase receipt of care from GOs	Use of a patient-centered medical home model	Structured ovarian cancer care like a patient-centered medical home with a single provider with training in gynecologic cancer coordinating multidisciplinary care.
		Multidisciplinary care	Ovarian cancer treatment should include multidisciplinary team of specialists, including GOs, radiation oncologists, medical oncologists, primary care physicians, advanced practice providers, oncology nurses, oncology pharmacists, genetic counselors, physical therapists, and additional supportive care providers.
		Use of referral systems	Improve electronic health record systems to facilitate access and coordination of care.
		Telemedicine	Use of telehealth systems to facilitate and coordinate care with patients and providers.
		Developing centers of excellence in gynecologic oncology	Provide incentives for hospitals to become centers of excellence in gynecologic oncology.
Stewart et al. (2011)22	Geographic availability of GOs; factors associated with GO use/non-use; strategies to increase GO care	Patient navigation	Cancer planners can assist with alleviating disparities through navigation of ovarian cancer patients to GOs.
Stewart et al. (2014)32	Geographic availability of GOs; facilitators/barriers to GO access; strategies to increase GO care	Centralization/regionalization of care	Reorganization of gynecologic cancer care to connect major comprehensive cancer centers that have GOs with smaller satellite hospitals without GOs to facilitate multidisciplinary care for patients in the smaller centers.
Stewart et al. (2016)19	Factors associated with GO use/non-use; facilitators/barriers to GO access; strategies to increase GO care	Patient navigation	Assistance of patients with communication and transportation needs following a diagnosis could help increase the numbers of women receiving care from GOs following a diagnosis.
		Telemedicine	Telemedicine, which would allow GOs to consult on patient cases through phone and/or videoconferencing, has been suggested to alleviate geographic disparities.
University of Colorado (2019)40	Strategies to increase GO care	Guest operations	Create travel systems for GO specialists to be available in rural/shortage areas when needed.
van Altena et al. (2013)38	Strategies to increase GO care	Centralization/regionalization of carea	Studied a regional collaboration in the Netherlands to optimize epithelial ovarian cancer treatment. GOs from the university center conducted surgery in community hospitals when ovarian cancer was considered based on the risk of malignancy index or clinical suspicion.
Woo et al. (2012)36	Geographic availability of GOs; factors associated with GO use/non-use; facilitators/barriers to GO access; strategies to increase GO care	Centralization/regionalization of care	Centralize care to specialized centers to increase survival outcomes among women with ovarian cancer.

^aApproach evaluated by authors.

GO, gynecologist oncologist.