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Wagar published in Gynecologic Oncology

A new article in the journal Gynecologic Oncology by UW Ob-Gyn resident Matt Wagar, MD, PGY-4 examines whether enrollments in clinical trials for PARP inhibitors reflects the racial and ethnic diversity of people who are diagnosed with ovarian cancer.

“Racial and ethnic enrollment disparities in clinical trials of poly(ADP-ribose) polymerase inhibitors for gynecologic cancers”, by Wagar and co-authors Rachel Mojdehbakhsh, MD, Amy Godecker, PhD, Laurel Rice, MD, and Lisa Barroilhet, MD, is a retrospective review utilizing data from 15 PARP inhibitor trials on ClinicalTrials.gov. The study found:

“[Non-Hispanic] NH-Black and Hispanic patients are significantly underrepresented in clinical trials evaluating PARP inhibitors for ovarian cancers compared to NH-White cohorts. Phase II/III trials assessing PARP inhibitors for ovarian cancers do not accurately represent the populations diagnosed with these malignancies. Enrollment strategies are needed to increase diversity in PARP inhibitor clinical trials for women's cancers.”

Read the whole study here!

Grand Rounds: Rice presents “The Nuances of Career Development”

On November 11, 2021, Laurel Rice, MD, Ben Miller Peckham, MD, PhD, Chair in Obstetrics and Gynecology, presented the Grand Rounds lecture “The Nuances of Career Development”. 

In the presentation, Rice shared perspectives for navigating career development in academic medicine through the power of articulating one's interests and passion, identifying and being open to pursuing opportunities, as well as recognizing that useful lessons may be found in many forms. 

Watch the whole lecture here. 

Spencer, Rice published in Obstetrics and Gynecology

A new study published in Obstetrics and Gynecology compares operative times in the American College of Surgeons’ National Surgical Quality Improvement Project with physician-reported operative times from the Centers for Medicare and Medicaid Services to assess for the impact on RVUs.

“Discrepancies Created by Surgeon Self-Reported Operative Time and the Effects on Procedural Relative Value Units and Reimbursement”, by Ryan Spencer, MD, MS and UW Ob-Gyn Department Chair Laurel Rice, MD is a cross-sectional review of registry data. The study found:

“Despite reliable electronic records, the AMA-RUC continues to use inaccurate self-reported RUC surveys for operative times. This results in discrepancies in RVU per hour (and subsequent reimbursement) across specialties and a persistent disparity for women-specific procedures in gynecology. Relative value unit levels should be based on the available objective data to eliminate these disparities.”

Read the whole paper here.

Study by UW CORE researchers published in Contraception

A new study in Contraception uses data from a survey of UW School of Medicine and Public Health physicians to assess physician support for abortion access and abortion providers. The study also examines physicians’ perceptions of their peers’ attitudes towards abortion and abortion providers.

“Physician attitudes about abortion and their willingness to consult in abortion care at a Midwestern academic medical center”, by Nicholas Schmuhl, PhD, Laurel Rice, MD, Cynthia Wautlet, MD, and Jenny Higgins, PhD, MPH, found faculty who were surveyed have strong support for abortion. In addition, 84% of respondents reported at least “a little” support for the efforts of faculty who provide abortion services.

While respondents reported a high level of support themselves for abortion services and abortion providers, they estimated a lower level of support among their peers. For example, 62% of physicians reported “a lot” of support for abortion access, but only 21% estimated the same level of support from their peers.

“Our findings have implications for abortion care access and quality in Wisconsin, as well as professional quality of life for physicians who directly and indirectly participate in abortion care. While these results should encourage supporters of comprehensive abortion rights, the climate surrounding abortion at our institution could improve. Self-reports portrayed a highly supportive environment surrounding abortion, while physicians perceived a more muted climate of support among their fellow faculty. Our findings demonstrate that these misperceptions have tangible consequences for access and quality of abortion care, as physicians who estimated relatively lower support among peers were less willing to consult in abortion-related cases. This discrepancy was greatest among specialties commonly associated with abortion care.”

Read the whole study here.

Rice, Higgins make case for health care provider proficiency with contraceptives in Health Affairs blog

UW Ob-Gyn Department Chair Laurel Rice, MD, and UW Collaborative for Reproductive Equity Director Jenny Higgins, PhD, co-authored an article for Health Affairs outlining the reasons it’s critical that health care providers seek out accurate information on contraceptive care.

Inaccuracies or misunderstandings about how birth control works shape public perception and affect health care policy, and even health care providers are not immune from misinformation. In “The Need For Accurate Contraceptive Awareness And Advocacy Among Health Care Providers”, Rice and Higgins correct some common misconceptions about how contraceptive methods work, and argue that health care providers – as long as they’re armed with accurate knowledge – can be great advocates for comprehensive contraceptive policies:

“Health care providers can hardly be expected to hold exhaustive knowledge about the universe of medications and medical products. However, we argue that proficiency about contraception’s actual mechanisms is critically important…

… Medical professionals armed with accurate information have an opportunity to push back against, not perpetuate, larger cultural misperceptions and deliberate political myths about birth control. These myths do not merely represent a benign lack of knowledge but affect policies and programs, limiting people’s ability to access this essential public health and medical good.”

Read the whole article here.

Mojdehbakhsh published in Gynecologic Oncology Reports

A quality improvement study by lead author Rachel Mojdehbakhsh, MD, PGY-2, was published in Gynecologic Oncology Reports. Co-authors include Stephen Rose, MD, Megan Peterson, DNP, Laurel Rice, MD, and Ryan Spencer, MD, all of the UW Ob-Gyn Division of Gynecologic Oncology.

In light of the COVID-19 pandemic that began in early 2020, industry organizations like the National Comprehensive Cancer Network recommended transitioning some appointments to telemedicine. Mojdehbakhsh’s study, “A quality improvement pathway to rapidly increase telemedicine services in a Gynecologic Oncology clinic during the COVID-19 pandemic with patient satisfaction scores and environmental impact”, outlines efforts at the UW Carbone Cancer Center’s gynecologic oncology clinic to move appointments to telehealth platforms over a short period of time. The study also assessed patient satisfaction with telemedicine visits, and environmental impact of moving visits online.

“With multidisciplinary team planning and standardized note templates, transitioning 50% of encounters to telemedicine and achieving high rates of consent documentation were accomplished in four weeks. This increase in telemedicine represented a measurable decrease in the amount of CO  2 emissions. Additionally, patients were overwhelmingly satisfied.”

Read the whole study here – incredible work, Dr. Mojdehbakhsh and Gyn Onc division team!

Higgins, Schmuhl, Wautlet, Rice publish in American Journal of Public Health

Findings from a UW Collaborative for Reproductive Equity study on how doctors view access to abortion has been published in the December issue of the American Journal of Public Health.

In the research-based editorial “The Importance of Physician Concern and Expertise in Increasing Abortion Health Care Access in Local Contexts”, Jenny Higgins, PhD, Nicholas Schmuhl, PhD, Cynthie Wautlet, MD, and Laurel Rice, MD—all UW CORE investigators—chronicle the impacts of increasingly restrictive policies on abortion access, underscoring the key importance of local and state-level attitudes. Even with the current legal protections of Roe v. Wade, many state regulations already curtail abortion access. If the Supreme Court overturns the landmark case, which seems likely given the new makeup of the court, existing passed and signed state laws would immediately become enforceable, criminalizing abortion in Wisconsin and the majority of other US states.

Using Wisconsin as a case study, UW CORE researchers examined physician attitudes on the impacts of abortion policy on patients, the practice of medicine, and public health. With doctors ranking above teachers, police officers, and clergy in terms of their perceived ethics and trustworthiness, they comprise an important, but often understudied, group of influencers of public opinion and, ultimately, policy.

Wisconsin, a political battleground state now considered hostile to abortion access, witnessed a number of restrictive abortion policies implemented after the 2010 election. To better understand physicians’ attitudes toward abortion access and its impacts, UW CORE researchers surveyed doctors at the University of Wisconsin School of Medicine and Public Health—the state’s largest and only publicly-funded medical school. The team sent 1,357 surveys to doctors in all specialties and received 913 responses (a surprisingly high 67 percent response rate) between February and May 2019.

The investigators found that physicians across specialties majorly opposed restrictions on abortion health care services. In terms of patient care, 91 percent believed women’s health care would get worse if Roe v. Wade were overturned. An overwhelming majority of respondents, 99 percent, were concerned about legislation interfering with the doctor-patient relationship.

Ninety-one percent of doctors also opposed policies that prohibit their involvement in abortion care—namely, restrictive employment covenants that prevent them from providing abortion health services on personal time. Finally, physicians worried that abortion restrictions could negatively affect the UW–Madison School of Medicine and Public Health by curtailing faculty and trainee recruitment.

“We had expected physicians in our study to be concerned about abortion restrictions on patients,” said lead author Jenny Higgins. “But we were struck by the overwhelming degree to which they were also concerned about policy interference in how physicians can practice medicine, both in general and in regard to abortion. Another surprising finding is that physicians worried not only about effects on patient care and physician autonomy, but also on their institution’s reputation and ability to recruit quality faculty and trainees. It’s also notable that these attitudes were shared by providers across virtually all medical specialties, and not just Obstetrics and Gynecology.”

The authors argued that physicians have the potential to influence policy and change public perception. By more widely sharing their feelings about the negative impact of abortion restrictions, doctors could potentially help ease restrictions and shape both public attitudes and public policy. Doing so could protect women’s health as well as physician autonomy.

Read the whole article here.

First HAGO Conference was a great success!

On September 10-11, the UW Ob-Gyn Division of Gynecologic Oncology hosted the first-ever Heartland Association of Gynecologic Oncology (HAGO) meeting. More than 70 gynecologic oncology professionals tuned in for the virtual conference, which included two keynote presentations and 21 research abstract presentations.

HAGO was founded in 2020 by UW Ob-Gyn Division of Gyn Onc Director Stephen Rose, MD, and the program committee included Ryan Spencer, MD and UW Ob-Gyn Gyn Onc fellowship graduates Andrea O’Shea, MD and Shitanshu Uppal, MD.

Of the 21 abstracts selected for presentation, five were from our department (Matthew Wagar, MD with mentor Sumer Wallace, MD; Wagar with mentor Makeba Williams, MD; Shannon Rush, MD with mentor Steve Rose, MD; Rachel Mojdehbakhsh, MD with mentor Ryan Spencer, MD; and Connor Wang, MD with mentor Spencer).

UW Ob-Gyn Gyn Onc fellow Shannon Rush, MD earned the first Award for Clinical Research for her abstract “65 Revisited: A Revised Markov Model for Evaluating Oophorectomy at the Time of Hysterectomy for Benign Disease”!

Lisa Barroilhet, MD was also an invited distillation presenter and UW Ob-Gyn Department Chair Laurel Rice, MD gave a keynote address and received the inaugural HAGO Award for Service and Leadership.

Our congratulations to everyone involved in planning and preparing the HAGO Conference – incredible work!