P-512 A value-based healthcare approach: Health-related quality of life and psychosocial functioning in women with Premature ovarian insufficiency
Authors: Van Zwol - Janssens C , Jiskoot G , Laven J , Schipper J , Louwers Y 
Published: June 2022

Abstract

Study question
What are the consequences of premature ovarian insufficiency (POI) on psychosocial wellbeing and quality of life (QOL)?

Summary answer
POI patients are at risk for mild to moderate depression. A multidisciplinary approach, embedded in a value-based healthcare setting, improves psychosocial wellbeing and QOL.

What is known already
POI is associated with an increased lifetime risk for depression and anxiety. Within the POI literature on QOL, few studies had set out to specifically and systematically examine QOL patterns and their physical and psychosocial predictors. Distinct aspects of POI such as the absence or presence of previous cancer diagnosis, concurrent unrelated health problems, vasomotor symptoms, and current treatment (e.g. fertility treatment or hormone replacement therapy (HRT)) may impact upon different QOL domains.

Study design, size, duration
All women were seen according to a value-based healthcare clinical pathway which included annual visits to the first multidisciplinary expertise center for POI. Women with POI who visited the outpatient clinic between January 2020 and January 2022 were prospectively included. As part of these visits patients were asked to complete 6 questionnaires (BDI-II, GCS, FertiQoL, WAI, PROMIS and a general health questionnaire), once before their first visit and again after 6 and 12 months.

Participants/materials, setting, methods
In total 199 women between 17 and 60 years completed the first set of questionnaires, at the time of analysis 89 women also completed the questionnaires at 6 months and 55 women at 12 months. The time between POI diagnosis and the first visit ranged from 0 to 36 years. Data was analyzed longitudinally and patients who were using HRT were compared to the ones that did not use HRT.

Main results and the role of chance
Women with POI reported mean ± SD BDI-II score of 15.2 ± 9.5 at the first visit, which is classified as mild to moderate depression. Furthermore, 52.3% of the patients had a BDI-II score of 14 or higher, indicating mild to moderate depression. Over time the BDI-II score decrease significantly (p = 0.023). 111 women used HRT at the first visit, but there was no difference between the BDI-II score of women how already used HRT and those that did not use HRT. The GCS score also improved significantly over time (p &lt; 0.001) especially between the first and second visit at six months, indicating that menopausal symptoms decreased over time with the biggest effect after the first visit. FertiQoL a questionnaire used to assess QOL in fertility patients showed an improvement of QOL over time, between the first visit and the second visit (p = 0.037).

Limitations, reasons for caution
At the time of the first visit women were at different stages of their life and disease, which could impact the outcome of the questionnaires about psychosocial wellbeing and quality of life.

Wider implications of the findings
We want to underline the need for screening POI patients with specific questionnaires for psychosocial functioning and QOL. Furthermore, treating patients according to a value-based healthcare clinical pathway will significantly improve depression, menopausal symptoms and quality of life in patients with POI.

Trial registration number
N/A