Centre for Medical Psychology & Evidence-based Decision-making, The University of Sydney, Sydney, NSW, Australia.
Support Care Cancer. 2012 Oct;20(10):2305-13. doi: 10.1007/s00520-011-1337-z. Epub 2011 Dec 8.
Pelvic radiotherapy for gynaecological cancer often leads to damage of the vaginal mucosa, resulting in stenosis (obstruction by scar tissue). Stenosis has been associated with sexual dysfunction and can hinder medical examinations to detect recurrence. The use of vaginal dilators is frequently recommended to prevent or minimise stenosis, but women are reluctant to use these devices. The aim of this study was to explore the patient experience of dilator use and identify the barriers and facilitators affecting compliance with clinician recommendations.
Women were eligible for the study if they had undergone pelvic radiotherapy for gynaecological cancer up to 2 years ago and received a vaginal dilator as part of their post-treatment rehabilitation. Fifteen participants completed a semi-structured interview.
Barriers to dilator use included: uncertainty about how/when to use dilators, viewing it as a negative experience, lack of time or forgetting and the need for discretion due to an association with sex aids. Facilitators included: concern about stenosis, belief that dilators work, reminders of stenosis, acceptance of dilator use as part of their normal routine or an extension of medical treatment and focusing on positive aspects. These factors were incorporated into a model of dilator use based on the Health Belief Model.
This is the first qualitative study to specifically investigate the patient experience of dilator use. The barriers and facilitators identified in this study and the proposed theory-based model provide new insights to inform future research and clinical management of dilator use.
妇科癌症的盆腔放疗常常导致阴道黏膜损伤，从而导致狭窄（瘢痕组织阻塞）。狭窄与性功能障碍有关，并可能阻碍医学检查以检测复发。经常建议使用阴道扩张器来预防或最小化狭窄，但女性不愿意使用这些设备。本研究旨在探讨患者使用扩张器的体验，并确定影响遵医嘱使用的障碍和促进因素。
如果女性在 2 年前接受过妇科癌症的盆腔放疗，并作为其治疗后康复的一部分接受阴道扩张器，则有资格参加本研究。15 名参与者完成了半结构化访谈。
使用扩张器的障碍包括：不确定如何/何时使用扩张器，将其视为负面体验，缺乏时间或忘记以及由于与性辅助工具有关而需要谨慎使用。促进因素包括：对狭窄的担忧、相信扩张器有效、对狭窄的提醒、接受将扩张器用作正常常规或医疗治疗的延伸以及关注积极方面。这些因素被纳入基于健康信念模型的扩张器使用模型。
这是第一项专门调查患者使用扩张器体验的定性研究。本研究中确定的障碍和促进因素以及提出的基于理论的模型为未来的研究和临床管理扩张器的使用提供了新的见解。
