Radiation Oncology Department, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil.
Nursing School, Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, São Paulo, Brazil.
PLoS One. 2019 Aug 9;14(8):e0221054. doi: 10.1371/journal.pone.0221054. eCollection 2019.
To propose a consensus for prevention of vaginal stenosis in patients submitted to pelvic radiotherapy.
In this methodological study, Delphi technique was applied for content validation on vaginal stenosis prevention. Data regarding content validation were collected from 32 specialists practicing in the oncology profession. The content validity index of items in the consensus was calculated based on the evaluations by the specialists.
In the first round, of the 38 items evaluated, 29 items reached a Content Validity Index (CVI-I) greater than 80%, and 9 items had a CVI lower than 80%. Of the items that did not obtain agreement, 2 items were excluded, and 7 were reformulated and included in the second round. In the second round, all 7 items obtained a CVI-I greater than 80%. The final instrument consisted of 29 items validated in the first round, plus 7 items reformulated and consolidated in the second round. The judges agreed that it is the responsibility of the health professionals to consult the patients undergoing radiation therapy in the area of sexuality to patients. The radiation oncologist should be the first professional to address this issue and the nurse oncologist in the follow-up consultation should pass the guidelines to the patients as comprehensively as possible. Patients should be informed about vaginal dilation, regardless of whether they are sexually active or have a partner. They should also be informed of when they can resume sexual activity. The procedure of vaginal dilation should be individualized. The prescribed vaginal dilators should be used with a lubricant for a duration of at least 5-10 minutes, 2-3 times a week, as per the need of each patient (sexual activity and/or clinical follow-up) for an indefinite time. Patients should seek medical help in case they experience pain, discomfort, or bleeding during dilation.
The Brazilian version of the consensus for vaginal stenosis prevention in patients submitted to pelvic radiotherapy was validated with 36 items in 7 categories related to Responsibility; Target population; Rationale; Vaginal dilator; Content instructions; Information provision; and Patient support. In Brazil, the educational practices on vaginal dilation for patients submitted to radiotherapy partly revealed similar difficulties as identified in other studies as well as countries with reference to specific guidelines for the start and duration of vaginal dilation. The final consensus developed in this study could strengthen the guidelines for education of patients in Brazil and provide a future scope to establish a single and safe guideline.
提出盆腔放疗患者阴道狭窄预防的共识。
本方法学研究采用 Delphi 技术对阴道狭窄预防进行内容验证。数据来源于 32 名从事肿瘤专业的专家。根据专家评估，计算共识中项目的内容效度指数。
在第一轮中，38 项评估中有 29 项达到内容效度指数（CVI-I）大于 80%，9 项小于 80%。在未达成一致的项目中，有 2 项被排除，有 7 项重新制定并纳入第二轮。在第二轮中，所有 7 项均达到 CVI-I 大于 80%。最终工具由第一轮验证的 29 项和第二轮重新制定和整合的 7 项组成。评估者认为，咨询接受放射治疗区域的患者的专业医务人员有责任对患者进行放射治疗。放射肿瘤学家应首先解决这个问题，而在后续咨询中，肿瘤护士应尽可能全面地向患者传达指导方针。无论患者是否有性行为或伴侣，都应告知其阴道扩张的相关知识。还应告知他们何时可以恢复性行为。阴道扩张的程序应个体化。根据每位患者的需求（性行为和/或临床随访），应使用润滑剂将规定的阴道扩张器使用至少 5-10 分钟，每周 2-3 次，使用时间不限。如果患者在扩张过程中感到疼痛、不适或出血，应寻求医疗帮助。
巴西版盆腔放疗患者阴道狭窄预防共识经过验证，共有 7 个类别 36 个项目，涉及责任、目标人群、基本原理、阴道扩张器、内容说明、信息提供和患者支持。在巴西，接受放疗的患者阴道扩张的教育实践与其他研究以及参考特定阴道扩张开始和持续时间指南的国家所发现的类似困难部分相似。本研究中最终达成的共识可以加强巴西患者教育指南，并为制定单一、安全的指南提供未来的方向。
