The Royal Marsden NHS Foundation Trust, Adult Psychological Support Service & Applied Health Research Group, London, UK.
Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, Leeds, UK.
J Sex Med. 2020 Oct;17(10):2005-2015. doi: 10.1016/j.jsxm.2020.06.019. Epub 2020 Jul 30.
Clinical assessment and management of sexual difficulties after gynecological cancer remain a neglected aspect of women's rehabilitation.
To develop and validate a patient-reported outcome measure of sexual well-being for women experiencing sexual consequences of cervical and endometrial cancer treatment for use in routine follow-up.
This is a sequential mixed method study comprising (i) in-depth qualitative interviews (n=21 of 118) to generate items regarding sexual consequences of cervical or endometrial cancer and treatment; (ii) questionnaire construction with 51 core items (all respondents) and 4 subsections (18-58 items), depending on the relationship status and whether or not participants were sexually active (SA/NSA); (iii) item refinement following cognitive debriefing (n=13 of 21); (iv) validation of resultant items via postal survey (n=788 women) and Rasch analysis; and (v) creation of brief (14-item) clinical screener. Women attending routine follow-up (3 months to 5 years) at 6 English cancer centers and members of 3 UK cancer patient websites, who met the study inclusion criteria, were invited to participate.
The primary outcome of this study was the construction and initial psychometric testing of SWELL-CE short and long form versions.
21 women participated in interviews and 250 of 788 (32%) returned the postal survey (T1). 110 draft items were evaluated using cognitive testing (n=13) to refine instrument design and test face validity, comprehension, and acceptability. Exploratory factor analysis of survey data (n=250) produced an initial 6 domain structure as a guidance for the Rasch analysis. Subsequent Rasch analysis yielded a 3 domain structure: physical sexual function, sexual and relationship concerns, and sexual desire and sexual self-esteem, each satisfying Rasch model requirements within their respective SA (item pool =59) and NSA (item pool =53) categories, including the absence of local response dependency and all showing strict unidimensionality. The 3 subscales demonstrated good psychometric properties, external validity, and test-retest reliability. A valid Rasch short form of 14 items was created from the larger item pool.
This PROM may assist clinicians to improve identification, discussion, and management of women who could benefit from sexual rehabilitation.
STRENGTHS & LIMITATIONS: Initial evaluation supports psychometric validity and reliability in the assessment of physical sexual function, sexual interest and sexual self-esteem, and sexual and relationship concerns in this study sample. However, given this study's modest response rate (32%, n=250), findings should be interpreted with caution. This PROM identifies sexual concerns in women who are sexually active or sexually non-active due to illness or treatment-associated sexual difficulties.
Sexual Well-being after Cervical or Endometrial Cancer is a novel and psychometrically valid sexual well-being measure for clinical assessment of female sexual difficulties after cervical or endometrial cancer treatment. White ID, Tennant A, Taylor C, Sexual Morbidity Assessment in Gyne-Oncology Follow-Up: Development of the Sexual Well-Being After Cervical or Endometrial Cancer (SWELL-CE) Patient-Reported Outcome Measure. J Sex Med 2020;17:2005-2015.
妇科癌症患者的临床评估和性困难管理仍然是女性康复中被忽视的一个方面。
为了开发和验证一种针对经历宫颈癌和子宫内膜癌治疗后性后果的患者报告的性健康测量工具，用于常规随访。
这是一项序贯混合方法研究，包括（i）深入的定性访谈（n=118 名中的 21 名），以生成关于宫颈癌或子宫内膜癌及其治疗后性后果的项目；（ii）使用 51 个核心项目（所有受访者）和 4 个小节（18-58 个项目）构建问卷，具体取决于关系状况和参与者是否有性行为（有/无）；（iii）认知审核后进行项目细化（n=21 名中的 13 名）；（iv）通过邮寄调查（n=788 名女性）和 Rasch 分析对所得项目进行验证；（v）创建简短（14 项）临床筛查器。邀请在 6 个英国癌症中心进行常规随访（3 个月至 5 年）并符合研究纳入标准的女性，以及来自 3 个英国癌症患者网站的成员，参加研究。
本研究的主要结果是构建和初步心理测量测试 SWELL-CE 短和长版本。
21 名女性参加了访谈，788 名中的 250 名（32%）返回了邮寄调查（T1）。使用认知测试（n=13）评估了 110 个草案项目，以改进仪器设计和测试表面有效性、理解性和可接受性。调查数据的探索性因素分析（n=250）产生了一个初始的 6 个领域结构，作为 Rasch 分析的指导。随后的 Rasch 分析产生了 3 个领域结构：身体性功能、性和关系问题、性欲望和性自尊，每个结构都在其各自的 SA（项目池=59）和 NSA（项目池=53）类别中满足 Rasch 模型要求，包括不存在局部反应依赖性，并且都显示严格的单维性。这 3 个分量表具有良好的心理测量特性、外部有效性和测试-重测信度。从更大的项目池中创建了一个有效的 Rasch 简短形式，其中包含 14 个项目。
该 PROM 可能有助于临床医生改善识别、讨论和管理可能受益于性康复的女性。
初步评估支持在评估研究样本中的身体性功能、性兴趣和性自尊以及性和关系问题方面的心理测量有效性和可靠性。然而，鉴于该研究的适度反应率（32%，n=250），应谨慎解释研究结果。该 PROM 可识别因疾病或与治疗相关的性困难而有性行为或无性行为的女性的性问题。
宫颈癌或子宫内膜癌后的性健康是一种新的和具有心理测量有效性的性健康衡量标准，用于评估宫颈癌或子宫内膜癌治疗后女性的性困难。White ID、Tennant A、Taylor C、妇科肿瘤随访中的性发病率评估：宫颈癌或子宫内膜癌后性健康（SWELL-CE）患者报告结局测量的开发。J 性医学 2020；17：2005-2015。
