Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA.
Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA.
J Cancer Surviv. 2024 Jun;18(3):800-809. doi: 10.1007/s11764-022-01327-4. Epub 2023 Jan 6.
Gynecologic cancer survivors often hesitate to raise sexual health concerns with their clinicians. We pilot tested Starting the Conversation (STC), a theory-guided intervention aimed at facilitating survivors' clinical communication about sexual health.
Survivors (N = 32) were randomized 2:1 to STC (23-min video and accompanying workbook grounded in social cognitive theory that provides information and skills training for communicating with providers about sexual concerns, and resource guide) or control (resource guide only). Feasibility was assessed through enrollment, retention, and intervention completion rates (benchmarks: 60%, 80%, 70%); acceptability was assessed through post-intervention program evaluations (benchmark: 75%). Preliminary effects were assessed for sexual health communication (self-reported after next clinic encounter), self-efficacy for clinical communication about sexual health (post-intervention and 2-month follow-up), and sexual activity and anxiety/depressive symptoms (2-month follow-up).
All feasibility/acceptability benchmarks were surpassed; 76% enrolled, 97% retained, ≥ 95% used intervention materials, and 100% endorsed STC as acceptable. Positive STC effects were seen for increases in self-efficacy (Cohen's d's = 0.45 at post-intervention; 0.55 at follow-up). In STC, 35% and 45% of women raised or asked about sexual health concerns during the post-intervention clinic visit, respectively, versus 0 and 27% in the control arm. Other measures showed little change.
Data support the STC intervention as feasible and acceptable, with promising effects for gynecologic cancer survivors' communication about sexual health concerns. Because sexual health communication is relevant across the treatment trajectory, we included both on-treatment and post-treatment survivors. While this may be a limitation, it could also enhance sample generalizability. A larger trial is needed to determine efficacy.
Communication about sexual health is important yet lacking for cancer survivors. Patient-focused interventions may help address concerns and improve survivors' health outcomes.
妇科癌症幸存者在与临床医生讨论性健康问题时常常犹豫不决。我们对起始对话（STC）进行了试点测试，这是一种基于理论的干预措施，旨在促进幸存者与提供者就性健康问题进行临床沟通。
将 32 名幸存者随机分为 2:1 组，分别接受 STC（23 分钟的视频和配套的工作手册，该手册基于社会认知理论，为与提供者沟通性问题提供信息和技能培训，并提供资源指南）或对照组（仅提供资源指南）。通过入组率、保留率和干预完成率（基准：60%、80%、70%）评估可行性；通过干预后计划评估（基准：75%）评估可接受性。对性健康沟通（下一次就诊后自我报告）、临床沟通性健康自我效能（干预后和 2 个月随访）以及性活动和焦虑/抑郁症状（2 个月随访）进行了初步效果评估。
所有可行性/可接受性基准均超过；76%的人入组，97%的人保留，≥95%的人使用干预材料，100%的人认可 STC 是可以接受的。STC 组的自我效能感显著提高（干预后 Cohen's d's 为 0.45；随访时为 0.55）。在 STC 组中，分别有 35%和 45%的女性在干预后的就诊期间提出或询问了性健康问题，而对照组分别为 0%和 27%。其他指标变化不大。
数据支持 STC 干预措施具有可行性和可接受性，对妇科癌症幸存者讨论性健康问题具有积极影响。由于性健康沟通在整个治疗过程中都很重要，我们纳入了正在治疗和治疗后幸存者。虽然这可能是一个限制，但也可以增强样本的普遍性。需要更大的试验来确定疗效。
沟通性健康问题对癌症幸存者很重要，但却缺乏。以患者为中心的干预措施可能有助于解决问题，改善幸存者的健康结果。
