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Starting the Conversation: randomized pilot trial of an intervention to promote effective clinical communication about sexual health for gynecologic cancer survivors

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Abstract

Purpose

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.

Methods

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).

Results

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.

Conclusions

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.

Implications for Cancer Survivors

Communication about sexual health is important yet lacking for cancer survivors. Patient-focused interventions may help address concerns and improve survivors’ health outcomes.

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Data availability

Reasonable requests for datasets generated during and/or analyzed during the current study will be considered by the corresponding author.

Notes

  1. Age data was missing from one clinician.

  2. We intended to assess preliminary effects on women’s sexual function using the Female Sexual Function Index (FSFI) [37]. However, preliminary analysis revealed a sizeable number of participants (N = 17; 53%) whose responses on the FSFI indicated they were not sexually active. Because the FSFI has been shown to be problematic in sexually inactive women [38], the responses were to be excluded from analyses. With such a large proportion of participants’ data to be excluded, the interpretation of findings would be highly problematic and thus, it was deemed inappropriate to conduct analyses with the FSFI.

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Funding

This study was supported by P30CA006927 from the National Cancer Institute of the National Institutes of Health.

Author information

Authors and Affiliations

  1. Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA

    Jennifer Barsky Reese, Kristen A. Sorice, Elizabeth Handorf, Danny Middleton & Sarah McIlhenny

  2. Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA

    Sharon L. Bober

  3. Biostatistics and Bioinformatics Facility, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA

    Elizabeth Handorf

  4. Department of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA

    Christina S. Chu

  5. Department of Hematology/Oncology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA

    Areej El-Jawahri

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  1. Jennifer Barsky Reese
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Contributions

JBR, SLB, EH, CSC, and AE-J contributed to the study conception and design. Data collection was performed by KAS, DM, and SM. Data preparation/analysis were performed by JBR, KAS, and EH. The first draft was written by JBR and all authors reviewed and contributed to the final manuscript.

Corresponding author

Correspondence to Jennifer Barsky Reese.

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Ethics approval and consent to participate

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Fox Chase Institutional Review Board (IRB Protocol #21–1066). Informed consent was obtained from all participants.

Competing interests

The authors declare no competing interests.

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Reese, J.B., Bober, S.L., Sorice, K.A. et al. Starting the Conversation: randomized pilot trial of an intervention to promote effective clinical communication about sexual health for gynecologic cancer survivors. J Cancer Surviv 18, 800–809 (2024). https://doi.org/10.1007/s11764-022-01327-4

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  • DOI: https://doi.org/10.1007/s11764-022-01327-4

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