Barriers to and facilitators of adherence to pelvic floor muscle exercises and vaginal dilator use among gynecologic cancer patients: a qualitative study

Abstract

Objective Women with gynecologic cancer may suffer from pelvic floor dysfunction (PFD). Before radiotherapy, prehabilitation with pelvic floor muscle exercises (PFME) and vaginal dilator (VD) might prevent it and foster sexual life. This study aims to explore the experience of gynecologic cancer patients getting external beam radiation treatments regarding barriers to and facilitators of adherence to a prehabilitation program to prevent PFD. Methods This qualitative research with thematic content analysis included 11 women with gynecologic cancer and different levels of adherence to PFME and VD. Participants were interviewed based on a semi-structured script. The information was analyzed manually, assisted with Nvivo12® software, and triangulated with open coding. Results High self-motivation, desire to improve their health, symptoms of improvement, availability of time, the desire to resume sexual life, and the support of the partner were facilitators of adherence. The instructional exercise audio, clarity of the information, and closer communication with the physical therapist were also valued. The main barriers were general malaise secondary to oncological treatments, forgetfulness, lack of time, misinformation, lack of coordination with the treatment team, discomfort with the VD, and a feeling of shame. Feedback from the attending physician was a facilitator when present or a barrier when absent. Conclusion These barriers and facilitators should be considered when designing and implementing preventive programs with PFME and VD. Behavioral counselling should consider the desire to remain sexually active; in such cases, including the partner in the therapeutic process is appraised. Otherwise, the focus should be on benefits for maintenance of pelvic floor function.

Attitudes and perceptions of cancer patients and healthcare providers towards prehabilitation: A thematic synthesis

“…(Cooper et al., 2022)

Well, you're always opening WhatsApp, so the first thing I saw was the WhatsApp which I had named ‘Physio’, so I listened to the exercises and it really helped! (Araya‐Castro et al., 2022)

…”

“…Our relationship got stronger and that's good. (Araya-Castro et al, 2022) Theme 4: Physical opportunities (124/660, 19%)…”

“…(Cooper et al, 2022) Well, you're always opening WhatsApp, so the first thing I saw was the WhatsApp which I had named 'Physio', so I listened to the exercises and it really helped! (Araya-Castro et al, 2022) With the proliferation and widespread use of electronic healthcare systems, the process simplification and ease of use associated with electronic prehabilitation referral clinics have facilitated the opportunity for HCP and patient engagement.…”

Implementation of Pelvic Floor Rehabilitation after rectal cancer surgery: A qualitative study guided by the Consolidated Framework for Implementation Research (CFIR)

“…Previous research conducted in a gynecological setting identified serious barriers to implementing PFR, including misinformation, lack of coordination with the treatment team, and feelings of shame [ 21 ].…”

“…At the end of therapy, feedback from the attending physician about the effect of treatment on a functional level, psychosocial development, and expectations for future improvements does not always reach the referring parties. Previous research shows that such feedback is an enabler when present or a barrier when absent [ 21 ].…”