Chore or priority? Barriers and facilitators affecting dilator use after pelvic radiotherapy for gynaecological cancer

Bonner, Carissa; Nattress, Kathryn; Anderson, Caroline; Carter, Jonathan; Milross, Chris; Philp, Shannon; Juraskova, Ilona

doi:10.1007/s00520-011-1337-z

Cited by 35 publications

(48 citation statements)

References 16 publications

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“…We did not explore positive influences, or “facilitators,” to adherence. One qualitative study of 15 participants [26] originally identified barriers and facilitators of VD use. The lack of standardized VS measures and methods of addressing VS makes it difficult to correlate results from different studies.…”

Section: Discussionmentioning

confidence: 99%

Prospective study of vaginal dilator use adherence and efficacy following radiotherapy

Law

Kelvin

Thom

et al. 2015

Radiotherapy and Oncology

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Background and purpose Vaginal stenosis (VS) after pelvic radiotherapy can impair long-term quality of life. We prospectively assessed adherence and efficacy of VD use as the primary and secondary objectives, respectively. Material and methods Women with gastrointestinal (n=63) and gynecologic (n=46) cancers self-reported use and VD size in monthly diaries for 12 months after radiotherapy. Adherence was measured as actual VD use out of recommended times over 12 months (3×/week × 52 weeks = 156). Results Among 109 participants, aged 28–81 years (median, 58 years), mean percent adherence over 12 months was 42% (95% confidence interval [CI], 36%–48%). Adherence was highest in the first quarter (56%), but fell to 25% by the fourth. Disease type, treatment sequence, and chemotherapy were predictors of adherence (all P<.05). Eighty-two percent maintained pre-RT VD size at 12 months; of 49% with decrease in VD size at 1 month post-RT, 71% returned to pre-RT VD size at 12 months. Disease type, younger age, and increased adherence at 6 months were associated with maintaining or returning to pre-RT size at 12 months (all P≤.05). Conclusions VD use is effective in minimizing VS, but adherence at 12 months was poor. Studies evaluating methods of improving adherence and determining the optimal frequency and duration of use are needed.

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Section: Discussionmentioning

confidence: 99%

Prospective study of vaginal dilator use adherence and efficacy following radiotherapy

Law

Kelvin

Thom

et al. 2015

Radiotherapy and Oncology

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“…Issues of consistency of information are often highlighted by authors describing rehabilitation to prevent vaginal stenosis after pelvic radiotherapy [12–14]. Miles and Johnson [15] in their 2014 update of a Cochrane Review into vaginal dilator therapy concluded that there is no reliable evidence supporting dilator therapy during radiotherapy treatment, and while several observational studies of dilator therapy after radiotherapy treatment suggest an association between frequent dilator therapy and a reduction in self‐reported stenosis, they acknowledge that there is no proof that a decrease in stenosis is an effect of the dilator therapy.…”

Section: Information Needsmentioning

confidence: 99%

“…Miles and Johnson [15] in their 2014 update of a Cochrane Review into vaginal dilator therapy concluded that there is no reliable evidence supporting dilator therapy during radiotherapy treatment, and while several observational studies of dilator therapy after radiotherapy treatment suggest an association between frequent dilator therapy and a reduction in self‐reported stenosis, they acknowledge that there is no proof that a decrease in stenosis is an effect of the dilator therapy. With no clear evidence as to the benefit of a rehabilitation therapy, there is inevitably a range of recommendations and advice given to patients [14].…”

Section: Information Needsmentioning

confidence: 99%

“…Bonner et al [14] interviewed women to assess their perception of vaginal dilator use and found that many women believed it would have been beneficial to receive a separate consultation with a nurse about how to manage this therapy so that they were not overloaded with information and would have an opportunity to discuss their particular concerns. Cullen et al [13] stressed that the implementation of vaginal dilator therapy for a woman requires an understanding of her relationship with her body and her sexuality in order to understand her acceptance of it as therapy.…”

Section: Information Needsmentioning

confidence: 99%

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Rehabilitation after gynecological cancer treatment

Weare

2015

Intl J Gynecology & Obste

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“…The nurse will address any ongoing issues from the first session and new concerns and provide coaching in relevant self-care. Barriers to self-care and stress-reduction strategies will be elicited and the importance of adherence reinforced [42]. …”

Section: Methodsmentioning

confidence: 99%

A nurse- and peer-led support program to assist women in gynaecological oncology receiving curative radiotherapy, the PeNTAGOn study (Peer and nurse support trial to assist women in gynaecological oncology): study protocol for a randomised controlled trial

Schofield

Juraskova

Bergin

et al. 2013

Trials

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BackgroundWomen who undergo radiotherapy for gynaecological cancer (GC) can experience distressing side effects which impact on psychosocial functioning and intimate relationships. Cancer-related distress may be ameliorated by comprehensive preparation for treatment and addressing women’s informational, physical, psychological and psychosexual needs. This paper describes the protocol for a multisite randomised controlled trial (RCT) testing a novel intervention package which combines tailored specialist nursing consultations and telephone peer support with the primary aim to reduce psychological distress. Secondary aims assess patient quality of life, symptom distress, unmet supportive care needs, preparation for treatment, psychosexual functioning and vaginal stenosis.Methods/designThis multifaceted intervention comprises four nurse-led consultations coupled with four phone calls from a peer support volunteer (GC survivor). The evidence-based intervention will be delivered at critical points in the illness trajectory: pre-treatment, mid-treatment, treatment completion and post-treatment. Nurses and peers undergo 2-day intensive training workshops, are guided by comprehensive study intervention manuals and receive ongoing supervision and support. Eligible patients will have a diagnosis of GC, be scheduled to receive curative radiotherapy, be aged 18 years or over and speak English. Three-hundred and six participants will be randomized to receive usual care or usual care with the intervention package. Study outcome measures will be collected at baseline, day 1 of radiotherapy and 1, 6 and 12 months post radiotherapy. Clinical assessments of vaginal toxicity will occur at baseline, and 3, 6, and 12 months post radiotherapy.DiscussionThis timely research has the potential to substantially reduce the physical, psychosexual and supportive care needs of women with GC. Using a telephone peer support model, the intervention package ensures equitable access to support services for geographically isolated patients. The novel intervention engages peer volunteers who liaise with nurses to encourage adherence to professionally-delivered information and provide emotional support. It has been designed to be potentially transferable to a range of treatment settings and diseases. Based on pilot data, the proposed intervention was found to be useful and acceptable to patients and clinicians. If effective and feasible in the multisite RCT, the program could be widely disseminated.Trial registrationAustralian New Zealand Clinical Trial Registry ACTRN12611000744954

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Chore or priority? Barriers and facilitators affecting dilator use after pelvic radiotherapy for gynaecological cancer

Abstract: This is the first qualitative study to specifically investigate the patient experience of dilator use. The barriers and facilitators identified in this study and the proposed theory-based model provide new insights to inform future research and clinical management of dilator use.

Cited by 35 publications

References 16 publications

Prospective study of vaginal dilator use adherence and efficacy following radiotherapy

Prospective study of vaginal dilator use adherence and efficacy following radiotherapy

Rehabilitation after gynecological cancer treatment

A nurse- and peer-led support program to assist women in gynaecological oncology receiving curative radiotherapy, the PeNTAGOn study (Peer and nurse support trial to assist women in gynaecological oncology): study protocol for a randomised controlled trial

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