Figure it out on your own: a mixed-method study on pelvic health survivorship care after gynecologic cancer treatments.

PURPOSE: Pelvic health issues after treatment for gynecological cancer are common. Due to challenges in accessing physiotherapy services, exploring virtual pelvic healthcare is essential. This study aims to understand needs, preferences, barriers, and facilitators for a virtual pelvic healthcare program for gynecological cancer survivors. METHODS: A multi-center, sequential mixed-methods study was conducted. An anonymous online survey (N=50) gathered quantitative data on pelvic health knowledge, opportunities, and motivation. Focus groups (N=14) explored patient experiences and consensus on pelvic health interventions and virtual delivery. Quantitative data used descriptive statistics, and focus group analyses employed inductive thematic analysis. Findings were mapped to the capability, opportunity, and motivation (COM-B) behavior change model. RESULTS: Participants reported lacking knowledge about pelvic health interventions and capability related to the use of vaginal dilators and continence care. Barriers to opportunity included lack of healthcare provider-initiated pelvic health discussions, limited time in clinic with healthcare providers, finding reliable information, and cost of physical therapy pelvic health services. Virtual delivery was seen favorably and may help to address motivational barriers related to embarrassment and frustration with care. CONCLUSION: Awareness of pelvic healthcare is lacking among people treated for gynecological cancer. Virtual delivery of pelvic health interventions is perceived as a solution to enhance access while minimizing travel, cost, embarrassment, and exposure risks. IMPLICATIONS FOR CANCER SURVIVORS: A better understanding of the pelvic health needs of individuals following gynecological cancer treatments enables the development of tailored virtual pelvic health rehabilitation interventions which may improve access to pelvic health survivorship care.

Preferences, barriers and facilitators regarding virtual pelvic healthcare in individuals with gynaecological cancers: protocol for a patient-oriented, mixed-methods study.

INTRODUCTION: Vaginal pain during intercourse and urinary incontinence are common complaints after gynaecological cancer treatments. Pelvic health physiotherapy treatments aim at optimising function through education on the use of vaginal moisturisers, dilation therapy programme and pelvic floor muscle training. Given that barriers such as time, travel, and costs are known to limit access to physiotherapy services, a virtual pelvic health physiotherapy programme may help to facilitate access. The primary objective of this study is to identify preferences, barriers and facilitators from individuals with gynaecological cancer regarding virtual pelvic healthcare survivorship care. METHODS AND ANALYSIS: This patient-oriented, mixed-methods study will involve an online cross-sectional survey data (phase I) and qualitative data from a series of virtual focus groups (phase II). PHASE I: an anonymous survey will be used to assess the demographics, health status, prevalence of urogenital symptoms, as well as knowledge, barriers and facilitators to pelvic health services of people with gynaecological cancer. A total of N=50 participants from Canada will be recruited through convenience and self-selection sampling. PHASE II: a series of virtual semi-structured focus groups will be conducted with 10-15 participants on key topics related to virtual pelvic healthcare. Interviews will be audio-recorded and transcribed, from which key themes and quotes will be identified. An interpretive description qualitative method will guide analysis and implementation of results. ETHICS AND DISSEMINATION: Approval from the Health Research Ethics Board of Alberta-Cancer Committee (HREBA.CC-21-0498) and of the CISSS Bas-Saint-Laurent (CISSSBSL-2021-10) have been obtained. Informed, electronically signed consent will be required from all participants. Results from this work will be published in a peer-reviewed journal and will be used to inform the development and implementation of a new Pelvic eHealth Module for individuals treated for gynaecological cancers. This module will be incorporated into a comprehensive educational and exercise programme offered by a web-based application.

No. 397 - Conservative Care of Urinary Incontinence in Women.

OBJECTIVE: To outline the evidence for conservative care, including both assessment and management options, for urinary incontinence in women. INTENDED USERS: Relevant primary care providers and medical specialists including but not limited to physicians, nurses, midwives, and pelvic health physiotherapists. TARGET POPULATION: Women (>18 years of age) with urinary incontinence. OPTIONS: Assessment options include gathering of a detailed history, physical examination, laboratory analysis, urodynamic evaluation, and cystoscopy. Conservative management options include lifestyle management, pelvic floor muscle training, behavioural management, and mechanical devices. OUTCOMES: To provide an evaluation-based summary of current available evidence concerning efficacy of conservative care (assessment and management) strategies for urinary incontinence in women. EVIDENCE: The Cochrane Library and Medline (2013-2018) were searched to find articles related to conservative care of urinary incontinence in women (>18 years). Articles were appraised, and the collective evidence was graded. VALIDATION METHODS: The evidence obtained was reviewed and evaluated by the Society of Obstetricians and Gynaecologists of Canada (SOGC) Urogynecology Committee under the leadership of the principal authors. The quality of evidence was rated using the criteria described in the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology framework. BENEFITS, HARMS, AND COSTS: Evidence for the efficacy of conservative care (assessment and management) options for women with urinary incontinence is strong. Furthermore, these options carry minimal or no harm and confer an established cost benefit. GUIDELINE UPDATE: This SOGC Clinical Practice Guideline will be automatically reviewed 5 years after publication. SUMMARY STATEMENTS: RECOMMENDATIONS.

Directive clinique no 397 - Prise en charge conservatrice de l'incontinence urinaire chez les femmes.

OBJECTIF: Exposer les données probantes relatives à la prise en charge conservatrice, y compris les options d'évaluation et de traitement, de l'incontinence urinaire chez les femmes. UTILISATEURS CONCERNéS: Les fournisseurs de soins de première ligne et les professionnels de la santé spécialisés, y compris, mais sans s'y limiter, les médecins, les infirmières, les sages-femmes et les physiothérapeutes en santé périnéale. POPULATION CIBLE: Les femmes (> 18 ans) atteintes d'incontinence urinaire. OPTIONS: Les options d'évaluation comprennent l'anamnèse détaillée, l'examen physique, les analyses de laboratoire, le bilan urodynamique et la cystoscopie. Les options de traitement conservateur comprennent l'adaptation du mode de vie, la rééducation périnéale, la thérapie comportementale et les dispositifs mécaniques. RéSULTATS: Fournir un résumé reposant sur l'évaluation des données probantes actuellement disponibles sur l'efficacité des stratégies de prise en charge conservatrice (évaluation et traitement) de l'incontinence urinaire chez les femmes. DONNéES PROBANTES: Des recherches ont été effectuées dans les bases de données Cochrane Library et Medline (2013-2018) pour recenser des articles relatifs à la prise en charge conservatrice de l'incontinence urinaire chez les femmes (> 18 ans). Les articles ont été évalués et les données probantes globales ont été cotées. MéTHODES DE VALIDATION: Les données probantes obtenues ont été revues et évaluées par le comité d'urogynécologie de la Société des obstétriciens et gynécologues du Canada (SOGC) sous la direction des auteures principales. La qualité des données probantes a été évaluée au moyen des critères de l'approche GRADE (Grading of Recommendations Assessment, Development and Evaluation). AVANTAGES, PRéJUDICE ET COûTS: Les données probantes sur l'efficacité des options de prise en charge conservatrice (évaluation et traitement) de l'incontinence urinaire chez les femmes sont fortes. De plus, ces options comportent peu d'effets nuisibles, voire aucun, et ont un rapport coûts-avantages bien établi. MISE à JOUR DE LA DIRECTIVE CLINIQUE: La présente directive clinique de la SOGC sera automatiquement passée en revue cinq ans après sa publication. DÉCLARATIONS SOMMAIRES: RECOMMANDATIONS.