Provider perspectives and recommendations on standardized sexual function screening intervention in adolescent/young adult oncology patients

Abstract

BackgroundSexual function (SF) concerns are common among adolescent and young adult (AYA) cancer survivors, are underrecognized and undertreated. This study sought AYA oncology provider input on the implementation of an SF screening tool to address this unmet need.ProcedureSemi‐structured interviews were completed with oncology providers (n = 25) who care for AYAs at a single institution. Interviews sought to understand barriers to addressing SF, elicit perspectives on use of an established screening tool, and obtain recommendations for SF screening intervention development and implementation. Interviews were developed using the Consolidated Framework for Implementation Research (CFIR); thematic analysis‐guided interpretation.ResultsAYA oncology providers were in favor of using an SF screening tool, but confirmed previously identified barriers and implementation considerations within multiple CFIR domains, including concerns about privacy, patient comfort, provider buy‐in, provider knowledge, resource needs, and workflow/capacity constraints. They identified numerous strategies to address barriers through screening intervention design and implementation approaches. For example, provider buy‐in could be optimized through education, availability of clinical resources, creation of a dedicated sexual healthcare team, provider engagement in intervention development, and leadership involvement.ConclusionsDevelopment and implementation of an effective SF screening intervention is necessary to improve diagnosis and treatment of sexual dysfunction, with the ultimate goal of improving sexual health‐related quality of life in AYA cancer survivors. AYA oncology providers identified numerous intervention and implementation design strategies for the development and implementation of an SF screening intervention, which must be integrated with patient recommendations.

Testing effectiveness and implementation of a standardized approach to sexual dysfunction screening among adolescent and young adult-aged survivors of childhood cancer: A type I hybrid, mixed methods trial protocol

“…Given the aforementioned barriers, which may be particularly salient in younger populations, our prior research evaluated the utility of using a patient-reported outcome measure for SD screening in AYA-CCS followed in pediatric settings (age 15–24 years), eliciting patient and provider perspectives in qualitative interviews [ 22 , 27 ]. Both groups were in favor of using a patient-reported outcome measure to address barriers and facilitate SD conversations.…”

“…The SexFS Brief was found to be acceptable and useful, with demonstrated response process and content validity [ 27 ]. In addition to evaluating the utility of the SexFS Brief, patients and providers offered perspectives for how the SexFS Brief could be implemented into clinical use, including recommendations for delivery, results storage and review, and needed resources [ 22 , 27 ]. These recommendations were included in an SD screening intervention prototype that is being iteratively adapted in an ongoing phase of research.…”

“…The intervention and implementation menus were developed based on prior patient- and provider-engaged stages of research. Further, the implementation menu was informed using established implementation science strategies to target known barriers [ 19 , 22 , 39 ]. For example, to address lack of provider knowledge, implementation should include provider education and resources, which can take several forms including education sessions, written education, clinical decision-making tools, or development of a dedicated expert team.…”

“…Of note, while AYA-CCS both receiving and having completed therapy will be included for secondary and exploratory outcomes, the primary outcome will evaluate effectiveness of the intervention among participants who have completed therapy (“off-therapy”). The population for the primary outcome was designed to mirror the inclusion criteria of our preceding qualitative study; the population was expanded to include patients currently on-therapy for secondary analyses based on subsequent recommendations from providers [ 22 , 40 ].…”