Effectiveness of the PLISSIT model for solving the sexual problems of patients with stoma

The Effect of Sexual Counseling Based on PLISSIT and EX-PLISSIT Models on Sexual Function, Satisfaction, and Quality of Life: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis study aimed to investigate the effect of sexual counseling based on PLISSIT (Permission, Limited Information, Specific Suggestions, and Intensive Therapy) and EX-PLISSIT models on sexual function, satisfaction, and quality of sexual life. We searched seven electronic databases (MEDLINE, CINAHL, Web of Science, Cochrane Library, ProQuest, Scopus, and PubMed). Studies published between January 1, 2010, and August 16, 2022, were included in the search. Eighteen articles were eligible for inclusion in the analysis. There was a significant difference in the sexual function scores of the PLISSIT and EX-PLISSIT groups and the comparison groups (standardized mean difference (SMD): 1.677; 95% CI 0.668, 2.686; p < 0.05) and "sexual and communication satisfaction" sub-dimension of sexual life quality (SMD: 0.748; 95% CI 0.022, 1.475; p < 0.05). There was no difference in the sexual satisfaction (SMD: 0.425; 95% CI - 0.335, 1.184; p > 0.05) and quality of sexual life scores of the PLISSIT and EX-PLISSIT groups and the comparison groups (SMD: - 0.09; 95% CI - 0.211, 0.032; p > 0.05). PLISSIT and EX-PLISSIT models-based sexual counseling on sexual function was affected by the moderator variables of the time of evaluation of the results after the intervention, type of comparison group, the study population, and by whom the intervention was applied. Sexual counseling based on the PLISSIT and EX-PLISSIT models improved sexual function scores and "sexual and communication satisfaction" sub-dimension of sexual life quality.

Effects of sexual counseling on sexual function and sexual quality of life of women with permanent intestinal ostomy

BACKGROUND

Patients with an intestinal ostomy may experience significant sexual dysfunction that may have adverse impacts on quality of life. Appropriate sexual health counseling can be beneficial for these patients.

AIM

This study was conducted to determine the effect of sexual counseling on the sexual function and sexual quality of life of women with a permanent intestinal ostomy.

METHODS

For this experimental study, 60 female patients with a permanent intestinal ostomy were selected through convenience sampling and then randomly assigned to either the intervention or control groups. Patients in the intervention group received four 90-minute individual counseling sessions based on the PLISSIT (permission [P], limited information [LI], specific suggestions [SS], and intensive therapy [IT] model over a period of 4 weeks). The control group underwent routine training. Data were collected by use of a demographic information questionnaire, the Female Sexual Function Index, and the Sexual Quality of Life Female questionnaire. Both groups completed the questionnaires before and after the intervention.

OUTCOMES

Study outcomes were the resulting data for the Female Sexual Function Index and the Sexual Quality of Life Female questionnaire.

RESULTS

The results revealed a significant increase in the mean score of sexual function in the intervention group after counseling (P = .001). No significant difference was observed in the mean score of sexual quality of life between the 2 groups before the intervention (P > .05). In contrast, a significant increase was noted in the intervention group's sexual quality of life after the intervention (P = .001).

CLINICAL IMPLICATIONS

The results indicate a need to sexual counseling interventions directed toward sexual function and sexual quality of life in women with permanent intestinal ostomy.

STRENGTHS AND LIMITATIONS

Study strengths include utilization of the PLISSIT model for sexual counseling as an invaluable roadmap for healthcare professionals, systematically addressing patient needs within a tailored framework, and prescribing appropriate strategies over 4 distinct phases. Limitations include the use of convenience sampling and no follow-up duration.

CONCLUSIONS

This study demonstrated the efficacy of counseling in enhancing sexual well-being of women with permanent intestinal ostomy.

eHealth Promoting Stoma Self-care for People With an Elimination Ostomy: Focus Group Study

BACKGROUND

The construction of an elimination stoma has a physical, psychological, and social impact on the person. The development of stoma self-care competence contributes to the adaptation to a new health condition and improvement of quality of life. eHealth refers to everything associated with information and communication technology and health care, including telemedicine, mobile health, and health informatics. The use of eHealth platforms by the person with an ostomy, as a digital application that includes websites and mobile phone apps, can bring scientific knowledge and well-informed practices to individuals, families, and communities. It also allows functionalities that enable the person to describe and identify early signs and symptoms and precursors of complications and to be guided to an adequate health response for their problems.

OBJECTIVE

This study aimed to define the most relevant content and features to promote ostomy self-care integrated into an eHealth platform as a digital app or website to be used by patients for self-management of stoma care.

METHODS

We developed a descriptive, exploratory study with a qualitative approach using the focus group methodology, which was oriented to reach a consensus of at least 80%. A convenience sample of 7 participants consisting of stomatherapy nurses was used. The focus group discussion was recorded, and field notes were taken. The focus group meeting was fully transcribed, and a qualitative analysis was performed. The research question was: Which content and features for ostomy self-care promotion should be integrated into an eHealth platform as a digital app or website?

RESULTS

An eHealth platform, which can be a smartphone app or website, for people with ostomy should provide content aimed at promoting self-care, namely in the field of knowledge and self-monitoring, as well as the possibility of interacting with a stomatherapy care nurse.

CONCLUSIONS

The stomatherapy nurse has a decisive role in promoting adaptation to life with a stoma, namely through the promotion of stoma self-care. Technological evolution has emerged as a useful tool to enhance nursing interventions and promote self-care competence. The development of an eHealth platform aimed at promoting ostomy self-care should include the capabilities for telehealth and help with decision-making regarding self-monitoring and seeking differentiated care.

Patient reported improvement in sexual health outcomes following care in a sexual health clinic for women with cancer

PURPOSE

Sexual health concerns are common among female cancer survivors. Few data exist regarding patient-reported outcomes following interventions in this population. We aimed to determine patient-reported adherence and impact of interventions provided in an academic specialty clinic for treatment of sexual health problems.

METHODS

A cross-sectional quality improvement survey regarding sexual problems, adherence with recommended therapies, and improvement following intervention was administered to all women seen at the Women's Integrative Sexual Health (WISH) program at the University of Wisconsin-Madison between November 2013 and July 2019. Descriptive and Kruskal-Wallis tests were used to explore differences between groups.

RESULTS

Two hundred twenty women (median age at first visit = 50 years, 53.1% breast cancer) were identified; N =113 surveys were completed (response rate = 49.6%). The most common presenting complaints were pain with intercourse (87.2%), vaginal dryness (85.3%), and low libido (82.6%). Menopausal women were more likely than premenopausal women to present with vaginal dryness (93.4% vs. 69.7%, p = .001) and pain with intercourse (93.4% vs. 76.5%, p = .02). Nearly all women adhered to recommendations for vaginal moisturizers/lubricants (96.9-100%) and vibrating vaginal wands (82.4-92.3%). A majority found recommended interventions helpful regardless of menopausal status or cancer type and reported persistent improvement. Nearly all women had improvement in understanding sexual health (92%) and would recommend the WISH program to others (91%).

CONCLUSION

Women with cancer report integrative sexual health care to address sexual problems that are helpful and result in long-term improvement. Patients are overall highly adherent to recommended therapies, and nearly all would recommend the program to others.

IMPLICATIONS FOR CANCER SURVIVORS

Dedicated care to address sexual health in women after cancer treatment improves patient-reported sexual health outcomes across all cancer types.

Nurse's Roles in Colorectal Cancer Prevention: A Narrative Review

The objective of this paper is to investigate the different roles of nurses as members of healthcare teams at the primary, secondary, and tertiary levels of colorectal cancer prevention. The research team conducted a narrative review of studies involving the role of nurses at different levels of colorectal cancer prevention, which included a variety of quantitative, qualitative, and mixed-method studies. We searched PubMed, Scopus, Web of Science, Cochrane Reviews, Magiran, the Scientific Information Database (SID), Noormags, and the Islamic Science Citation (ISC) databases from ab initio until 2021. A total of 117 studies were reviewed. Nurses' roles were classified into three levels of prevention. At the primary level, the most important role related to educating people to prevent cancer and reduce risk factors. At the secondary level, the roles consisted of genetic counseling, stool testing, sigmoidoscopy and colonoscopy, biopsy and screening test follow-ups, and chemotherapy intervention, while at the tertiary level, their roles were made up of pre-and post-operative care to prevent further complications, rehabilitation, and palliative care. Nurses at various levels of prevention care also act as educators, coordinators, performers of screening tests, follow-up, and provision of palliative and end-of-life care. If these roles are not fulfilled at some levels of colorectal cancer, it is generally due to the lack of knowledge and competence of nurses or the lack of instruction and legal support for them. Nurses need sufficient clinical knowledge and experience to perform these roles at all levels.

Comparing the Effect of Extended PLISSIT Model and Group Counseling on Sexual Function and Satisfaction of Pregnant Women: A Randomized Clinical Trial

Introduction: Changes in the performance and sexual satisfaction of women during pregnancy can be one of the important factors involved in the emergence of sexual problems in women. This study aimed to compare the effect of Extended Permission, Limited Information, Specific Suggestion, Intensive Therapy (Ex-PLISSIT) and group counseling on sexual function and satisfaction of pregnant women. Methods: A randomized clinical trial was conducted on 111 pregnant women from 2016 to 2018 in Zanjan, Iran. Eligible participants were selected through convenience sampling method and allocated into three groups Ex-PLISSIT model, group counseling and control group, using block randomization method. Sexual function and sexual satisfaction were evaluated via the Female Sexual Function Index (FSFI) and Hudson’s sexual satisfaction questionnaire at baseline and four weeks after the last counseling session. Data were analyzed using SPSS ver. 13 and ANCOVA, ANOVA, Wilcoxon, chi-square, Mann-Whitney U, and Kruskal Wallis tests. Results: Median (interquartile range) of the participants’ sexual function in the Ex-PLISSIT group was 25.9 (4) in the counseling group, 26 (5.5), in the control group, and 25.8 (4.8) at the baseline. These scores changed to 28.9 (5.4), 27.9 (5.1), and 25.2 (4.3) at the 4-week follow-up, respectively. These differences were statistically significant. Moreover, there was a statistically significant difference in the mean sexual satisfaction scores between the three groups, at the follow up period. Conclusion: Providing sexual counseling by any approach during routine prenatal care by community midwives may improve couples’ sexual health.

The Effect of Sexual Health Counseling Based on REDI Model on Sexual Function of Lactating Women with Decreased Sexual Desire

Introduction: Sexual problems have significant effects on individual sexual function. The aim of this study was to determine the effect of counseling on sexual function of lactating women with decreased sexual desire. Methods: This is a quasi-case research. The sample consisted of 104 lactating mothers with sexual desire disorder from 2 to 6 months after childbirth. Samples were randomly selected and divided into two control and case groups. Data were collected using questionnaires, including the decreased sexual desire scale, sociodemographic characteristics, and midwifery questionnaire, and female sexual function index (FSFI). Sexual function was measured before and 4 weeks after consultation based on the rapport building, exploration, decision making, and implementing the decision (REDI) model. The results were analyzed by using SPSS-24 software and a significant level of <5%. Results: The mean age of participants was 30.71 ± 6.23 years and 29.65 ± 5.66 years in the case and control group, respectively (p = 0.380), ∼50% had a diploma degree or more, 100% were living in urban areas, and 95.90% of women were housewives. Both case and control groups were homogeneous in terms of demographic and midwifery variables (p > 0.05). There was a highly significant difference between study and control groups regarding mean FSFI domains except for orgasm, as well as in the total FSFI score 4 weeks after the intervention (p < 0.001). The results of the linear mixed effects model for assessing the trend of mean total FSFI score present that the mean of total FSFI score in the case group was increased 2.26 in comparison with the control group. Estimated slopes for female indicate that the mean of total FSFI score was increased 3.44 for 1 month. Conclusions: The results of this study show that supporting lactating women with decreased sexual desire through sexual counseling based on the REDI model can make a significant difference in their sexual function.

Randomized Controlled Trial Protocol for Evaluating the Effect of Group Education on Postmenopausal Sexual Dysfunction

Objectives

This study primarily aimed to determine the effect of group education on sexual dysfunction in postmenopausal women referred to health centers in Hamadan, Iran.

Methods

This randomized controlled clinical trial conducted on 90 postmenopausal women from October 2018 to March 2019. Postmenopausal women who met the inclusion criteria and received approval of a psychiatrist were randomly divided into intervention and control groups (n = 45 in each group). They completed the demographic questionnaire and the Female Sexual Function Index questionnaire. Thereafter, four sessions of group training were conducted for women in the intervention group; these women were followed up for 1 month after the last training session. Data were analyzed using the SPSS ver. 16 software, and descriptive statistics and ANCOVA/ANOVA test were used for data analysis.

Results

We found that the two groups were homogenous in most of the demographic variables and the data were normal. The total mean score of sexual function and standard deviation after the intervention was 23.70 ± 3.67 in the intervention group and 19.94 ± 3.64 in the control group, indicating that these scores were significantly higher in the intervention group than in the control group (P < 0.001).

Conclusions

Based on the results, group training is recommended to reduce sexual dysfunction in postmenopausal women at health centers.

The Relationship Between Gender Role Orientation and Sexual Health Care in Taiwanese Nurses: A Structural Equation Model

Introduction

Patients’ sexual concerns are private, sensitive issues, and providing sexual health care (SHC) is a legitimate area of concern for the nursing practice.

Aims

This study tests a structural equation model for factors that affect SHC among Taiwanese nurses.

Methods

A cross-sectional study was performed between August 2014 and July 2015. A total of 471 registered nurses from a medical center in Taiwan were enrolled in this study. All nurses participated anonymously and completed 3 questionnaires: Nursing Attitude in Sexual Health Care scale, Nursing Intervention in Sexual Health scale, and Gender Role Orientation scale. The Permission-Limited Information-Specific Suggestions-Intensive Therapy model based on scale was application, and theory of planned behavior was used to examine the relationship of these 3 scales in nurses.

Main Outcome Measures

SHC surveys were developed for nurses. These valid and reliable instruments included Nursing Attitude in Sexual Health Care, Nursing Intervention in Sexual Health, and Gender Role Orientation.

Results

The fitted structural equation model was valid. The construct reliability of latent variables ranged from 0.730 to 0.942, which met the requirement of 0.70. The attitude about SHC (β = 0.182, P < .001), subjective norms on SHC (β = 0.146, P < .001), and confidence about SHC (β = 0.583, P < .001) had significant effects on the behavioral intention to provide SHC. Subsequently, the behavioral intention to provide SHC had a significant, direct effect on the behavioral frequency of providing SHC (β = 0.356, P < .001). However, gender role orientation was not significantly associated with behavioral intention and behavioral frequency to provide SHC.

Conclusions

The good fit for the structural equation model suggests that the predictors of behavioral intention and behaviors of providing SHC include attitude, subjective norms, and perceived control. The stronger behavioral intention of providing SHC resulted in a higher frequency of providing SHC. However, the relationship between gender role orientation and SHC had no significant effect.

Huang C-Y, Liou C-F, Lee S-H, et al. The Relationship Between Gender Role Orientation and Sexual Health Care in Taiwanese Nurses: A Structural Equation Model. Sex Med 2020;8:565–573.

A Pilot Intervention Study to Improve Sexuality Outcomes in Breast Cancer Survivors

Objective:

The main objective of the study is to assess the efficacy of the Permission, Limited information, Specific Suggestion, and sexual therapy (PLISSIT) model directly with breast cancer survivor (BCS) on sexual function and quality of life (QOL) domains.

Methods:

A pilot control trial was conducted comparing the PLISSIT model intervention to usual care. The intervention was delivered by two health professionals (nurse and professional sexual therapist) consisted of five sessions on counseling, genitalia anatomy, human sexual response, and sexual function. Data were collected before and 3 months after the intervention using the Female Sexual Function Index and the World Health Organization QOL-BREF questionnaire.

Results:

The sample consisted of 19 BCS (11 intervention, 8 controls) with a mean age of 54.5 8 years (standard deviation = 7.14) and the majority were married, Black or mixed Brazilian, received chemotherapy, radiation and/or hormonal therapy, and education varied from high school to college. There was significant improvement in physical health (P = 0.031), social relationships (P = 0.046), orgasm (P = 0.055), and pain (P = 0.049) over time and the intervention resulted in improved arousal (P = 0.038).

Conclusions:

The results suggest that the PLISSIT model may be an effective intervention for BCS in coping with and managing changes in sexuality and sexual function after treatment. It is important that nurses are aware of sexual intimacy concerns for BCS and integrate assessment into their nursing care.

Effect of a structured educational package on women's sexual function during pregnancy

OBJECTIVE

To explore the effect of a structured educational package based on ADDIE (analysis, design, development, implementation, evaluation) to reduce sexual dysfunction during pregnancy.

METHODS

A randomized controlled trial study among pregnant women attending prenatal clinics in Tehran, Iran, from October 2017 to September 2018. The implementation group received the structured educational package; the control group received training on breastfeeding and normal delivery. The outcome measure was changes in total and domain scores of the Female Sexual Function Index (FSFI) questionnaire before and after the intervention; the groups were compared by repeated-measures analysis of variance (ANOVA).

RESULTS

Overall, 70 women completed the study: 36 in the intervention group and 34 in the control group. Sexual desire (P=0.019), arousal (P=0.001), lubrication (P=0.001), orgasm (P=0.001), satisfaction (P=0.007), and total FSFI score (P<0.001) improved significantly in the intervention group as compared with the control group. However, there was no difference in sexual pain after the intervention (P=0.78).

CONCLUSION

The structured educational package was found to reduce sexual dysfunction by improving knowledge of and attitudes toward the physical and psychologic changes that occur during pregnancy among Iranian women attending routine prenatal care visits as part of a healthcare center's program. Iranian Registry of Clinical Trials: IRCT20140907019077N14.

PLISSIT Interventions and Sexual Functioning: Useful Tools for Social Work in Palliative Care?

Discussing sexual health with healthcare patients and their partners is difficult and often avoided. The PLISSIT model is a framework to effectively initiate the conversation about sexual concerns. This rapid review and small meta-analysis explores and clarifies knowledge about the effectiveness of PLISSIT in resolving sexual dysfunction and glean insight into its utility as a social work intervention in a palliative care setting. Evidence from 15 interventional studies was synthesized. Cohen's d-index served as the meta-analytic effect size statistic for each individual study. Significant ds were converted to Cohen's U₃ statistic to aid in practical interpretations. Between-study heterogeneity was evaluated with Cochran's Q statistic to examine possible relationships between effect sizes and moderator variables. Statistically and practically significant evidence revealed that PLISSIT is effective in treating sexual dysfunction (d = 1.00, U₃ = 84%, 95% CI = 1.06, 1.08): 84% of participants who received PLISSIT interventions scored lower on sexual dysfunction measures than did the typical participant in the comparison condition. Study design and frequency of intervention delivery moderated the overall effect. The findings and inferences may be best thought of as developed hypotheses for future research testing.

Effects of Education About Rheumatoid Arthritis and Sexuality on the Sexual Problems of Women With Rheumatoid Arthritis

The present quasi-experimental study was conducted to determine the effects of education about rheumatoid arthritis (RA) and sexuality on the sexual problems of women with RA. The study included 103 women with RA (51 in the experimental group, 52 in the control group). The study data were collected using the Personal Information Form and Female Sexual Function Index (FSFI). The women in the experimental group were provided education on sexuality, while those in the control group received no intervention. The aforementioned scales were administered twice: during the recruitment visit and then 1 month after the intervention. In the second measurement, the mean FSFI score increased in the experimental group, but was low in the control group, with the differences between the two groups being significant. Thus, providing sexual education to women with RA was effective in reducing sexual problems in women.

Interventions to Address Sexual Problems in People With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Adaptation of Cancer Care Ontario Guideline

Purpose

The adaptation of the Cancer Care Ontario (CCO) guideline Interventions to Address Sexual Problems in People With Cancer provides recommendations to manage sexual function adverse effects that occur as a result of cancer diagnosis and/or treatment.

Methods

ASCO staff reviewed the guideline for developmental rigor and updated the literature search. An ASCO Expert Panel ( Table A1 ) was assembled to review the guideline content and recommendations.

Results

The ASCO Expert Panel determined that the recommendations from the 2016 CCO guideline are clear, thorough, and based upon the most relevant scientific evidence. ASCO statements and modifications were added to adapt the CCO guideline for a broader audience.

Recommendations

It is recommended that there be a discussion with the patient, initiated by a member of the health care team, regarding sexual health and dysfunction resulting from cancer or its treatment. Psychosocial and/or psychosexual counseling should be offered to all patients with cancer, aiming to improve sexual response, body image, intimacy and relationship issues, and overall sexual functioning and satisfaction. Medical and treatable contributing factors should be identified and addressed first. In women with symptoms of vaginal and/or vulvar atrophy, lubricants in addition to vaginal moisturizers may be tried as a first option. Low-dose vaginal estrogen, lidocaine, and dehydroepiandrosterone may also be considered in some cases. In men, medication such as phosphodiesterase type 5 inhibitors may be beneficial, and surgery remains an option for those with symptoms or treatment complications refractory to medical management. Both women and men experiencing vasomotor symptoms should be offered interventions for symptomatic improvement, including behavioral options such as cognitive behavioral therapy, slow breathing and hypnosis, and medications such as venlafaxine and gabapentin.Additional information is available at: www.asco.org/survivorship-guidelines and www.asco.org/guidelineswiki .

Addressing the Sexual Function of Women During First Six Month After Delivery: Aquasi-Experimental Study

Introduction

Pregnancy and childbirth are important periods of women's life that cause hormonal and bodily changes, and these changes could have significant effects on sexual function.

Aim

The aim of this study was to assess the effectiveness of PLISSIT-based counselling model on the sexual function of women during the first six months after childbirth.

Material and Methods

This was a randomized controlled clinical trial study from June to November, 2015. Ninety lactating women,with at least one sexual problem, were included in this study. Samples were recruited and randomized into two groups (intervention group and control group). Demographic and obstetric information, Edinberg postpartum depression, Larson's sexual satisfaction and female sexual function index questionnaire were used. Data were collected from participants at two points: before consultation and 4weeks after consultation. The statistical analyses were performed using SPSS software and Data were analyzed using the Paired t-test,dependent t-test with parametric data and Chi-square tests.

Results

Ninety women who were the nulliparous and lactating criteria subjects were randomly divided into two groups and all recruited women completed the questionnaires. Mean score of sexual function was 19.35 before consultation and 27.90 after consultation in experimental group. In the control group, mean score of sexual function was 20.55 before consultation and 22.41 after consultation. These differences were statistically significant in pre-counseling stage and 4 weeks after counseling in the two groups (P<0.001 and P=0.002). Four weeks after consultation, there was significant difference in the mean score of sexual function between the control and experimental groups (P<0.001).

Conclusion

Based on the result of this study, sexual problems in lactating women decreased by using the PLISSIT model. The use of the PLISSIT model is recommended in health care setting.

Patient education interventions for colorectal cancer patients with stoma: A systematic review

OBJECTIVES

To describe the various types of patient education interventions for colorectal cancer patients with stoma and to examine their effects on quality of life, psychosocial skills and self-management skills.

METHODS

A systematic review was performed. Six electronic databases were searched. Inclusion criteria were: studies about patient education applying quantitative methods including digestive stoma adults with colorectal cancer. The primary outcome was quality of life. Secondary outcomes were psychosocial and self-management skills.

RESULTS

Thirteen studies were identified and included. Five studies examined quality of life and three reported improvements. Patient education improved some psychosocial and self-management skills. Contrasting findings were reported for specific-disease quality of life, emotional distress, length of hospital stay, stoma complications and readmission rate.

CONCLUSIONS

Patient education has a positive impact on some psychosocial and self-management skills, indicating that this area should be developed. Contrasting findings were reported for quality of life. Methodologies are heterogeneous making it difficult to produce evidence-based guidelines. This article proposes tools to carry out further studies on this subject and to improve understanding.

PRACTICE IMPLICATION

Further education intervention for stoma patients with colorectal cancer should be standardized in terms of intervention, duration and outcome measures to compare intervention and determine best practice.

Interventions to address sexual problems in people with cancer

BACKGROUND

Sexual dysfunction in people with cancer is a significant problem. The present clinical practice guideline makes recommendations to improve sexual function in people with cancer.

METHODS

This guideline was undertaken by the Interventions to Address Sexual Problems in People with Cancer Expert Panel, a group organized by the Program in Evidence-Based Care (pebc). Consistent with the pebc standardized approach, a systematic search was conducted for existing guidelines, and the literature in medline and embase for the years 2003-2015 was systematically searched for both systematic reviews and primary literature. Evidence found for men and for women was evaluated separately, and no restrictions were placed on cancer type or study design. Content and methodology experts performed an internal review of the resulting draft recommendations, which was followed by an external review by targeted experts and intended users.

RESULTS

The search identified 4 existing guidelines, 13 systematic reviews, and 103 studies with relevance to the topic. The present guideline provides one overarching recommendation concerning the discussion of sexual health and dysfunction, which is aimed at all people with cancer. Eleven additional recommendations made separately for men and women deal with issues such as sexual response, body image, intimacy and relationships, overall sexual functioning and satisfaction, and vasomotor and genital symptoms.

CONCLUSIONS

To our knowledge this clinical practice guideline is the first to comprehensively evaluate interventions for the improvement of sexual problems in people with cancer. The guideline will be a valuable resource to support practitioners and clinics in addressing sexuality in cancer survivors.

Effects of Sexual Rehabilitation Using the PLISSIT Model on Quality of Sexual Life and Sexual Functioning in Post-Mastectomy Breast Cancer Survivors

Background and Objectives: As one of the most common treatments for breast cancer, mastectomy has adverse effects on the quality of sexual life and sexual functioning in the impacted women. Various strategies have therefore been proposed to resolve their sexual problems. The present study was conducted to determine the effect of sexual rehabilitation using the PLISSIT model in post-mastectomy breast cancer survivors. Materials and Methods: The present quasi-experimental study was conducted on a population of post-mastectomy breast cancer survivors and their husbands. Sample size was calculated as 50 each for intervention and non-intervention groups. The former received sexual counseling based on the PLISSIT model consisting of four levels of intervention: permission, limited information, specific suggestion and intensive therapy, presented in four 90-minute sessions. Data were collected using the Sexual Quality of Life-Female (SQOL-F) questionnaire and the Female Sexual Function Index (FSFI). Results: No significant differences were observed in the mean quality of sexual life scores between the intervention and control groups (P>0.05) before the intervention; however, a significant difference emerged between the groups after the intervention (P<0.01). Thus the mean score for sexual functioning in the intervention group was 26.3±3.76 before and30.0±4.38 after the intervention (P<0.0001). In the control group, however, the difference between the pre- and post-intervention mean scores was not statistically significant (P=0.713). Conclusion: The present study showed that nurses can use the PLISSIT model in conjunction with chemotherapy and radiotherapy to teach coping and problem-solving skills to women with breast cancer and their husbands and to encourage their participation in group programs for expressing their feelings and attitudes about their current sex life and thus help enhance quality of sexual life and sexual functioning in this group.

The effectiveness of the Permission, Limited Information, Specific suggestions, Intensive Therapy (PLISSIT) model based sexual counseling on the sexual function of women with Multiple Sclerosis who are sexually active

OBJECTIVE

This study was conducted to evaluate the effectiveness of sexual counseling based on the Permission, Limited Information, Specific Suggestion, Intensive Therapy (PLISSIT) model on the Sexual Dysfunction (SD) of married sexually active women who suffer from Multiple Sclerosis (MS). This is the first sexual intervention applied by a midwife as a health professional on MS patients in Iran where the cultural and religious limitations are important challenging issues.

STUDY DESIGN

This randomized clinical trial was carried out in Iranian Community of Support for MS Patients in Tehran, Iran. The participating women who had a definite diagnosis of MS and SD, Expanded Disability Status Scale (EDSS) scores <7, and aged 18-55 years were randomly assigned to experimental (EG, n=43) and control group (CG, n=45). Participants in the EG group received 4 weekly sexual counseling sessions based on the PLISSIT model (90-120min per session).

MAIN OUTCOME MEASURES

Sexual function was assessed three times (before the intervention, and 2 months and 3 months after the intervention) using the Female Sexual Function Index (FSFI). Chi-square test, Fisher's exact test, and Repeated Measures ANOVA were employed to analyze the data.

RESULTS

The mean total FSFI score of the women in EG improved at 2 and 3 months after the intervention when it was compared with the FSFI score before the intervention (p<0.05). There was no significant difference in the total FSFI score when the data of 3 evaluations was compared in CG. A significant increase in the mean score of 6 subgroups was seen in EG (p<0.05) but not in CG.

CONCLUSION

According to this study, utilizing the PLISSIT model as a framework for sexual counseling can improve sexual function in women who are sexually active and suffer from SD due to MS.

A randomized trial of a minimal intervention for sexual concerns after cancer: a comparison of self-help and professionally delivered modalities

BACKGROUND

Information and discussion of sexual changes with a health professional is a high priority for many cancer patients in order to assist with sexual changes and ensure that sexual intimacy does not cease post-cancer. The PLISSIT model is widely recommended as a framework for providing sexual information and support, allowing for the discussion of sexual changes at various levels of increasing intensity. The aim of the present study is to evaluate the early stages of the PLISSIT model by examining the relative efficacy of written information provision about cancer related sexual changes, and information provision accompanied by a single session of counselling, for people with cancer and their partners, across a range of cancer types.

METHOD

Eighty-eight people with cancer and 53 partners across a range of sexual and non-sexual cancers, took part in a randomised trial which adopted mixed method analysis to examine changes in psychological wellbeing, quality of life, relationship satisfaction and communication, and sexual functioning, following written information provision about cancer related sexual changes (self-help condition; SH), or written information accompanied by a single session of counselling (health professional condition; HP).

RESULTS

Ratings of the usefulness and efficacy of the SH and HP interventions, collected through analysis of Likert scales, open ended survey items and interviews, indicated that both conditions were found to be useful and efficacious by the majority of participants, serving to increase awareness of sexuality, improve couple communication about sex, and help in the management of sexual changes, through the exploration of non-coital sexual practices. In contrast, the quantitative analysis of standardized instruments found no significant improvements in psychological wellbeing, quality of life, relationship satisfaction and communication, or sexual functioning. There were significant reductions in self-silencing in the HP condition, and a trend towards increases in sexual satisfaction across both conditions.

CONCLUSION

These results offer support for the early stages of the PLISSIT model, in terms of normalization and increased awareness of sexual changes after cancer, increased couple communication about sexual changes, and legitimation of exploration of a range of non-coital sexual practices and intimacy. However, more complex and intensive interventions are needed to address sexual functioning and psychological wellbeing. The findings provide support for the proposition that providing permission to discuss sexuality should be the core feature underpinning all stages of interventions designed to provide sexuality information and support for people with cancer and their partners, and also demonstrate the potential importance of limited information and specific suggestions.

TRIAL REGISTRATION

This study was registered in the Australian New Zealand Clinical Trials Registry. ( ACTRN12615000399594 ) on 29 April 2015.

Effectiveness of a PLISSIT model intervention in patients with type 2 diabetes mellitus in primary care: design of a cluster-randomised controlled trial

Background

Sexual dysfunction is prevalent in patients with type 2 diabetes mellitus, but remains one of the most frequently neglected complications in diabetes care. Both patients and care providers appear to have difficulty with discussing sexual problems in diabetes care. A sexual counselling model for care providers, such as the PLISSIT model, might be a useful tool to improve the discussion of sexual issues in patients with type 2 diabetes mellitus. PLISSIT stands for Permission, Limited Information, Specific Suggestions, and Intensive Therapy. Even though the use of the PLISSIT model has often been recommended in diabetes care, no evidence with regards to its effectiveness in patients with type 2 diabetes mellitus exists. This study describes the design of a cluster-randomised controlled trial evaluating the effectiveness of a PLISSIT-model intervention in men and women with type 2 diabetes mellitus in primary care.

Methods/Design

Patients with type 2 diabetes mellitus, aged 40–75 years, who indicate to be dissatisfied about their sexual functioning and that they would like to talk about their sexual problem(s) with their general practitioner are recruited. All participants receive an information leaflet from the practice nurse. In the intervention group, each participant will also receive sexual counselling based on the PLISSIT model from their general practitioner. In the control group, usual care will be provided to those participants requesting an appointment with their general practitioner when the information leaflet was not deemed sufficient. Primary outcomes include sexual functioning, satisfaction about sexual function, and quality of life. Secondary outcomes are depressive symptoms, sexual distress, emotional well-being, and treatment satisfaction. Outcomes will be measured by means of self-report questionnaires at baseline, and after 3 and 12 months post-baseline. Treatment satisfaction will be assessed in telephone interviews.

Discussion

This paper describes the design of a cluster-randomised controlled trial that will investigate the effectiveness of a PLISSIT-model intervention in patients with type 2 diabetes mellitus in primary care. Our study will add important and currently missing insight into the effectiveness of PLISSIT on important patient-reported outcomes of men and women with type 2 diabetes mellitus.

Trial registration

Dutch Trial Registry NTR4807.

Empowerment needs of women with breast cancer: a qualitative study

Background:

Due to the increasing number of women suffering from breast cancer worldwide, promoting the empowerment of these patients is an important factor affecting their survival.

Objectives:

Few studies have investigated the empowerment needs of the breast cancer women, especially in Iran. Therefore, this study was performed to explain the empowerment needs of women with breast cancer in Iran.

Patients and Methods:

In this qualitative study, 19 women with breast cancer were interviewed regarding their empowerment needs using the individual open-ended and, in-depth interviews and then the qualitative data were analyzed through content analysis.

Results:

Three main categories of empowerment needs from the participants’ perspectives were as follows: 1- information: the initial empowerment plans (timely and comprehensive information, coordination and continuity of information, easy and full-time access to information), 2- beliefs: the approval of the empowerment plans for execution (actuality, trust and hope and new beliefs), and 3- skills: efficient execution of the empowerment plans (communication skills, expression the needs, emotions, questions and use of the internet).

Conclusions:

It seems that promoting the empowerment of women with breast cancer is essential. Factors found in this study and also in similar studies, in which empowerment needs are explained in-depth through the experiences of the patients, should be considered and used in the treatment, educational and counseling programs to promote the empowerment of women with breast cancer.

Compare the effectiveness of PLISSIT and sexual health models on women's sexual problems in Tehran, Iran: a randomized controlled trial

INTRODUCTION

Sexuality is an important aspect of human life and sexual problems are common, but there is limited evidence for cost-effective treatments of women's sexual dysfunctions.

AIMS

The aim of this study was to assess whether group therapy such as Sexual Health Model (SHM) can be as effective as individual therapy like Permission, Limited Information, Specific Suggestions, and Intensive Therapy (PLISSIT) model in women with sexual problems.

METHODS

A randomized controlled trial was conducted between May 2012 and September 2013 in five Tehran, Iran health clinics. Eighty-four consecutive married women aged 20-52 years, with sexual problems who were admitted for the first time, were recruited and randomized into two groups. The intervention included two therapeutic models: the SHM, which consisted of two sessions of 3 hours of group education, and the PLISSIT model, which required a total of 6 hours of one-on-one consultation at an interval of 1-2 weeks.

MAIN OUTCOME MEASURES

Sexual function and sexual distress were assessed, respectively, with the Brief Index of Sexual Function for Women and Female Sexual Distress Scale Revised questionnaires.

RESULTS

Seven months after intervention, the mean (SD) of the sexual distress score decreased and sexual composite score increased significantly in both groups (P < 0.001). The overall analysis of repeated measure manova revealed borderline significance differences for combined outcomes between two groups (P = 0.051).

CONCLUSIONS

Due to the considerable human resource, time, and cost spent conducting the PLISSIT, it seems that group education based on SHM could be more cost-efficient and nearly as effective. This conclusion may be more applicable in communities where the treatment of sexual problems is in the beginning stages and where people have not received any sexual education or knowledge during their lifetime.

Exploring the feasibility and acceptability of couple-based psychosexual support following prostate cancer surgery: study protocol for a pilot randomised controlled trial

BACKGROUND

Men who undergo surgery for prostate cancer frequently experience significant side-effects including urinary and sexual dysfunction. These difficulties can lead to anxiety, depression and reduced quality of life. Many partners also experience psychological distress. An additional impact can be on the couple relationship, with changes to intimacy, and unmet psychosexual supportive needs in relation to sexual recovery and rehabilitation. The aim of this exploratory randomised controlled trial pilot study is to determine the feasibility and acceptability of a novel family-relational-psychosexual intervention to support intimacy and reduce distress among couples following prostate cancer surgery and to estimate the efficacy of this intervention.

METHODS/DESIGN

The intervention will comprise six sessions of psychosexual and relationship support delivered by experienced couple-support practitioners. Specialist training in delivering the intervention will be provided to practitioners and they will be guided by a detailed treatment manual based on systemic principles. Sixty-eight couples will be randomised to receive either the intervention or standard care (comprising usual follow-up hospital appointments). A pre-test, post-test design will be used to test the feasibility of the intervention (baseline, end of intervention and six-month follow-up) and its acceptability to couples and healthcare professionals (qualitative interviews). Both individual and relational outcome measures will assess sexual functioning, anxiety and depression, couple relationship, use of health services and erectile dysfunction medication/technologies. An economic analysis will estimate population costs of the intervention, compared to usual care, using simple modelling to evaluate the affordability of the intervention.

DISCUSSION

Given the increasing incidence and survival of post-operative men with prostate cancer, it is timely and appropriate to determine the feasibility of a definitive trial through a pilot randomised controlled trial of a family-relational-psychosexual intervention for couples. The study will provide evidence about the components of a couple-based intervention, its acceptability to patients and healthcare professionals, and its influence on sexual and relational functioning. Data from this study will be used to calculate sample sizes required for any definitive trial.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT01842438.Registration date: 24 April 2013; Randomisation of first patient: 13 May 2013.

The effect of face-to-face with telephone-based counseling on sexual satisfaction among reproductive aged women in Iran

This study was designed to investigate and compare the effect of face-to-face with telephone-based counseling on sexual satisfaction in women of reproductive age in Iran. This study was a randomized controlled trial in which 46 married women who got married 1-5 years ago were randomly selected and assigned to 1 of 2 groups (face-to-face and telephone-based counseling). Two groups received counseling by a trained midwife once a week for 4 weeks. The sexual satisfaction (using the Sexual Satisfaction Index) score was calculated in the beginning of the study and after 4 weeks. An independent t test, chi-square test, likelihood ratio test, Fisher's exact test, and linear-by-linear test were used for analyzing data. The mean score of sexual satisfaction in the face-to-face group was 93.6 (SD = 7.1) and improved significantly to 108.08 (SD = 5.44) after intervention (p =.001). The mean score of sexual satisfaction in the telephone-based counseling was 93.52 (SD = 5) and increased to 113 (SD = 6.07) after 4 weeks (p =.001). Telephone-based counseling could increase the sexual satisfaction better than face-to-face counseling (mean difference: 20.34 [SD = 7.38] vs. 14.47 [SD = 5.32], p =.003). The telephone-based counseling is an effective and affordable method to solve the sexual problems and could increase the sexual satisfaction. Using this method in public health centers is recommended.

The sexual health care needs after colorectal cancer: the view of patients, partners, and health care professionals

PURPOSE

Sexual dysfunction among patients with colorectal cancer is frequently reported. Studies examining patients' sexual health care needs are rare. We examined the sexual health care needs after colorectal cancer treatment according to patients, partners, and health care professionals (HCPs). Factors that impede or facilitate the quality of this care were identified.

METHOD

Participants were recruited from three Dutch hospitals: St. Elisabeth, TweeSteden, and Catharina hospitals. Patients (n = 21), partners (n = 9), and 10 HCPs participated in eight focus groups.

RESULTS

It is important to regularly evaluate and manage sexual issues. This does not always occur. Almost all participants reported a lack of knowledge and feelings of embarrassment or inappropriateness as barriers to discuss sexuality. HCPs reported stereotypical assumptions regarding the need for care based on age, sex, and partner status. The HCPs debated on whose responsibility it is that sexuality is discussed with patients. Factors within the organization, such as insufficient re-discussion of sexuality during (long-term) follow-up and unsatisfactory (knowledge of the) referral system impeded sexual health care. The HCPs could facilitate adequate sexual health care by providing patient-tailored information and permission to discuss sex, normalizing sexual issues, and establishing an adequate referral system. It is up to the patients and partners to demarcate the extent of sexual health care needed.

CONCLUSIONS

Our findings illustrate the need for patient-tailored sexual health care and the complexity of providing/receiving this care. An adequate referral system and training are needed to help HCPs engage in providing satisfactory sexual health care.

Gastrointestinal ostomies and sexual outcomes: a comparison of colorectal cancer patients by ostomy status

PURPOSE

Research examining effects of ostomy use on sexual outcomes is limited. Patients with colorectal cancer were compared on sexual outcomes and body image based on ostomy status (never, past, and current ostomy). Differences in depression were also examined.

METHODS

Patients were prospectively recruited during clinic visits and by tumor registry mailings. Patients with colorectal cancer (N = 141; 18 past ostomy; 25 current ostomy; and 98 no ostomy history) completed surveys assessing sexual outcomes (medical impact on sexual function, Female Sexual Function Index, International Index of Erectile Function), body image distress (Body Image Scale), and depressive symptoms (Center for Epidemiologic Studies Depression Scale-Short Form). Clinical information was obtained through patient validated self-report measures and medical records.

RESULTS

Most participants reported sexual function in the dysfunctional range using established cut-off scores. In analyses adjusting for demographic and medical covariates and depression, significant group differences were found for ostomy status on impact on sexual function (p < .001), female sexual function (p = .01), and body image (p < .001). The current and past ostomy groups reported worse impact on sexual function than those who never had an ostomy (p < .001); similar differences were found for female sexual function. The current ostomy group reported worse body image distress than those who never had an ostomy (p < .001). No differences were found across the groups for depressive symptoms (p = .33) or male sexual or erectile function (p values ≥ .59).

CONCLUSIONS

Colorectal cancer treatment puts patients at risk for sexual difficulties and some difficulties may be more pronounced for patients with ostomies as part of their treatment. Clinical information and support should be offered.

Sexuality and stroke: the effects and holistic management

Since the days of the early pioneering work of authors such as Glover (1985) and Woods (1987), there has been a proliferation of research and practice guidelines related to the effects of ill health on individuals' and couples' sexuality and sexual health (Reis et al, 2010; Sadovsky et al, 2010; Royal College of Nursing, 2000). This article reviews the common difficulties experienced by individuals and couples affected by stroke regarding to their sexuality and sexual health. Furthermore, it presents and explores a possible model of care that can be used in practice to address these difficulties with people affected by stroke.