Detailed Description The considerable prevalence of sexual dysfunction (SD) after
prostate cancer (PCa) treatment makes SD post-treatment a substantial health-related
quality of life burden for patients and their partners. Research indicates that 40% to
75% of men suffer from SD post-PCa. Sixty percent of men experience significant distress
in response to SD. Significant distress is also reported by partners and couples.
Overall, patients cite sexual health concerns as the most significant unmet need
following treatment for PCa. Accordingly, there is an existent need for equitable,
timely, and affordable access to high-quality SD treatment for Canadian PCa patients and
their partners.
Unfortunately, none of the empirically-based, comprehensive interventions reported in the
literature have been implemented into clinical settings in Canada. The lack of
translation from research evidence to clinical implementation is common across healthcare
provision. It is known that most research, even positive full-scale studies, do not
result in practice-change or take years to do so. A key aspect contributing to this lack
of knowledge translation is the complexity of transitioning an "experimental
intervention" to "real world" clinical settings. In sexual healthcare in oncology,
ineffective knowledge translation is ubiquitous and includes several unique complexities
that impair the implementation, integration, and sustainability of empirically-based
treatment.
The recent advent of virtual care in healthcare offers an opportunity to address many of
the barriers to implementing sexual recovery programs within PCa treatment facilities.
Virtual care provides greater accessibility for patients not proximal to cancer centres,
or who are unable to travel due to financial constraints or physical limitations.
Encouragingly, examples of internet-delivered interventions exist for men with PCa and
their partners. Schover and colleagues found that a digitally-based intimacy enhancement
intervention was as effective as a brief in-person sex therapy intervention in improving
sexual outcomes in couples after PCa. Although these advances in models of care provision
are inspiring, the majority of Canadian PCa patients and their partners have yet to
benefit from virtual care innovations.
In an effort to advance evidence-based survivorship programming in the treatment of SD
post-PC, a team of expert Canadian healthcare practitioners and patient/partner advocates
developed the Sexual Health and Rehabilitation eClinic (SHAReClinic). SHAReClinic is a
web-based, bio-psychosocial SD intervention specifically for patients/couples who have
undergone treatment for PCa. A pilot study evaluating the acceptability and engagement of
SHAReClinic achieved significant patient activity on the platform and 80% patient
engagement at 1-year follow-up. Additionally, evaluation of the effectiveness of
SHAReClinic showed non-inferior sexual health outcomes when compared to a "best practice"
in-person sexual health clinic.
Rationale Sexual dysfunction after PCa treatment has significant adverse impacts on
patient/partner health-related quality of life. Few Cancer Centres in Canada offer
comprehensive care for SD post-PCa treatment, resulting in significant barriers to care
equity and access. SHAReClinic is established as effective virtual care programming for
SD post-PCa.
The goal of this research is to evaluate the SHAReClinic in 2 cancer centres currently
using it as usual care and 9 cancer centres which has newly implemented SHAReClinic as
part of their usual care. The SHAReClinic will be offered to 1. Newly diagnosed patients
at who are scheduled to undergo active treatment for localized prostate cancer, 2.
patients currently undergoing active treatment for prostate cancer and 3. patients who
have undergone prostate cancer treatment within the last 6 months. Active treatment can
include any of the following options surgical, radiation, and/or ADT. The SHAReClinic
goals are to re-establish optimal sexual function, satisfaction and to support the
maintenance of intimacy following prostate cancer treatment. These goals are addressed
through two complementary components: 1) a bio-medical component (erectile
rehabilitation), focused on the long term penile health or short-term erectile function
as per patient preference, and 2) a psychological component (intimacy maintenance),
involving the maintenance or restoration of couples' intimacy and sexual activity
(penetrative or non-penetrative). Both physical and psychological factors can affect
patients' sexual satisfaction after cancer treatment; resultantly, interventions should
incorporate a bio-psychosocial approach to rehabilitation.
Study Design This is a prospective observational evaluation of a virtual sexual health
and rehabilitation intervention program. As part of patient standard care, facilitated
web-based clinic visits will be provided to patients once before treatment, 6 weeks, 10
weeks, 4 months, 6 months and 12 months post cancer treatment. Patients who opt-in to the
SHAReClinic will also be invited to register for this study. The study involves no
additional requirements from patients, as all questionnaires (baseline, 6-weeks, 6
months, and 12 months) are completed as part of their enrolment in the SHAReClinic.
Patients experience in the SHAReClinic involves the following: Upon registration,
patients will be paired with a sexual health coach from their center and asked about
their availability to receive a phone/video call from their sexual health coach. At the
beginning of the first clinic visit, participants will be asked to complete a set of
questionnaires. The questionnaires take around 10-15 minutes to complete. Patients are
also asked to complete the same questionnaires at 6 week, 6 months and 12 months. The
topics covered in each clinic visit vary and are based on the treatment schedules of the
participants. A Q&A session on the web page will be available for participants to leave
any questions or concerns regarding their sexual health, rehabilitation process and the
content of the portal. Participants are free to request for a check-in call with their
sexual health coach if they want to chat about their concerns by phone. Each clinic visit
will last approximately 30 minutes. If participants miss their clinic visit, they will
get a notification from the platform and then a reminder call from their sexual health
coach. At the end of their final SHAReClinic clinic visit, participants will be asked to
fill out a satisfaction questionnaire, including questions about the ease of access to
the website, their experience with SHAReClinic portals and communication with their
sexual health coach. The satisfaction questionnaire takes about 10 minutes to complete.