A Systematic Review of Communication Tools to Improve Reproductive and Sexual Health Outcomes in Female Cancer Patients Identified Significant Gendered Data Gaps in Care

Introduction

Female patients with cancer (including blood cancer) are particularly at risk of having their reproductive concerns neglected. Despite the considerable impact of cancer, including blood cancers, and their treatment on sexual health, healthcare professionals frequently face barriers in discussing these changes. This study reviewed the tools that facilitate communication with female patients of childbearing age regarding their reproductive needs with healthcare professionals. The scope of this review includes fertility preservation, menstrual disturbances, contraceptive use, and sexual dysfunction.

Methods

A systematic search of PubMed, Embase, and PsycInfo databases for interventional studies was conducted until May 2024. The Mixed Methods Appraisal Tool (MMAT) was used to evaluate the quality of relevant studies. Data were extracted using standardized collection sheets, summarized in a narrative synthesis, and visualized in tables.

Results

The search yielded 2435 studies published between 2001 and 2024, of which 14 met the inclusion criteria. All studies had a quantitative design, with 13 randomised controlled trials (RCTs). Eleven unique interventions were described, with the most common tool being the PLISSIT (permission, limited information, specific suggestions, and intensive therapy) stepwise counselling model. Three studies used online web-based fertility preservation decision aids, two investigated educational programs, and the remaining nine used trialled counselling models. A total of 41 different measurement instruments were used to report the outcomes.

Outcomes related to fertility and sexual dysfunction were reported in six and ten studies, respectively, with some overlapping themes. Only one study explored contraception and menstrual disturbances. Ten studies reported statistically significant improvements in reproductive outcomes. The tools used included decision aids, web-based and print education programs, and communication models that were integrated into counselling. The interventions were applied in individualized, group-based, coupled, and mixed settings.

In facilitating discussions of fertility preservation, the psycho-educational couples’ counselling model (O!PEACE) and web-based decision aids were effective. The O!PEACE intervention significantly improved knowledge compared to the control and yielded a significant increase in patients receiving fertility preservation care through increased fertility preservation consultation. Patients using web-based decision aids reported significantly less decisional conflict in the medium-to short-term.

Successful communication tools for sexual dysfunction included online solution-focused counselling, an empowerment education-based nursing counselling method, Good Enough Sex (GES), PLISSIT, Group Sexuality Education (GSE), and Bring up topic (Explain, Telling, Timing, Education, Recording) models. In studies comparing PLISSIT with other models, both the GSE and BETTER mechanisms of counselling had better outcomes pertaining to sexual assertiveness and sexual behavior, respectively. Studies reporting on body image demonstrated significant improvements using the GES couple-based, GSE, and PLISSIT models.

No effective communication tools for improving outcomes related to menstrual symptoms or contraceptive use have been identified. Although clinical improvements were observed in both domains when using a web-based educational program, they were not statistically significant.

Conclusion

Counselling as an intervention was the most effective and commonly researched communication tool, reporting significant improvements with various models demonstrating improvement in either fertility or sexual dysfunction outcomes, although none of the models showed higher scores in both domains. The PLISSIT model is the most studied and frequently utilized framework; however, emerging models of counselling, such as BETTER and GSE, may be more effective in improving outcomes, especially with regard to sexual dysfunction, and warrant further investigation. Additionally, this review identified menstruation and contraception needs as understudied despite acknowledged unmet needs in patients with cancer, underscoring a significant gap in the current research landscape that demands attention.