| Objective:1.Evaluate the prevalence and severity of female sexual dysfunction(FSD)in breast cancer survivors(BCSs).2.Obtain a more in-depth understanding of sexual experiences of BCSs in China.3.Develop a measurement tool for evaluating sexual quality of life in BCSs and carry out respective reliability and validity testing in order to ultimately achieve the purpose of reducing the prevalence and severity of sexual dysfunction in BCSs and promote women's health in China.Methods:Mixed methods research1.Prevalence and severity of FSD in BCSs: Meta-analysis A database search was conducted on CNKI,Pub Med,Cochrane,and six other large databases for studies from April 1,2000 to December 31,2016 that involved the female sexual function index(FSFI).A meta-analysis was performed on 21 eligible articles to evaluate the prevalence of sexual dysfunction and sexual function in BCSs and determine the differences between China and other countries.2.Sexual experiences of BCSs Using descriptive phenomenological methods,19 BCSs were interviewed between June 2015 to December 2015 and information was collected via voice recording.By using content analysis to analyze the data,the research framework and theme of research was refined to obtain a deeper understanding of sexual experiences and sexual changes in BCSs.3.Develop a questionnaire to measure sexual quality of life of BCSs A sexual quality of life questionnaire for BCSs(45 items)was constructed based on the established theme and framework and review of relevant literatures.From October 2016 to January 2017,246 eligible BCSs who have prescriptions or follow-ups with the Breast Surgery Department of the First Affiliated Hospital of China Medical University,Shenyang,and the Breast Surgery Clinic of Tangshan City People's Hospital were investigated with this questionnaire to determine its final items,reliability and validity.Results:1.Prevalence and severity of FSD in BCSs(1)The results of combined studies indicated that the prevalence of FSD in BCSs was 73.4%(95%CI 64.0%-82.8%);Subgroup analysis showed a statistically significant difference in FSD prevalence among BCSs in Asia,the Americas and Europe(P<0.05);And there was marginal statistical difference in the prevalence of BCSs with FSD between mainland China and other countries(P=0.06).(2)The results of combined studies indicated that the overall score of sexual function is 19.28(95%CI:17.39-21.16).The sexual function levels(FSFI's score)among BCSs in Asia,the Americas and Europe had marginal statistical significance(P=0.07).(3)The results of combined studies indicated that scores of BCSs' sexual desire,sexual arousal,vaginal lubrication,orgasm score,sexual satisfaction,algopareunia were 2.95(95%CI 2.59-3.31),3.08(95%CI 2.69-3.48),3.27(95%CI 2.87-3.67),3.18(95%CI 2.81-3.54),3.54(95%CI 2.92-4.16),3.72(95%CI 3.20-4.25);The sexual desire and algopareunia among BCSs in Asia,the Americas and Europe had statistically significant difference(P<0.05).2.Sexual experiences of BCSs(1)The post-operative resumption of sexual activity for BCSs was delayed,ranging from one week post-discharge to indefinitely.Most BCSs resumed sexual activity in about 6 months.Although most BCSs and their sexual partners were able to achieve successful mutual adaptation,the processes were difficult.(2)The framework and themes of the sexual life of BCSs included four dimensions: sexual physiology(senescence),sexual psychology(sex-negativity),sexual socialization(changes in marital relationships,passiveness),and sexual culture(sexual shame).(3)The changes in the relationships between husband and wife in the social dimension were manifested as a development of "polarization".The passive coping style was shown through a "demand but not seeking" manner toward sex.3.The development of the sexual quality of life questionnaire for BCSsA questionnaire of 28 items was developed,8 items(sexual pgysiology),7 items(sexual psychology),5 items(sexual relationship),5items(sexual image),3 items(sexual cognition).(1)Validity(1)Content validity: The content validity index ranged from 0.8 to 1.0(0.8608±0.2479);(2)Construct validity: Five factors(sexual physiology,sexual psychology,sexual relationship,sexual body Image,and sexual cognition)were extracted using exploratory factor analysis,accounting for 60.37%.The factor loadings for each item of the questionnaire were above 0.4.Structure equation modeling by AMOS further verified that the questionnaire had good construct validity;(3)Criterion validity: The correlation coefficients between the sexual quality of life questionnaire for BCSs and the FSFI,the SDS,and the Locke-Wollance marital adjustment scale were 0.402,-0.356,and 0.315 respectively(P<0.01).(2)Reliability(1)Internal consistency reliability: The overall Cronbach's alpha coefficient of the questionnaire was 0.929.Cronbach's alpha coefficients for each of the 5 factors ranged between 0.571 and 0.869;(2)Test-retest reliability: The correlation coefficient for the overall questionnaire was 0.816,the correlation coefficients for each of the 5 factors ranged from 0.685 to 0.847(P<0.01);(3)Split-half reliability: Guttman split-half coefficient was 0.899.Conclusion:1.The prevalence of SD in BCSs is high and poses a serious problem.The results of studies indicated that the prevalence of FSD in BCSs in China was significantly higher than other countries in the world.There is an urgent need to improve the nursing evaluation system of BCSs with sexual dysfunction and to improve the intervention program.2.From the point of view of the patients,the diagnosis and treatment of breast cancer in China has proven to have a negative impact on patients' sexual lives,such as on sexual physiology,sexual psychology,marital relationship,sexual body image,and sexual cognition.Most BCSs had a passive approach to sex and could not respond effectively.Therefore,it is badly needed to carry out nursing intervention for SD in order to improve the quality of life of patients.3.Influenced by the unique social and cultural background of China,the sexual quality of life questionnaire for BCSs based on patients own experiences displayed good reliability and validity.It can be used as an assessment tool in clinical nursing work to promote application and further validation. |
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