Amita Kulkarni

Can we talk about sex? Feasibility of universal sexual health screening for BRCA1/2 patients

Abstract Background Risk-reducing salpingo-oophorectomy for ovarian cancer risk reduction in individuals with BRCA1/2 pathogenic variants can cause sexual dysfunction, yet sexual health discussions between patients and providers remain limited. Aim We describe the feasibility of universal sexual health screening and rates of sexual health dysfunction among individuals with BRCA1/2 pathogenic variants. Methods Patients with BRCA1/2 pathogenic variants presenting to an outpatient gynecologic oncology clinic from January 2022 to February 2023 were offered a sexual health screener. The screener combined a validated, single-item sexual dysfunction assessment with three additional questions exploring discussions of sexual health with healthcare providers, desire for information about sexual health, and preferred methods for delivery of information. Outcomes The primary outcome was the proportion of patients who completed the sexual health screener and the secondary outcomes included rate of sexual dysfunction and impact of patient characteristics on sexual dysfunction. Results Among 103 patients offered the sexual health screening, 100% completed it. Median age was 42 years (range 25-84). Eighty three (81%) patients self-identified as White, 32 (31%) patients had a history of cancer, 42 (41%) had undergone risk-reducing salpingo-oophorectomy, and 47 (46%) were pre-menopausal. Thirty seven (36%) patients screened positive for sexual dysfunction. Among patients with premature menopause following salpingo-oophorectomy, 6/15 (40%) on hormone replacement therapy reported sexual dysfunction versus 6/10 (60%) not on hormone replacement therapy (P = .43). Across all patients, 38 (37%) had never previously discussed sexual health concerns with a provider. There were no significant differences in sexual dysfunction rates based on any measured patient characteristics. Clinical Implications Universal sexual health screening for individuals with BRCA1/2 pathogenic variants is feasible and may provide an avenue for more in-depth discussion with at-risk patients, who may not have previously discussed this issue with their medical team. Strengths and Limitations Our study found that it was feasible to administer a sexual health screening tool among an at-risk patient population in a clinical setting. Generalizability may be limited due to the composition of our cohort, which was small, majority White and non-Hispanic, and from a single institution. Conclusion Providers should consider implementing standardized sexual health screening practices among patients with BRCA1/2 pathogenic variants. Research highlights

Bridging Gaps in Cervical Cancer Care: A Web-Based Intervention to Improve Knowledge and Follow-up

Objectives Contributors to disparities and worse cervical cancer outcomes include limited education and loss to follow-up after an abnormal Pap smear. Effective interventions are necessary to engage diverse populations. The authors piloted an intervention to assess acceptability, knowledge uptake, and follow-up. Materials and Methods This prospective pilot study recruited patients scheduled for colposcopy visits at a government-insured clinic and faculty clinics within an academic medical center to use the Patient Activated Learning System (PALS). The PALS intervention included 5 short educational videos about human papillomavirus and colposcopy. Participants completed a baseline knowledge questionnaire, viewed PALS videos followed by post-intervention knowledge and acceptability surveys. Perceptions of PALS, anxiety, and impact on follow-up were evaluated. Results Of 63 (70%) participants completing the intervention, 24 (38%) were from the government-insured clinic and 39 (62%) from faculty clinics. Median age was 36 (range 30–48), 38 (63%) were racial and ethnic minorities, and 21 (33%) were non-Hispanic White. The intervention improved knowledge scores for the entire cohort (60%–75%, p < .01), even when stratified by race/ethnicity (p < .01 for all), income (p < .01), education (p < .01), practice (p < .01), and insurance type (p < .001). Participants found PALS convenient to use (4.6/5), enjoyable (4.2/5), and acceptable (4.6/5); 75% said the videos alleviated colposcopy-related anxiety, and 84% indicated PALS made them more likely to follow up. The guideline concordant follow-up rate among study completers was 73%. Conclusion In this pilot study, PALS was effective and acceptable among a diverse cohort. These free, widely viewed videos can successfully engage diverse populations to improve colposcopy knowledge and follow-up.