Table 3.
Outcomes regarding effectiveness of tools supporting communication about intimacy and sexuality
| Outcomes related to intimacy and sexuality | ||||
| First author, year | Tool (model, programme, intervention, components, duration) | Sexual functioning | Other outcomes related to intimacy or sexuality | MMAT1 |
| Akeflo, 2022 [38] |
PLISSIT2 Nurse-led intervention with visits and/or phone calls or digital meetings, applied 3 months to several years (individualized care) |
Sexual functioning assessed with a self-developed questionnaire, reported reduced genital pain (p3 < .05) and decrease in ability to have an orgasm (p < .05) post intervention Majority of participants reported no changes in sexual functioning |
Overall sexuality and sexual life assessed with a self-developed questionnaire, reported increased satisfaction with overall sexuality and sexual life post intervention (p < .05) | * |
| De Almeida, 2020 [39] |
PLISSIT counselling, five weekly sessions of 1.5 h each Control group received one lecture (2 h) |
Sexual function, assessed with FSFI4 (ns5) | *** | |
| Bokaie, 2022 [41] | Problem-solving approach (sessions), counselling, eight weekly sessions, 90 min per session | Sexual function assessed with FSFI, improved function at follow-up as compared to baseline (p < .001) | Sexual satisfaction assessed with Larson questionnaire, higher satisfaction at follow-up as compared to baseline (p < .01) | *** |
| Chambers, 2015 [43] | DVD and tip sheet and sessions, counselling, six–eight telephone sessions delivered by nurses (intervention 1) or by peers (intervention 2) | Sexual function assessed with IIEF6 (men, ns) or FSFI (women, ns) |
Utilization of erectile dysfunction treatments, in intervention groups higher as compared to control (p < .05) Sexual self-confidence assessed with the Psychological Impact of Erectile Dysfunction – Sexual Experience (ns) Marital satisfaction assessed with the Revised Dyadic Adjustment Scale (ns) |
** |
| Cullen, 2021 [45] | Online couple based psychosexual intervention, six sessions | The intervention programme deepened emotional intimacy and connection. Also, it improved sexual relationship and sexual communication (qualitative data) | ** | |
| Du, 2020 [46] | Group intervention with education sessions, seven sessions of at least 30 min | Sexual function assessed with FSFI, improved function in the intervention group as compared to control (p < .05) | ** | |
| DuHamel, 2016 [47] |
Sessions and booster call, educational intervention, four sessions of 1 h, booster call between sessions Control group: no calls |
Sexual function assessed with FSFI (ns) | * | |
| El- Sayed Saboula, 2015 [48] | PLISSIT, counselling, six sessions lasting 2 h each during 3 weeks | Sexual function assessed with FSFI, improved function post intervention as compared to baseline (p < .05) | Couple satisfaction assessed with Revised dyadic adjustment scale, improved satisfaction post intervention (p < .001) | ** |
| Faghani, 2016 [50] |
PLISSIT Counselling, 4 × 90-min sessions Control group: no intervention |
Sexual function assessed with FSFI, improved function in the intervention group as compared to control (p < .05) and improved function post intervention as compared to baseline in the counselling group (p < .01) | *** | |
| Fatehi, 2019 [51] | Schover’s sexual assessment method, psychosexual counselling, six weekly sessions of 90–120 min | Sexual function assessed with FSFI, improved function in intervention group as compared to control (p < .001) | Sexual satisfaction assessed with Larson Inventory of Sexual Satisfaction (ISS) (ns) | **** |
| Jonsdottir, 2021 [52] | Couple based Strengths-Oriented Therapeutic Conversation (CO-SOTC), three sessions of 45 min | Sexual concerns assessed with Sexual Concern Questionnaire (SCQ), reduced concerns post intervention as compared to baseline (p < .05) | *** | |
| Jonsdottir, 2021 [53] | Couple based Strengths-Oriented Therapeutic Conversation (CO-SOTC), three sessions of 45 min | Quality of relationship assessed with Partnership Questionnaire, improved quality post intervention as compared to baseline in women and partners (p < .05) | *** | |
| Keshavarz et al., 2021 [54] |
PLISSIT Counselling, seven sessions of 60 min for 4 weeks |
Sexual function assessed with FSFI, improved function post intervention as compared to baseline (p < .01) | Sexual distress assessed with FSDS-R7, reduced distress post intervention as compared to baseline (p < .01) | *** |
| Khoei, 2022 [55] |
PLISSIT (individual) and Grouped Sexuality Education (group) Counselling, one–three sessions of 40–60 min (individual) or 6-h workshop (group) |
Sexual behaviour assessed with Sexual Behaviour Questionnaire: - Between groups: improved sexual behaviour in GSE8-group as compared to control (p < .001) - Within groups: Improved sexual behaviour in GSE group and in control group post intervention as compared to baseline (p < .001) - PLISSIT group (ns) |
** | |
| Li et al., 2023 [56] |
Systematic Transactional Model of Stress and Coping; psychosocial intervention programme (WeChat), 8-week programme Control group: six articles received over an 8-week period |
Sexual function assessed with FSFI (ns) | Relationship satisfaction assessed with Chinese version of the Revised Dyadic Adjustment Scale (CR-DAS), indicating significant improvement post intervention as compared to baseline for both patients (p = .001) and partners (p < .05) | ** |
| Maughan, 2001 [57] |
Information, advice and support, psychosexual intervention by Clinical Nurse Specialist, with visit prior to surgery and home visits (3 on average) Control group had no visits |
Sexual functioning assessed with Lasry Sexual Functioning Scale (ns) | * | |
| Mohammadi, 2022 [59] |
EX-PLISSIT9, Counselling, four weekly sessions lasting 60–90 min Control group: one online session |
Sexual function assessed with FSFI, significantly higher overall sexual function post intervention compared to baseline in both groups (p < .001) | **** | |
| Olcer, 2022 [60] |
BETTER10 Counselling, four sessions with 1-week interval |
Sexual functioning assessed with FSFI, improved functioning after counselling as compared to control group after 4 weeks (p < .05) |
Relationship satisfaction measured with the Brief Dyadic Adjustment Scale (BDAS), in self-help group improved dyadic adjustment and a lower level of distress as compared to baseline (p < .05) Satisfaction with sexual relationship assessed with one question (ns) |
***** |
| Perz, 2015 [61] |
PLISSIT Self-help booklet consisting of 68 pages providing self-help information (group) or information and 1-h telephone consultation (group 2) |
Sexual function assessed with the Changes in Sexual Functioning Questionnaire (CSFQ-14)(ns) | * | |
| Reese, 2012 [62] |
Intimacy Enhancement Intervention, Counselling, four phone-based sessions of 50 min |
Sexual function assessed with FSFI (female) and IIEF (men), indicating improved female functioning post intervention as compared to baseline (effect size 1.15) and little improvement in male functioning |
Sexual distress assessed with the Index of Sexual Satisfaction, indicating decrease in sexual distress post intervention as compared to baseline (effect size − 1.01) Intimacy assessed with Miller Social Intimacy Scale, indicating little improvement Dyadic adjustment assessed with Dyadic Adjustment Scale, indicating medium effect size |
** |
| Reese, 2021 [63] |
Starting the Conversation, Online patient training including video slideshow (20 min) and five-page workbook |
Sexual function assessed with items from the PROMIS SexFS11 Brief Profile version 2.0, indicating more women being sexually active in intervention group as compared to control (p < .05) | *** | |
| Taleb, 2023 [67] |
Structured sessions, nursing intervention consisting of 5 sessions |
Erectile function assessed with the Sexual Health Inventory for Men (SHIM), indicating improved sexual function post intervention (p < .05) | *** | |
| Outcomes related to quality of life | ||||
| First author, year | Tool (model, programme, intervention, components, duration) | Quality of Life overall | Related to quality of life | MMAT |
| Akeflo, 2022 [38] |
PLISSIT Nurse-led intervention with visits and/or phone calls or digital meetings, applied 3 months to several years (individualized care) |
Quality of life assessed with several items in a self-developed questionnaire, reported significantly increased level of quality of life post intervention (p < .001), significant reduced depressive mood (p = .003) and significant reduction of anxious mood (p < .001) | * | |
| De Almeida, 2020 [39] |
PLISSIT counselling, five weekly sessions of 1.5 h each Control group received one lecture (2 h) |
Quality of life, assessed with WOHQOL-BREF12 (ns) | *** | |
| Bokaie, 2023 [42] |
Solution-focused approach, online counselling, eight weekly sessions, 90 min per session Control group: educational pamphlet to read every 3 weeks |
Sexual quality of life assessed with the Sexual Quality of Life (SQL) Questionnaire, significant increase in sexual quality of life post intervention as compared to baseline (p < .05) | *** | |
| Chow, 2014[44] |
Structured sessions, psycho-educational intervention programme, three individual sessions and one group session Control group received attention on four occasions |
Quality of life assessed with TCHI FACT-G13 (ns) | ** | |
| Du, 2020 [46] | Group intervention with education sessions, seven sessions of at least 30 min | Quality of life assessed with EORTCQ-QLQ-C3014 (ns) | Depression assessed with the self-rating depression scale (SDS), improved depression scores in intervention and control group, with lower scores in Intervention group as compared to Control group (p < .05) | ** |
| DuHamel, 2016 [47] |
Sessions and booster call, educational intervention, four sessions of 1 h, booster call between sessions Control group: no calls |
Quality of life assessed with EORTC-QLQ-C30 (ns) | * | |
| El- Sayed Saboula, 2015 [48] | PLISSIT, counselling, six sessions lasting 2 h each during 3 weeks |
Side effects of treatment, reduced side effects regarding nausea and vomiting, diarrhoea and pain post intervention (p < .05) Body image assessed with Body Image Scale, improved post intervention (p < .05) |
** | |
| Esmkhani, 2021 [49] |
PLISSIT (individual) and Sexual Health Model [SHM] (group), counselling, one–three sessions of 40–60 min (individual), 6-h workshop (group) Control group received usual care |
Quality of life assessed with EORTC QLQ C30 (ns) | ** | |
| Faghani, 2016 [50] |
PLISSIT Counselling, 4 × 90-min sessions Control group: no intervention |
Quality of life assessed with the Sexual Quality of Life-Female (SCOL-F)(ns) | *** | |
| Fatehi, 2019 [51] | Schover’s sexual assessment method, psychosexual counselling, 6 weekly sessions of 90–120 min | Quality of life assessed with Sexual Quality of Life-Female (SCOL-F), with higher levels of sexual quality of life in intervention as compared to control at follow-up (91.0 and 38.2, respectively; p < .001) | **** | |
| Keshavarz, 2021 [54] | PLISSIT counselling, 7 × 60-min sessions | Quality of life assessed with WHOQOL-BREF: Improved quality of life post intervention (p < .01) | *** | |
| Li, 2023 [56] |
Systematic Transactional Model of Stress and Coping; psychosocial intervention programme (WeChat), 8-week program Control group: six articles received over an 8-week period |
Quality of life assessed with the Functional Assessment of Cancer Therapy-General (FACT-G), significant improvement for patients in overall quality of life as compared to baseline (p < .05). Also significant improvement in subdomains physical well-being (p < .05), social well-being (p < .05) and functional well-being (p < .05) Partners in the intervention group only had significant improvement on the subdomain physical health (p < .05) compared to control group |
** | |
| Maughan, 2001 [57] |
Information, advice and support, psychosexual intervention by Clinical Nurse Specialist, with visit prior to surgery and home visits (3 on average) Control group had no visits |
Quality of life assessed with EORTC QLQ-C30, improved global health status (p < .05) and less sleep disturbances (p < .05) post intervention as compared to baseline in intervention group | * | |
| Mohammadi, 2022 [59] |
EX-PLISSIT, Counselling, four weekly sessions lasting 60–90 min Control group: one online session |
Sexual quality of life assessed with the Sexual Quality of Life-Female (SQL-F) questionnaire, indicating higher scores on overall SQL post intervention (ns) | **** | |
| Olcer, 2022 [60] | BETTER, Counselling, four sessions with 1-week interval | Quality of life assessed with EORTC-BR2315, no significant difference between counselling and control group (ns) | Presence of body image issues assessed with Body Cathexis Scale, no significant difference between counselling and control group (ns) | ***** |
| Perz, 2015 [61] |
PLISSIT Self-help booklet consisting of 68 pages providing self-help information (group) or information and 1-h telephone consultation (group 2) |
Quality of life assessed with Medical Outcomes Study Health Survey Short Form (SF-12) (ns) | Psychological well-being assessed with Hospital Anxiety and Depression Scale (HADS) (ns) | * |
| Reese, 2021 [63] |
Starting the Conversation, Online patient training including video slideshow (20 min) and five-page workbook |
Quality of Life assessed with FACT-B16 (ns) | Psychological distress assessed with HADS17, indicating reduced anxiety in intervention group as compared to control (p < .05) | *** |
| Reese, 2023 [64] | Starting the Conversation, educational intervention for patients including video slideshow (23 min) and five-page workbook |
Psychological distress assessed with the Hospital Anxiety and Depressions Scale Anxiety (HADS-A), indicated small improvement regarding anxiety post intervention (no information about significance provided) Depressive symptoms assessed with the Hospital Anxiety and Depression Scale depressive symptoms (HADS-D), indicated no effect post intervention (no information about significance provided) |
*** | |
| Shalamzari, 2022 [66] |
PLISSIT and BETTER-model, Counselling, four sessions of 60–90 min with 1-week interval |
Sexual quality of life assessed with Sexual Quality of Life Questionnaire Female (SQoL-F) indicated an increase in quality of life in both groups post intervention as compared to baseline (p < .01), with higher scores in the BETTER group. No difference was found between groups in mean changes post intervention as compared to baseline | **** | |
| Outcomes related to quality of care | ||||
| First author, year | Tool (model, programme, intervention, components, duration) | Satisfaction with communication | Other outcomes related to Quality of Care | MMAT |
| Bingham, 2022 [40] | Engagement, Assessment, Support and Signposting (EASSi) framework, one-time training (eLearning), duration approximately 1 h | Sexual attitudes and beliefs assessed with the modified Sexual Attitudes and Beliefs Survey (SABS), significant increase post intervention compared to baseline (p < .001) | ** | |
| McCaughan, 2020 [19] |
EASSi18 framework (Tablet-based) Training (e-learning) of 30 min to use tool |
Sexual well-being attitudes and beliefs, assessed with patient survey, indicating that the tool helped in discussing sexual well-being | ** | |
| McCaughan, 2021 [58] | EASSi framework, brief e-learning consisting of three sections | Sexual attitudes and beliefs assessed with the modified Sexual Attitudes and Beliefs Survey (SABS), no significant difference in overall scores after completing the e-learning as compared to baseline (ns) | * | |
| Perz, 2015 [61] |
PLISSIT Self-help booklet consisting of 68 pages providing self-help information (group) or information and 1-h telephone consultation (group 2) |
Sexual communication assessed with Dyadic Sexual Communication scale (ns) | * | |
| Reese, 2012 [62] |
Intimacy Enhancement Intervention, Counselling, four phone-based sessions of 50 min |
Sexual communication assessed with Dyadic Sexual Communication Scale, indicating improved communication post intervention as compared to baseline (effect size 0.82) | ** | |
| Reese, 2019 [34] |
PLISSIT Training to equip clinicians for counselling, two modules 15 and 60 min) |
Clinical communication assessed with audio recordings of encounters, indicating an increase in discussing sexual health and an improvement of communication behaviours post intervention as compared to baseline (no information about significance) | Patient satisfaction assessed with the Consumer Satisfaction Index (ns) | * |
| Reese, 2021 [63] |
Starting the Conversation, Online patient training including video slideshow (20 min) and five-page workbook |
Clinical communication behaviours assessed with audio recorded clinical encounters, indicating greater odds of asking a question about sexual health in the intervention group as compared to control (OR19 2.85 [1.27–6.38], p < .05) | *** | |
| Reese, 2023 [64] | Starting the Conversation, educational intervention for patients including video slideshow (23 min) and five-page workbook | Self-efficacy for sexual health communication assessed with two items indicated increased self-efficacy for communication about sexual health post intervention (no information about significance provided) | *** | |
| Roberts, 2020 [65] | Brief Sexual Symptom checklist for Women applied in routine care | Referral to sexual counsellor or pelvic floor physiotherapist ascertained from medical records, indicating no significant difference in referrals in intervention group as compared to control | ** | |
| Wang, 2022 [68] | EX-PLISSIT applied in training for HCPs20 |
Baseline knowledge and comfort with conversations assessed with HCP survey, indicating an increase in conversations after training (no information about significance provided) Frequency of and satisfaction with conversations about relationship, body image and intimacy assessed through patient survey, indicating conversations in 74% of patients |
- | |
| Zhang, 2022 [69] |
Structured sessions, Nurse-led intervention, monthly sessions of 4 h, lasting for three consecutive treatment cycles |
Marital quality assessed with Olson Marital Quality Questionnaire (ENRICH), indicating post intervention an improved communication in the intervention group as compared to control (p < .05) and no significant difference in marital satisfaction or sexual life between intervention and control group (ns) | ***** | |
Abbreviations:
1MMAT Mixed Methods Appraisal Tool
2PLISSIT Permission, Limited Information, Specific Suggestions, Intensive Therapy
3P P-value
4FSFI Female Sexual Function Index
5NS not significant
6IIEF International Index of Erectile Function
7FSFD-R Female Sexual Distress Scale-Revised
8GSE Grouped Sexual Education
9EX-PLISSIT Extended-PLISSIT
10BETTER Bring up the topic, Explain, Telling, timing, Education, Recording
11PROMIS SexFS Patient Reported Outcomes Measurement Information System Sexual Functioning and Satisfaction
12WOHQOL-BREF World Health Organization Quality of Life – Brief Version
13TCHI-FACT-G Traditional Chinese Version of Functional Assessment of Cancer Therapy-General
14EORTC-QLQ-C30 European Organization for Research and Treatment for Cancer Quality of Life Questionnaire
15EORTC-BR23 European Organization for Research and Treatment of Cancer Quality of life Questionnaire Breast
16FACT-B Functional Assessment of Cancer Therapy-Breast
17HADS Hospital Anxiety and Depression Scale
18EASSi Engagement, Assessment, Support and Signposting
19OR odds ratio
20HCPs Healthcare professionals