« Figure it out on your own »: a mixed-method study on pelvic health survivorship care after gynecologic cancer treatments

Abstract Purpose. Pelvic health issues after treatment for gynecological cancer are common. Due to challenges in accessing physiotherapy services, exploring virtual pelvic healthcare is essential. This study aims to understand needs, preferences, barriers, and facilitators for a virtual pelvic healthcare program for gynecological cancer survivors. Methods. A multi-center, sequential mixed-methods study was conducted. An anonymous online survey (N=50) gathered quantitative data on pelvic health knowledge, opportunities, and motivation. Focus groups (N=14) explored patient experiences and consensus on pelvic health interventions and virtual delivery. Quantitative data used descriptive statistics and focus group analyses employed inductive thematic analysis. Findings were mapped to the Capability, Opportunity and Motivation (COM-B) behavior change model. Results. Participants reported lacking knowledge about pelvic health interventions and capability related to the use of vaginal dilators and continence care. Barriers to opportunity included lack of healthcare provider initiated pelvic health discussions, limited time in clinic with healthcare providers, finding reliable information, and cost of physical therapy pelvic health services. Virtual delivery was seen favorably and may help to address motivational barriers related to embarrassment and frustration with care. Conclusion. Awareness of pelvic healthcare is lacking among people treated for gynecological cancer. Virtual delivery of pelvic health interventions is perceived as a solution to enhance access while minimizing travel, cost, embarrassment, and exposure risks. Implications for cancer survivors. A better understanding of the pelvic health needs of individuals following gynecological cancer treatments enables the development of tailored virtual pelvic floor rehabilitation interventions which may improve access to pelvic health survivorship care.