title: Chore or priority? Barriers and facilitators affecting dilator use after pelvic radiotherapy for gynaecological cancer.
abstract: OBJECTIVE
  Pelvic radiotherapy for gynaecological cancer often leads to damage of the vaginal mucosa, resulting in stenosis (obstruction by scar tissue). Stenosis has been associated with sexual dysfunction and can hinder medical examinations to detect recurrence. The use of vaginal dilators is frequently recommended to prevent or minimise stenosis, but women are reluctant to use these devices. The aim of this study was to explore the patient experience of dilator use and identify the barriers and facilitators affecting compliance with clinician recommendations.
  
  
  METHODS
  Women were eligible for the study if they had undergone pelvic radiotherapy for gynaecological cancer up to 2 years ago and received a vaginal dilator as part of their post-treatment rehabilitation. Fifteen participants completed a semi-structured interview.
  
  
  RESULTS
  Barriers to dilator use included: uncertainty about how/when to use dilators, viewing it as a negative experience, lack of time or forgetting and the need for discretion due to an association with sex aids. Facilitators included: concern about stenosis, belief that dilators work, reminders of stenosis, acceptance of dilator use as part of their normal routine or an extension of medical treatment and focusing on positive aspects. These factors were incorporated into a model of dilator use based on the Health Belief Model.
  
  
  CONCLUSIONS
  This is the first qualitative study to specifically investigate the patient experience of dilator use. The barriers and facilitators identified in this study and the proposed theory-based model provide new insights to inform future research and clinical management of dilator use.
authors.affiliation: Centre for Medical Psychology & Evidence-based Decision-making, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Carissa
authors.initials: C
authors.lastname: Bonner
authors.forename: Kathryn
authors.initials: K
authors.lastname: Nattress
authors.forename: Caroline
authors.initials: C
authors.lastname: Anderson
authors.forename: Jonathan
authors.initials: J
authors.lastname: Carter
authors.forename: Chris
authors.initials: C
authors.lastname: Milross
authors.forename: Shannon
authors.initials: S
authors.lastname: Philp
authors.forename: Ilona
authors.initials: I
authors.lastname: Juraskova
mesh_terms: D000328:Adult; D000368:Aged; D003251:Constriction, Pathologic / Q000628:therapy; D004106:Dilatation / Q000295:instrumentation*; D005260:Female; D005833:Genital Neoplasms, Female / Q000532:radiotherapy*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008875:Middle Aged; D009517:New South Wales; D010349:Patient Compliance; D010388:Pelvis / Q000000981:diagnostic imaging*; D036301:Qualitative Research; D011859:Radiography; D011878:Radiotherapy / Q000009:adverse effects; D014621:Vagina / Q000473:pathology / Q000528:radiation effects*