eSense-Cancer: Adapting an Online Intervention for Sexual Health Concerns to Gynecologic Cancer (eSense-Cancer)

Sexual health is a vital component of gynecologic cancer treatment and survivorship. Unfortunately, most gynecologic cancer survivors lack sufficient information about the impact of cancer on sexual health and treatment opportunities. This research aims to assess how well an adapted online health intervention meets the sexual health needs of gynecologic cancer survivors and to test the efficacy of the new platform. If successful, eSense-Cancer may increase access to treatment for gynecologic cancer survivors, including those living in remote areas or facing other accessibility barriers. It may also fill healthcare gaps for survivors of varying ethnicity, sexual orientation, socioeconomic status, and gender.

Study Overview

• Status: Recruiting
• Conditions: Gynecologic Cancers
• Intervention / Treatment: Behavioral: eSense-Cancer CBT: an online cognitive-behavioural therapy based intervention for sexual health concerns after gynecologic cancer; Behavioral: Navigator support for eSense-Cancer; Behavioral: Behavioral: eSense-Cancer MBT: an online cognitive-behavioural therapy based intervention for sexual health concerns after gynecologic cancer

Detailed Description

Once participants have consented to participate in the study, they will complete baseline questionnaires, then undergo a 4-week waiting period. After this 4 week waiting period, they will complete a second baseline questionnaire, and then be randomized to one of four arms:

• CBT with navigator support (n=15)
• CBT with no navigator support (n=15)
• MBT with navigator support (n=15)
• MBT with no navigator support (n=15)

Participants will receive an online link to complete the questionnaires consisting of demographics, primary outcomes (sexual distress; FSDS-R, and sexual function; PROMIS SexFS measure adapted for cancer survivors). For those in the navigator support arms, before beginning the eSense-Cancer modules, participants will have an initial 15-30 minute conversation via the UBC-hosted version of Zoom with their assigned navigator, who will explain their role.

Following this meeting, participants will gain access to the CBT or MBT arm of eSense-Cancer and receive an individualized link to access eSense-Cancer. They will work through one module weekly/biweekly (on their own time) and complete the related exercise during that week. This process should take 8-16 weeks. After each module, they will complete a questionnaire to assess usability of the module just completed.

For those in the navigator arms, when participants complete a module, they will fill out their calendar preferences to find a day and time to meet with their navigator over the next week. The navigator will receive an automatic email when their assigned participant has finished a module. If a week has passed and participants have not scheduled a time to meet with their navigator, the navigator will email the participant to schedule their meeting. These meetings will entail 2-3 minutes of general introduction, 10-15 minutes to check in on any eSense-Cancer-related concerns or questions that arose over the week, and 2-3 minutes to close and schedule their next session, for a total of 15-25 minutes.

Navigators will be current or graduated psychology undergraduate students with a GPA of 3.5, coursework or experience with research methods/clinical psychology/human sexuality. Navigators must be available to complete training and commit a minimum of a year to the project. As a licensed clinical psychologist, Dr. Brotto will interview potential navigators to assess their interpersonal skills, ability to listen empathetically, and comfort in discussing sexual issues. Navigators will receive training from co-investigator, Dr. Kyle Stephenson and other study team members to minimize inter-navigator variation. Navigators will have access to both treatment arms to familiarize themselves with eSense-Cancer content. They can choose whether they want to navigate participants in the CBT or MBT arms based on their interests. They will also be given a reading list relevant to treating women's sexual concerns.

After participants complete the final eSense-Cancer module, they will fill out a post-treatment set of questionnaires online. Using the evidence-based framework for feasibility testing, the investigators plan to measure the feasibility dimensions of:

• acceptability: how participants reacted to eSense- Cancer
• implementation: whether the program can be delivered online
• practicality: the ability of a small team to deliver the intervention without providing individualized guidance to participants)
• adaptation: whether the various skills and mindfulness exercises could be delivered online and if participants reported engaging with them)
• limited efficacy testing.

Specific measures include (a) global impressions of eSense-Cancer, (b) preliminary clinical outcomes and (c) navigator-related measures (only administered in the navigator arms):

1. . Global impressions of eSense-Cancer: After completing module 8, participants in both arms will be sent a link and asked qualitative questions on their impressions of the intervention

2. Clinical outcomes:

   1. Sexual distress (FSDS-R)
   2. Sexual function (PROMIS SexFS)

3. Navigator-related measures:

   1. Empathy subscale of Barrett-Lennard Relationship Inventory, a valid measure of perceived provider empathy that predicts outcomes in CBT
   2. Perceived navigator effectiveness with the Working Alliance Inventory, Short Form
   3. Amount of time spent with the participant; each navigator will track how long they spend and engage with each of their assigned participants throughout the eight modules.

The investigators will also use a validated measure of treatment acceptance (Treatment Evaluation Inventory), which has been described as the goodness of fit between the intervention and the system from which it is disseminated), including:

1. The number screened who are appropriate based on study inclusion/exclusion criteria, and from that figure, the number that enrolled in the study.
2. The percentage of participants that completed each intervention module and the entire protocol.
3. The percentage of participants lost to follow-up.

Participants will only receive access to one arm of eSense-Cancer, not both given that our goal is to measure and compare the feasibility and effect size of both arms separately.

Participants' treatment compliance will be measured:

• by recording the number of weeks and treatment sections completed
• through eSense website engagement and performance by a user engagement tracking platform (e.g. page views, #visits/sessions, page views/visits, visit duration, unique/returning users
• by a homework completion measure on a Likert scale ranging from [did not attempt] to [completed all assignments] weekly, which navigators will ask participants to complete
• by having participants complete the Homework Rating Scale (HRS) after each module to provide a comprehensive measure of experience with the homework
• by measuring navigator adherence to study guidelines by recording a random 20% of webcam sessions (with participant knowledge and consent) and coding them for compliance using an adherence scale that the investigators have utilized in the past.

The number of individuals who contact the study coordinator and express interest in the study, regardless of their eligibility, will also be recorded.

During the study, women must agree not to change medications known to have sexual side effects unless directed by their treating physician. (Study investigators will collect data on medication use at each assessment point.) Participants will also be encouraged to limit or eliminate internet research on sexual dysfunction during the trial. The post-treatment questionnaire will assess participant compliance with this request. Past research suggests that this request is feasible.

• Study Type: Interventional
• Enrollment (Estimated): 60
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Nisha Marshall, MSc; Phone Number: 68901 6048754111; Email: nisha.marshall@cw.bc.ca
• Study Contact Backup: Name: Kira McNamee; Phone Number: 68901 6048754111; Email: kira.mcnamee@vch.ca

Study Locations

• Canada
  • British Columbia
    • Vancouver, British Columbia, Canada, V5Z 1M9
      • Recruiting
      • University of British Columbia
      • Contact: Nisha Marshall, MSc; Phone Number: 68901 6048754111; Email: nisha.marshall@cw.bc.ca
      • Contact: Kira McNamee; Phone Number: 68901 6048754111; Email: kira.mcnamee@vch.ca
      • Principal Investigator: Lori A Brotto, PhD, RPsych

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• self-report a current or history of gynecologic cancer of any subtype
• self-report symptoms of sexual difficulties and score of greater than 11 on the Female Sexual Distress Scale-Revised
• are fluent in English (eSense content is delivered in English)
• have reliable internet access and basic competency in using online platforms (individuals will self-report)
• are available for 8 - 16 weeks and able to complete eSense modules and associated questionnaires
• any gender

Exclusion Criteria:

• have visual impairments or disabilities interfering with reading and ability to interact with online materials
• have poorly managed anxiety or mood disorder (assessed using the degree of life interference evaluation at screening)
• individuals who are in active treatment for their cancer (including radiation, chemotherapy and any planned surgeries).

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Factorial Assignment
• Masking: None (Open Label)

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: CBT - Navigator; Participants will complete the CBT arm of eSense with support from a treatment "navigator"	Behavioral: eSense-Cancer CBT: an online cognitive-behavioural therapy based intervention for sexual health concerns after gynecologic cancer; eSense-Cancer CBT is an online, cognitive behavioural therapy based intervention for sexual health concerns after gynecologic cancer. eSense-Cancer CBT contains 8 modules and is intended to be completed over 8-16 weeks. It contains theoretical content, case-based learning, and at-home exercises.; Behavioral: Navigator support for eSense-Cancer; The eSense digital health tool has been previously tested alongside the support of treatment navigators - trained undergraduate students, not licensed therapists, who provide encouragement and answer any questions users may have as they work through eSense.
Active Comparator: CBT - No navigator; Participants will complete the CBT arm of eSense without support from a treatment "navigator"	Behavioral: eSense-Cancer CBT: an online cognitive-behavioural therapy based intervention for sexual health concerns after gynecologic cancer; eSense-Cancer CBT is an online, cognitive behavioural therapy based intervention for sexual health concerns after gynecologic cancer. eSense-Cancer CBT contains 8 modules and is intended to be completed over 8-16 weeks. It contains theoretical content, case-based learning, and at-home exercises.
Active Comparator: MBT - Navigator; Participants will complete the MBT arm of eSense with support from a treatment "navigator"	Behavioral: Navigator support for eSense-Cancer; The eSense digital health tool has been previously tested alongside the support of treatment navigators - trained undergraduate students, not licensed therapists, who provide encouragement and answer any questions users may have as they work through eSense.; Behavioral: Behavioral: eSense-Cancer MBT: an online cognitive-behavioural therapy based intervention for sexual health concerns after gynecologic cancer; eSense-Cancer MBT is an online, mindfulness-based therapy based intervention for sexual health concerns after gynecologic cancer. eSense-Cancer MBT contains 8 modules and is intended to be completed over 8-16 weeks. It contains theoretical content, case-based learning, and at-home exercises.
Active Comparator: MBT - No navigator; Participants will complete the MBT arm of eSense without support from a treatment "navigator"	Behavioral: Behavioral: eSense-Cancer MBT: an online cognitive-behavioural therapy based intervention for sexual health concerns after gynecologic cancer; eSense-Cancer MBT is an online, mindfulness-based therapy based intervention for sexual health concerns after gynecologic cancer. eSense-Cancer MBT contains 8 modules and is intended to be completed over 8-16 weeks. It contains theoretical content, case-based learning, and at-home exercises.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
A change in sexual distress (FSDS-R)	Sexual distress will be measured using the Female Sexual Distress Scale-Revised (FSDS-R). This scale is measured on a scale of 0-52 with higher values representing more distress.	Assessed at enrolment (T1), treatment start (T2) and treatment end (T3). Time between T1 and T2: 4 weeks. Time between T2 and T3: 8-16 weeks
A change in sexual function and satisfaction (PROMIS SexFs)	The PROMIS SexFS scale will be used to measure sexual function and satisfaction. The scale consists of 14 questions with higher scores indicating greater levels of sexual function and satisfaction. Scores are differentially calculated for those who are sexually active versus not sexually active.	Assessed at enrolment (T1), treatment start (T2) and treatment end (T3). Time between T1 and T2: 4 weeks. Time between T2 and T3: 8-16 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Usability of each module	11-items regarding impressions and the ease of use of each module in eSense-Cancer. These are in-house developed items. 5 items are qualitative, 6 items are quantitative.	Assessed after completion of each module. There are 8 modules total. Each module should be completed in 1-2 weeks.
Treatment satisfaction of each module	Face-valid single-item measures, asking participants to rate helpfulness of content covered each week, and ease of reading the content (0-10 scale). Research suggests a cut-off of 6.5/10 on these measures to indicate acceptable utility and clarity of content. Asked after completing each module.	Assessed after completion of each module. There are 8 modules total. Each module should be completed in 1-2 weeks.
Treatment satisfaction as assessed by the adapted Erectile Dysfunction Inventory of Treatment Satisfaction	Adapted Erectile Dysfunction Inventory of Treatment Satisfaction. Scores range from 0-40, with higher scores reflecting higher treatment satisfaction.	Assessed at post-treatment (T3): 8-16 weeks after treatment start
Global Impressions of eSense-Cancer	Global impressions of the intervention will be assessed by adapting questions developed by previous work on eSense. All questions are free-response.	Assessed at post-treatment (T3): 8-16 weeks after treatment start

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Treatment compliance: between-module activity completion assessed by Homework Rating Scale-II (moderator)	Participants complete the Homework Rating Scale-II (HRS-II) after each module. Scores can range from 0-48, with higher scores reflecting high levels of between-module activity completion.	Assessed after completion of each module. There are 8 modules total. Each module should be completed in 1-2 weeks.
Treatment compliance: Participant engagement with website as assessed by user analytics data capturing (moderator)	eSense-Cancer website engagement assessed by user analytics data (e.g., total duration of time on website). This will provide a measure of participant engagement.	Collected throughout engagement with the intervention. Collection will stop at post-treatment (8-16 weeks after treatment start)
Treatment compliance: Number of weeks in program (moderator)	Recording number of weeks participant took to complete the program.	Assessed at post-treatment (T3) (8-16 weeks after treatment start).
Treatment compliance: Number of program modules completed (moderator)	Recording number of program modules participants complete.	Assessed at post-treatment (T3) (8-16 weeks after treatment start)
Perceived navigator empathy (moderator)	Empathy subscale of the Barrett-Lennard Relationship Inventory. Scores range from -48 to 48, with higher scores reflecting that participants perceive higher levels of empathy in their navigator.	Assessed at post-treatment (T3) for those in a navigator support arm (8-16 weeks after treatment start)
Perceived navigator alliance (moderator)	Perceived navigator alliance with the Working Alliance Inventory, Short Form. Scores range from 12-84, with higher levels reflecting that participants perceive higher levels of working alliance with their navigator.	Assessed at post-treatment (T3) for those in a navigator arm (8-16 weeks after treatment start)

Collaborators and Investigators

• Sponsor: University of British Columbia
• Collaborators: Xavier University of Louisiana.
• Investigators: Principal Investigator: Lori A Brotto, PhD, RPsych, University of British Columbia; Principal Investigator: Kyle Stephenson, PhD, RPsych, Xavier University of Louisiana.

Publications and helpful links

General Publications

• Derogatis L, Clayton A, Lewis-D'Agostino D, Wunderlich G, Fu Y. Validation of the female sexual distress scale-revised for assessing distress in women with hypoactive sexual desire disorder. J Sex Med. 2008 Feb;5(2):357-64. doi: 10.1111/j.1743-6109.2007.00672.x. Epub 2007 Nov 27.
• Kazdin AE. Acceptability of alternative treatments for deviant child behavior. J Appl Behav Anal. 1980 Summer;13(2):259-73. doi: 10.1901/jaba.1980.13-259.
• Barrett-Lennard GT. The Relationship Inventory: A Complete Resource and Guide.
• Baker TB, Gustafson DH, Shaw B, Hawkins R, Pingree S, Roberts L, Strecher V. Relevance of CONSORT reporting criteria for research on eHealth interventions. Patient Educ Couns. 2010 Dec;81 Suppl:S77-86. doi: 10.1016/j.pec.2010.07.040. Epub 2010 Sep 16.
• Brotto LA, Stephenson KR, Zippan N. Feasibility of an Online Mindfulness-Based Intervention for Women with Sexual Interest/Arousal Disorder. Mindfulness (N Y). 2022;13(3):647-659. doi: 10.1007/s12671-021-01820-4. Epub 2022 Jan 4.

Study record dates

Study Major Dates

• Study Start (Actual): October 1, 2024
• Primary Completion (Estimated): March 30, 2026
• Study Completion (Estimated): August 31, 2026

Study Registration Dates

• First Submitted: September 27, 2024
• First Submitted That Met QC Criteria: September 27, 2024
• First Posted (Actual): October 1, 2024

Study Record Updates

• Last Update Posted (Estimated): September 25, 2025
• Last Update Submitted That Met QC Criteria: September 20, 2025
• Last Verified: February 1, 2025

More Information

Terms related to this study

• Keywords: eHealth; digital health; cognitive behavioural therapy; behavioural intervention; mindfulness based therapy
• Other Study ID Numbers: H22-02043

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: We will be providing all IPD that underlie results in a publication. We will provide Analytic Code only in addition to the data and data dictionaries. Other information will be presented in the publications or available upon request from the main author or PI.
• IPD Sharing Time Frame: The data will be made available within 3 months after publication.
• IPD Sharing Access Criteria: The data will be freely available on the OSF website so no need for requests.
• IPD Sharing Supporting Information Type: ANALYTIC_CODE

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No