Dilator Use After Vaginal Brachytherapy for Endometrial Cancer: A Randomized Feasibility and Adherence Study.
Alexandra Hanlon, William Small, Jonathan Strauss and 6 others
PMID 28437283WHAT IT FOUND
Enhanced nurse-led education with telephone follow-up did not improve vaginal dilator adherence over standard instruction.
Recruitment was feasible, but dropout was high, and only 8.3% of participants were adherent to three-times-weekly use at six months.
Key findings
01Enhanced nurse-led education with telephone follow-up did not improve vaginal dilator adherence over standard instruction.
02Recruitment was feasible, with 76% of eligible patients consenting, but retention was lower at six months, with 21 patients remaining in standard instruction and 8 in enhanced education.
03Only 8.3% of participants were adherent to prescribed three-times-weekly dilator use at six months.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a small pilot, so the tests were underpowered and could only detect large effects. Only 42 patients were analyzed, and attrition was high, especially in the enhanced education arm: 8 of 18 remained at six months compared with 21 of 24 in standard instruction. The nurses who delivered the education knew which group each patient was in, and the authors say usual care and the enhanced intervention may have overlapped enough to hide a difference. The sample was mostly stage I disease, college educated, white, non-smoking, overweight or obese, and 45.2% were married, so it may not apply to all patients after vaginal brachytherapy. The authors did not report vaginal length or sexual function outcomes in this paper, and they note that neither education method produced adherence rates high enough to be confident about maintaining vaginal patency or sexual function.
Declared interests
The authors declare no conflicts of interest. The supplied metadata lists NIH extramural research support.
The easy way to misread this
Do not conclude that enhanced education with telephone follow-up is useless. This was a small pilot, only 42 patients were analyzed, and dropout was high, especially in the enhanced education arm.