Bober, Sharon L.

Abstract Introduction Sexual problems are common throughout the lifespan. Therefore, it is important for medical students and other health professionals to receive instruction in sexual medicine that is sufficient to prepare them to address these issues as a routine part of practice. Objectives To consolidate and update recommendations published from prior International Consultations on Sexual Medicine and other consensus-based recommendations from across the world for standards of sexual health education (SHE) among medical students. To evaluate the status of recommendations for various health professionals and of existing training and educational platforms. Methods A conceptual review of previous reports on curriculum standards of SHE in medical schools and an updated literature review from 2016 to current was conducted. Results We provide a summary and comprehensive recommendations based on expert opinion, accumulated experience, and literature review for a sexual health curriculum for medical students, including how it should be taught, recognizing that curricula are diverse worldwide. Scant research exists regarding the impact of sexual medicine training on sustained clinical skills and patient outcomes. Existing sexual medicine education platforms can be applied, adapted, and optimized across training levels, disciplines, and geographic locations. We discuss opportunities to improve evaluation of knowledge and competency, as well as the importance of studying methodologies to improve curriculum and methods of evaluation, particularly for disciplines in which these curricula have not previously been evaluated. Conclusions Sexual medicine societies are encouraged to implement previous recommendations and make medical student SHE a priority. Extending these recommendations to post-graduate and practicing clinician and other health professionals’ education would help close education and clinical practice gaps. Future training interventions should incorporate assessment of skill acquisition and meaningful patient outcomes, as well as integrate educational platforms including web-based formats, interactive technology, and experiential learning strategies. Recommendations of Expert Consensus Committee Sexual health educational curricula should be expanded to include sexual well-being and pleasure in addition to pregnancy and sexually transmitted infection (STI) prevention. (Strong) ISSM and affiliated sexual medicine societies (ASMS) should follow through on previous recommendations (ICSM 2009, 2016) and prioritize sexual health education in their missions. (Strong) Sexual medicine societies should join with other organizations to promote standards through position statements and other joint efforts. (Strong) ISSM/ASMS should play a key role in setting curriculum standards, promoting sexual health education in medical schools and other health professions, providing teaching methods and materials, and training of educators. (Strong) ISSM/ASMS are encouraged to establish standing committees promoting sexual medicine education in medical schools, other health professions, and graduate/postgraduate training. (Weak) ISSM/ASMS should utilize international, regional, and virtual meetings as vehicles for disseminating updated knowledge and training educators. (Strong) ISSM/ASMS should advocate to regulatory organizations that set standards for the requirement of sexual health training and assessment of competency in all professions. (Strong) The committee encourages exploration of the use of digital interactive platforms and modern technologies (avatars, AI -artificial intelligence, NLP -natural language processing) and inclusion of quality assurance of virtual domains. (Weak) Beyond the evaluation of student and postgraduate trainee performance and curricula effectiveness, the committee urges research on the impact of educational interventions on sustained clinical practices and patient outcomes in sexual health. (Strong)

Abstract Introduction As the field of sexual medicine continues to grow, there has been increasing attention on methodological integrity and rigor of sexual medicine research, including an emphasis on guidelines for quantitative research design and standards for assessing clinical trial outcomes. However, qualitative research (QR) methodology has garnered relatively scant attention in comparison. Objectives To clarify the value of QR and provide recommendations for improving implementation of QR methods in sexual medicine research. Methods A PubMed review was conducted. Expert opinion was based on a process of literature review and expert consensus. Results An essential goal of QR is to describe and explain unknown or insufficiently understood phenomena through detailed investigation of subjective human experience. Results from QR allow for generating hypotheses that may then be tested. More recently, mixed-methods research, ie, research integrating both qualitative and quantitative methods, is being increasingly used across domains of biomedical and health science research. While there remain differences of opinion regarding use of qualitative methodology in sexual medicine, best-practice models of QR underscore the principle of trustworthiness and include ethics and transparency in protocols for data collection and analysis. It is recommended that established QR frameworks for developing a research question are utilized and that consolidated criteria for reporting research results are employed. Furthermore, authors and reviewers need training in both QR methods and qualitative reporting frameworks to be able to adequately report and review this type of research. Specific areas in sexual medicine that would ideally benefit from QR methods are suggested. Conclusion As the field of sexual medicine continues to expand, qualitative methodologies including mixed-methods research, offer significant value for understanding domains of inquiry that have not been thoroughly investigated. To achieve these targets, training of authors and reviewers on QR is needed.

AbstractBackgroundPatients with prostate cancer suffer significant sexual dysfunction after treatment which negatively affects them and their partners psychologically, and strain their relationships.AimWe convened an international panel with the aim of developing guidelines that will inform clinicians, patients and partners about the impact of prostate cancer therapies (PCT) on patients’ and partners’ sexual health, their relationships, and about biopsychosocial rehabilitation in prostate cancer (PC) survivorship.MethodsThe guidelines panel included international expert researchers and clinicians, and a guideline methodologist. A systematic review of the literature, using the Ovid MEDLINE, Scopus, CINAHL, PsychINFO, LGBT Life, and Embase databases was conducted (1995–2022) according to the Cochrane Handbook for Systematic Reviews of Interventions. Study selection was based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Each statement was assigned an evidence strength (A-C) and a recommendation level (strong, moderate, conditional) based on benefit/risk assessment, according to the nomenclature of the American Urological Association (AUA). Data synthesis included meta-analyses of studies deemed of sufficient quality (3), using A Measurement Tool to Assess Systematic Reviews (AMSTAR).OutcomesGuidelines for sexual health care for patients with prostate cancer were developed, based on available evidence and the expertise of the international panel.ResultsThe guidelines account for patients’ cultural, ethnic, and racial diversity. They attend to the unique needs of individuals with diverse sexual orientations and gender identities. The guidelines are based on literature review, a theoretical model of sexual recovery after PCT, and 6 principles that promote clinician-initiated discussion of realistic expectations of sexual outcomes and mitigation of sexual side-effects through biopsychosocial rehabilitation. Forty-seven statements address the psychosexual, relationship, and functional domains in addition to statements on lifestyle modification, assessment, provider education, and systemic challenges to providing sexual health care in PC survivorship.Clinical ImplicationsThe guidelines provide clinicians with a comprehensive approach to sexual health care for patients with prostate cancer.Strengths & LimitationsThe strength of the study is the comprehensive evaluation of existing evidence on sexual dysfunction and rehabilitation in prostate cancer that can, along with available expert knowledge, best undergird clinical practice. Limitation is the variation in the evidence supporting interventions and the lack of research on issues facing patients with prostate cancer in low and middle-income countries.ConclusionThe guidelines document the distressing sexual sequelae of PCT, provide evidence-based recommendations for sexual rehabilitation and outline areas for future research.

Abstract Disparities in care, treatment-related toxicity and health-related quality of life (HRQoL) for adolescents and young adults (AYAs, aged 15-39 years) with cancer are under-addressed partly because of limited collection of patient-reported outcomes (PROs) in cancer clinical trials (CCTs). The AYA years include key developmental milestones distinct from younger and older patients, and cancer interrupts attainment of critical life goals. Lack of consensus on a standardized approach to assess HRQoL and treatment-related toxicity in AYA CCTs has limited the ability to improve patient outcomes. The National Cancer Institute’s Clinical Trials Network AYA PRO Task Force was assembled to reach consensus on a core set of PROs and foster its integration into AYA CCTs. Eight key considerations for selecting the core PRO AYA battery components were identified: relevance to AYAs; importance of constructs across the age continuum; prioritization of validated measures; availability of measures without licensing fees; availability in multiple languages; applicability to different cancer types and treatments; ability to measure different HRQoL domains and toxicities; and minimized burden on patients and sites. The Task Force used a modified Delphi approach to identify key components of the PRO battery. The Patient-Reported Outcomes Measurement Information System (PROMIS) and the PRO Common Terminology Criteria for Adverse Events Measurement System met all criteria and were selected to assess HRQoL and treatment toxicity, respectively. Investigators are rapidly incorporating the recommendations of the Task Force into AYA trials. Inclusion of a standardized assessment of HRQoL and treatment toxicities in AYA CCTs is a vital first step to develop interventions to improve health outcomes for AYAs diagnosed with cancer.