Sexual Health Outcomes of PLISSIT-based Counseling versus Grouped Sexuality Education among Iranian Women with Breast Cancer: A Randomized Clinical Trial

Abstract

Background: In-person counseling using the Permission, Limited Information, Specific Suggestion, and Intensive Therapy (PLISSIT) model is a well-known approach to people with sexual problems. Evidence suggests that Grouped Sexuality Education (GSE) can be as effective as in-person Counseling at educating individuals about their sexuality. However, the efficacy of PLISSIT versus GSE has not previously been evaluated in women with Breast Cancer (BC). Methods: In this paper, we report on the primary outcomes, i.e. the influence of PLISSIT and GSE on the main elements of sexual behavior: sexual capacity, motivation and performance as well as sexual distress experienced by women throughout the post BC life (n=75). The women (married, age 20-50 years, sexual distress > 11, at least three months post treatment, and mastectomy) were randomly allocated into three groups, with 25 women in each arm. The PLISSIT group received at least three private sessions over the 6 week study period, while the other intervention group received GSE, and the control group received routine care. Data were collected at baseline, six and 12 weeks post intervention. This study was part of a larger study focused on sexual behavior and quality of life. That main outcome of the current analysis was the sexual behavior of women with breast cancer, comparing two intervention groups and one control group across two follow-up periods of six and 12 weeks. Results: Data analysis of the intention-to-treat population (n=65) revealed a significant intervention impact for both GSE and PLISSIT on the elements of sexual behaviors (P< 0.0001) with positive change in sexual capacity, motivation and performance after 6 and 12 weeks post intervention. We found a greater effect size (1.4) in GSE group compared with the PLISSIT group (68.1%). The mean sexual behavior assessment score was increased in both intervention groups; however, the GSE group was significantly higher than the control group (P<0.0001). Conclusions: To the best of our knowledge, this is the first three-armed randomized trial of sexuality counseling and education for women with BC employing two interventions of PLISSIT and GSE. We found GSE to be more efficacious than PLISSIT. Our findings recommend the integration of sexuality counseling and education into health care delivery before BC treatment and during BC post life rehabilitation.