Session Item

Brachytherapy is an invasive procedure that can cause a wide range of physical and emotional difficulties; however, very little data exists on this subject in the literature.

The aim of this study was to establish cervical cancer patients’ expectations, experiences, informational needs and understandings of the high dose-rate (HDR) intracavitary brachytherapy procedure, as part of a process to develop guidelines for quality patient-centered care.

A prospective, qualitative study with a descriptive phenomenological approach was used. Purposive sampling was carried out to recruit 31 women undergoing HDR brachytherapy for cervical cancer from June to August 2020 at the National Institute of Oncology in Rabat.

Semi-structured, one-to-one interviews guided by a theme list were conducted by a female radiation oncologist in Arabic before, during and after treatment. The following aspects were discussed: treatment information given and understood, expectations, experiences in the waiting room, in the treatment room, and suggestions for improvement. Data was transcribed, translated and thematic analysis performed.

Four themes were identified: (i) informational needs, (ii) psychological experience, (iii) physical experience and (iv) coping strategies.

Most of the patients felt unprepared and did not have a clear understanding of brachytherapy, describing it as a process of "cleansing the uterus”. The informational needs included: providing patients with treatment-related information; adequate information concerning pre-treatment preparation and scheduled appointments, possible side-effects and sexuality.

Brachytherapy was a difficult experience causing fear and anxiety throughout treatment. Most women dreaded the procedure, before receiving the first treatment and even after having had one.

Pain was a major problem for the participants. It started as soon as the spinal anesthesia wore off and persisted for hours and even days after the procedure. Some women compared this pain to childbirth, a process they preferred to brachytherapy. Patients agreed that the preventative medication received was not efficient to relieve the pain.

Despite these negative experiences, patients were left with a positive outlook, saying it is a necessary treatment. Faith and spirituality gave them courage to endure the procedure. Dialogue with the healthcare professionals, envisaged outcomes and desires to heal were used to cope.

Women undergoing uterovaginal brachytherapy for cervical cancer experience pain and emotional distress. Providing patients with understandable information, more sensitive support during the procedure and debriefing afterwards could lessen feelings of fear and anxiety. Our findings highlight the importance of providing patients with informative material adapted to their needs and advocate for the revision of pain management protocols. Further studies should be carried out to define patient-centered recommendations and provide quality care to this group of women.