Improving Sexual and Reproductive Health Communication for Adolescent and Young Adult Oncology Patients

Feasibility will be evaluated based on intervention enrollment (% of participants that complete consent/assent that complete all enrollment procedures, including the T1 survey), completion (% of enrolled AYAs completing the PVQ and the T2 survey) and retention (% of enrolled AYAs and clinicians completing all steps through the T3 survey). ReSPECT will be deemed feasible if intervention enrollment, completion and retention rates are ≥80%, ≥80%, and ≥70%, respectively

Acceptability will include usability. Acceptability measures will be modeled on the Theoretical Framework of Acceptability, and include the rating of seven statements on a 5-point Likert scale (Strongly Disagree to Strongly Agree). Acceptability will be defined as ≥70% of AYA and clinician participants rating the intervention acceptable (average score 4 or higher). Usability will be assessed by the Intervention Usability Scale (IUS), a 10-item survey that measures responses to statements on a 5-point Likert scale ("strongly disagree" to "strongly agree". Scores are converted and averaged to produce a total score from 0 to 100, with a score of 70 or higher set as the threshold for satisfactory usability. ReSPECT will be deemed usable if ≥70% of AYA and clinician participants rate the intervention usable (average score 70 or higher).

Perceived usefulness will be evaluated in post-encounter semi-structured qualitative interviews with AYAs and clinicians. Sample questions include, "Was the SRH conversation helpful? Why or why not?" and, "What is the most useful part of ReSPECT? What is the least useful?". Additional questions will also cover perceived potential impact of ReSPECT improving SRH, barriers encountered using ReSPECT, and opportunities for improvement.

Participants will be asked if the sexual health topic(s) selected on the PVQ were discussed during the clinic visit (yes/no) and about who initiated the conversation (AYA patient/clinician). They will also complete a brief survey listing each of the 7 sexual health subtopics and indicate whether or not the topic was discussed, who initiated the topic conversation, and (for patients) whether they asked their clinician any questions about the specific topic. AYA patient participants will also be asked if there were topics/information not addressed or inadequately addressed during the visit along with whether or not additional people were in the room during the conversation. Data to be collected were adapted from an instrument used for similar sexual health communication research in adult cancer populations

Self-efficacy will be measured by a two-item scale assessing AYA and clinician confidence (1) initiating and (2) participating in discussions about SRH topics. Responses range from 0 (not at all confident) to 10 (extremely confident) for each topic.

The Outcome Expectancy Scale is a 6-item scale assessing AYA's perception of the extent to which outcomes may result from discussing SRH topics with their oncology clinician. Potential outcomes include answering question(s), finding a solution to a problem, giving peace of mind, helping play an active role in one's health care, improving SRH, and helping make decisions. For each item, responses range from 0 (not at all) to 10 (very much).

Decisional confidence will be assessed by a single-item survey measure to assess whether ReSPECT helped AYAs make an informed decision about a SRH question/concern. Participants will be asked to respond with yes/no, then to describe why/why not.

The Level of Bother Scale is a single-item scale assessing the extent to which participants have been bothered by specific SRH concerns in the last month. Responses are scored on a 4-point Likert scale, with higher scores indicating greater levels of bother.

A 9-item questionnaire adapted from the National Youth Risk Behavior Survey will be used to characterize quality and frequency of health risk behaviors among AYA participants.

The Human Connection (THC) scale is a 16-item scale measuring therapeutic alliance (TA) between AYAs and clinicians. Items are scored on a 4-point Likert scale, with response categories based on question content, and higher scores indicating greater TA.

The Chew Health Literacy Screen is a validated 3-item questionnaire designed to identify individuals with inadequate health literacy. Items are scored on a 5-point Likert scale, with higher scores indicating greater health literacy

The Hospital Anxiety and Depression Scale (HADS) is a 14-item scale with subscales for anxiety and depression (7 items each). Items were validated in the outpatient medical clinic setting and do not assess somatic complaints. Each item is rated on a 4-point scale ranging from 0 (absence) to 3 (extreme presence), with higher scores indicating greater levels of anxiety and depression

The COG Sexual Health Task Force Sexual Health Assessment is an 8-item survey designed to assess SH outcomes among AYAs with cancer and includes sexual history, sexual function, body image, and romantic relationships. Question types include Likert scales, yes/no questions, and multiple-response checklists.