Understanding Engagement With a Couple-Based Intimacy Enhancement Intervention for Breast Cancer Survivors: An In-Depth Examination of Recruitment and On-Trial Engagement

Background: Barriers hinder cancer survivors' participation in and engagement with psychosocial interventions, particularly for trials evaluating dyadic interventions. Aims: We examined patterns of enrollment (Study 1) and intervention engagement (Study 2) in a trial of a couple-based Intimacy Enhancement (IE) intervention for breast cancer survivors with sexual concerns and their partners. Methods: Study 1 examined reasons for non-participation and support preferences of study-eligible survivors who declined participation and completed a standardized survey (n = 38) and compared decliners to participants on socio-demographic characteristics and sexual/relationship outcomes. Study 2 characterized participant engagement with IE sessions, home practice completion, and post-intervention IE skills use. More versus less engaged survivors/partners (interventionist-rated) were compared on variables as in Study 1 and on at-home/post-intervention engagement measures using Chi-square or t-tests. Results: Of 233 study-eligible survivors, 120 enrolled (52%). Lack of partner interest was the most common reason for declining. Compared to participants, study decliners were in longer relationships and more identified as being from a racial minority group. Decliners reported generally low levels of interest in any sexual support. Engagement in IE activities, including session and homework completion, was high among patients and partners. Younger survivor age was associated with lower interventionist-rated in-session engagement. Conclusions: Findings suggest strong overall interest in and engagement with the IE intervention and suggest the importance of understanding how to increase uptake of sexual support to survivors across diverse backgrounds and preferences. The methods used in examining study-eligible candidates' preferences and intervention participants' engagement could have broader relevance for psycho-oncology research design.