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Abstract：
BACKGROUND: Sexual changes in breast cancer occur after diagnosis and treatment, including a mastectomy. Sexual assertiveness is an effective factor in sexual satisfaction, which means the ability to convey sexual feelings, beliefs, and thoughts. Given the limited studies on sexual assertiveness in breast cancer and different client participation, this study was conducted to compare the effect of sexual counseling based on two models of PLISSIT (Permission, Limited Information, Specific Suggestion, Intensive Therapy) and BETTER (Bring Up, Explain, Tell, Time, Education, Record) on sexual assertiveness in women after mastectomy.
METHODS: This quasi-experimental intervention was conducted in 2021 in Mashhad, Iran. Seventy-eight mastectomized women with breast cancer were assigned to the BETTER (n = 39) and PLISSIT (n = 39) groups using permuted block randomization with a block size of 4 and an allocation ratio of 1:1. Both groups received four individual counseling sessions, one week apart. The research tools included a demographic information form and the Hulbert index of sexual assertiveness. Changes in the mean scores of sexual assertiveness between the two groups were evaluated before and four weeks after the intervention, and the mean changes were compared between the groups. Data analysis was conducted using the Kolmogorov-Smirnov test, independent t-test, paired t-test, and Chi-square tests using Statistical Package for the Social Sciences (SPSS) version 25 (P < 0.05).
RESULTS: The results of the study showed that before the intervention, there was no significant difference in the score of sexual assertiveness in both groups (P = 0.253). The mean score of sexual assertiveness changes before and after the intervention in the BETTER group (8.07 ± 4.9) was significantly higher than in the PLISSIT group (5.58 ± 4.7) (P < 0.001).
CONCLUSIONS: The results indicated that BETTER sexual counseling was more effective in increasing the sexual assertiveness of mastectomized women than PLISSIT counseling. Due to its simplicity and client-centeredness, this model can be used in breast cancer care programs.
METHODS: This quasi-experimental intervention was conducted in 2021 in Mashhad, Iran. Seventy-eight mastectomized women with breast cancer were assigned to the BETTER (n = 39) and PLISSIT (n = 39) groups using permuted block randomization with a block size of 4 and an allocation ratio of 1:1. Both groups received four individual counseling sessions, one week apart. The research tools included a demographic information form and the Hulbert index of sexual assertiveness. Changes in the mean scores of sexual assertiveness between the two groups were evaluated before and four weeks after the intervention, and the mean changes were compared between the groups. Data analysis was conducted using the Kolmogorov-Smirnov test, independent t-test, paired t-test, and Chi-square tests using Statistical Package for the Social Sciences (SPSS) version 25 (P < 0.05).
RESULTS: The results of the study showed that before the intervention, there was no significant difference in the score of sexual assertiveness in both groups (P = 0.253). The mean score of sexual assertiveness changes before and after the intervention in the BETTER group (8.07 ± 4.9) was significantly higher than in the PLISSIT group (5.58 ± 4.7) (P < 0.001).
CONCLUSIONS: The results indicated that BETTER sexual counseling was more effective in increasing the sexual assertiveness of mastectomized women than PLISSIT counseling. Due to its simplicity and client-centeredness, this model can be used in breast cancer care programs.
摘要：
背景：乳腺癌在诊断和治疗后发生性改变，包括乳房切除术.性自信是性满意度的有效因素，这意味着传达性感觉的能力，信仰,和思想。鉴于对乳腺癌患者性自信的研究有限，以及不同的客户参与，这项研究是为了比较基于两种PLISSIT模型的性咨询的效果(许可，有限的信息，具体建议,强化治疗）和更好（提起，解释,告诉，时间,教育,记录）关于乳房切除术后女性的性自信。
方法：这项准实验性干预于2021年在马什哈德进行，伊朗。78名乳房切除的乳腺癌妇女被分配到BETTER（n=39）和PLISSIT（n=39）组，使用置换区组随机化，区组大小为4，分配比例为1：1。两组都接受了四次个人咨询，相隔一周。研究工具包括人口统计信息表格和Hulbert性自信指数。在干预前和干预后4周评估两组之间的性自信平均得分的变化，并比较各组间的平均变化。数据分析采用Kolmogorov-Smirnov检验,独立t检验，配对t检验，使用社会科学统计软件包（SPSS）25版进行卡方检验（P<0.05）。
结果：研究结果表明，在干预之前，两组的性自信评分无显著差异(P=0.253).BETTER组干预前后的性自信变化平均得分（8.07±4.9）明显高于PLISSIT组（5.58±4.7）（P<0.001）。
结论：结果表明，更好的性咨询比PLISSIT咨询更有效地提高乳房切除妇女的性自信。由于其简单性和以客户为中心，该模型可用于乳腺癌护理计划。
方法：这项准实验性干预于2021年在马什哈德进行，伊朗。78名乳房切除的乳腺癌妇女被分配到BETTER（n=39）和PLISSIT（n=39）组，使用置换区组随机化，区组大小为4，分配比例为1：1。两组都接受了四次个人咨询，相隔一周。研究工具包括人口统计信息表格和Hulbert性自信指数。在干预前和干预后4周评估两组之间的性自信平均得分的变化，并比较各组间的平均变化。数据分析采用Kolmogorov-Smirnov检验,独立t检验，配对t检验，使用社会科学统计软件包（SPSS）25版进行卡方检验（P<0.05）。
结果：研究结果表明，在干预之前，两组的性自信评分无显著差异(P=0.253).BETTER组干预前后的性自信变化平均得分（8.07±4.9）明显高于PLISSIT组（5.58±4.7）（P<0.001）。
结论：结果表明，更好的性咨询比PLISSIT咨询更有效地提高乳房切除妇女的性自信。由于其简单性和以客户为中心，该模型可用于乳腺癌护理计划。
