Patient-clinician communication about sexual health in breast cancer: A mixed-methods analysis of clinic dialogue

Abstract

Objectives: Breast cancer patients' sexual health needs are frequently unmet. We examined the prevalence and content of communication about sexual health between breast cancer patients and clinicians. Methods: Female breast cancer patients being seen in oncology clinic follow-up had a clinic visit audio recorded and self-reported sexual problems after the visit. Transcripts were coded for sexual health communication; data were analyzed descriptively or using Chi-square tests. Results: We recorded 67 patients (81% participation rate) interacting with one of 7 cancer clinicians (5 physicians; 2 advanced practice clinicians). Approximately 1/3 of women (n = 22) reported sexual problems; sexual health communication occurred with 10/22 of those women (45%). Across all 67 patients, 27 (40%) visits contained communication about sexual health. Seventy-percent of sexual health communication was clinician-initiated. When in-depth sexual health discussions occurred, the most common topics discussed were sexual inactivity (6), body image (5), vaginal dryness (4), and safety of sexual activity (2). Conclusion: Communication about sexual health was uncommon even for women reporting sexual problems and was largely initiated by clinicians.

A brief intervention to enhance breast cancer clinicians' communication about sexual health: Feasibility, acceptability, and preliminary outcomes

“…For example, findings suggest that a sexual health communication intervention could have effects on clinicians' communication during routine clinical encounters, making the intervention directly relevant to practice. In addition, lack of time is a major perceived barrier to breast cancer clinicians in raising the topic of sexual concerns, and the findings of this study suggested that including discussions of sexual health did not significantly add time to the clinic visits. Whether longer discussions lead to better patient satisfaction or sexual health outcomes will need to be assessed in future research.…”

“…Audio recordings of clinic encounters were transcribed and coded for sexual health communication using two levels of analysis. First, two coders determined the presence (y/n) of any sexual health communication, as described elsewhere . Second, dialogue relevant to sexual health was coded using a codebook developed for this study, with coding difficulties resolved through discussion.…”

“…Two key clinician communication behaviors selected a priori were (1) asking questions about sexual health, defined as asking at least one question pertaining to sexual health or body image during the clinic encounter and (2) offering information pertaining to sexual health, defined as offering either anticipatory counseling (related to the potential future possibility of treatment side effects) or counseling related to a current concern or issue reported by the patient. The complexity of these behaviors was also examined and defined as “neither asked nor offered,” “asked or offered,” and “both asked and offered.” In addition, a qualitative analysis of the dialogue in a prior report yielded two informative codes that we included in the present analysis to explore communication outcomes: (1) raising the topic (clinician initiated the discussion) of sexual health (0 = no; 1 = yes), regardless of other behaviors and (2) raising the topic with counseling (eg, “Many women on this treatment experience sexual concerns”; 0 = no, 1 = yes). The length of the discussion about sexual health in seconds was also recorded.…”

“…Clinical cancer guidelines put forth by the National Comprehensive Cancer Network (NCCN) and the American Society for Clinical Oncology (ASCO) recommend that sexual function be addressed in patients with cancer along with other psychological and physical health issues . Yet, cancer clinicians infrequently raise the topic of sexual health with patients, and fewer than half of women with breast cancer receive any sexual health communication . Thus, for many women with breast cancer suffering from sexual problems is likely unaddressed .…”

“…5,6 Yet, cancer clinicians infrequently raise the topic of sexual health with patients, 7 and fewer than half of women with breast cancer receive any sexual health communication. 8,9 Thus, for many women with breast cancer suffering from sexual problems is likely unaddressed. 6,10,11 Lack of training is a key barrier contributing to breast cancer clinicians' reluctance to raise the topic of sexual health with patients.…”