Talking about women's sexual health after cancer: Why is it so hard to move the needle?

Reese, Jennifer Barsky; Bober, Sharon L.; Daly, Mary B.

doi:10.1002/cncr.31084

Cited by 38 publications

(24 citation statements)

References 88 publications

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“…This finding suggests that the iSHARE intervention may have positive effects on the extent to which breast cancer clinicians believe that discussing sexual concerns with their patients will lead to positive outcomes. Cancer clinicians are often reluctant to raise sexual health clinically if they believe the discussion will not be received positively by patients or lead to desired endpoints (eg, successful treatments), lending importance to this finding.…”

Section: Discussionmentioning

confidence: 99%

“…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 . Lack of training is a key barrier contributing to breast cancer clinicians' reluctance to raise the topic of sexual health with patients .…”

Section: Introductionmentioning

confidence: 99%

“…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. 12 Given that breast cancer patients are unlikely to raise the topic on their own-even if they have sexual problems 9 -interventions that equip clinicians with the knowledge and skills to effectively discuss sexual concerns with patients are needed.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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Objective Sexual concerns are often unaddressed for breast cancer patients; one reason is inadequate clinician training. We examined the feasibility, acceptability, and potential benefits of a novel intervention, improving Sexual Health and Augmenting Relationships through Education (iSHARE) for breast cancer clinicians. Methods Clinicians received training in communicating about sexual concerns with breast cancer patients. Intervention feasibility and acceptability were measured through enrollment/participation and postintervention program evaluations, respectively. Intervention effects were assessed through (1) clinician self‐reported beliefs about sexual health communication, assessed at baseline, post‐intervention, and 1‐ or 6‐month follow‐up, (2) clinical communication coded from audio recorded, transcribed clinic encounters at preintervention or postintervention, and (3) patient satisfaction with clinical care, reported immediately after the clinic visit. Patients also reported sociodemographic characteristics and level of sexual concerns. Results Seven breast cancer clinicians enrolled (88% participation), completed the intervention, and were audio recorded in clinic encounters with 134 breast cancer outpatients (67 each at preintervention or postintervention). Program evaluations supported intervention acceptability. Effect sizes suggest iSHARE increased clinicians' self‐efficacy (d = 0.27) and outcome expectancies for communicating about sexual concerns (d = 0.69) and reduced communication barriers (d = −0.14). Clinicians' sexual health communication behaviors increased from baseline to postintervention, including for raising the topic (28% vs 48%), asking questions (33% vs 45%), and offering information (18% vs 24%). Neither patient satisfaction nor duration of sexual health communication changed (mean duration less than 1 minute at both time points). Conclusions The iSHARE intervention was feasible and well received by clinicians and may change breast cancer clinicians' beliefs and communication behaviors regarding sexual health.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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“…Thus, patientfocused interventions should be developed to encourage patients to raise the issue with their clinicians as well. Finally, the fact that in-depth discussions of sexual health, both for women reporting and not reporting sexual problems, tended to focus on one key topic as opposed to covering many different topics may come as encouraging news to cancer clinicians who are reluctant to raise the topic of sexual health for fear of opening a Pandora's box [37].…”

Section: Practice Implicationsmentioning

confidence: 99%

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

Reese

Sorice

Lepore

et al. 2019

Patient Education and Counseling

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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.

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“…These alterations can last for years into survivorship and may become chronic. 11 Healthcare providers find it difficult and often feel ill-equipped to communicate about sexuality with their patients, [12][13][14] which leads to inconsistencies in psychosexual support post treatment. 15 Strengths and limitations of this study ► The use of a holistic sexuality framework allowed for sexual functioning to be considered beyond physical acts of intercourse.…”

Section: Introductionmentioning

confidence: 99%

Sexuality post gynaecological cancer treatment: a qualitative study with South African women

et al. 2020

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ObjectivesThis study investigated women’s experiences of their sexuality post gynaecological cancer treatment. Using a holistic sexuality framework, the study explored how women felt their sexual functioning, sexual relationships and sexual identity had been affected by treatment.DesignThe study was qualitative in nature and made use of an interpretive descriptive design. Data were analysed using thematic analysis.SettingData collection took place at a follow-up clinic within the gynaeoncology unit at a public-sector tertiary hospital in Cape Town, South Africa.ParticipantsPurposive sampling was used to recruit participants, and the final sample consisted of 34 women aged 29–70 (x´=52). All women had received a gynaecological cancer diagnosis and had been treated with either surgery, chemotherapy, radiation or a combination of these. On average, the participants were between 12 and 30 months post treatment.ResultsWomen expressed how their sexual functioning post treatment was both nuanced and complex, how heteronormative gender expectations influenced their intimate relationships, and how they experienced a re-embodiment of their sexual subjectivity post treatment. Participants felt that more sexual functioning information from healthcare providers, as well as peer support groups, would assist them in navigating the sexuality changes they experienced.ConclusionsThe findings of this study broaden conceptualisations of sexuality post treatment by detailing the ways that it is complex, nuanced, relational and ever shifting. More research is needed about how to incorporate holistic psychosexual support post treatment into the public healthcare system in South Africa.

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Talking about women's sexual health after cancer: Why is it so hard to move the needle?

Cited by 38 publications

References 88 publications

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

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

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

Sexuality post gynaecological cancer treatment: a qualitative study with South African women

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