Perpetuating the cycle of silence: the intersection of uncertainty and sexual health communication among couples after breast cancer treatment

Development of the Partner Version of the Self-Efficacy to Communicate about Sex and Intimacy (SECSI-PV) Scale in the Context of Cancer Survivorship

PURPOSE

This study aimed to develop the Partner Version of the Self-Efficacy to Communicate about Sex and Intimacy (SECSI-PV) scale.

METHODS

Candidate items derived from the patient version of the instrument were refined with input from an expert panel specializing in sexual health, psychosocial oncology, and instrument development (n = 6). Partners (n = 17) of female cancer survivors participated in cognitive interviews to assess the revised scale's content validity.

RESULTS

Transcripts were analyzed qualitatively. Participants endorsed the items as relevant, clear, and appropriate.

CONCLUSIONS

The present work illustrates the iterative development of the SECSI-PV scale. The study highlights the importance of including partners in sexual health discussions and emphasizes the need for psychosocial interventions supporting partners' confidence communicating about sexuality and intimacy. Additional research is recommended to validate the instrument in larger samples encompassing cancer types that are not sex-based and partners from diverse backgrounds, including sexual and gender minority groups.

LGBTQI Sexual Well-Being and Embodiment After Cancer: A Mixed-Methods Study

This study examined lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) cancer patients' sexual well-being post-cancer, and the associations between sexual well-being and social support, physical concerns, distress, quality of life (QOL), and coping. We used a mixed-methods approach, including 430 surveys and 103 interviews, representing a range of tumor types, sexual and gender identities, age groups, and intersex status. The findings indicated that LGBTQI people with cancer experience declines in sexual well-being following cancer, which are associated with reduced QOL, greater physical concerns, and lower social support. The perceived helpfulness of coping mechanisms was associated with greater sexual well-being across genders, with cisgender men reporting the sharpest declines in sexual well-being and highest use of coping mechanisms. Across all groups, searching for information online was the most frequently used coping mechanism, with support groups and counseling the most under-utilized. Qualitative findings facilitated interpretation of these results, providing examples of ways in which cancer impacted sexual well-being and how physical changes influence sexual embodiment or desire to engage in sex. Concerns about reduced sexual desire and activity, associated with changes to breasts, vulva, vagina, penis, erectile dysfunction, incontinence, scarring, and stoma, reflect previous findings in the non-LGBTQI cancer population. Unique to this population are the impact of physical changes on LGBTQI embodiment, including disruption to sexual and gender identities, and feelings of disconnection from queer communities. Addressing LGBTQI sexual well-being within oncology healthcare is a matter of sexual and reproductive justice, for a population whose needs are often overlooked within cancer care.

An integrated intervention on well-being: A qualitative study on relationships and emotions

BACKGROUND

Oncological treatments lead to physical and emotional difficulties with notable consequences in everyday life. Thus, integrated interventions that can promote quality of life are needed. Since current studies suggest that integrated programs of both physical exercises and psychological sessions can promote positive emotions, this pilot study aims to explore the impact of a one-week intervention that combines sailing activities and psychological support.

METHODS

Twenty-nine breast cancer survivors took part in this study. Before and after the intervention, participants were invited to answer three open questions to evaluate their perceptions of personal evaluations about their relationships and emotions. A Qualitative Thematic Analysis was used to evaluate participants' answers and to compare the sub-themes that emerged in the two times.

RESULTS

Findings highlighted three main themes: a) caregivers and emotional closeness - family members are generally a crucial point of reference for participants. Friends, colleagues, and healthcare professionals were also cited as relevant figures during the cancer journey and after the psychological intervention; b) emotions towards others - positive and negative emotions towards these figures emerged, and some women felt alone, and c) emotions towards oneself - exploring emotions related to themselves highlighted positive and negative feelings and the desire for change to promote love and care towards themselves. Interestingly, the number of negative emotions towards themselves decreased after the intervention.

CONCLUSIONS

The integrated intervention could promote the reflection on personal relationships and emotions.

Group Sex Counseling Based on a Modified "Good Enough Sex" Model: A Randomized Trial on Sexual Health Variables among Breast Cancer Survivors in Iran

A randomized controlled clinical trial conducted in Iran from April 2020-2021 involved 100 eligible breast cancer survivors (BCSs). The study examined the impact of sexual counseling using a modified "Good Enough Sex" (GES) model on BCSs' sexual health variables. The intervention group, consisting of BCSs and their spouses, participated in four weekly group counseling sessions lasting 90-120 min each. The control group attended routine medical checkups. The intervention was designed based on a previous qualitative study assessing sexual needs and concerns in BCSs, as well as the GES model. Sexual satisfaction, function, and communication were evaluated at baseline, two, and three months follow-ups. Most participants (77%) had undergone a mastectomy, with diagnoses typically occurring between ages 39-49 and 5-7 years post-diagnosis. Initially low sexual satisfaction and function significantly improved in the intervention group (p < 0.001), reaching high satisfaction and moderate function levels. After three months, significant differences in sexual health variables were observed between the intervention and control groups (p < 0.001), indicating substantial positive effects, particularly in sexual satisfaction (0.99). Given the challenges in improving sexual function due to cancer complications, sex education based on sexual dialogue and realistic expectations can promote sexual well-being.

RCT Number: IRCT20120609009975N8, dated 2020-04-18, https://en.irct.ir/trial/42030.

Experiences of Women With Breast Cancer and Their Partners in Achieving Coherence as a Couple During the Disease Journey

OBJECTIVE

To describe the experiences of female patients with breast cancer and their partners in achieving coherence as a couple during the disease journey.

DESIGN

Qualitative study.

SETTING

Colombia, South America.

PARTICIPANTS

Women diagnosed with breast cancer in the last 2 years and their intimate partners with whom they lived during the 6 months before study enrollment. In total, 16 heterosexual couples participated in individual interviews and focus groups.

METHOD

Interviews and focus groups were analyzed using content analysis.

RESULTS

Four themes were identified: The Diagnosis: A Moment That Destabilizes the Couple, Couple's Sexuality: Seeking the Best Conditions Between Desire and Reality, Generating Mutually Supportive Dynamics in the Face of Cancer, and The Transformation of a Negative Situation Into a Positive One and Achieving Coherence Within the Couple. The first theme represents the initial moment of uncertainty and emotional reactions due to the confirmation of the diagnosis of breast cancer. The second captures the physical and emotional effects in the couple's sexuality generated by the treatment and diagnosis as well as the strategies used to strengthen the couple's relationship. The third reflects how the couple's support is based on commitment, companionship, and the performance of daily actions. The last describes how the adaptation process allows couples experiencing the disease to achieve coherence.

CONCLUSION

These findings highlight that couples experiencing breast cancer can transform the negative situation into an opportunity to strengthen their relationship by achieving coherence. Future research is needed to investigate the antecedents, attributes, and outcomes related to couples' coherence. Moreover, health professionals should perform periodic assessments on the dynamics, coping strategies, and resources at couples' disposal to help promote couples' adaptation and coherence.

Psychosocial experiences of breast cancer survivors: a meta-review

PURPOSE

Advances in breast cancer care have led to a high rate of survivorship. This meta-review (systematic review of reviews) assesses and synthesises the voluminous qualitative survivorship evidence-base, providing a comprehensive overview of the main themes regarding breast cancer survivorship experiences, and areas requiring further investigation.

METHODS

Sixteen breast cancer reviews identified by a previous mixed cancer survivorship meta-review were included, with additional reviews published between 1998 and 2020, and primary papers published after the last comprehensive systematic review between 2018 and 2020, identified via database searches (MEDLINE, Embase, CINAHL, PsycINFO). Quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Systematic Reviews and the CASP (Critical Appraisal Skills Programme Qualitative) checklist for primary studies. A meta-ethnographic approach was used to synthesise data.

RESULTS

Of 1673 review titles retrieved, 9 additional reviews were eligible (25 reviews included in total). Additionally, 76 individual papers were eligible from 2273 unique papers. Reviews and studies commonly focused on specific survivorship groups (including those from ethnic minorities, younger/older, or with metastatic/advanced disease), and topics (including return to work). Eight themes emerged: (1) Ongoing impact and search for normalcy, (2) Uncertainty, (3) Identity: Loss and change, (4) Isolation and being misunderstood, (5) Posttraumatic growth, (6) Return to work, (7) Quality of care, and (8) Support needs and coping strategies.

CONCLUSIONS

Breast cancer survivors continue to face challenges and require interventions to address these.

IMPLICATIONS FOR CANCER SURVIVORS

Breast cancer survivors may need to prepare for ongoing psychosocial challenges in survivorship and proactively seek support to overcome these.

Partner presence in clinical conversations about sexual health: Breast cancer survivors', partners', and providers' perspectives of triadic interactions

PURPOSE

Breast cancer survivors' (BCSs') sexual health (SH) clinical conversations are rarely studied from a dyadic perspective let alone from a triadic perspective. Using a triadic approach, we evaluated BCSs' comfort discussing SH with partners present and identified factors that can contribute to their comfort level.

DESIGN

Qualitative approach using in-depth interviews.

PARTICIPANTS

93 BCSs, partners, and providers involved in BCS care.

METHODS

In-depth interviews with BCSs, partners, and providers explored triadic perspectives to understand factors informing BCSs' comfort level. Thematic analysis was used to analyze data.

FINDINGS

Four themes characterize potential benefits of partner presence: 1) partner facilitates information exchange, 2) partner realizes BCS's SH concerns are "a real thing," 3) partner better understands SH challenges, and 4) partner presence encourages relational communication about SH. Five themes illustrate potential complications of partner presence: 1) partner feels/becomes embarrassed, 2) partner is/becomes defensive, 3) partner presence constrains BCS's agency in clinical conversations, 4) partner presence threatens partner's view of BCS as a sexual being, and 5) partner presence increases partner burden.

IMPLICATIONS FOR PSYCHOSOCIAL ONCOLOGY

Providers should (1) initiate conversations about BCS comfort with partner presence, (2) be aware of the interaction between BCS primary and secondary goals, (3) consider how BCS/partner goal conflicts obstruct BCS agency and sexual/relational health, and (4) offer opportunities to clarify goals and expectations, and coordinate therapeutic options.

Investigation of the Effect of Sexual Attitudes and Attachment Styles of Spouses of Cancer Patients on Their Psychological Resilience

It is pointed out that the attachment styles of spouses are also very important in terms of coping with the psychological problems experienced in illness and sexual satisfaction. The aim of this study is to investigate the effect of sexual attitudes and attachment styles of spouses of cancer patients on their psychological resilience. The research was carried out as a descriptive study based on the relational screening model between January and November 2021. A total of 429 spouses of cancer patients who met the inclusion criteria were included in the study. The data were collected online using the Participant Information Form, which was prepared by the researcher, Resilience Scale for Adults (RSA), Experiences in Close Relationships Scale (ECR-S), and Hendrick Sexual Attitude Scale (BSAS). Data analyses included descriptive statistics, Mann-Whitney U -test, Kruskal-Wallis, and linear regression using the SPSS 25.0 program. Two hundred forty-six women and 183 men were included in the study, and it has been detected that RSA scores of female participants were higher than male participants. In addition, a positive relation between RSA scores and ECR-S scores ( r = 0.247) and a negative relation between RSA and BSAS ( r = -0.414) were detected ( p < 0.05). It was determined that the psychological resilience of spouses of cancer patients was related to sexual attitudes and attachment styles.

Sexual Health after a Breast Cancer Diagnosis: Addressing a Forgotten Aspect of Survivorship

Breast cancer is the most common cancer in women. The life expectancy after a breast cancer diagnosis is improving steadily, leaving many more persons with the long-term consequences of treatment. Sexual problems are a common concern for breast cancer survivors yet remain overlooked in both the clinical setting and the research literature. Factors that contribute to sexual health concerns in breast cancer survivors are biopsychosocial, as are the barriers to addressing and treating these health concerns. Sexual health needs and treatment may vary by anatomy and gender. Multidisciplinary management may comprise lifestyle modifications, medications, sexual health aids such as vibrators, counseling, and referrals to pelvic health physical therapy and specialty care. In this article, we review the contributing factors, screening, and management of sexual difficulties in cisgender female breast cancer survivors. More information is needed to better address the sexual health of breast cancer survivors whose sexual/gender identity differs from that of cisgender women.

Profiles of women's adjustment after cancer based on sexual and psychosocial wellbeing: results of a cluster analysis

BACKGROUND

Sexual wellbeing is a critical yet often overlooked aspect of overall wellbeing for women across cancer diagnoses.

OBJECTIVE

We identified profiles of women cancer survivors by sexual and psychosocial outcomes and compared groups for differences in relevant outcomes and individual characteristics.

METHODS

Partnered women treated for cancer (n = 226; M age = 51.1 (12.6); 54% breast cancer; 86% White) completed a cross-sectional survey assessing sexual and psychosocial wellbeing. K-means cluster analysis modeled subgroups (clusters) with similar response patterns on measures of sexual wellbeing (sexual function, distress, sexual communication, and self-efficacy for communication), psychosocial wellbeing (quality of life (QOL), anxiety and depressive symptoms), and time since treatment. ANOVAs with Tukey post-hoc analyses and chi-square analyses tested cluster mean differences.

RESULTS

Three distinct clusters of women differed by levels of adjustment in sexual and psychosocial wellbeing: higher-adjustment (32.7%), intermediate (37.6%), and lower-adjustment (29.6%). Significant differences among the clusters were found for all outcomes, with largest effect sizes for sexual distress (η²_p = 0.66), sexual communication (η²_p = 0.51), sexual satisfaction (η²_p = 0.44), and anxiety and self-efficacy for communication (η²_p = 0.32). The intermediate adjustment group was characterized by lower adjustment on measures of sexual and relationship function, and better adjustment on measures of QOL and mood.

CONCLUSIONS

Findings suggest that for women cancer survivors, measures of sexual and psychosocial wellbeing can model distinct profiles to inform targeted interventions to meet women's needs. Evidence-based targeted interventions could lead to better sexual function, and ultimately to better QOL and overall wellbeing.

IMPLICATIONS FOR PRACTICE

A stepped intervention approach to sexual health care for women with cancer, where content and format depend on degree of sexual and psychosocial adjustment after cancer, may be most appropriate. Interdisciplinary teams may address sexual, emotional, and relationship functioning.

Kölner Fragebogen zur Sprachlosigkeit

Hintergrund

Mit dem Kölner Fragebogen zur Sprachlosigkeit (KFS) liegt erstmals ein validiertes Erhebungsinstrument zur Erfassung von Sprachlosigkeit vor. Die empirische Prüfung des KFS hinsichtlich seiner Eignung zur validen Unterscheidung von Personen mit gering und hoch ausgeprägter Sprachlosigkeit ist von zentraler Bedeutung für den klinischen Einsatz des Instruments.

Material und Methoden

Die Stichprobe umfasste die KFS-Daten von insgesamt 205 teilnehmenden Personen einer Onlineerhebung. Mithilfe mehrerer inferenzstatistischer Verfahren wurden die prädiktiven Eigenschaften des KFS-Item 12 analysiert, um es für die Bestimmung eines Schwellenwerts beim Einsatz des KFS nutzbar zu machen. Basierend auf dem 75. Perzentil des KFS-Item 12 erfolgte eine Dichotomisierung der Stichprobe mit anschließender „Receiver-operating-characteristic“(ROC)-Analyse zur KFS-Gesamtskala.

Ergebnisse

Die Ergebnisse der ROC-Analyse („area under the curve“ [AUC]: 0,863; p < 0,001) ergaben bei Verwendung des Youden-Index den optimalen Schwellenwert von >29, mit einer Sensitivität von 76 % und einer Spezifität von 79 % für die Gesamtskala des KFS.

Diskussion

Der Schwellenwert der KFS-Gesamtskala ist zur Differenzierung von Personen mit gering oder stark ausgeprägter Sprachlosigkeit geeignet. Das Item 12 des KFS kann zudem als Prädiktor einer potenziellen Sprachlosigkeit herangezogen werden.

Relationship Dynamics among Couples Dealing with Breast Cancer: A Systematic Review

Most studies have been concerned with the experiences and needs of women with breast cancer and spouses/partners separately. In this review, the relationship dynamics that characterize the couple’s experience of breast cancer treatment were investigated. Findings will inform both researchers and professionals in the area of oncology. A systematic literature search was performed in CINAHL, PsychINFO, MEDLINE, Scopus and Web of Science. A checklist for qualitative and observational studies was used to evaluate the methodological quality of the studies. Seventeen studies were included, and the synthesis of the literature revealed five domains that characterized the dyadic process: dyadic coping strategies, psychosocial support, communication, the couple’s sexual life and spirituality. The included studies provide the basis for knowledge and awareness about the experience of couples with cancer, the specific dimensions enacted during the breast cancer treatment path and the type of responses that are associated with a positive couple’s adjustment to the disease.

Effectiveness of a couple-based intervention on sexuality and intimacy among women in active cancer treatment: A quasi-experimental study

PURPOSE

To evaluate the effectiveness of a strenghts-oriented therapeutic conversation intervention on confidence about how illness beliefs affect sexuality and intimacy and on perceived relationship quality among women in active cancer treatment and their partners.

METHODS

A quasi-experimental single-group pre-post-follow-up design was used. Women in active cancer treatment and their intimate partners were randomly assigned to a nurse-managed couple-based intervention (experimental group, n = 30 couples) or wait-list (delayed intervention) control group (n = 27 couples) plus 4 additional couples who pilot tested feasibility of the intervention, prior to the RCT. However, baseline differences in demographic and clinical variables prevented comparisons between groups. Therefore, a repeated-one-group pre-post test setup was used, comparing women with cancer and their partners over three time points. The intervention consisted of three Couple-Strengths-Oriented Therapeutic Conversations (CO-SOTC) sessions. The participants also had access to web-based evidence-based educational information. Data were collected before intervention (T1, baseline), one to two weeks post-intervention (T2), and after a follow-up session at three months (T3). Data from 60 couples (N = 120) were analyzed.

RESULTS

Significant differences were observed, for both women and intimate partners, over time in more confidence about how illness beliefs affected sexuality and intimacy (T1 versus T2, and T1 versus T3), and increased overall quality of the relationship (T1 versus T2, and T1 versus T3). No differences were found between dyad members' scores on illness beliefs or relationship quality at any time point.

CONCLUSIONS

The CO-SOTC intervention was effective in supporting sexual adjustment among women in cancer treatment and their intimate partners.

TRIAL REGISTRATION NUMBER

NCT03936400 at clinicaltrials.gov.