Patient’s sexuality – A neglected area of cancer nursing?

Perspectives and Concerns on Late Effects Regarding Sexuality among Adolescents and Young Adults Treated for Testicular Germ Cell Tumor: The PRICELESS-Study-A Qualitative Study

This study aimed to explore perspectives and concerns regarding sexuality among adolescents and young adults (AYAs) possibly experiencing late effects after testicular germ cell tumor (TGCT) treatment. A qualitative study was performed in which semi-structured interviews were held with thirteen AYAs from a center of expertise for TGCT in the Netherlands. Data were analyzed using Braun and Clark's thematic analysis method. Seven interacting and interconnected themes were found: desire to have children, rediscovering sexuality, insecurity about sexual performance, acceptance of physical change, loss of masculinity, burden on relationship, and openness in discussing sexuality. Concerns about the desire to have children seem to play a significant role. In conclusion, TGCT patients face multiple changes (physical, emotional, relational, and sexual), followed by a difficult period of acceptance, after which a new phase of rediscovering sexuality appeared. These findings can help to make healthcare professionals aware of the underlying mechanisms and concerns about sexuality. Furthermore, insights can help to develop sexuality-themed items for a broader monitoring tool to structurally assess the late effects to support discussing sexuality.

Sexual well-being needs of patients with chronic illness expressed in health care: A scoping review

AIMS

To systematically identify and summarize the needs of chronically ill people concerning their sexual well-being in peer-reviewed published literature, to enable healthcare professionals to provide support in self-management satisfying the needs.

DESIGN

A scoping review was performed according to the framework of (JBI Manual for Evidence Synthesis. JBI Global Wiki, 2020). Findings are reported in line with the PRISMA extension for scoping reviews.

REVIEW METHODS

A literature search and thematic analysis were conducted.

DATA SOURCES

Full research was carried out in 2022 in the search engine BASE and the following databases: Scopus, MEDLINE, Science Citation Index Expanded, Social Sciences Citation Index and CINAHL. Peer-reviewed articles published after 2011 were included.

RESULTS

Fifty articles could be found. Seven categories of needs could be identified. People with chronic diseases want their providers to initiate discussions about sexual concerns and treat them trustfully and respectfully. Most of the patients would like the issue of sexuality to be included in routine care. They perceive their medical specialists and psychologists as preferred providers to talk to about this issue. Nurses are seen as primary contact persons but in a smaller number of studies.

CONCLUSION

Although the scoping review included different types of chronic diseases, the needs of chronically ill patients concerning their sexual well-being are not very different. Healthcare professionals, especially nurses, who are often the first point of contact for people with chronic illnesses, should take the initiative for open discussions about sexual issues. That requires a new understanding of the role of nurses, training and further education.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Providing patient education and facilitating an open discussion about sexuality require further training in the new understanding of the role of the nurse and the concept of sexual well-being.

IMPACT

What problem did the study address? Chronic diseases have an impact on patients' sexuality. Patients want to be informed about sexual issues, but providers often do not address them. What were the main findings? Patients with a chronic condition expect providers to initiate discussions about sexual well-being, regardless of the type of chronic disease. Where and on whom will the research have an impact? The research will impact healthcare professionals', especially nurses', future educational standards and ultimately patients.

REPORTING METHOD

PRISMA extension for scoping reviews.

NO PATIENT OR PUBLIC CONTRIBUTION

Not required as it was a literary work (scoping review).

Chinese medical staff's knowledge, attitudes and practices towards breast cancer patients' sexual health management: A cross-sectional study

Objective

The objective of this research was to assess the level and determinants of medical personnel's knowledge, attitudes, and practices regarding the management of sexual health in breast cancer survivors residing in western China.

Background

Sexual well-being is a crucial aspect of one's overall satisfaction with life. Once female sexual dysfunction (FSD) occurs, it will affect patients' satisfaction and life quality seriously. In all healthcare settings, the management of sexual health relies heavily on the vital contribution of medical personnel. Nevertheless, the sexual requirements of individuals with breast cancer are still partially unmet.

Design

A web-based questionnaire was used to conduct a multi-centered, cross-sectional study involving medical staff from 26 hospitals in nine cities of Guizhou Province, China.

Methods

Data was gathered from healthcare professionals using a validated tool, the knowledge, attitudes, practices assessment scale for managing the sexual health of breast cancer patients in medical staff. This tool was used to evaluate the knowledge, attitudes, and practices of medical staff regarding sexual health management.

Results

In this study, a grand total of 3181 healthcare professionals took part. The overall KAP scores, including knowledge, attitudes, and practices, were 47.15 ± 11.91, 72.55 ± 12.56, and 58.61 ± 11.45, respectively. Three variables exhibited a strong and favorable correlation. The study identified significant concerns regarding the limited understanding of medical personnel regarding effective strategies for enhancing sexual health function in breast cancer patients, as well as their diminished confidence in addressing FSD. The scores of knowledge, attitudes, and practices related to sexual health management were significantly influenced by whether or not training was received.

Conclusions

The study results emphasize the importance of adopting a holistic approach to enhance the understanding, perspectives, and behaviors of healthcare professionals regarding the management of sexual health. In addition to enhancing the standard of care for individuals with breast cancer.

Barriers to and strategies for dealing with vaginal dilator therapy - Female pelvic cancer survivors' experiences: A qualitative study

PURPOSE

Vaginal changes, a frequently reported late effect among women treated with pelvic radiotherapy, can result in sexual dysfunction and distress. Women are recommended vaginal dilator therapy after completed radiotherapy; however, low adoption has been recognized. This study aims to provide insight into women's difficulties with carrying out vaginal dilator therapy and their experiences of information.

METHODS

Face-to-face, semi-structured interviews were undertaken with 12 pelvic cancer survivors in a selected sample of women with difficulties adopting the therapy. Interviews were audio-recorded, transcribed and analyzed using qualitative content analysis.

RESULTS

One overarching theme, Being unprepared, emerged from three identified categories relating to Experience of received information, Experience of performing the therapy, and Motivation to perform the therapy. The women experienced the information as unrealistic and insufficient, and requested clearer and earlier information. Bleeding, pain, fear of cancer recurrence, and recalling memories from treatments were experienced. Women described intestinal symptoms, fatigue, and feeling that the therapy was self-harm as barriers to performing the therapy. They described creating routines, breathing exercises, relaxation, pre-warming the dilator and performing therapy together with their partner as helpful strategies.

CONCLUSIONS

Careful discussion, early and clear communication, psychoeducation and supportive follow-up of vaginal changes should be integrated into cancer treatment and follow up. Healthcare professionals should be aware of potential difficulties with vaginal dilator therapy and identify women in need of extended support. Research is required to investigate interventions that suit the needs of female pelvic cancer survivors.

Sexual health and wellbeing among female pelvic cancer survivors following individualized interventions in a nurse-led clinic

PURPOSE

Treatment-induced sexual and intestinal dysfunctions coexist among women after pelvic radiotherapy. We aimed to explore if sexual health and wellbeing may be improved after radiotherapy following nurse-led interventions and if an association exists between improved intestinal health and sexual health.

METHODS

A population-based cohort of women treated with pelvic radiotherapy underwent interventions at a nurse-led clinic at Sahlgrenska University Hospital, Sweden, from 2011 to 2017. Self-reported questionnaires were used, pre- and post-intervention, to compare self-reported changes in sexual health and wellbeing. A regression model was performed to explore the association between intestinal and wellbeing variables.

RESULTS

Among the 260 female pelvic cancer survivors included in the study, more women reported increased than decreased satisfaction with overall sexual health post-intervention (26.0% vs. 15.3%, p = 0.035). They also reported significantly reduced superficial genital pain (25.8% vs. 13.1%, p ≤ 0.025), reduced deep genital pain (23.1% vs. 8.0%, p ≤ 0.001), increased QoL (42.7% vs. 22.4%, p < 0.001), and reduced levels of depression (43.1% vs. 28.0%, p = 0.003) or anxiety (45.9% vs. 24.4%, p < 0.001) post-intervention. We found a significant association between reduced urgency to defecate and improved satisfaction with overall sexual health (RR 3.12, CI 1.27-7.68, p = 0.004) and between reduced urgency to defecate with fecal leakage and reduced anxious mode (RR 1.56, CI 1.04-2.33, p = 0.021).

CONCLUSION

Sexual health and wellbeing can be improved by interventions provided in a nurse-led clinic focusing on physical treatment-induced late effects. Further research to optimize treatment strategies in female pelvic cancer survivors is needed.

A Scoping Review to Identify Barriers and Enabling Factors for Nurse-Patient Discussions on Sexuality and Sexual Health

Background: Sexuality and sexual health (SSH) are essential aspects of care that have evolved since a 1975 World Health Organization (WHO) report on SSH. However, nurses still consider discussing the subject with patients a challenge. This scoping review aimed to map, synthesize, and summarize findings from existing literature regarding barriers and enabling factors for nurse–patient SSH discussions in care contexts. Methods: A scoping review model inspired by Arksey and O’Malley was used to search for and synthesize studies published between 2009 and 2019. The databases searched were the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Medical Literature Analysis and Retrieval System Online, i.e., MEDLARS Online. A total of nineteen articles were eligible to be included. Results: Two main categories of enabling factors were identified, i.e., a professional approach via using core care values and availability of resources. Three major categories of barriers were identified: beliefs and attitudes related to age, gender, and sexual identity; fear and individual convictions; and work-related factors. Conclusions: Applying professionalism and core care values as well as making resources available are likely to promote SSH discussions between nurses and patients. Moreover, there is a need for a norm-critical approach in education and practice.

The management of sexual dysfunction resulting from radiotherapy and androgen deprivation therapy to treat prostate cancer: A comparison of uro-oncology practice according to disease stage

OBJECTIVES

To establish current uro-oncology practice in the management of sexual dysfunction (SD) following radiotherapy (RT) and/or androgen deprivation therapy (ADT) to treat prostate cancer. To identify differences in approach to the management of SD according to disease stage.

SUBJECTS AND METHODS

A 14-question mixed methods survey was designed to assess the current UK practice. Closed- and open-ended questions were used to quantify results while allowing participants to expand on answers. The survey was distributed to members of the British Uro-Oncology Group at the 2019 annual meeting.

RESULTS

Surveys were completed by 63 uro-oncologists attending the annual meeting of the British Uro-Oncology Group (response rate 66%). The major issue highlighted was a difference in approach to managing SD according to disease stage. More than half of the participants (56%) said 'advanced stage of disease' was a barrier to discussing SD. Clinicians were less likely to discuss SD, take baseline assessments, refer to a specialist clinic or offer rehabilitation when dealing with patients with advanced disease. Only a minority said that the management of SD was primarily their responsibility (11%). Nearly all clinicians (92%) had access to SD clinics; however, the majority of clinicians did not routinely refer patients.

CONCLUSIONS

This study shows that men with advanced prostate cancer need better support in managing SD. Patients receiving long-term ADT are less likely to be offered any kind of help or intervention. Specific guidance on managing SD in this cohort may result in improvements in sexual function, emotional well-being, quality of life, mental health and confidence.

Nurse's practices and attitudes toward sexual health, wellbeing, and function in people receiving haemodialysis: A scoping review

BACKGROUND

Sexual health, wellbeing, and function are important parts of a person's identity. Chronic diseases, such as kidney failure can alter, impair, and profoundly, affect sexual wellbeing and function.

OBJECTIVE

To conduct a scoping review of studies about renal nurses' practice and attitudes towards sexual health, wellbeing, and function in people with kidney failure receiving haemodialysis.

METHODS

Using Arksey and O'Malley's framework, seven databases were searched (CINAHL, MEDLINE, EMBASE, OvidPsycINFO, Scopus, Cochrane library, and JBI library). The search included studies published in English from January 2009 to January 2020.

RESULTS

Four studies met the review criteria (two cross-sectional surveys and two qualitative). Role confusion in discussing sexual issues, lack of training, and education in addressing sexual concerns, personal, and workplace related barriers were four factors that emerged from the review of the studies. This review identified that renal nurses were uncomfortable and hesitant in initiating discussions about sexual health, wellbeing, and function with people receiving haemodialysis.

CONCLUSION

Renal nurses experience role confusion about whose responsibility it is to initiate and discuss sexual concerns with patients, as well as who's role is it to conduct sexual health assessments. Work related and personal barriers impeded nurses' practice regarding sexual health, wellbeing, and function. Nurses working in renal units need knowledge and practical training about how to initiate and address sexual concerns in those affected by kidney disease.

Nursing Care in Dermatologic Oncology: a Qualitative Study

Nurses in hospital dermatology departments must increasingly provide care for patients with skin cancer. Although the experience of oncology nurses in numerous specialties has been widely explored, no study has focused on the experience of nurses in dermatologic oncology. We aimed to explore how nurses experience their care for patients with skin cancer. This is an inductive, exploratory study employing semi-structured interviews and focus groups with nurses, followed by thematic analysis. The study included purposive sample of 14 nurses practicing in different sectors of this dermatology department. Data were collected via two focus groups of six nurses each and 14 individual, semi-structured interviews, both using a researcher-developed interview guide. Interviews were transcribed and analyzed with thematic analysis. The most illustrative quotes were translated into English. Nurses' experiences of providing care in dermatologic oncology are organized around two themes: (1) their practices for these patients and (2) their management of emotional distress as the major issue in care, especially at night. Our results show the predominant place of relationships with patients in nurses' practices and of their emotional distress due to their closeness to the patients. Specific and original aspects have also been demonstrated with practical implications to be drawn for nurses' supportive care role: the distress engendered by the specific and harrowing experience of nurses dealing with skin cancer, which can be both seen and smelled.

[Perceptions and attitudes of nurses on emotional and sexual lives of cancer patients]

INTRODUCTION

Despite the frequency of sexual issues during cancer care, the majority of nurses do not bring up the topic with their patients. The purpose of this study is to encourage nurses in oncology and hematology units on how to better participate in the assessment of the well-being of cancer patients as part of their sexual health.

METHODS

Using an interview guide, we conducted a qualitative study by interviewing twenty nurses working in the Oncology and Hematology Units of four Belgian hospitals. The twenty semi-structured interviews were transcribed, and we performed a content analysis of the data collected.

RESULTS

Sexuality is still a taboo topic, sexual dysfunction is undervalued, nurses lack knowledge on the topic which create many barriers to sexual health assessment. Obstacles are intrinsic or extrinsic towards nurses: prejudices, embarrassment, lack of evaluation tools, lack of support, resources, the environment is not always adequate. This is linked to the lack of knowledge of side effects of treatments, the lack of know-how, well-being and reflexivity. The assessment of sexual health is however part of their role. Nurses would like to have tools and better education to address the various shortcoming on how to address sexual health.

CONCLUSION

Nurses must acknowledge the existence of sexual health issues in cancer patients by rectifying their perceptions of sexuality, improving their knowledge and management of care, by addressing the issue of sexual health early enough.

Effectiveness of postpartum sexual health education programme structured according to Levine's conservation model: An interventional study

AIM

This study aimed to determine the effects of a postpartum sexual health education programme structured according to Levine's conservation model on postpartum women.

METHODS

The interventional study was completed with 67 postpartum women. The intervention group was given the postpartum sexual health education programme structured according to Levine's conservation model. The control group received routine discharge training. The data were collected using a personal information form, The Index of Female Sexual Function, Arizona Sexual Experience Scale and Golombok-Rust Inventory of Sexual Satisfaction.

RESULTS

It has been determined that the decrease in sexual arousal and desire is the first among postpartum sexual problems experienced by women. This study demonstrated that sexual function, sexual satisfaction and sexual response were higher in nonbreastfeeding women, women who had sexual intercourse one to three times a week and women who could talk to health care professionals on sexual matters. After the programme, the intervention group had more adequate sexual function, and they developed a strong, easy and satisfactory sexual response than the control group (p < 0.05).

CONCLUSION

This programme was effective in increasing the sexual functions and satisfaction of the postpartum women. Models provide guidance to nurses for provision of care in a systematic manner.

Prevalence and possible predictors of sexual dysfunction and self-reported needs related to the sexual life of advanced cancer patients

Background: Sexual dysfunction and problems are common late effects after treatment of cancer. However, little is known about the prevalence and risk factors for sexual dysfunction in patients with advanced cancer. The aim of this study was to investigate the prevalence and predictors of sexual problems and needs in a large sample of Danish patients with advanced cancer. Methodology: The data derived from a representative cross-sectional study of patients with advanced cancer. Patients who had been in contact with 1 of 54 hospital departments were invited to fill out a questionnaire on symptoms and problems. Five items asked about sexuality. Ordinal logistic regression was used to identify variables associated with sexual functioning in explorative analyses. Results: A total of 1,447 patients completed the questionnaire and of those, 961 patients (66%) completed the sexuality items. More than half of the patients (60%) had not been sexually active within the previous month, despite a high prevalence of desire for sexual intimacy (62%). More than half of the patients (57%) experienced that their physical condition or treatment had impaired their sex life. Of those, 52% experienced an unmet need for help with sexual problems from the health care system. Older patients were less likely to report sexual problems than younger patients. Having prostate or gynecologic cancer was associated with the feeling that one's sexual life was negatively influenced. Conclusion: Sexual problems are common among patients with advanced cancer and should be addressed by the health care system.

Healthcare professional perceived barriers and facilitators to discussing sexual wellbeing with patients after diagnosis of chronic illness: A mixed-methods evidence synthesis

OBJECTIVES

To explore healthcare professional perceived barriers and facilitators to discussing sexual health and wellbeing with patients after diagnosis of chronic illness.

METHODS

Five databases were searched and included data were synthesised using a meta-ethnographic approach. Confidence in findings was assessed using the GRADE-CERQual framework. Searches, extraction and quality assessment procedures were conducted independently by at least two authors.

RESULTS

Concepts extracted from 30 included studies were used to develop a conceptual framework based on five overarching themes. These were [1] individual and societal attitudes to sex and sexual wellbeing [2], patient specific factors [3], organizational and professional factors [4], strategies to overcome barriers in practice and [5] perceived training needs. Healthcare professionals acknowledged the importance of discussing and providing support for sexual wellbeing needs, but recognized it is not routinely provided.

CONCLUSIONS

While patient specific factors and organizational issues such as lack of time were frequently identified as barriers, intra-personal and social perceptions appear to have the strongest influence on healthcare professional perspectives.

PRACTICE IMPLICATIONS

Brief education and tools to support healthcare professionals to have effective conversations with patients are required. These should address social barriers, normalise sexual issues, and support healthcare professionals to initiate discussions around sexual concerns.

Addressing treatment-related sexual side effects among cancer patients: Sub-optimal practice in radiation therapy

OBJECTIVE

Sexual side effects of treatment are common among cancer patients receiving radiation therapy. Little attention has been given to the role of radiation therapists (RTs) in managing sexual issues. The current study sought to address this by assessing the provision of care for sexual issues by RTs in Ireland.

METHODS

Cross-sectional data were collected using an online questionnaire. Measures included: participant characteristics; sexuality-related practice; knowledge, awareness and confidence in dealing with sexual issues; the sexual attitudes and beliefs survey; and opinions as to the "ideal" management of sexual issues.

RESULTS

Discussion of sexual issues with patients was rare, and most participants (N = 46) did not feel these issues were addressed effectively in their departments. Barriers to the discussion of sexual issues included low knowledge, awareness and confidence; perceptions of professional role boundaries; and concerns about personal and patient discomfort. Nonetheless, participants indicated that RTs should ideally be equipped to discuss sexual side effects of treatment, as they would any other side effect.

CONCLUSION

This study has identified a sub-optimal provision of care for sexual issues by RTs. Training is needed if RTs are to effectively support the work of the multidisciplinary team in this area.

Experiences of Scandinavian nurses in discussing sexuality with patients, clients and residents: a qualitative systematic review protocol

REVIEW QUESTION/OBJECTIVE

The objective of this review is to critically appraise, synthesize, and present the best available evidence to address the question: How do Scandinavian nurses experience discussing sexual issues with patients, residents and clients?

Telephone follow-up after treatment for endometrial cancer: A qualitative study of patients' and clinical nurse specialists' experiences in the ENDCAT trial

PURPOSE

Endometrial cancer is the sixth most common female cancer worldwide. There is little evidence that routine hospital surveillance increases survival or decreases morbidity following treatment. Gynaecology Oncology clinical nurse specialists (CNSs) are ideally placed to provide the care, information and support to enable women with a gynaecological cancer to self-manage and live well. A multi-centre randomised controlled trial (RCT) compared hospital follow-up (HFU) with telephone follow-up (TFU) by CNSs. The structured telephone intervention focused on information provision to meet patients psychosocial and information needs. This study aimed to explore the views of women who had received TFU and the CNS's who had delivered the service.

METHOD

A qualitative study to complement the RCT using semi-structured interviews was conducted. Twenty-five patients were randomly selected from participants in the TFU arm stratified by study site. Seven CNSs were interviewed.

RESULTS

Patient and CNS regarded TFU positively; Three themes emerged from the patient interviews; Convenient Care, Discrete Personalised Care, Confidence and Reassurance. Themes arising from the CNS interviews were Patient Centred Care, Holistic Care and, Confidence and Skills. Patients found that TFU with CNS's was convenient and enabled discussion of issues and information provision at time-points relevant to them. The CNS's found the structured format of TFU enabled them to utilise their skills and knowledge to identify and meet patients holistic needs.

CONCLUSIONS

Alternative models of care such as TFU provided by CNSs provides the care, information and support to enable women treated for endometrial cancer to self-manage and live well.

Sexual health in patients with hematological malignancies: a neglected issue

Current evidence, although limited, outlines that sexual dysfunction may represent a prominent part of the symptom burden experienced by the patients with hematologic malignancies (HM). However, despite their presumed negative effects on quality of life (QoL), sexual health is not typically considered in the QoL assessment of HM patients. In addition, very few studies have been conducted in this area. Therefore, it would be important to further investigate how newer drugs developed in recent years for patients with HM, including targeted therapies and impact on sexual health, and how this influence overall patients' QoL outcomes.

Perception and Assessment of Verbal and Written Information on Sex and Relationships after Hematopoietic Stem Cell Transplantation

This study aimed to investigate experiences of verbal and written information about sex and relationships among men and women treated with hematopoietic stem cell transplantation. The study also aimed to investigate the demand for information and assessment of the quality of written patient information material entitled "Sex and relationships in the treatment of blood diseases." Few studies exist that shed any light on the demand for information about sex and relationships on the part of patients with hematological diseases before, during, and after their treatment. A total of 216 patients undergoing treatment for malignant blood diseases between 2000 and 2010 participated in this study. Patients' experiences of information about sex and relationships, and their opinions about the written patient information, were assessed using a questionnaire created specifically for this study. Most patients (81 %) had not received information about sex and relationships from a healthcare professional. Almost 90 % of men felt that verbal information was important, compared with 82 % of women. The majority also held that written information was important. These results indicate that patients, regardless of gender, age, and treatment, consider oral and written information about sex and relationships to be important and that the healthcare system should provide the information. The written patient information was considered to play an important role in creating an opening for a conversation about a sensitive topic such as sexuality, and also as a source of reference and support for the patient and his/her partner.

Sexual Health: Exploring Patient Needs and Healthcare Provider Comfort and Knowledge

BACKGROUND

Sexual health is an important quality-of-life issue for many cancer survivors; however, this issue remains inadequately discussed by healthcare providers (HCPs) and patients.

OBJECTIVES

The purpose of this study is to explore whether clinical oncology HCPs have adequate knowledge and are comfortable addressing sexual health issues, and to explore and describe patients' attitudes, beliefs, and informational needs regarding sexual health.

METHODS

A survey was completed by HCPs and three patient focus groups were conducted to learn more about sexual health. Survey data were analyzed using descriptive statistics, and qualitative responses were analyzed using content analysis.

FINDINGS

The majority of survey respondents reported on the importance of discussing sexual concerns with patients, lacked sexual health training, and were uncomfortable discussing sexual health with patients. Focus group participants wanted access to timely information during treatment, online educational resources, and brochures and handouts; involvement of significant others; support from providers, peers, and survivors; and expert consultation.

Nurses' perceptions of providing psychosexual care for women experiencing gynaecological cancer

PURPOSE

To gain insight into how Western Australian nurses conceptualise the provision of psychosexual care for women undergoing gynaecological cancer treatment and how this aligns with nurses globally.

METHODS

A qualitative descriptive design was chosen to facilitate insight into nurses' perspectives of their reality. Seventeen nurses working at a tertiary women's hospital in Western Australia participated in one-on-one interviews and were asked to describe their perceptions and identify factors that facilitate or challenge psychosexual care provision.

RESULTS

Data analysis revealed five themes affecting the provision of psychosexual care: (1) Nurses use strategies to aid the conversation (subthemes: supporting the woman, facilitating engagement); (2) Women have unique psychosexual needs (subthemes: diversity, receptiveness); (3) Nurses are influenced by personal and professional experience and values (subthemes: confidence, values, making assumptions); (4) Systems within the health service affect care (subthemes: being supported by the system, working as a team); and (5) Society influences attitudes around sexuality. Nurses' views differed around whether these factors had a positive or negative impact on the conversation required to provide this care.

CONCLUSIONS

Factors influencing nurses' provision of psychosexual care are multifaceted and differ amongst nurses. Recommended strategies to improve service provision include guidelines and documentation to integrate assessment of psychosexual issues as standard care, encouraging shared responsibility of psychosexual care amongst the multidisciplinary team and implementing education programs focussed on improving nurses' confidence and communication skills.

Sexuality education for health professionals: A literature review

Abstract The objective of this study was to review the scientific literature addressing educational actions related to the training of health professionals in sexuality between 2003 and 2013. The results obtained show that college seniors, recent college graduates, or those working in hospitals and other health care facilities are not adequately prepared to meet patients' needs regarding sexuality. Several studies have shown improvement in the health practitioners' ability to deal with patients' sexuality issues after participating in training programs in sexuality, regardless of the course load. According to the articles reviewed, in order to improve the performance and comfort level of health practitioners to deal with patients' sexuality concerns, investments in educational actions are necessary.

Changes in Sexuality, Body Image and Health Related Quality of Life in Patients Treated for Hematologic Malignancies: A Longitudinal Study

Longitudinal studies exploring sexuality, body image and health-related quality of life (HRQoL) are lacking in patients treated with chemo- or chemoimmuno-therapy for hematologic malignancies. The aim was to describe and explore changes in sexuality, body image and HRQoL in patients treated for hematologic malignancies, from baseline until 6 months after treatment. Twenty patients above 45 years (median age 62) treated for DLBCL, CLL or AML participated. Data were collected at baseline, 1- and 6-months after treatment by means of three instruments: SAQ-S, BIS and EORTC QLQ-C30. The results showed that patients' sexuality was negatively affected 1 month after treatment, but after 6 months the patient reported scores had returned almost entirely to baseline scores. Body image was slight negatively affected after 1 month and after 6 months, 50 % reported that body image was not affected at all. Regarding HRQoL, patients reported gradually improved scores during the study period. Regression analysis showed that changes in sexuality and body image seemed to influence changes in HRQoL. This study has shown changes in sexuality, body image and HRQoL over time in patients above age 45 treated for hematologic malignancies. One month after treatment all three areas becomes negatively affected, and thereafter the patients' scores recovered to a great extent regarding these issues within 6 months. Sexuality and body image seem to be important aspects of HRQoL for these patients and need to be integrated in the cancer rehabilitation during and after treatment.

Changes in attitudes, practices and barriers among oncology health care professionals regarding sexual health care: Outcomes from a 2-year educational intervention at a University Hospital

PURPOSE

To examine the attitudes, practices and perceived barriers in relation to a sexual health care educational intervention among oncology health care professionals at the Landspítali-National University Hospital of Iceland.

METHODS

The design was quasi experimental, pre - post test time series. A comprehensive educational intervention project, including two workshops, was implemented over a two year time period. A questionnaire was mailed electronically to all nurses and physicians within oncology at baseline (T1, N = 206), after 10 months (T2, N = 216) and 16 months (T3, N = 210).

RESULTS

The response rate was 66% at T1, 45% at T2 and 38% at T3. At all time points, the majority of participants (90%) regarded communication about sexuality part of their responsibilities. Mean scores on having enough knowledge and training, and in six of eight practice issues increased significantly over time. Overall, 10-16% reported discussing sexuality-related issues with more than 50% of patients and the frequency was significantly higher among workshop attendants (31%) than non-attendants (11%). Overall, the most common barriers for discussing sexuality were "lack of training" (38%) and "difficult issue to discuss" (27%), but the former barrier decreased significantly by 22% over time.

CONCLUSIONS

The intervention was successful in improving perception of having enough knowledge and training in providing sexual health care. Still, the issue remains sensitive and difficult to address for the majority of oncology health care professionals. Specific training in sexual health care, including workshops, should be available to health care professionals within oncology.

Discussing sexuality with cancer patients: oncology nurses attitudes and views

BACKGROUND

Sexual health and function frequently are overlooked by healthcare professionals despite being identified as an essential aspect of patient care. Patients with cancer have identified sexuality issues as being of equal importance to other quality-of-life issues.

OBJECTIVES

The aim of this study was to determine the views and attitudes of oncology nurses caring for cancer patients regarding sexual counseling.

PARTICIPANTS AND METHODS

A descriptive cross-sectional study was conducted on the web site of the Turkish Oncology Nurses Association. With the participation of 87 nurses from oncology departments, the study determined that most nurses do not evaluate and counsel patients regarding their sexual problems and many difficulties prevent them from focussing on sexual health. The most important reasons for ignoring sexual counseling were the absence of routine regarding sexual counseling in oncology departments, the belief that the patient may become ashamed and the nurses' self-evaluation that they have insufficient skills and education to counsel in this subject.

CONCLUSIONS

The most important variables in sexual evaluation and counseling are long years of service in the profession and a postgraduate degree.

Conceptions of learning research: variations amongst French and Swedish nurses. A phenomenographic study

BACKGROUND

The development of nursing research capacity and interactions with cultural and structural issues is at various stages throughout Europe. This process appears to be remarkably similar irrespective of the country. Sweden has developed this capacity since the 1990s, whereas France is experiencing a transition. Nevertheless, knowledge about how nurses conceive their learning about nursing research and transitioning toward being researchers is scarce.

OBJECTIVES

The aim of this study was to explore French and Swedish RNs' conceptions of research education and educational passage toward research and to describe how learning research contributes to the understanding of their norms and practices.

DESIGN

A phenomenographic approach was used to understand and describe the qualitatively different ways in which French and Swedish RNs conceive research and its apprenticeship.

SETTINGS AND PARTICIPANTS

A purposive maximum variation sampling of five French and five Swedish Nurse Researchers with PhDs.

METHODS

Individual in-depth interviews conducted in France and Sweden between November 2012 and March 2013 were analysed using phenomenography.

FINDINGS

The analysis revealed one main category, "Organisational factors to sustain individual apprenticeship". Three descriptive categories have emerged from the data and its variations amongst French and Swedish nurses: (1) entrance into research--modes of commitment; (2) nurses' engagement--the need for dedicated support; and (3) research as the means to resolve nursing situations.

CONCLUSIONS

This study demonstrates how registered nurses have integrated nursing and researcher roles following different efficient paths. Education in nursing research is part of the strategy needed for the development of nursing research and is supported by the integration of research and practice.

Sexuality is not a priority when disease and treatment side effects are severe: conceptions of patients with malignant blood diseases

AIMS AND OBJECTIVES

To describe how patients with malignant blood diseases conceive the influence of chemo- or chemoimmunotherapy on sexuality, and their need of support related to this issue.

BACKGROUND

Sexuality is often negatively affected in cancer patients with sex-specific diagnoses. For patients with malignant blood diseases, the research is limited with regard to the effect on sexuality. Knowledge about their need for support related to sexuality is also needed as nurses are found to often avoid this area of their responsibility.

DESIGN

Qualitative design.

METHODS

Twelve patients treated for malignant blood diseases were interviewed twice. Phenomenography was used for the analysis.

RESULTS

The analyses revealed an outcome space consisting of two main categories: 'Sexuality is overshadowed by the cancer experience' and 'No need of support but timely information might be helpful', both comprehensively related to three interrelated description categories 'Affected strength', 'Affected sexual desire' and 'Affected body image', which describe conceptions of how sexuality was affected.

CONCLUSION

Patients experienced negative effects on sexual function and sexual relationship during and after treatment period due to affected strength, sexual desire and negatively body image. However, when disease and side effects were experienced as severe, thoughts and interest of sexuality were overshadowed, and the need or wish for support related to this issue was very low. It is important to note that some patients expressed that pre- or post-treatment information might have been helpful.

RELEVANCE TO CLINICAL PRACTICE

It is acknowledged in the cancer care of today that cancer follow-up should address psychosocial support in which sexuality is an important area. Therefore, it is imperative that cancer care is organised in a patient centred way, with adequate time for nurses to provide continuity in the nurse-patient relation and supportive care also during cancer rehabilitation.