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

Sexual quality of life after gynaecological cancer: what young women want

PURPOSE

Psychosexual distress is known to be a common complication of treatment for gynaecological cancer (GC), affecting the sexual quality of life (SQoL) for an increasing number of young gynaecological cancer survivors (YGCS). The SQoL in YGCS study aimed to identify strategies that are acceptable and helpful to YGCS in protecting and improving SQoL, using a salutogenic approach.

METHODS

A qualitative study was undertaken with young women aged 18-45 and pre- or perimenopausal at diagnosis. Semi-structured interviews were conducted on Zoom and a thematic analysis of transcripts was completed in NVivo.

RESULTS

Fifteen interviews with YGCS revealed three themes for strategy development: psychosexual education, psychosocial support, and healthcare policy and strategy to establish SQoL as standard care in gynaecologic oncology.

CONCLUSION

The strategies put forward by YGCS showed the need for a holistic, patient-centric, and multidisciplinary approach to SQoL. A better understanding of the strategies acceptable to YGCS, including the importance of using a trauma-informed approach to communication and care, can help healthcare providers play a vital role in protecting and improving SQoL.

Nurse-patient sexual health communication in gynaecological cancer follow-up: A qualitative study from nurses' perspectives

AIM

To explore nurse-patient sexual health communication from the perspectives of nurses trained to address sexual health in gynaecological cancer follow-up.

DESIGN

A qualitative hermeneutic approach.

METHODS

Individual semi-structured interviews with 10 nurses at five different hospitals in Norway were conducted in March and April 2021. A Gadamerian-inspired research method was used in the analysis.

RESULTS

Three main themes with six sub-themes were identified. The three main themes were: (1) building relationships through communication, (2) practice makes perfect-the importance of experience and knowledge, and (3) personal attitudes as promoters or inhibiters of sexual health communication.

CONCLUSION

This study provides valuable insights into nurse-patient sexual health communication from the perspectives of nurses. The nurses in this study experienced the importance of having a good, respectful nurse-patient relationship as the foundation for sexual health communication. The professional confidence gained through experience and knowledge was emphasized, including the significance of how attitudes and taboos can influence sexual health communication.

IMPACT

The main findings of this study indicate that training in sexual health communication and the possibility of addressing sexual health repeatedly give nurses skills and professional confidence to address sexual health in cancer follow-up. Our study indicates that sexual health communication can be achieved in a clinical setting without being overly resource demanding. Our results may also motivate nurses to enhance their knowledge about sexual health in cancer follow-ups.

PATIENT OR PUBLIC CONTRIBUTION

A patient representative from the Norwegian Gynaecological Cancer Society have been involved in the planning of this study. She has given valuable contributions from the view of a gynaecological cancer patient.

Possible sexual dysfunction in traumatically injured clients: improving the approach at initial assessment

AIM

To explore the perceived barriers experienced by rehabilitation case managers to discussing sexual function with clients after a traumatic injury, at the point of initial assessment. Study design: Small-scale semi-structured interviews were conducted to inform baseline measures for a service improvement proposal within the author's employing company. A qualitative phenomenological methodology was used for the interpretation of the data, with application of framework analysis.

FINDINGS

Case managers within the company do not routinely ask clients about issues of sexual dysfunction at the initial assessment of rehabilitation needs. Identified inhibitors included the client's age, cultural background, the presence of other people during the assessment, embarrassment for either party, or any apparent reservations about the assessment process for the client. These echoed findings from the wider healthcare literature. Prompts to initiating conversations were also identified, including the nature of injury or the openness of the client.

CONCLUSION

In their holistic assessment of clients' rehabilitation needs, and as part of the development of the therapeutic relationship, case managers are ideally situated to encourage conversations concerning issues of sexual dysfunction with clients, having the opportunity to signpost them to the most appropriate support or to facilitate referrals for treatment.

The effect of the EX-PLISSIT model-based psychosexual counseling on improving sexual function and sexual quality of life in gynecologic cancer survivors: a randomized controlled clinical trial

PURPOSE

Psychosexual support has received considerable attention in the improvement of sexuality in gynecologic cancer survivors. The current study was conducted to examine the effect of EX-PLISSIT model-based psychosexual counseling on improving sexual function and sexual quality of life in this group of patients.

METHODS

One hundred ten eligible women with the most common gynecologic cancers were randomized 1:1 to intervention (EX-PLISSIT-based counseling sessions for 4 weeks) and control groups. Sexual function and sexual quality of life were assessed via FSFI and SQOL-F self-reported questionnaires at baseline and 8 weeks post-intervention.

RESULTS

One hundred fifty patients were registered; 110 were equally randomized to the intervention and control groups (55 each). Ninety-nine patients completed both questionnaires at baseline and 8 weeks post-intervention. There were no significant differences in the FSFI and SQOL-F scores between the study arms compared to baseline using the independent t-test (P > 0.05). Positive changes in FSFI and SQOL-F scores were observed in patients in both arms at 8 weeks. However, the mean difference was higher in the intervention arm but was statistically significant only in the domains of sexual desire, lubrication, orgasm, pain, overall sexual function, and sexual and relationship satisfaction subscale of SQOL-F (P < 0.05).

CONCLUSIONS

Based on our findings, by facilitating communication, the EX-PLISSIT-based psychosexual counseling resulted in positive changes in sexual function and sexual quality of life in gynecologic cancer survivors. Therefore, we recommend this type of counseling in combination with other therapeutic and rehabilitative services for survivors of gynecologic cancers.

TRIAL REGISTRATION

This study was registered in Iran's Clinical Trial Registry under registration code IRCT20160808029255N6 on 29 June 2019.

Pharmacists' practices and views regarding management of sexual health in patients with cancer

INTRODUCTION

Sexual health issues associated with cancer can significantly impact patients' psychosocial well-being and overall quality of life. These issues are frequently medication-related, placing pharmacists in an opportune position to manage sexual health concerns in patients with cancer. Currently, no literature exists exploring pharmacists' practices related to the management of sexual health in oncology patients.

METHODS

An anonymous, descriptive, cross-sectional, web-based survey was conducted to elicit pharmacists' views and practices regarding managing sexual health in oncology patients. Pharmacists practicing in Canada who provide care to adult malignant hematology or oncology patients were eligible to participate. The survey was disseminated through the Canadian Association of Pharmacy in Oncology and through informal oncology pharmacy practitioner networks.

RESULTS

Of the 102 pharmacists who participated, 96 completed the survey in its entirety. Most respondents were female, practiced in Alberta, and primarily saw oncology patients in outpatient cancer facilities. Although 85% of participants felt pharmacists should be involved in giving patients an opportunity to discuss sexual health, only 8% reported managing sexual health in at least 50% of their oncology patients. The most commonly agreed upon barriers to this were presence of family members and friends at appointments, lack of knowledge or training, limited time, and the belief that sexual health is not applicable to all oncology patients.

CONCLUSIONS

This study explored pharmacists' views and practices regarding managing sexual health in patients with cancer. Several barriers were identified, which may aid in future development of resources to assist pharmacists in routinely addressing sexual health in oncology patients.

Addressing patient sexuality issues in cancer and palliative care

The impact of cancer and subsequent treatments can have serious implications for patient sexuality, both physically and psychologically. Patients report inadequate communication and support from professionals in relation to sexual issues. The aim of this literature review was to ascertain the educational requirements of health professionals practising in oncology and palliative care, to enable effective assessment and support in this area of clinical practice. There appear to be numerous barriers preventing professionals from addressing patient sexuality-lack of knowledge and poor confidence levels being among the most common. Appropriate education is required to equip staff, and it appears that short training programmes can be effective. The use of sexuality assessment tools and information cards, and accessing information from cancer charity websites may improve clinical practice. Addressing sexuality concerns is the responsibility of each person in the multidisciplinary team. Patients require open discussion and professionals must skilfully address the topic of sexuality. Education in this area must be accessible, cost effective and sustainable.

Factors of sexual quality of life in gynaecological cancers: a systematic literature review

Background

The impact of cancer diagnosis and treatment on sexual quality of life (SQoL) is a well-established survivorship issue for gynaecological cancer survivors (GCS), yet little is known on how to intervene.

Purpose

The aim of this systematic review was to identify the factors explaining the variability in SQoL for GCS.

Methods

We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework and the software Covidence. Electronic databases Scopus, Web of Science, PUBMED and CINAHL were searched for original research on GCS published between 2002 and 2018. We performed a two-stage screening process against selection criteria and quality assessment of individual studies. The Salutogenic Theory and the PRECEDE–PROCEED model were used as theoretical frameworks to identify and categorise factors.

Results

The initial search yielded 3,505 articles resulting in a total of 46 studies used to examine the association between factors of SQoL and gynaecological cancers. Our findings suggested that SQoL varies across subgroups based on age, menopausal status, relationship status, and treatment modality. Protective factors included clinicians’ knowledge and confidence, preventive medical approach, risk and needs assessment, patient–clinician communication, relationship quality, psychosocial support, symptom management, accessibility of psychosexual care, and self-efficacy in the rediscovery of sexuality.

Conclusion

Despite the high incidence and long-term impact of sexual health issues on quality of life, supportive care needs are not being met. A better understanding of the evidence base around the factors of SQoL can help health professionals take steps to protect and improve SQoL in GCS.

Nurses' attitudes towards support for and communication about sexual health-A qualitative study from the perspectives of oncological nurses

AIM AND OBJECTIVES

To explore nurses' articulations of support and communication regarding sexual health with patients.

BACKGROUND

Sexual health is adversely effected by cancer and various oncological treatments. Patients' often have the experience that healthcare professionals do not talk about sexual health.

METHOD

Semi-structured interviews were conducted with seven nurses in Southern Sweden. Content analyses were made, inspired by Foucault's concepts of power, discipline and normalisation. SRQR checklist was used.

RESULTS

Patients' sexual health had low priority in the oncological clinic from the perspective of nurses. The medical logic directed nurses' articulations about sexual health towards a physical view, understood as sex, and sexual problems, which could be treated pharmacologically. Further, nurses articulated a sexual norm that sex belongs to young people and younger persons in permanent, monogamous and heterosexual relationships. This norm-governed nurses' inclusion and exclusion of patients in communication about sexual health. According to nurses, most patients did not mention sex, but some patients challenged the clinic's norms. Assessing sexual health problems, nurses often engaged other professions and thereby became gatekeepers for patients' options for getting help.

CONCLUSIONS

From the perspective of nurses, nurses' support and communication regarding sexual health with patients with cancer diagnosis were relatively absent and had a low priority in an oncological clinic. Overall, the nurses had the power to set the agenda about patients' sexual health in the oncological clinic. The clinical gaze became a disciplinary technique that tacitly defined by whom, in what way and how sexual health could be articulated in an oncological clinic.

RELEVANCE TO CLINICAL PRACTICE

By illuminating nurses' preconceptions, thoughts and actions in relation to cancer patients' sexual health, the results invite practitioners to reflect upon and discuss the challenges, opportunities and limitations in providing inclusive and supportive sexual health care to cancer patients.