Development of a conceptual framework to improve sexual wellbeing communication in routine prostate cancer care

Enhancing healthcare professional-led sexual support in cancer care: Acceptability and usability of an eLearning resource and its impact on attitudes towards providing sexual support Authorship

OBJECTIVE

Barriers to healthcare professional (HP)-led sexual support in cancer care include lack of knowledge, skills and evidence-based educational interventions, to equip HPs to address sexual challenges faced by patients and partners. Consequently, sexual support is often avoided. This study examined HPs' acceptability and usability of the Maximising Sexual Wellbeing: Cancer Care (MSW|CC) eLearning resource for HPs and evaluated its impact on HPs' sexual attitudes and beliefs to providing sexual support in cancer care.

METHODS

HPs (n=87) completed pre and post-test surveys using the modified 12-item Sexual Attitudes and Beliefs Scale (SABS). Post-test, participants rated acceptability and usability of the MSW|CC, with optional free-text comments. A repeated measures t-test assessed changes in HPs' scores on the SABS. Descriptive statistics and reporting of free text comments were used to explore HPs' perspectives of the MSW|CC.

RESULTS

SABS scores increased significantly from Time 1 (M=35.1, SD=4.8) to Time 2 (M=40.1, SD=4.3), t(86) =-10.2, p<0.001 (two-tailed) with a medium effect size (d = 0.55); indicating a decrease in HPs' attitudinal barriers to providing sexual support. The MSW|CC was deemed acceptable, user-friendly and easy to navigate. HPs would recommend the use of this eLearning resource to others (3.78/4, SD=0.5), considered it a good informational resource (3.78/4, SD=0.5) and straightforward to use (3.8/4, SD 0.42).

DISCUSSION/CONCLUSION

The MSW|CC reduced HPs' attitudinal barriers towards the provision of HP-led sexual support in cancer care, whilst being acceptable and usable. The MSW|CC could support implementation of global clinical guidelines advocating for HP-led sexual support across the treatment trajectory. This article is protected by copyright. All rights reserved.

Adapting and usability testing of an eLearning resource to enhance healthcare professional provision of sexual support across cancer care

OBJECTIVES

To adapt the theory-driven and positively evaluated Maximising Sexual Wellbeing| Prostate Cancer (MSW|PC) eLearning resource to an eLearning resource suitable for health professionals (HPs) working with mixed cancer populations, followed by usability and acceptability testing.

METHODS

Guided by Person-Based Approach (PBA) and Biopsychosocial Model, the MSW|PC was adapted by combining evidence from the literature, an expert group (n = 27: patients, partners, and HPs working in cancer care) and the research team. New content was developed relevant for a mixed cancer population. The Maximising Sexual Wellbeing| Cancer Care (MSW|CC) eLearning prototype was usability tested and modified with HPs using "think aloud" interviews (n = 18).

RESULTS

Many identified sexual challenges were common across cancer populations, with additional information required for breast, colorectal, gynaecological, head and neck, and prostate cancers. During the testing phase, navigational difficulties were identified and resolved. HPs reported the MSW|CC as engaging, informative, and relevant with helpful communication and signposting tools to support practice.

CONCLUSION

This systematic and iterative PBA yielded important insights to enhance the content and usability of MSW|CC. This novel resource provides HPs working across cancer care with tools to potentially address the gap in knowledge and skills and positively impact future sexual healthcare provision across cancer care.

Factors influencing self-esteem after radical prostatectomy in older adult patients

Older adult patients with prostate cancer experience symptoms such as uncontrolled sexual and urinary dysfunction after radical prostatectomy, which lowers self-esteem. Lack of access to information about the illness increases uncertainty, requiring interventions from healthcare providers. This study aimed to identify factors affecting the self-esteem of older adult patients who underwent prostate cancer surgery and provided data for establishing nursing strategies to promote healthy lifespans. This cross-sectional study examined participants over 65 years old who underwent radical prostatectomy at two university hospitals in 2017. The results indicated that the most influential factor for self-esteem was inconsistency-related uncertainty, followed by postoperative symptom experience and healthcare provider support. These variables explained 43% of the variance in self-esteem. To improve self-esteem among older adult patients who undergo radical prostatectomy, integrated programs that include sexual-related symptom management, such as erectile dysfunction and incontinence, and healthcare provider support should be developed to reduce inconsistency-related uncertainty.

The Tablet-Based, Engagement, Assessment, Support, and Sign-Posting (EASSi) Tool for Facilitating and Structuring Sexual Well-Being Conversations in Routine Prostate Cancer Care: Mixed-Methods Study

Background

Long-term side-effects associated with different prostate cancer treatment approaches are common. Sexual challenges are the most frequently occurring issues and can result in increased psychological morbidity. It is recognized that barriers to communication can make initiating discussions around sexual concerns in routine practice difficult. Health care professionals need to routinely initiate conversations, effectively engage with patients, and assess needs in order to provide essential support. One proposed method that could support health care professionals to do this involves the use of prompts or structured frameworks to guide conversations.

Objective

This study aimed to assess feasibility, acceptability, and satisfaction with the tablet-based Engagement, Assessment, Support, and Sign-posting (EASSi) tool designed to facilitate and structure sexual well-being discussions in routine prostate cancer care.

Methods

Health care professionals (n=8) used the EASSi tool during 89 posttreatment appointments. Quantitative data were recorded based on program usage and surveys completed by health care professionals and patients. Qualitative data exploring perceptions on use of the tool were gathered using semistructured interviews with all health care professionals (n=8) and a sample of patients (n=10).

Results

Surveys were completed by health care professionals immediately following each appointment (n=89, 100%). Postal surveys were returned by 59 patients (66%). Health care professionals and patients reported that the tool helped facilitate discussions (81/89, 91% and 50/59, 85%, respectively) and that information provided was relevant (82/89, 92% and 50/59, 85%, respectively). The mean conversation duration was 6.01 minutes (SD 2.91). Qualitative synthesis identified the tool’s ability to initiate and structure discussions, improve the “depth” of conversations, and normalize sexual concerns.

Conclusions

The EASSi tool was appropriate and acceptable for use in practice and provided a flexible approach to facilitate routine brief conversations and deliver essential sexual well-being support. Further work will be conducted to evaluate the effectiveness of using the tablet-based tool in prostate cancer care settings.

Promoting Sexual Well-being for Men and Their Partners Affected by Prostate Cancer

OBJECTIVE

To present an overview of the issues related to the sexual well-being of people affected by prostate cancer and their partners, and propose ways to manage and address these by oncology nurses and the wider multi-disciplinary team.

DATA SOURCES

Electronic databases such as PubMed and Cinahl were used to retrieve relevant literature published between 2010 and 2020.

CONCLUSION

Sexual well-being in patients with prostate cancer and their partners is multifaceted, comprising physical, emotional, social, and cultural aspects.

IMPLICATIONS FOR NURSING PRACTICE

A combination of pharmacologic and non-pharmacologic interventions, together with enhanced communication, can be successful in providing culturally competent, person-centered care by oncology nurses and the wider multi-disciplinary team.