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Girard A, Arenella K, Rider GN, Teoh D, Vogel RI. Gynecologic cancer survivor preferences for provider communication regarding sexual health after treatment: a qualitative study. Support Care Cancer 2024; 32:629. [PMID: 39225859 DOI: 10.1007/s00520-024-08787-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 08/05/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE Survivorship from gynecologic cancers is becoming increasingly prevalent. There are significant sexual side effects that influence quality of life that would be reduced with proper intervention; however, existing literature highlights the lack of understanding of the sexual health needs within this population. Furthermore, multiple studies show that one contributing factor to sexual well-being in survivorship is provider-patient communication. The aim of this study is to explore experiences of sexual distress and survivor experiences of sexual health communication. METHODS Adult participants who had been out of active treatment for 3 months were recruited to participate in focus groups. Six focus groups (n = 32) were conducted with survivors of gynecologic cancers via Zoom. Research team members analyzed content using thematic analysis. RESULTS Two broad themes were identified: Experiences of provider communication and Preferences for provider communication, with subthemes nested under both. Subthemes from the Experiences theme included absent/lacking communication, negative experiences, emotional reaction to lack of communication, and feeling like sexuality was not valued. Subthemes from the Preferences theme included more conversation and open communication about sexuality, more resources/referrals, and more provider training on sexuality. CONCLUSION Survivor experiences of subjective sexual health are often dependent on the type and quality of information they receive from their healthcare team during treatment. Unfortunately, the majority of participants endorsed negative or absent communication related to their sexual health needs, leading to additional distress.
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Affiliation(s)
- A Girard
- Department of Family Medicine and Community Health, Eli Coleman Institute for Sexual & Gender Health, University of Minnesota Medical School, Minneapolis, MN, USA.
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA.
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.
| | - K Arenella
- California School of Professional Psychology, Alliant International University, Los Angeles, CA, USA
| | - G N Rider
- Department of Family Medicine and Community Health, Eli Coleman Institute for Sexual & Gender Health, University of Minnesota Medical School, Minneapolis, MN, USA
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - D Teoh
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, MN, USA
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - R I Vogel
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, MN, USA
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
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Reese JB, Bober SL, Sorice KA, Handorf E, Chu CS, Middleton D, McIlhenny S, El-Jawahri A. Starting the Conversation: randomized pilot trial of an intervention to promote effective clinical communication about sexual health for gynecologic cancer survivors. J Cancer Surviv 2024; 18:800-809. [PMID: 36604391 PMCID: PMC10323044 DOI: 10.1007/s11764-022-01327-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/23/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Gynecologic cancer survivors often hesitate to raise sexual health concerns with their clinicians. We pilot tested Starting the Conversation (STC), a theory-guided intervention aimed at facilitating survivors' clinical communication about sexual health. METHODS Survivors (N = 32) were randomized 2:1 to STC (23-min video and accompanying workbook grounded in social cognitive theory that provides information and skills training for communicating with providers about sexual concerns, and resource guide) or control (resource guide only). Feasibility was assessed through enrollment, retention, and intervention completion rates (benchmarks: 60%, 80%, 70%); acceptability was assessed through post-intervention program evaluations (benchmark: 75%). Preliminary effects were assessed for sexual health communication (self-reported after next clinic encounter), self-efficacy for clinical communication about sexual health (post-intervention and 2-month follow-up), and sexual activity and anxiety/depressive symptoms (2-month follow-up). RESULTS All feasibility/acceptability benchmarks were surpassed; 76% enrolled, 97% retained, ≥ 95% used intervention materials, and 100% endorsed STC as acceptable. Positive STC effects were seen for increases in self-efficacy (Cohen's d's = 0.45 at post-intervention; 0.55 at follow-up). In STC, 35% and 45% of women raised or asked about sexual health concerns during the post-intervention clinic visit, respectively, versus 0 and 27% in the control arm. Other measures showed little change. CONCLUSIONS Data support the STC intervention as feasible and acceptable, with promising effects for gynecologic cancer survivors' communication about sexual health concerns. Because sexual health communication is relevant across the treatment trajectory, we included both on-treatment and post-treatment survivors. While this may be a limitation, it could also enhance sample generalizability. A larger trial is needed to determine efficacy. IMPLICATIONS FOR CANCER SURVIVORS Communication about sexual health is important yet lacking for cancer survivors. Patient-focused interventions may help address concerns and improve survivors' health outcomes.
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Affiliation(s)
- Jennifer Barsky Reese
- Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA.
| | - Sharon L Bober
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA
| | - Kristen A Sorice
- Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Elizabeth Handorf
- Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
- Biostatistics and Bioinformatics Facility, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Christina S Chu
- Department of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Danny Middleton
- Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Sarah McIlhenny
- Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Areej El-Jawahri
- Department of Hematology/Oncology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
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Pimsen A, Lin WH, Lin CY, Kuo YL, Shu BC. Healthcare providers' experiences in providing sexual health care to breast cancer survivors: A mixed-methods systematic review. J Clin Nurs 2024; 33:797-816. [PMID: 38108237 DOI: 10.1111/jocn.16943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 09/20/2023] [Indexed: 12/19/2023]
Abstract
AIMS To analyse healthcare providers' (HCPs) experiences in sexual health care through the mixed-methods systematic review (MMSR). BACKGROUND Sexual health for breast cancer survivors (BCSs) is becoming increasingly important as survivors live longer. HCPs are critical in providing sexual health care. DESIGN A mixed-methods systematic review. METHODS Literature searches were conducted in databases MEDLINE, CINAHL, Psychology & Behavioral Sciences Collection, Web of Science, Cochrane Library, Scopus, ClinicalTrials.gov and reference lists were searched from inception to 30 December 2022. Two independent reviewers extracted and analysed the data using the JBI guidelines for MMSR. RESULTS After screening for 2849 citations, 19 studies were eligible for MMSR, involving 2068 HCPs. Most HCPs believe that sexual health care is their responsibility. However, sexual health was not adequately addressed. A lack of knowledge was the most significant barrier to providing sexual health care. Moreover, HCPs would like to acquire more knowledge and felt that current sexual healthcare training was inadequate. CONCLUSIONS Findings suggest that HCPs did not frequently address sexual health in BCSs and that lack of knowledge was the most common barrier. Healthcare session administrators should allocate resources for sexual healthcare training that offer multiple formats, accessible content and convenience. They should also be multifaceted and proactive, meet the diverse needs of BCS at different stages and focus on effective communication. RELEVANCE TO CLINICAL PRACTICE This study highlights the importance of addressing sexual health in BCSs and the need for HCPs to receive training in this area. Training should be multifaceted, proactive and meet the diverse needs of BCSs at different stages, with a focus on effective communication. By addressing this issue, HCPs will be better equipped to support the sexual health needs of BCSs, ultimately improving their overall well-being and quality of life. PROSPERO Registration Number: CRD42022327018 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=327018).
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Affiliation(s)
| | - Wen-Hua Lin
- Department of Nursing, Min-Hwei Junior College of Health Care Management, Tainan, Taiwan, ROC
| | - Chung-Ying Lin
- Institution of Allied Health Science, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC
| | - Yao-Lung Kuo
- Department of Surgery, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Breast Medical Center, National Cheng Kung University Hospital, Tainan, Taiwan, ROC
| | - Bih-Ching Shu
- Institution of Allied Health Science, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC
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Benedict C, Shaffer KM, Wirtz MR, Ford JS, Reese JB. Current Considerations in Interventions to Address Sexual Function and Improve Care for Women with Cancer. CURRENT SEXUAL HEALTH REPORTS 2022. [DOI: 10.1007/s11930-022-00343-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Huynh V, Vemuru S, Hampanda K, Pettigrew J, Fasano M, Coons HL, Rojas KE, Afghahi A, Ahrendt G, Kim S, Matlock DD, Tevis SE. No One-Size-Fits-All: Sexual Health Education Preferences in Patients with Breast Cancer. Ann Surg Oncol 2022; 29:6238-6251. [PMID: 35915298 PMCID: PMC9342599 DOI: 10.1245/s10434-022-12126-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/16/2022] [Indexed: 11/18/2022]
Abstract
Background Using explanatory mixed methods, we characterize the education that patients with breast cancer received about potential sexual health effects of treatment and explore preferences in format, content, and timing of education. Patients and Methods Adult patients with stage 0–IV breast cancer seen at an academic breast center during December 2020 were emailed questionnaires assessing sexual health symptoms experienced during treatment. Patients interested in further study involvement were invited to participate in semistructured interviews. These interviews explored sexual health education provided by the oncology team and patient preferences in content, format, and timing of education delivery. Results Eighty-seven (32%) patients completed the questionnaire. Most patients reported decreased sexual desire (69%), vaginal dryness (63%), and less energy for sexual activity (62%) during/after treatment. Sixteen patients participated in interviews. Few women reported receiving information about potential sexual effects of breast cancer treatment; patients who did reported a focus on menopausal symptoms or fertility rather than sexual function. Regarding preferences in format, patients were in favor of multiple options being offered rather than a one-size-fits-all approach, with particular emphasis on in-person options and support groups. Patients desired education early and often throughout breast cancer treatment, not only about sexual side effects but also on mitigation strategies, sexual function, dating and partner intimacy, and body image changes. Conclusion Few patients received information about the sexual health effects of breast cancer treatment, though many experienced symptoms. Potential adverse effects should be discussed early and addressed often throughout treatment, with attention to strategies to prevent and alleviate symptoms and improve overall sexual health.
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Affiliation(s)
- Victoria Huynh
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sudheer Vemuru
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Karen Hampanda
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jessica Pettigrew
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA.,Women's Sexual Health Consultation Services, Aurora, CO, USA
| | - Marcella Fasano
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Helen L Coons
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA.,Women's Sexual Health Consultation Services, Aurora, CO, USA.,Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kristin E Rojas
- Division of Surgical Oncology, Dewitt-Daughtry Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Anosheh Afghahi
- University of Colorado Cancer Center, Aurora, CO, USA.,Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Gretchen Ahrendt
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.,University of Colorado Cancer Center, Aurora, CO, USA
| | - Simon Kim
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Dan D Matlock
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.,Veterans Affairs Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO, USA
| | - Sarah E Tevis
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA. .,University of Colorado Cancer Center, Aurora, CO, USA.
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Critical Retrospection of Performance of Emerging Mobile Technologies in Health Data Management. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:8903604. [PMID: 35345655 PMCID: PMC8957038 DOI: 10.1155/2022/8903604] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/16/2022] [Accepted: 02/16/2022] [Indexed: 11/25/2022]
Abstract
The recent advancement in mobile technologies has led to opening a new paradigm in the field of medical healthcare systems. The development of WBAN sensors, wearable devices, and 5G/6G wireless technology has made real-time monitoring and telecare of the patient feasible. The complex framework to secure sensitive data of the patient and healthcare professionals is critical. The fast computation of health data generated is crucial for disease prediction and trauma-related services; the security of data and financial transactions is also a major concern. Various models, algorithms, and frameworks have been developed to tame critical issues related to healthcare services. The efficiency of these frameworks and models depends on energy and time consumption. Thus, the review of recent emerging technologies in respect of energy and time consumption is required. This paper reviews the developments in recent mobile technologies, their application, and the comparative analysis of their performance parameters to explicitly understand the utility, capacity, and limitations. This will help to understand the shortcomings of the recent technologies for the development of better frameworks with higher performance capabilities as well as higher quality of services.
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Reese JB, El-Jawahri A, Sorice K, Cruz C, Bober SL, Daly MB, Zimmaro LA, Beach MC, Wittenberg E, Wolff AC, Handorf E, Lepore SJ. Investigating the impact of the COVID-19 pandemic on breast cancer clinicians’ communication about sexual health. Support Care Cancer 2022; 30:5801-5810. [PMID: 35352140 PMCID: PMC8964249 DOI: 10.1007/s00520-022-07003-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/22/2022] [Indexed: 11/12/2022]
Abstract
Purpose We assessed breast cancer clinicians’ perspectives on how the COVID-19 pandemic and increased use of telehealth affected their clinical communication about sexual heath. Methods Breast cancer clinicians participating in a sexual health communication intervention study (N = 29; 76% female; 66% oncologists; 34% advanced practice clinicians) completed an online survey. Data analysis consisted of descriptive statistics and thematic analysis. Results All clinicians were using telehealth, with most (66%) using it for up to half of their clinic appointments. Although only 14% of clinicians reported having shorter clinic visits, 28% reported having less time to discuss sexual health; 69% reported no change; and 3% said they had more time. Forty-one percent reported sexual health was less of a priority; 55% reported no change; and 3% said it was more of a priority. Thirty-five percent reported telehealth was less conducive to discussing sexual health; 59% reported no change; and 7% reported more conducive. Qualitative analysis revealed key issues underlying the perceived impact of the pandemic on discussions of sexual health including heightened clinician discomfort discussing such issues via telehealth, the less personal nature and privacy issues in telehealth visits, increased concerns about risk of COVID-19 infection and other health concerns (e.g., missing recurrence, mental health) taking priority, and clinician-perceived patient factors (e.g., discomfort, decreased priority) in discussing sexual concerns. Conclusion Pandemic-related changes in breast cancer clinicians’ practice could be exacerbating challenges to discussing sexual health. Methods for integrating sexual health into cancer care are needed, regardless of the mode of delivery. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-022-07003-8.
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