Article Text

PDF
Patient–provider communication about sexuality and intimacy after a cancer diagnosis was described in terms of unmet needs and mismatched expectations
  1. France Bouthillette, RN, DNS
  1. University of British Columbia,
 Vancouver, British Columbia, Canada

    Statistics from Altmetric.com

    
 
 Q What are the perceptions of patients and healthcare providers regarding communicating about sexuality and intimacy after a cancer diagnosis?

    DESIGN

    Reflexive inquiry.

    SETTING

    Cancer and palliative care settings in a large public teaching hospital in Victoria, Australia.

    PARTICIPANTS

    50 patients (22–85 y of age) who were receiving treatment for cancer and 32 healthcare professionals who had been working in cancer or palliative care settings for ⩾12 months.

    METHODS

    Patients and healthcare providers participated in individual semistructured interviews of about 45 minutes. Topics included experiences of communicating about patient sexuality, unmet needs, and factors that helped or hindered communication. Interviews were audiotaped and transcribed. Interview data were analysed alongside a textual analysis of 33 cancer and palliative care clinical practice guidelines. Validation was provided through presentation of preliminary interview data at 15 educational forums attended by patients and providers.

    MAIN FINDINGS

    2 major themes were identified: unmet needs of patients and mismatched expectations in the communication process between patients and providers. (1) Unmet needs. Patients’ responses clustered along a continuum ranging from a more traditional approach (“Survival is more important than my sexuality,” and “Trust the expert”) to a more reflexive approach (“Tell it to me straight,” “Search for options,” or “Am I normal?”). Patients wanted negotiated communication with healthcare providers to allow them to discuss changes in sexuality and intimacy in ways suited to their individual needs. Structural features of clinical cultures, including clinical practice guidelines, made it difficult to view patients as individuals with different views about the importance of sexuality and intimacy. (2) Mismatched expectations. Healthcare professionals’ responses mostly clustered around a more traditional approach (“It is not life or death,” and “I manage to avoid the topic”). Given these beliefs, there often wasn’t time or privacy provided for discussion of patient sexuality. As well, the clinical structure supported these beliefs such that professionals felt that they were addressing sexuality and intimacy issues when they talked about treatment-induced infertility, reduced libido, or contraception. Mismatched expectations resulted as patients felt that providers made assumptions about their sexuality and intimacy without consulting them. A few of the healthcare professionals admitted that they felt embarrassed (“I can’t expose my vulnerability”) or unable to discuss such issues with patients who might remind them of their own parents (“It is a risky business”). Only 2 healthcare professionals felt comfortable talking about sexuality with their patients (“I am comfortable with who I am…my own sexuality…You have to work yourself out first…”).

    CONCLUSIONS

    Patients with cancer perceived that many of their information and support needs related to sexuality and intimacy were unmet. Healthcare professionals and patients had mismatched expectations about communicating around these topics.

    Commentary

    The study by Hordern and Street is foremost a call for health professionals to engage in discussions about sexuality with their patients and to view situations from their patients’ perspectives rather than their own. These research findings reveal a gap between patients and health professionals in terms of communicating and providing support in the area of sexuality and intimacy. Although more than two-thirds of patients were ⩾51 years of age, it is unlikely that the identified themes are not transferable, as the findings are consistent with those of other studies,1 suggesting that patient–provider communication around sexuality is a widespread problem.

    Patients searched for practical advice on, and informational and emotional support relating to, how to live with sexual and intimate changes. Providing such advice requires that nurses open communication channels. Nurses may be uncomfortable discussing sexuality with patients, but it is our ethical responsibility (no matter how uncomfortable we may be) to ensure that patients’ needs are met. One way of maximising the opportunities for communication is to be knowledgeable about available referral resources. For instance, a body image issue might require referral to a counsellor. Indeed, the authors identified the need for formal referral processes and resources.

    Hordern and Street also recommended more communication training for health professionals. Training in this area has been shown to be helpful.2 For instance, defining sexuality as the authors do, as “an ever-changing, lived experience affecting the way in which people view themselves, their body and their ability to intimately connect with significant others throughout life” might help in shifting the focus from sexual pleasure to connecting with another person on a deep level. Nurses may also find this definition helpful since it allows us to focus on broader areas of interpersonal relationships such as body image, negative emotions and their impact on sexuality, and changes in roles and relationships.

    View Abstract

    Footnotes

    • For correspondence: Dr A J Hordern, Cancer Council Victoria, Carlton, Victoria, Australia. amanda.hordern{at}cancervic.org.au

    • Source of funding: no external funding.

    Request permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    References