A randomized trial of a minimal intervention for sexual concerns after cancer: a comparison of self-help and professionally delivered modalities (original) (raw)
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Sexual Health Communication During Cancer Care
The Cancer Journal, 2009
With improved cancer survival rates, it is becoming increasingly important to focus on quality of life issues throughout all stages of cancer treatment. Sexual problems often result from the physical and psychological side effects associated with cancer and cancer treatment regimens, yet few cancer patients recall discussing sexual risks before treatment or treatment options for sexual dysfunction after treatment. This review summarizes the literature, to date, on patient and clinician communication about sexual dysfunction. Patients' views about the importance of these discussions and patient and clinician barriers to sexual dysfunction communication are presented. We adapted a behavioral health counseling model, the 5 A's, and present it as a proposed framework for sexual health communication with cancer patients in a multidisciplinary setting.
Supportive Care in Cancer, 2024
Purpose Patients diagnosed with cancer might experience changes in intimacy and sexuality due to the illness itself, treatment, or psychological and social factors. Healthcare professionals (HCPs) often feel reluctant to discuss these changes. This study aimed to provide an overview of the feasibility and effectiveness of communication tools that support communication regarding changes in intimacy or sexuality among patients with cancer. Methods This is a systematic review. Databases are PubMed, Embase, CINAHL, PsycInfo, Web of Science and Cochrane Library from inception to June 2023. The Mixed Methods Appraisal Tool was used to assess included studies. Data were summarized in data charting forms. Results In total 35 studies were included, published between 2001 and 2023. Most had a quantitative design and moderate methodological quality. In 11 studies, the PLISSIT model (Permission, Limited Information, Specific Suggestions, Intensive Therapy) was used. Tools were integrated in counselling sessions or training programmes for individual patients, couples, groups of patients, or HCPs. All tools were considered feasible by patients or HCPs. Twenty studies reported significant improvement in sexual functioning, quality of life, quality of care or combined outcomes. Conclusion Tools to support communication about changes in intimacy and sexuality among patients with cancer seem feasible and effective. The most commonly used tool, the PLISSIT model, proved to be feasible for HCPs and to have a positive effect on patients' and partners' sexual functioning and quality of life. Giving attention to changes in intimacy and sexuality seems to be important in itself, regardless of the communication tool or approach used.
Patient experiences with communication about sex during and after treatment for cancer
Psycho-Oncology, 2011
Objective-We studied patients' experiences with oncology providers regarding communication about sexual issues during and after treatment for cancer. Methods-During development of the Patient-Reported Outcomes Measurement Information System (PROMIS®) Sexual Function measure, we collected focus group and survey data on communication with oncology professionals about sexual problems. We conducted 16 focus groups with patients and survivors (n = 109) and analyzed the discussions for major themes, including experiences discussing sex during oncology visits. During testing of the PROMIS Sexual Function measure, we assessed experiences discussing sexual problems with oncology professionals (n = 819) and measured bivariate associations between asking for information from clinicians and sexual function and satisfaction with sex life. Results-Most patients and survivors (74%) thought discussions with oncology professionals about sexual problems were important, but whether they had ever received information about sexual function from a provider varied by cancer type (23% lung, 29% breast, 39% colorectal, and 79% prostate). Those who had asked an oncology professional about sexual problems had significantly greater interest in sexual activity as well as more sexual dysfunction. Conclusions-Sexual problems are a widespread concern among patients and survivors, but there is much variation in experiences of communication about sexual issues and many patients do not receive the information they need from their oncology providers. There are large differences in
Journal of Oncology Practice, 2018
Extraordinary advances in cancer diagnosis and treatment have led to. 16.5 million people living with and beyond cancer in the United States. 1 Modern multimodality treatment, including surgery, radiotherapy, systemic chemotherapy, and targeted therapy, can result in short-term and long-term adverse physical and/or psychosocial effects. Although prevalence rates of sexual difficulties associated with cancer and its treatment vary with primary diagnosis, treatment modality, methods of assessment, and type of sexual difficulty, 2 estimates are reported to range from 40% to 100%. 3,4 Sexual difficulties include disorders of sexual desire and sexual response that are influenced by the biologic, physiologic, and psychological challenges that cancer and its treatments present. Sexual health is an integral component of quality of life across the lifespan. Cancer survivors who experience sexual morbidity are at an increased risk of distress and poor quality of life. Impaired emotional wellbeing and quality of life in turn contribute to higher rates of morbidity and mortality among affected cancer survivors. 5,6 Sexual problems commonly include decreased desire, arousal disorders, pain (largely in women), and erectile dysfunction (in men). In addition to cultural and religious influences, sexual function is affected in a multifactorial way by one's overall health (the patient's and that of his or her partner), partner relationships, previous sexual history, medications, fatigue and stress, mood, view of sexual self, body image, incontinence, and hormonal changes. Cancer can independently affect sexual function by the nature of the disease and its treatment; resulting changes in health, body image, or view of sexual self; and altered relationships secondary to illness. An overall reluctance remains from both clinicians and patients to talk about cancer-and treatment-related sexual difficulties. 2,7,8 Barriers from the clinician's perspective can include feeling inadequately trained or insufficiently skilled, limited awareness of effective interventions, lack of time, lack of privacy, and concerns about making patients feel uncomfortable. 2 Beyond these reasons, studies also suggest that clinicians may make assumptions on the basis of such factors as age and presumed interest, overall prognosis, and whether the patient has a current partner. 3 For patients, barriers similarly may include concerns about making the physician feel uncomfortable, embarrassment around the topic, belief that the clinician is responsible for raising the issue, and belief that their sexual health concerns are not valid or are an expected and untreatable complication of their disease and its treatment. 2,4-6
Interventions to Address Sexual Problems in People with Cancer
Current Oncology, 2017
Background: Sexual dysfunction in people with cancer is a significant problem. The present clinical practice guideline makes recommendations to improve sexual function in people with cancer. Methods: This guideline was undertaken by the Interventions to Address Sexual Problems in People with Cancer Expert Panel, a group organized by the Program in Evidence-Based Care (PEBC). Consistent with the PEBC standardized approach, a systematic search was conducted for existing guidelines, and the literature in MEDLINE and EMBASE for the years 2003–2015 was systematically searched for both systematic reviews and primary literature. Evidence found for men and for women was evaluated separately, and no restrictions were placed on cancer type or study design. Content and methodology experts performed an internal review of the resulting draft recommendations, which was followed by an external review by targeted experts and intended users. Results: The search identified 4 existing guidelines, 13 s...
Psychological interventions for the sexual sequelae of cancer: A review of the literature
Journal of Cancer Survivorship, 2010
Introduction Despite the frequency of sexual side effects of cancer, treatment outcome studies focus almost exclusively on pharmacologic agents, most of which are completely ineffective for women. We conducted a systematic review of the literature on psychological interventions for sexual difficulties following cancer. Methods We searched eight research databases using the terms "sexual dysfunction," "cancer," and "psychological therapy" for empirical studies (not case illustrations). Three independent raters evaluated studies using a modified version of the Oxford Centre for Evidence-Based Medicine System to rate the level of evidence for every retrieved study. Results We identified 27 papers ranging in level of evidence from 1b (randomized controlled trial) to 4 (expert committee report or clinical experience). Youth showed positive outcomes on sexual knowledge, body image, and sexual functioning, and treatments administered by paraprofessionals were equally effective. Thematic counseling, addressing mental health, social functioning, and sexual functioning, significantly improved quality of sexual relationships, independent partner presence, whereas other studies revealed more pronounced benefits if the partner participated. Despite the importance of talking to a cancer care provider about sexual difficulties, interventions designed to empower patients to do so were ineffective. Treatments addressing sex education were more effective if they also addressed motivation and selfefficacy. Only three treatment outcome studies focused on ethnic minority (African-American or Hispanic) sexual concerns and one focused on sexual minority (Lesbian) issues. Discussion There was moderate support for the effectiveness and feasibility of psychological interventions targeting sexual dysfunction following cancer but attrition rates are high, placebo response is notable, and there are often barriers impeding survivors from seeking out psychological interventions for sexual concerns. Implications for cancer survivors Despite the prevalence of sexual difficulties following cancer treatment, psychological interventions are a viable, but not often sought after option to help improve sexual functioning, intimacy, and quality of life for cancer survivors and their partners.
Patient-provider communication about sexual concerns in cancer: a systematic review
Journal of Cancer Survivorship, 2016
Purpose-Cancer survivors' needs around sexual concerns are often unmet. The primary objective of this systematic review was to examine the prevalence of and factors associated with patient-provider communication about sexual concerns in cancer. Methods-Using PRISMA guidelines, we searched PubMed/MEDLINE, PsychInfo, and CINAHL databases for peer-reviewed quantitative research papers (2000-2015) in cancer samples. Search terms across three linked categories were used (sexuality; communication; cancer). The National Comprehensive Cancer Network (NCCN) Sexual Function Guidelines were used as a framework to categorize communication reported in each study. Results-Twenty-nine studies from 10 countries (29% in USA) were included. Studies assessed patients only (21), providers only (4), and both (4). Communication measures differed across studies and many lacked validity data. When reported by patients or providers, the average prevalence of discussing potential treatment effects on sexual function was 50% (60% for men; 28% for women) and 88%, respectively. As reported by patients or providers, respectively, assessing patients' sexual concerns (10% and 21%), and offering treatments (22% and 17%) were measured in fewer studies and were reported less frequently. Both patients and providers (28% and 32%, respectively) reported a low prevalence of other non-specific communication. Greater
Talking about sex with health professionals: the experience of people with cancer and their partners
GILBERT E., PERZ J. & USSHER J.M. (201) European Journal of Cancer Care Talking about sex with health professionals: the experience of people with cancer and their partners Changes to sexuality can be one of the most difficult aspects of life following cancer. This study examines the experience of discussing sexuality post cancer with health care professionals (HCPs), from the perspective of women and men with cancer (PWC), and their partners (PPWC), across a range of cancer types. A total of 657 PWC (535 women, 122 men) and 148 PPWC (87 women, 61 men) completed a survey containing closed and open-ended items, analysed by analysis of variance and thematic analysis. Discussions about sexuality with a HCP were more likely to be reported by men (68%) compared to women PWC (43%), and by women (47%) compared to men PPWC (28%), as well as by those with a sexual or reproductive cancer. Men PWC and women PPWC were most likely to want to discuss sexuality with a HCP, with men PWC and PPWC reporting highest levels of satisfaction with such discussions. Open-ended responses revealed dissatisfaction with the unwillingness of HCPs to discuss sexuality, unhappiness with the nature of such discussion, and positive accounts of discussions about sexuality with HCPs. These findings lend support to the notion that people with cancer and their partners may have unmet sexual information and support needs. Keywords: communication with health professionals, mixed method survey, patient and partner perspectives , sexual and non-sexual cancers, sexual well-being after cancer.
Information needs associated with changes to sexual well-being after breast cancer
Aims. This article is the report of a study of sexual information needs, experiences of obtaining such information, and patient communication about sexuality with health professionals, after breast cancer. Background. Changes to sexuality after breast cancer can significantly affect quality of life. However, information needs associated with such changes are little understood , resulting in the absence of a knowledge base to guide information provision aimed at preventing or ameliorating distress. Design. This study employs a mixed method analysis, integrating qualitative and quantitative responses to an online survey. Method. Participants were 1965 individuals with breast cancer (98AE8% female) drawn from the membership of a national Australian breast cancer organization. The data were collected over 2 weeks in December 2010. Results. Eighty-five per cent of participants reported changes to sexual well-being after breast cancer, with 68% wanting information on such changes, primarily in a written form. Information on physical changes, sexual response, relationship issues, psychological consequences, and body image or identity, were rated as very important by a substantial proportion of participants. Only 41% had obtained such information; however, 65% had spoken about sexual changes, to partner (76%), G.P. (49%), friend/relative (47%), oncologist (39%), or breast-care nurse (21%). Ratings of satisfaction with the discussion were highest for breast-care nurses (60%) and lowest for oncologists (34%). Conclusion. These findings provide clinicians and cancer organizations with specific suggestions about sexual information needs after breast cancer and the modalities which are preferred, to prevent and ameliorate distress.
Journal of advanced nursing, 2017
To describe the characteristics of couple-based intervention studies that address sexuality following cancer. Sexuality-related problems are common among cancer survivors and their partners. Systematic literature review with a narrative summary of results. Electronic searches were conducted in PubMed, CINAHL and PsychINFO. We included studies published from 1 January 2009 - 31 December 2016. Additional information was retrieved by scrutinizing reference lists, conducting citation tracking and contacting authors. We included all types of quantitative intervention studies published in the English language which contained outcome measures corresponding to the neo-theoretical framework of sexuality-sexual function, sexual relationship and sexual self-concept. Our review was guided by the Joanna Briggs Institute reviewer's manual. Data were extracted and appraised using the standardized checklists for quantitative studies. This assessment was conducted independently by two reviewers....