Introduction Barrett's esophagus is a premalignant condition in the lower part of the esophagus, caused by gastroesophageal reflux disease. Previous studies found that having a Barrett's esophagus is associated with a significant decrease of health-related quality of life (HRQOL). Over the past decade, a considerable amount of literature has been published on the development of endoscopic treatment for (early) neoplasia in Barrett's esophagus. Though, currently very little is known about the impact of those endoscopic treatments on HRQOL from the perspective of patients. In this study, we aim to assess the factors influencing HRQOL according to Barrett's esophagus patients. Methods By using a qualitative focus group design, patients with nondysplastic Barrett's esophagus and patients with a history of endoscopic treatment for Barrett's dysplasia were included. Data were analysed following the conventional content analyses approach. Results A total of 34 patients participated in the four focus group sessions. Experiencing symptoms was valued as the most important factor in both groups. Other factors identified as important HRQOL influencers were: use of medication, fear of cancer and trust in physicians and endoscopic procedures. Conclusions In general, Barrett's esophagus patients experienced a good HRQOL, with a minimal emotional burden from the diagnosis of Barrett's esophagus. Most influencing factor on HRQOL was: experiencing reflux and dyspepsia symptoms. This study underlines the importance of adequate gastroesophageal reflux treatment and providing information to Barrett's esophagus patients, tailored to their personal needs.
Purpose
Surgical treatment for vulvar cancer has impact on women’s self-esteem, body image and sexuality. Health Care Professionals experience difficulties in discussing these issues with patients. The aim of this study was to explore the experiences of patients with vulvar cancer regarding sexual changes, and their needs and expectations regarding sexual counseling.
Methods
Individual semi-structured interviews were conducted with patients who were surgically treated for vulvar cancer. All interviews were transcribed verbatim and thematically analyzed.
Results
Seven patients (mean age 54, 86% stage 1B vulvar cancer) participated. Seven themes were identified and were linked to the biopsychosocial framework: 1) the impact of physical disabilities on body image, 2) sexual dysfunction, 3) grieving the loss of sexual health, 4) ambivalence in the acceptance of sexual changes, 5) the effect of the partner on sexual experience, 6) the attitude of the Health Care Professional (HCP), and 7) discussing sexuality: the right moment
Conclusion
Patients who are surgically treated for vulvar cancer experience problems related to impairment on daily activities, altered body image and sexuality. Especially difficulties in reaching an orgasm or anorgasmia are hard to accept. Both the partner and HCP play an important role in how patients experience discussing and exploring sexuality after treatment. Since informational needs regarding sexuality change over time and patients start to fantasize about sex after 4–6 months, it is recommended to schedule an appointment 4–6 months after surgery to discuss patients’ needs regarding sexual information and counseling.
To improve sexual health among people living with HIV, sexual health should be addressed during consultations in routine HIV care. The aim of the present study was to investigate to what extent Sexual Health Counselling (SHC) is incorporated into routine Dutch HIV care and to explore differences between physicians and nurses in their practices and views regarding SHC. A crosssectional survey was conducted among all HIV physicians (N=110) and HIV nurses (N=82) in the Netherlands. A questionnaire assessed socio-demographic characteristics, current SHC practice, topics addressed, and factors associated with engaging in SHC. The response rate was 53.6% (N=59) among physicians and 60.0% (N=40) among nurses. SHC was performed by 26.1% of physicians and 83.9% of nurses (Χ² (1) = 27.68, p<.001). The most frequently reported barrier for SHC was the presence of a third party, endorsed by 50.9% of physicians and 60.4% of nurses. Nurses were more likely to address issues related to sexual wellbeing, while physicians mainly discussed medical topics. While, both HIV physicians and nursed felt responsible for providing SHC, nurses were more likely to address SHC that physicians. There is scope for improving SHC for PLHIV through a multidisciplinary approach based on clear guidelines for physicians and nurses.
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