Effective patient-provider communication about sexual concerns in breast cancer: a qualitative study

Abstract

Purpose Breast cancer patients commonly experience sexual concerns, yet rarely discuss them with clinicians. The study examined patient and provider experiences and preferences related to communication about breast cancer-related sexual concerns with the goal of informing intervention development. Methods Patient data (n=28) were derived from focus groups and interviews with partnered and unpartnered women treated for breast cancer reporting sexual concerns. Provider data (n=11) came from interviews with breast cancer oncologists and nurse practitioners. Patient and provider data were analyzed separately using the framework method of qualitative analysis. Results Findings revealed individual and institutional barriers to effective communication about sexual concerns and highlighted key communication facilitators (e.g., a positive patient-provider relationship, patient communication as a driver of provider communication and vice versa). Patients expressed preferences for open, collaborative communication; providers expressed preferences for focused intervention targets (identifying concerns, offering resources/referrals) and convenient format. A model of effective communication of sexual concerns was developed to inform communication interventions. Conclusions Findings suggest that to improve patient-provider communication about sexual concerns, knowledge and skills-based interventions that activate patients and that equip providers for effective discussions about sexual concerns are needed, as are institutional changes that could incentivize such discussions.

Talking about women's sexual health after cancer: Why is it so hard to move the needle?

“…There is also increasing interest in evaluating provider-focused communication skills interventions on sexual health for women with cancer among researchers in this area, including one such intervention currently being pilot tested by the first author (JBR). 45 …”

“…37–43 Yet despite these calls to action, the majority of women experiencing treatment-related sexual dysfunction suffer without help. 44 Although oncology clinicians generally acknowledge the importance of addressing sexual health for women who have been treated for cancer 45,46 and patients say they want their physicians to ask about these concerns, 47,48 communication about sexual health is not part of routine care for most cancer patients and survivors. 44,49 Results of a recent systematic review published in Journal of Cancer Survivorship demonstrate that across different studies and a range of cancer sites, fewer than one third of women with cancer reported receiving information about potential sexual side effects of treatments, compared to twice as many men with cancer who had reported receiving such information.…”

“…45,52 Yet in fact, efficacious treatments for women with cancer-related sexual problems are available and the evidence base is rapidly growing. 41,51,53–56 Physical aids such as vaginal moisturizers and lubricants for sexual intercourse have garnered substantial efficacy data for women who have mild to moderate vaginal dryness and discomfort.…”

“…Although clinician gender could theoretically influence clinical discussions of sexual health for women with cancer, current research has not uncovered clear patterns to this effect, whereas clinicians’ years of clinical experience may be a relatively more important factor in determining the presence of discussions about sexual health. 45 …”

“…77 With a lack of both time and training, providers may understandably worry about opening a Pandora’s box when raising the subject of sexual concerns with a female patient, 77 particularly with respect to emotional or motivational issues that could surface such as low libido or relationship concerns. 45 Although clinical guidelines have emerged with recommendations for providers in addressing sexual concerns, 40,78–80 these guidelines neither solve the problem of time constraints nor are they likely to be employed by providers lacking basic skills and training in sexual health. Furthermore, without adequate compensation for their time, it is unreasonable to expect providers to spend considerable amounts of time with patients on this issue, such as by conducting detailed sexual health assessments, considering that this may result in lost clinical revenue for them.…”