Health Care Professionals' Views on Discussing Sexual Wellbeing with Patients Who Have Had a Stroke: A Qualitative Study

Abstract

ObjectivesTo examine the experiences of health care professionals discussing sexual wellbeing with patients who have had a stroke.DesignIn-depth qualitative interview study with purposive sampling and thematic analysis.Participants30 health care professionals purposively recruited to include different roles and settings along the stroke patient pathway in secondary and primary care.SettingTwo hospitals and three general practices in the West Midlands, UK.ResultsSexual wellbeing was a topic that participants did not raise with patients and was infrequently raised by patients. Barriers to raising discussion were on four levels: structural, health care professional, patient, and professional-patient interface. Barriers within these levels included: sexual wellbeing not present within hospital stroke policy; the perception that sexual wellbeing was not within participants' role; participants' concern that raising the issue could cause harm to the patient; and the views that discussion would be inappropriate with older people or unimportant to women. Resources exist to aid discussion but many participants were unaware of them, and most of those that were, did not use them routinely.ConclusionsParticipants lacked motivation, ownership, and the confidence and skills to raise sexual wellbeing routinely after stroke. Similar findings have been reported in cancer care and other taboo subjects such as incontinence potentially resulting in a sub-optimal experience for patients. Normalisation of the inclusion of sensitive topics in discussions post-stroke does not seem to need significant structural intervention and simple changes such as information provision and legitimisation through consideration of the issue in standard care policies may be all that is required. The experiences recounted by professionals in this study suggest that such changes are needed now.

Older Adults’ Experiences of Sexual Difficulties: Qualitative Findings From the English Longitudinal Study on Ageing (ELSA)

“…The majority of those who had sought help pointed out that their health professional had not been helpful, and examples of perceived ageism of the health professional were given. Other studies have identified similar barriers to health professionals asking about sex as including assumptions of asexuality, embarrassment, lack of confidence and feeling deskilled (Mellor et al, 2013), and discomfort based on the age of the patient (Wei & Mayouf, 2009). …”

“…Evidence is growing which suggests that older adults do not always seek help for sexual difficulties (see Hinchliff & Gott, 2011), and that health professionals do not routinely ask older patients about sex due to reasons including a lack of confidence, discomfort and feeling deskilled (Gleser, 2015;Mellor et al, 2013;Wei & Mayouf, 2009). Given that sex can be a quality of life issue for older adults, and that they may experience sexual difficulties but not receive appropriate care, it is important to explore the area further and increase our understanding.…”

The experience of urinary incontinence in stroke survivors: A follow-up qualitative study

“…However, a Canadian study of GPs identified wide variations in knowledge, attitudes, practices, and comfort level among clinicians in dealing with UI (Swanson, Skelly, Hutchison, & Kaczorowski, 2002). Likewise a recent study identified that allied health professionals demonstrate difficulties initiating discussion about management of difficult topics, such as sexuality and incontinence, leaving the onus on patients to raise it (Mellor et al, 2013). Overall, there is a need for improved education of all community health staff regarding UI/ PSUI to improve competency issues.…”

Organisational enablers and barriers to the recognition of sexuality in aged care: A systematic review

“…F88: Spouse/ family presence in assessment/ care is a barrier to sexuality discussion (Mellor et al, 2013) [C] F89: Consult family regarding sexuality in residents with cognitive impairment (McAuliffe et al, 2007) [C] F90: Make time for family expression of concern about resident's personal relationships (Chandler et al, 2004) [US] F91: Accept same-sex partners as representatives for older adults (Hurd, 2015) [C] F92: Accept same-sex partners/friends as representatives and decision makers for older adults (Taylor, 2016) [C] F115: Staff need training in taking a sexual history/assessment (Milspaw, Brandon, & Sher, 2016) [C] F116: Using a safe and private space facilitates discussion of sexuality with older clients (Syme, 2014) [C] F117: Ensure assessment and care planning is inclusive of sexual minorities (Simpson, Horne, Brown, Dickinson, & Wilson, 2016) [C] F118: Undertaking a sexual assessment increases visibility and improves facilitation of sexuality (Rowntree & Zufferey, 2015) F119: Assessing sexual needs can help ensure those needs are met (Milspaw et al, 2016) [C]…”