Talking about sex after cancer: A discourse analytic study of health care professional accounts of sexual communication with patients

Abstract

There is consistent evidence that health care professionals (hcps) are not addressing the sexual information and support needs of people with cancer. Thirty-eight Australian hcps across a range of professions working in cancer care were interviewed, to examine constructions of sexuality post-cancer, the subject positions adopted in relation to sexual communication, and the ways in which discourses and subject positions shape information provision and communication about sexuality. Participants constructed sexual changes post-cancer in physical, psychological and relational terms, and positioned such changes as having the potential to significantly impact on patient and partner well-being. This was associated with widespread adoption of a discourse of psychosocial support, which legitimated discussion of sexual changes within a clinical consultation, to alleviate distress, dispel myths and facilitate renegotiation of sexual practices. However, this did not necessarily translate into patient-centred practice outcomes, with the majority of participants positioning personal, patient-centred and situational factors as barriers to the discussion of sex within many clinical consultations. This included: absence of knowledge, confidence and comfort; positioning sex as irrelevant or inappropriate for some people; and limitations of the clinical context. In contrast, those who did routinely discuss sexuality adopted a subject position of agency, responsibility and confidence.

Sexual Health as a Survivorship Issue for Female Cancer Survivors

“…Unfortunately, data suggest this does not happen routinely. As with patients, multiple barriers exist to that can explain why providers may not engage in sexual health discussions [43].Time constraint was shown to be a real issue in a survey of gynecologic oncologists in New England, where less than 50% of doctors practiced taking a sexual history with new patients and only 20% felt they had sufficient time to discuss sexual concerns [44]. Beyond time, studies also suggest clinicians often make assumptions about patients that "justify" not inquiring about sexual health.These assumptions can be varied, based onfactors such as age (the older the patient,the likelihood [isthat] they are not interested), overall prognosis (patients with a poor prognosis are likely not interested), and whether the patient has a current partner (single people are less likely to be interested because they are not sexually active) [45,46].…”

The clinical communication and information challenges associated with the psychosexual aspects of prostate cancer treatment

“…Evidence suggests that there is variability in how well this is achieved in clinical practice and that clinicians inadequately address cancer patients' sexual information and support needs (Tucker, Peters & Speer, 2016;Flynn et al, 2012;Gilbert, Perz and Ussher, 2016;NICE, 2014, p. 115ff;Ussher et al, 2013;Watson et al, 2015;Zhou et al, 2016). For example, in their observational study of communication in British PC clinics, Forbat et al (2012, p.98) note that patients' psychosexual concerns are often side-lined by clinicians, with limited opportunities 'to discuss the specific impact of prostate cancer and its treatments on sexual functioning'.…”

“…Clinicians may be reticent to talk about psychosexual issues with cancer patients because they lack sufficient time, knowledge, confidence and comfort, think it is someone else's responsibility, or assume a patient's age or relationship status render sexual concerns irrelevant (Hordern and Street, 2007;Park, Norris & Bober, 2009;Ussher et al, 2013). Likewise, patients may be reluctant to disclose psychosexual concerns due to embarrassment and perceptions that clinicians lack the time to discuss such issues, regarding them as trivial compared with survival (e.g., Carr, 2007;Flynn et al, 2012;Stead, Brown, Fallowfield, & Selby, 2003).…”

Health Care Students’ Attitudes Towards Working with Sexual Health in Their Professional Roles: Survey of Students at Nursing, Physiotherapy and Occupational Therapy Programmes

“…In this study the definition of sexual health by the World Health Organization will be used (World Health Organization, 2006 In the study by Haboubi and Lincoln, health professionals agreed that sexual health could be part of care and rehabilitation for patients, but there was a need for more knowledge and education concerning sexual health and communication about sexual health issues (Coleman et al, 2013;Haboubi & Lincoln, 2003). In some research, health professionals (physiotherapists, occupational therapists, nurses, and doctors) considered themselves to have sufficient knowledge about sexual health, but experienced barriers limiting the implementation of knowledge in clinical practice (Haboubi & Lincoln, 2003;Ussher et al, 2013). Attitudes and/or beliefs about the importance of sexual health for persons with different types of physical, psychological, or sexual dysfunctions may affect how health care professionals interact with patients (Evans, 2013;Gianotten, Bender, Post, & Höing, 2006;Haboubi & Lincoln, 2003;Shakespeare, Iezzoni, & Groce, 2009).…”