Patient-clinician communication about sexual health in breast cancer: A mixed-methods analysis of clinic dialogue

Patient Educ Couns. 2019 Mar;102(3):436-442. doi: 10.1016/j.pec.2018.10.003. Epub 2018 Oct 4.

Abstract

Objectives: Breast cancer patients' sexual health needs are frequently unmet. We examined the prevalence and content of communication about sexual health between breast cancer patients and clinicians.

Methods: Female breast cancer patients being seen in oncology clinic follow-up had a clinic visit audio recorded and self-reported sexual problems after the visit. Transcripts were coded for sexual health communication; data were analyzed descriptively or using Chi-square tests.

Results: We recorded 67 patients (81% participation rate) interacting with one of 7 cancer clinicians (5 physicians; 2 advanced practice clinicians). Approximately 1/3 of women (n = 22) reported sexual problems; sexual health communication occurred with 10/22 of those women (45%). Across all 67 patients, 27 (40%) visits contained communication about sexual health. Seventy-percent of sexual health communication was clinician-initiated. When in-depth sexual health discussions occurred, the most common topics discussed were sexual inactivity (6), body image (5), vaginal dryness (4), and safety of sexual activity (2).

Conclusion: Communication about sexual health was uncommon even for women reporting sexual problems and was largely initiated by clinicians.

Practice implications: Because women with breast cancer often do not raise sexual concerns during clinic visits, breast cancer clinicians should raise the topic of sexual health for all patients.

Keywords: Breast cancer; Dialogue analysis; Patient-provider communication; Sexual health.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Breast Neoplasms* / complications
  • Breast Neoplasms* / psychology
  • Breast Neoplasms* / surgery
  • Coitus* / physiology
  • Coitus* / psychology
  • Communication*
  • Female
  • Humans
  • Interviews as Topic
  • Mastectomy
  • Middle Aged
  • Physician-Patient Relations*
  • Qualitative Research
  • Quality of Life* / psychology
  • Reproductive Health
  • Sexual Behavior* / psychology
  • Sexual Dysfunction, Physiological* / psychology
  • Sexual Dysfunctions, Psychological / psychology
  • Sexual Health*
  • Sexuality / psychology
  • Surveys and Questionnaires
  • Survivors* / psychology