Challenges having conversations about sexuality in ambulatory settings: part II--health care provider perspectives.

Cancer treatment can have a significant impact on an individual's quality of life. In particular, body image and sexuality can be compromised. There is increasing evidence that conversations about these specific consequences are not happening often between cancer patients and health care providers, especially in busy ambulatory settings. This study was undertaken to explore the perspectives of cancer care providers regarding the conversations about sexuality that happen following a cancer diagnosis. There was a desire to understand more about the barriers that exist with regards to having this conversation in daily practice. Thirty-four cancer care professionals (nurses, physicians, social workers and radiation therapists) were interviewed to explore their experiences in having conversations about sexuality. Transcripts were subjected to a standard qualitative content and theme analysis. Six themes emerged from the analysis. Overall, participants acknowledged treatment can have an impact on a patient's sexuality. For the most part, any conversations about sexuality topics occurred during informed consent processes before treatment began or when a patient raised a question about a side effect. However, these conversations rarely covered more than the physical side effects and did not focus on the impact of those side effects on emotional and personal relationships or intimacy. Most providers waited for patients to raise any concerns and expressed their own personal discomfort and lack of training in holding these types of conversations. They perceived the conversations as difficult for themselves and for patients. The findings support the need to clarify role expectations for cancer nurses, as well as other members of the cancer care team, about patient care regarding sexuality, and the provision of education to support the expected role.