Wang Katie, Ariello Krista, Choi Matthew, Turner Angela, Wan Bo Angela, Yee Caitlin, Rowbottom Leigha, Macdonald Rachel, Lam Henry, Drost Leah, Chow Edward
Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Ann Palliat Med. 2018 Apr;7(2):256-264. doi: 10.21037/apm.2017.10.05. Epub 2017 Nov 15.
Palliative care aims to improve quality of life (QoL) for patients and families and does so by addressing issues not limited to pathology, but other symptoms that may be debilitating to patient experience and QoL. Despite sexual health being an important aspect of life for many patients, it is often omitted in clinical practice. This review summarizes published primary studies to explore the prevalence and importance of incorporating sexual health in the symptom screening and assessments of palliative patients, to identify current interventions that are implemented to address sexual health issues, and identify the barriers that health care professionals (HCPs) and patients may encounter which may prevent sexual health discussions. A literature review was conducted on Medline and Embase databases using keywords including "cancer", "sexual health", "intimacy", and "palliative care". Eleven papers focusing on the sexual health and intimacy of terminally ill patients in hospice, palliative or terminal care settings were identified for inclusion. Discussions about sexual health, functioning, and intimacy were not common in patient care, despite being a service that both patients and their partners desired. Referrals to sexologists, or discussions with patients and partners about intimacy and sexuality over the course of the disease trajectory were shown to improve QoL as well as alleviate some of the stress of receiving palliative care services. HCPs cited a lack of training, their own life experiences, or discomfort with the topic as barriers to initiating conversations with patients. In conclusion, sexuality and intimacy remain important parts of many people's lives regardless of their health, and should be incorporated into the care of all patients including those in palliative care. There is a need for further research to evaluate different methods or procedures for educating and counselling patients and their partners on sexual health issues. HCPs should have specific training and education in sexual health care to enable them to initiate and direct these discussions.
姑息治疗旨在提高患者及其家属的生活质量(QoL),其实现方式是解决不仅限于病理学方面的问题,还包括其他可能会削弱患者体验和生活质量的症状。尽管性健康对许多患者来说是生活的一个重要方面,但在临床实践中它常常被忽视。本综述总结了已发表的原始研究,以探讨在姑息治疗患者的症状筛查和评估中纳入性健康的患病率和重要性,确定为解决性健康问题而实施的当前干预措施,并确定医护人员(HCPs)和患者可能遇到的、可能阻碍性健康讨论的障碍。使用包括“癌症”“性健康”“亲密关系”和“姑息治疗”等关键词,对Medline和Embase数据库进行了文献综述。确定了11篇关注临终关怀、姑息或终末期护理环境中绝症患者性健康和亲密关系的论文以供纳入。尽管性健康、功能和亲密关系的讨论是患者及其伴侣都希望获得的服务,但在患者护理中并不常见。研究表明,转诊至性学家处,或在疾病发展过程中与患者及其伴侣讨论亲密关系和性行为,可改善生活质量,并减轻接受姑息治疗服务的一些压力。医护人员指出,缺乏培训、自身生活经历或对该话题感到不适是与患者展开对话的障碍。总之,无论健康状况如何,性和亲密关系仍然是许多人生活的重要组成部分,应纳入所有患者的护理中,包括姑息治疗患者。需要进一步研究,以评估针对患者及其伴侣进行性健康问题教育和咨询的不同方法或程序。医护人员应接受性健康护理方面的特定培训和教育,以便能够发起并引导这些讨论。