Center for Cancer and Blood Disorders, Connecticut Children's Medical Center, Hartford, Connecticut.
Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts.
Pediatr Blood Cancer. 2018 Aug;65(8):e27087. doi: 10.1002/pbc.27087. Epub 2018 Apr 26.
Sexual and reproductive health (SRH) is identified by adolescent and young adult (AYA) patients with cancer as an important but often neglected aspect of their comprehensive cancer care. The purpose of this study was to investigate the attitudes and perceptions of pediatric oncology clinicians towards discussing SRH with AYAs, and to understand perceived barriers to effective communication in current practice.
Pediatric oncology clinicians (physicians, certified nurse practitioners, and physician assistants) participated in semi-structured qualitative interviews investigating attitudes about SRH communication with AYAs and barriers to such conversations. Twenty-two clinicians participated from seven institutions in the Northeastern United States. Interviews were audio-recorded, transcribed, and coded using a thematic analysis approach.
Interviews with pediatric oncology clinicians revealed the following five primary themes: the role for pediatric oncology clinicians to discuss SRH, the focus of current SRH conversations on fertility, the meaning of "sexual health" as safe sex and contraception only, clinician-reported barriers to SRH conversations, and the need for education and support. Communication barriers included lack of knowledge/experience, lack of resources/referrals, low priority, parents/family, patient discomfort, clinician discomfort, time, and lack of rapport. Clinicians identified resource and support needs, including formal education and SRH education materials for patients and families.
Although the study participants identified a role for pediatric oncology clinicians in SRH care for AYA patients with cancer, multiple barriers interfere with such discussions taking place on a regular basis. Future efforts must focus on resource development and provider education and training in SRH to optimize the care provided to this unique patient population.
性与生殖健康（SRH）被青少年和年轻成人（AYA）癌症患者确定为其全面癌症护理的一个重要但经常被忽视的方面。本研究的目的是调查儿科肿瘤临床医生对与 AYA 讨论 SRH 的态度和看法，并了解当前实践中有效沟通的障碍。
儿科肿瘤临床医生（医生、注册护士从业人员和医师助理）参与了半结构化定性访谈，调查了对与 AYA 进行 SRH 沟通的态度和此类对话的障碍。来自美国东北部的七家机构的 22 名临床医生参与了访谈。访谈通过主题分析方法进行录音、转录和编码。
对儿科肿瘤临床医生的访谈揭示了以下五个主要主题：儿科肿瘤临床医生讨论 SRH 的角色、当前 SRH 对话的重点是生育、“性健康”仅意味着安全性行为和避孕、临床医生报告的 SRH 对话障碍，以及对教育和支持的需求。沟通障碍包括缺乏知识/经验、缺乏资源/转介、优先级低、父母/家庭、患者不适、临床医生不适、时间和缺乏融洽关系。临床医生确定了资源和支持需求，包括为患者和家属提供正式教育和 SRH 教育材料。
尽管研究参与者确定了儿科肿瘤临床医生在青少年和年轻成人癌症患者的 SRH 护理中的作用，但许多障碍会干扰定期进行此类讨论。未来的努力必须集中在 SRH 的资源开发和提供者教育和培训上，以优化为这一独特患者群体提供的护理。
