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Effective patient-provider communication about sexual concerns in breast cancer: a qualitative study

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Abstract

Purpose

Breast cancer patients commonly experience sexual concerns, yet rarely discuss them with clinicians. The study examined patient and provider experiences and preferences related to communication about breast cancer-related sexual concerns with the goal of informing intervention development.

Methods

Patient data (n = 28) were derived from focus groups and interviews with partnered and unpartnered women treated for breast cancer reporting sexual concerns. Provider data (n = 11) came from interviews with breast cancer oncologists and nurse practitioners. Patient and provider data were analyzed separately using the framework method of qualitative analysis.

Results

Findings revealed individual and institutional barriers to effective communication about sexual concerns and highlighted key communication facilitators (e.g., a positive patient-provider relationship, patient communication as a driver of provider communication, and vice versa). Patients expressed preferences for open, collaborative communication; providers expressed preferences for focused intervention targets (identifying concerns, offering resources/referrals) and convenient format. A model of effective communication of sexual concerns was developed to inform communication interventions.

Conclusions

Findings suggest that to improve patient-provider communication about sexual concerns, knowledge and skills-based interventions that activate patients and that equip providers for effective discussions about sexual concerns are needed, as are institutional changes that could incentivize such discussions.

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Acknowledgments

This study was supported by a Mentored Research Scholar Grant (MRSG-14-031-CPPB) from the American Cancer Society and R21CA191354 from the National Cancer Institute. J.B.R. is also supported by P30CA006927 from the National Cancer Institute.

Author information

Authors and Affiliations

  1. Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Ave., 4th Floor, Young Pavilion, Philadelphia, PA, 19111, USA

    Jennifer Barsky Reese & Kristen E. Casale

  2. Department of Medicine, Johns Hopkins School of Medicine, 2024 E. Monument St., Baltimore, MD, 21205, USA

    Mary Catherine Beach

  3. Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Hampton House 726, Baltimore, MD, 21205, USA

    Katherine Clegg Smith

  4. Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, EB-1650 Orleans St CRB-1 189, Baltimore, MD, 21287, USA

    Elissa T. Bantug

  5. Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, DUMC 90399, Durham, NC, 27708, USA

    Laura S. Porter

  6. Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Avenue, Shields-Warren 320, Boston, MA, 02215, USA

    Sharon L. Bober

  7. Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Avenue, DA-2016A, Boston, MA, 02215, USA

    James A. Tulsky

  8. Department of Clinical Genetics, Fox Chase Cancer Center, 333 Cottman Ave., 4th Floor, Young Pavilion, Philadelphia, PA, 19111, USA

    Mary B. Daly

  9. Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B. Moore Ave., Ritter Annex, 9th Floor, Philadelphia, PA, 19122, USA

    Stephen J. Lepore

Authors
  1. Jennifer Barsky Reese
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  2. Mary Catherine Beach
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  3. Katherine Clegg Smith
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  4. Elissa T. Bantug
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  5. Kristen E. Casale
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  6. Laura S. Porter
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  7. Sharon L. Bober
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  8. James A. Tulsky
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  9. Mary B. Daly
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  10. Stephen J. Lepore
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Corresponding author

Correspondence to Jennifer Barsky Reese.

Ethics declarations

The funding agencies had no role in the conduct of this study and the authors declare they have no conflicts of interest to report. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study. This article does not contain any studies with animals performed by any of the authors.

Additional information

Relevance to inform research, policies, and/or programs: Sexual concerns are among the most common, distressing, and persistent supportive care concerns experienced by breast cancer survivors. Improving communication about sexual concerns should therefore be a high priority in clinical care. Key implications of the model developed to explain effective patient-provider communication about sexual concerns in the context of breast cancer are that effective communication can be self-sustaining, that skills-based interventions for patients and providers could each enhance communication potentially through increasing positive beliefs about such communication, and contextual factors consisting of patient, provider, and systemic factors can influence whether discussions are effective. Effective communication about sexual concerns is important because it can validate patients’ concerns, underscore a positive patient-provider relationship, and lead to the adoption of strategies supporting patients’ health and relationship outcomes.

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Reese, J.B., Beach, M.C., Smith, K.C. et al. Effective patient-provider communication about sexual concerns in breast cancer: a qualitative study. Support Care Cancer 25, 3199–3207 (2017). https://doi.org/10.1007/s00520-017-3729-1

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  • DOI: https://doi.org/10.1007/s00520-017-3729-1

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