Talking about sexuality and intimacy : health professional sexual communication in the context of cancer and palliative care

Abstract

It is now well established that cancer and cancer treatments often have detrimental impacts on the sexual wellbeing and relationships of palliative patients and their partners. Consequently, most palliative cancer patients have reported wanting the opportunity to discuss the impact of these sexual and intimate changes with health professionals. However, whilst most health professionals working in the field of cancer consider sexual communication and information provision to be important, they have reported that in practice, this rarely happens. Previous research has identified a number of personal and structural barriers to such sexual communication; however discursive barriers have received less attention. Equally, there has also been an absence of research examining palliative cancer care health professionals' knowledge of the potential sexual and intimate concerns of palliative patients and their partners, and how they may respond to these concerns. This study examined how personal, structural and discursive barriers may interact to facilitate or limit health professional and patient or partner sexual communication in the context of palliative cancer care. A material-discursive-intrapsychic analytical framework was adopted, situated within a critical realist epistemological paradigm. Thirty palliative cancer care health professionals, including physicians, nurses, psychologists, bereavement counsellors and social workers, took part in semi-structured individual interviews. The interview accounts were analysed using thematic discourse analysis. Overall, the participants identified a broad range of physical, psychological and relational changes in relation to sexuality that could potentially be experienced by palliative cancer patients and their partners. Health professionals reported that they most often responded to the sexual and intimate concerns of palliative patients and their partners by providing emotional support, by facilitating couple communication, and through encouraging non-sexual expressions of intimacy. However, a number of challenges to sexual communication with palliative patients and their partners were identified. In particular, it was found that normative discourses around heterosex, gender, age, illness and dying contributed to sexuality being positioned as irrelevant or inappropriate for particular groups of patients and partners. It was also found that the biomedical discourse shaped the material structure of clinical settings problematically, particularly in relation to time and privacy constraints. Participants also reported that sexual expression by patients and partners was largely considered to be 'inappropriate' within hospital and hospice settings, and thus not supported by many hospital and hospice staff. Further, it was identified that these discursive and material barriers allowed palliative care health professionals opportunity to take up subject positions which could excuse them from addressing sexual concerns. The implications of these research findings suggest that interventions to improve health professional sexual communication in the context of palliative cancer care could focus on challenging sexual myths, and on improving the material constraints of clinical settings. It is also argued that further research is needed to explore how discursive factors, along with intrapsychic and material factors, shape how palliative cancer patients and their partners experience post-cancer sexual and relational changes.

Date of Award	2016
Original language	English