Talking about sex after cancer: A discourse analytic study of health care professional accounts of sexual communication with patients

Abstract

There is consistent evidence that health care professionals (hcps) are not addressing the sexual information and support needs of people with cancer. Thirty-eight Australian hcps across a range of professions working in cancer care were interviewed, to examine constructions of sexuality post-cancer, the subject positions adopted in relation to sexual communication, and the ways in which discourses and subject positions shape information provision and communication about sexuality. Participants constructed sexual changes post-cancer in physical, psychological and relational terms, and positioned such changes as having the potential to significantly impact on patient and partner well-being. This was associated with widespread adoption of a discourse of psychosocial support, which legitimated discussion of sexual changes within a clinical consultation, to alleviate distress, dispel myths and facilitate renegotiation of sexual practices. However, this did not necessarily translate into patient-centred practice outcomes, with the majority of participants positioning personal, patient-centred and situational factors as barriers to the discussion of sex within many clinical consultations. This included: absence of knowledge, confidence and comfort; positioning sex as irrelevant or inappropriate for some people; and limitations of the clinical context. In contrast, those who did routinely discuss sexuality adopted a subject position of agency, responsibility and confidence.

Keywords:

• cancer
• sexuality
• health care professional
• communication
• discourse analysis

Acknowledgements

This research was funded by an Australian Research Council Linkage Grant, LP0883344, in conjunction with the Cancer Council New South Wales and the National Breast Cancer Foundation. We received in-kind support from Westmead Hospital and Nepean Hospital. The chief investigators on the project were Jane Ussher, Janette Perz and Emilee Gilbert, and the partner investigators were Gerard Wain, Gill Batt, Kendra Sundquist, Kim Hobbs, Catherine Mason, Laura Kirsten and Sue Carrick. We thank Caroline Joyce, Emma Hurst, Jan Marie and Chloe Parton for research support and assistance.