Understanding Sexual Health in Breast Cancer Survivorship: Capturing Patient, Partner, and Provider Narratives to Enhance Biopsychosocial Care

Mollie Rose Canzona

Advisor: Carla L Fisher, PhD, Department of Communication

Committee Members: Gary Kreps, Christy Ledford, Kevin Wright

Johnson Center, Gold Room
April 01, 2015, 12:30 PM to 09:30 AM

Abstract:

Breast cancer survivors experience a range of physical, psychological, and relational sexual health issues that affect quality of life. While other quality of life issues may improve two to three years after primary treatment, sexual health has been reported in up to 50% of breast cancer survivors and is among the complications that can worsen across time (Denlinge & Ligibe, 2013; Ganz et al., 1996). Prior research indicates survivors want to discuss sexuality with medical providers; however, these conversations rarely take place (Sporn et al., 2014). Communication is critical as patients who do not discuss sexual health problems with providers are more disposed to sexual dysfunction(Murray, 2010). Rolland’s Family Systems Genetic Illness Model (2005) provides a framework in which to better understand the complex biopsychosocial nature of sexual health experiences in breast cancer survivorship at various points across the life span.

This dissertation consisted of two phases and associated goals. In phase one, 305 breast survivors representing young, middle, and older adulthood completed an online survey to determine the impact of breast cancer on women’s sexual health experiences broadly and the potential for provider-patient communication about these issues. To capture a more comprehensive view of women’s sexual health experiences and concerns, in phase two, a subsection of these women (n = 40) completed written reflections and participated in in-depth interviews using the Critical Incident Technique. To fully explore this, multiple perspectives were sought. Thirteen romantic partners of survivors completed the same process. Finally, interviews with a range of medical providers (gynecologists, family medicine physicians, general medicine internists, behavioral health specialists, and nurses) were conducted (n = 40). Interview transcripts were thematically analyzed using the constant comparative method. Survivor, partner, and provider narratives were then compared to identify similarities and discrepancies, which could inform efforts to enhance care.

Results reveal that survivors experience significant sexual health distress regardless of age or survivorship length, that willingness to communicate is related to sexual health outcomes, and that a range of providers have the opportunity to discuss sexual health with patients, however, over 70% of survivors reported they are not quick to make a medical appointment specifically to discuss their sexual health issues. Phase 2 results demonstrate that women experience interrelated biopsychosocial concerns as well as interpersonal and system level barriers to addressing those concerns. Providers and partners were not always aware of the full complexities of women’s concerns or the magnitude of the barriers they face. Groups also reported varying perspectives about the helpfulness of certain provider communication behaviors within the medical interaction. The narrative findings offer translational insights for relational coping, organizational health care communication, provider medical education, and patient-centered care.