The Oncology and Sexuality, Intimacy, and Survivorship Program Model: An Integrated, Multi-disciplinary Model of Sexual Health Care within Oncology.

Cancer-related sexual dysfunction is documented as one of the most distressing and long-lasting survivorship concerns of cancer patients. Canadian cancer patients routinely report sexuality concerns and difficulty getting help. In response to this gap in care, clinical practice guidelines were recently published in the Journal of Clinical Oncology. A sweeping trend is the creation of specialized clinics for patients' sexual health concerns. However, this much-needed attempt to address this service gap can be difficult to sustain without addressing the cancer care system from a broader perspective. Herein, we describe the implementation of a tiered systemic model of cancer-related sexual health programming in a tertiary cancer center. This program follows the Permission, Limited Information, Specific Suggestions, Intensive Therapy (PLISSIT) model, used previously for guiding individual practitioners. Visually, the model resembles a pyramid. The top 2 levels, corresponding to Intensive Therapy and Specific Suggestions, are comprised of group-based interventions for common cancer-related sexual concerns and a multi-disciplinary clinic for patients with complex concerns. The bottom 2 levels, corresponding to Permission and Limited Information, consist of patient education and provider education and consultation services. We describe lessons learned during the development and implementation of this program, including the necessity for group-based services to prevent inundation of referrals to the specialized clinic, and the observation that creating specialized resources also increased the likelihood that providers would inquire about patients' sexual concerns. Such lessons suggest that successful sexual health programming requires services from a systemic approach to increase sustainability.

Quality improvement in sexual health care for oncology patients: a Canadian multidisciplinary clinic experience.

PURPOSE: With the goal of improving the quality of sexual health care provision at our tertiary cancer centre, we developed, implemented, and assessed a multidisciplinary sexuality in an oncology program, to identify patient needs and apply interventions that could be effective in a broader oncology care context. METHODS: The establishment of our institution's first oncology-focused sexual health program is described within a quality improvement framework. A complementary retrospective chart review was performed to evaluate clinicodemographic data, including responses to validated sexual health questionnaires, from a 2-year clinical pilot. RESULTS: A sexual health program was introduced for cancer patients identified by health care providers or self-referred, receiving 130 referrals and conducting 64 consultation and 75 follow-up visits within a 2-year pilot period. Patients attending the program were 75% female, of mean age 52 years, and had most often breast (33%) or hematologic (30%) malignancies. Most (84%) had completed curative-intent treatment, with no evidence of disease, with 34% on ongoing endocrine therapy. The most frequent reasons for referral were sexual pain (38%), decreased libido (35%), and vaginal dryness (35% of females). All female patients demonstrated sexual dysfunction on the Female Sexual Function Index, and 80% of male patients demonstrated moderate to severe erectile dysfunction on the Sexual Health Inventory for Men. Patients waited a median of 63 days (SD 107, range 3-516) from referral to consultation, suggesting that demand for multidisciplinary sexual health care overwhelmed existing resources. CONCLUSIONS: We have demonstrated unmet sexual health needs across a diverse oncology patient population and have presented a framework for addressing these issues, highlighting the challenges encountered and proposing improvements. Insights emerging from a quality improvement perspective included the role of group-based sexual health support to improve accessibility and the need for staff education to encourage proactive intervention before referral for specialized care is needed.