Affirming Care for Sexual and Gender Minority Prostate Cancer Survivors: Results from an Online Training.

Sexual and gender minority people have unique, unaddressed healthcare needs following prostate cancer. The research team along with a group of established subject matter experts developed a training and companion materials for healthcare professionals to address this need. Post-assessment evaluation was reported in frequencies and percentages by combining results from learners who attended an original, live web-based training and learners who completed the same training on-demand via a Learning Management System. Learners from both the live and archived training reported that the training increased their knowledge to effectively work with sexual and gender minority prostate cancer survivors. Learners also reported gaining new resources and strategies they could apply to their work. Results indicate the training fills an educational gap for healthcare professionals and supports the need for additional training of healthcare professionals focused on the healthcare needs of SGM cancer survivors.

Sexual Violence and Chemsex among Substance-Using Sexual and Gender Minorities in Texas.

Chemsex is the use of methamphetamine or other substances to enhance sexual experiences, and is most often associated with sexual minority men. Within the chemsex literature, questions of sexual violence emerge due, in part, to ambiguity about what constitutes consent within sexualized environments with co-occurring substance use.To understand the context in which sexual violence occurs, data from an online survey of sexual and gender minority Texans were analyzed using bivariate and logistic regression (N = 1273), and qualitative interviews with substance-using sexual minority men from a separate sample were thematically analyzed (N = 22).Among survey participants, 12.8% experienced a form of sexual violence (10.1% experienced intimate partner violence and 7.6% experienced sexual assault). When participants were categorized based on past year substance use and sex party attendance, 48.0% of participants who used drugs and attended sex parties (a proxy for chemsex) experienced sexual violence (41.6% experienced intimate partner violence and 41.0% experienced sexual assault). When variables statistically significant at the bivariate-level were entered into logistic regression models, participants in the chemsex category were 12.5 [95% CI: 6.9, 22.8] times more likely to experience sexual violence. Substance-using sexual minority men experiencing sexual violence describe situations in which consent is difficult to revoke and sexual exploitation is likely to occur.Studies which more deeply explore the relationship between sexual and relationship violence and chemsex among sexual and gender minorities are needed. Particularly, the notion of consent needs further conceptualization in the context of drug use and sex parties. HIGHLIGHTS: Measures of recent substance use and sex party attendance were combined to create a proxy measure for chemsex, which is the use of substances to enhance sexual experiences.Substance-using sexual and gender minorities engaging in chemsex were at increased risk of sexual violence.In addition to engaging in chemsex, variables associated with an increased odds of sexual violence among sexual and gender minorities were younger age, having a non-monosexual sexual identity, and receiving a mental health diagnoses.Studies on sexual and gender minorities engaging in chemsex should be developed to further explore sexual exploitation.

Collaboration Between Oncology Social Workers and Nurses: A Patient-Centered Interdisciplinary Model of Bladder Cancer Care.

OBJECTIVES: We propose a bladder cancer patient-centered, interdisciplinary collaboration model of care adapted from an earlier model by Black, Dornan, and Allegrante (1986). The Bladder Patient-Centered Interdisciplinary Team (BPIT) model provides a conceptual foundation for assembling interdisciplinary teams and emphasizes the patient as an active participant in treatment and member of the care team, along with oncology nurses, wound ostomy and continence nurses, and oncology social workers. DATA SOURCES: This model integrates scopes of practice and practice standards from nursing and social work professional organizations, findings from peer-reviewed articles, and expert clinical opinion in conceptualizing interdisciplinary bladder cancer care. CONCLUSION: BPIT is not meant to be an exhaustive or proscriptive catalog of roles and responsibilities. Future research is needed in this area to further refine and delineate the oncology social worker and nursing scopes of practice and standards for collaborative teamwork. IMPLICATIONS FOR NURSING PRACTICE: The unmet supportive care needs of patients with bladder cancer across all phases of the cancer continuum are well documented. Oncology and wound ostomy and continence nurses are of critical importance to holistically addressing these needs and enhancing the health-related quality of life. The BPIT model provides a broad overview of the discipline-specific and interdisciplinary team-specific roles and responsibilities for bladder cancer care.

Development and evaluation of a bladder Cancer specific survivorship care plan by patients and clinical care providers: a multi-methods approach.

BACKGROUND, CONTEXT AND PURPOSE: In spite of the mixed evidence for their impact, survivorship Care Plans (SCPs) are recommended to enhance quality of care for cancer survivors. Data on the feasibility of SCPs in bladder cancer (BC) is sparse. Using a mixed-methods approach, this study describes the iterative development, acceptability and feasibility of BC specific SCP (BC-SCP) in clinical settings. METHODS: In Phase I, we developed the BC-SCP. In Phase II, we conducted four focus groups with 19 patients and 15 providers to examine its acceptability and usability challenges. Data analyses using the Atlas.ti program, informed refinement of the BC-SCP. In Phase III, we conducted feasibility testing of the refined BC-SCP with 18 providers from 12 health-centers. An encounter survey was completed after each assessment to examine the feasibility of the BC-SCP. Chi-square and Fisher Exact tests were used for comparative analyses. RESULTS: During phase I, we observed high patient and provider acceptability of the BC-SCP and substantial engagement in improving its content, design, and structure. In Phase II, providers completed 59 BC-SCPs. Mean time for BC-SCP completion was 12.3 min. Providers reported that BC-SCP content was clear, did not hamper clinic flow and was readily completed with easy-to-access information. Comparative analyses to examine differences in SCP completion time by patient clinico-demographic characteristics and provider type revealed no significant differences. CONCLUSIONS: Our BC-SCP has clinical relevance, and can be used in an active practice setting. However, considerable progress will be necessary to achieve implementation of and sharing the BC-SCP with patients and care providers, particularly within the electronic medical record. In summary, BC-SCPs are essential to improve the follow up care of BC survivors. Clinical resources are required to ensure appropriate implementation of BC-SCPs. TRIAL REGISTRATION: Study HUM00056082.

Development of a Training to Address Needs of Sexual and Gender Minority Prostate Cancer Survivors: Results of Formative Research.

Background: There are limited training opportunities for healthcare professionals focused on the supportive care needs of sexual and gender minority (SGM) patients. SGM prostate cancer survivors have unique physical, psychosocial, and sexual needs that often go unaddressed due to lack of provider understanding of those needs. Methods: To inform the development of a training and companion materials for healthcare professionals to fill this gap, the authors conducted formative research to assess the needs of target learners and SGM patients. Formative research included a survey and focus group of oncology social workers, and interviews with SGM prostate cancer survivors. Results: Survey respondents indicated SGM patients deserved the same quality care as heterosexual, cisgender patients; however, one-third indicated they were not well informed regarding health needs of SGM people. Focus group themes included differing social support structures for SGM people and the need for healthcare professional training. Patient interviews indicated a need for SGM-specific training of healthcare professionals. Conclusion: There is a need for ongoing education and training among healthcare professionals to meet the needs of SGM prostate cancer survivors.

Lesbian, gay, and transgender veterans' experiences in the Veterans Health Administration: Positive signs and room for improvement.

This study explored the characteristics of lesbian, gay, and transgender veteran users of Veterans Health Administration (VHA) services and nonusers, using a national convenience sample. Participants responded to an online, anonymous survey posted on LGBT websites and forwarded through personal contacts, using a snow-ball sampling strategy, resulting in a final sample of 218. Most participants were enrolled in VHA (n = 151). VHA users were older, more ethnically diverse, had less income, and were less public about their sexual or gender minority identity than nonusers. VHA users and nonusers did not differ on depression, anxiety, alcohol use, or tobacco use; although VHA users had more physical limitations and chronic medical conditions and lower health literacy than nonusers. Most lesbian, gay, and transgender VHA users felt welcome at their facility and comfortable disclosing their sexual orientation and gender identity with their provider. Compared with earlier studies, the positive experiences of lesbian, gay, and transgender VHA users in this study provide supportive evidence that VHA staff training efforts to raise awareness and competency have been successful. Additional efforts are needed to understand why transgender men feel less welcome and comfortable disclosing their gender identity. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Mental Health Differences Between Older and Younger Lesbian, Gay, Bisexual, and Transgender Veterans: Evidence of Resilience.

OBJECTIVE: To examine health and identity differences between older (50+) and younger (< 50) lesbian, gay, bisexual, and transgender (LGBT) veterans. METHODS: Participants (N = 254) completed an internet survey assessing depression, anxiety, alcohol use, identity, minority stress, and outness. T tests and logistic regression were used to analyze results. RESULTS: Older LGBT veterans reported less alcohol use (p < .01) than younger counterparts. No age differences in depression or anxiety were reported. Older participants reported LGBT identity as more central to their overall identity (p < .01) and having less minority stress (p < .05), than younger participants. CONCLUSIONS: Compared to younger LGBT veterans, older LGBT veterans appeared more resilient over stressors that can impact mental health. Overall older LGBT veterans experienced less alcohol use and reported less minority stress than younger veterans. LGBT identity was more central to older veterans' overall identity than younger Veterans. CLINICAL IMPLICATIONS: LGBT veterans may experience stressors that can impact mental health, although older LGBT veterans show remarkable resilience. Clinicians should assess sexual orientation and gender identity, as well as veteran status, of patients in order to best evaluate their health risks and strengths.

Veterans Health Administration's Physician Assistant Primary Care Residency: An Evaluation of the First 3 Years.

PURPOSE: Results from an evaluation of a 12-month postgraduate Veterans Health Administration (VHA) residency in primary care for physician assistants (PAs). METHODS: Descriptive and open-ended data were collected to describe the experience of faculty and trainees participating in the first 3 years of this pilot residency. Quantitative data were summarized using descriptive statistics. Text data were transcribed and reviewed for common themes across residency sites and respondents. Data were collected at 2 time points-the end of the first year and the beginning of year 4. RESULTS: In the first 3 years of the program, 18 residents were enrolled at 6 sites, with 89% completing the residency. At the second time point, 8 more residents were enrolled. Residents were primarily female (69%). Of the residents completing the program, 56% obtained VHA employment, and 75% of the current residents planned to work for the VHA upon completing the program. Program infrastructure, such as written curriculum, a dedicated administrative staff, and written evaluations for trainees, was more common at the second time point. Recurring themes included the importance of establishing relationships with potential applicants, preceptors, medical center leadership, and trainees to support the program and the importance of securing resources such as space and protected time for faculty. CONCLUSIONS: Although postgraduate residency programs are less common for PAs than for some other health professions, our data suggest that a one-year residency can provide training for new graduates to help solidify their clinical experience and facilitate their transition to practice.

Health Differences Among Lesbian, Gay, and Transgender Veterans by Rural/Small Town and Suburban/Urban Setting.

PURPOSE: We explored the relationship between geographic location and health indicators for lesbian, gay, and transgender veterans. METHODS: We solicited participation in an online survey through national and city LGBT organizations and personal contacts to examine differences in depression, anxiety, alcohol and tobacco use, and body mass index among lesbian, gay, and transgender veterans (n = 252) in suburban/urban and rural/small town locations. Bisexual participants were too few to include in the analyses. RESULTS: As expected, rural/small town lesbian, gay, and transgender veterans spent more time traveling to their primary care provider. Travel time was also positively related to depressive and anxiety symptoms. However, only suburban/urban and rural/small town gay men differed in measures of depression and anxiety and tobacco use. That is, rural/small town gay men reported greater depressive and anxiety symptoms and greater tobacco use than their suburban/urban counterparts. Consistent with this finding, rural/small town gay men reported less community-related identity than suburban/urban men. Suburban/urban lesbian women showed a nonsignificant trend for community identity compared with rural/small town women. CONCLUSION: Similar to civilian studies, suburban/urban and rural/small town lesbian, gay, and transgender veterans evidenced few health differences, with the exception of suburban/urban gay men. Although rural/small town gay male veterans evidenced more depression and anxiety and less community identity than suburban/urban men, social networks likely differ for lesbian, gay, and transgender subgroups. Lesbian, gay, and transgender veterans may also differ from their civilian counterparts in ways that we do not yet understand.

Threat of Sexual Disqualification: The Consequences of Erectile Dysfunction and Other Sexual Changes for Gay and Bisexual Men With Prostate Cancer.

Gay and bisexual (GB) men with prostate cancer (PCa) have been described as an "invisible diversity" in PCa research due to their lack of visibility, and absence of identification of their needs. This study examined the meaning and consequences of erectile dysfunction (ED) and other sexual changes in 124 GB men with PCa and 21 male partners, through an on-line survey. A sub-sample of 46 men with PCa and seven partners also took part in a one-to-one interview. ED was reported by 72 % of survey respondents, associated with reports of emotional distress, negative impact on gay identities, and feelings of sexual disqualification. Other sexual concerns included loss of libido, climacturia, loss of sensitivity or pain during anal sex, non-ejaculatory orgasms, and reduced penis size. Many of these changes have particular significance in the context of gay sex and gay identities, and can result in feelings of exclusion from a sexual community central to GB men's lives. However, a number of men were reconciled to sexual changes, did not experience a challenge to identity, and engaged in sexual re-negotiation. The nature of GB relationships, wherein many men are single, engage in casual sex, or have concurrent partners, influenced experiences of distress, identity, and renegotiation. It is concluded that researchers and clinicians need to be aware of the meaning and consequences of sexual changes for GB men when designing studies to examine the impact of PCa on men's sexuality, advising GB men of the sexual consequences of PCa, and providing information and support to ameliorate sexual changes.

The effects of attachment and outness on illness adjustment among gay men with prostate cancer.

OBJECTIVE: Previous research has suggested that gay men facing prostate cancer may be particularly vulnerable to poor illness adjustment. Moreover, although attachment and greater disclosure of sexual orientation have been associated with health outcomes, their associations in this population have been largely unexamined. The purpose of the present study was to investigate whether greater outness about one's sexual orientation significantly mediated the associations between anxious and avoidant attachment and illness intrusiveness among gay men with prostate cancer. METHODS: Ninety-two gay and bisexual men who had received a diagnosis of prostate cancer in the past 4 years were recruited for the present study. Self-report questionnaires assessed demographic and medical variables, attachment, outness level and comfort, and illness intrusiveness. Bootstrapping procedures were used to assess for mediation. RESULTS: Results suggested significant associations between anxious attachment, outness comfort, and illness intrusiveness. Less comfort with outness significantly mediated the association between greater anxious attachment and more illness intrusiveness. Avoidant attachment was not significantly associated with illness intrusiveness. CONCLUSIONS: Findings support the mediating role of the subjective experience of being an out gay man in the association between anxious attachment and illness intrusiveness. These results suggest that facilitating greater comfort with outness would be beneficial for illness adjustment among gay men with prostate cancer whom have more anxious attachment styles. Copyright © 2015 John Wiley & Sons, Ltd.

Unmet informational and supportive care needs of patients following cystectomy for bladder cancer based on age, sex, and treatment choices.

PURPOSE: Assessing the unmet needs of cancer patients can help providers tailor health care services to patients' specific needs. This study examines whether the unmet informational and supportive care needs of the patients with muscle-invasive bladder cancer vary by the patients' age, sex, or individual treatment choices. METHODS AND MATERIALS: Participants (N = 30 survivors; 73.3% men) were recruited from the Mount Sinai Medical Center and through advertisements posted on a national Bladder Cancer Advocacy Network website between December 2011 and September 2012. Data were collected through individual interviews and electronic medical record review. A prior qualitative study of this cohort, using immersion/crystallization approach, confirmed the prevalence of unmet needs across the disease trajectory. This is a secondary quantitative analysis of the initial interview data we collected (i.e., quantitative analyses of transformed qualitative data using Chi-square and Fisher exact tests) to examine differences in unmet needs based on the patient's age, sex, and treatment choices. RESULTS: Younger patients (<60y) were less satisfied with the treatment information received presurgery and more likely to report posttreatment complications, choose a neobladder, and seek and receive professional support regarding sexual function, than were older patients (P<0.05). More women than men reported difficulties with self-care and relied on themselves in disease self-management as opposed to relying on spousal support (P<0.05). Patients with neobladder were more likely to report difficulties with urinary incontinence and deterioration in sexual function, whereas patients with ileal conduit were more likely to require spousal help with self-care. Patients who received chemotherapy were significantly more likely to report changes in everyday life (P<0.05). Lastly, regardless of age, sex, or treatment choice, up to 50% of patients reported feeling depressed before or after treatment. CONCLUSIONS: Unmet informational and supportive needs of patients with muscle-invasive bladder cancer during survivorship, and vary by age, sex, and treatment choices. Educational and psychological assessments as well as clinical interventions should be tailored to a patient's specific unmet needs, and to specific clinical and demographic characteristics.

Health-Related Quality of Life, Psychological Distress, and Sexual Changes Following Prostate Cancer: A Comparison of Gay and Bisexual Men with Heterosexual Men.

INTRODUCTION: Decrements in health-related quality of life (HRQOL) and sexual difficulties are a recognized consequence of prostate cancer (PCa) treatment. However little is known about the experience of gay and bisexual (GB) men. AIM: HRQOL and psychosexual predictors of HRQOL were examined in GB and heterosexual men with PCa to inform targeted health information and support. METHOD: One hundred twenty-four GB and 225 heterosexual men with PCa completed a range of validated psychosexual instruments. MAIN OUTCOME MEASURE: Functional Assessment of Cancer Therapy-Prostate (FACT-P) was used to measure HRQOL, with validated psychosexual measures, and demographic and treatment variables used as predictors. RESULTS: GB men were significantly younger (64.25 years) than heterosexual men (71.54 years), less likely to be in an ongoing relationship, and more likely to have casual sexual partners. Compared with age-matched population norms, participants in both groups reported significantly lower sexual functioning and HRQOL, increased psychological distress, disruptions to dyadic sexual communication, and lower masculine self-esteem, sexual confidence, and sexual intimacy. In comparison with heterosexual men, GB men reported significantly lower HRQOL (P = .046), masculine self-esteem (P < .001), and satisfaction with treatment (P = .013); higher psychological distress (P = .005), cancer related distress (P < .001) and ejaculatory concern (P < .001); and higher sexual functioning (P < .001) and sexual confidence (P = .001). In regression analysis, psychological distress, cancer-related distress, masculine self-esteem, and satisfaction with treatment were predictors of HRQOL for GB men (R2Adj = .804); psychological distress and sexual confidence were predictors for heterosexual men (R2Adj = .690). CONCLUSION: These findings confirm differences between GB and heterosexual men in the impact of PCa on HRQOL across a range of domains, suggesting there is a need for GB targeted PCa information and support, to address the concerns of this "hidden population" in PCa care.

The Need for Survivorship Care in Genitourinary Cancers: Considerations from SUO and LUGPA.

INTRODUCTION: A quarter of American cancer survivors have genitourinary malignancies that are largely managed by urologists. We explored urologist perceptions about survivorship care for genitourinary malignancies. METHODS: A total of 701 SUO (Society of Urologic Oncology) and 1,746 LUGPA (Large Urology Group Practice Association) members were invited to complete a web based survey composed of 5 domains, including 1) demographics, 2) current survivorship care practices, 3) perceived barriers, 4) accessibility to survivorship resources and 5) perceptions of advocacy groups. RESULTS: Of 191 respondents 137 (72%) had no training in survivorship care. Of the 174 respondents 129 (74%) practiced shared care models while 45 (26%) preferred pure specialized followup care. Only 39 of 129 respondents (30%) with a shared care model always provided a written care plan. These plans infrequently included information on lifestyle modifications and educational resources. Routine patient referral to advocacy organizations was highest for prostate cancer at 40% followed by bladder, testicular and kidney cancers at 17%, 10% and 8%, respectively. Lack of time/resources and practice guidelines were considered the 2 most important barriers to survivorship care by 31% and 30% of participants, respectively. Web based information on advocacy groups and best practice guidelines were selected as the most important initiatives to promote survivorship care. CONCLUSIONS: Despite the low response rate this study highlights important practice gaps in survivorship care for patients with genitourinary malignancies. In collaboration with advocacy organizations professional societies should initiate programs to better educate and train their members in survivorship care guidelines and consensus best practices.

Relationship between illness uncertainty, anxiety, fear of progression and quality of life in men with favourable-risk prostate cancer undergoing active surveillance.

OBJECTIVES: To evaluate prospectively the associations between illness uncertainty, anxiety, fear of progression and general and disease-specific quality of life (QoL) in men with favourable-risk prostate cancer undergoing active surveillance (AS). PATIENTS AND METHODS: After meeting stringent enrollment criteria for an AS cohort study at a single tertiary care cancer centre, 180 men with favourable-risk prostate cancer completed questionnaires at the time of enrollment and every 6 months for up to 30 months. Questionnaires assessed illness uncertainty, anxiety, prostate-specific QoL (using the Expanded Prostate Cancer Index Composite [EPIC] scale) and general QoL (using the 12-time short-form health survey [SF-12]) and fear of progression. We used linear mixed-model analyses and multilevel mediation analyses. RESULTS: Sexual scores on the EPIC scale significantly declined over time (P < 0.05). Illness uncertainty was a significant predictor of all EPIC summary scores, SF-12 physical component summary (PCS) scores, mental component summary (MCS) scores and fear of progression scores (all P < 0.05), after controlling for demographic and clinicopathological factors. Anxiety predicted all EPIC summary, MCS and fear of progression scores (all P < 0.05) but not PCS scores (P = 0.08). Scores on PCS, MCS, EPIC summary scales (except sexual scale), and fear of progression did not change significantly over the study period (all P > 0.10). CONCLUSION: Over the 2.5-year follow-up, QoL remained stable; only sexual function scores significantly declined. Illness uncertainty and anxiety were significant predictors of general and prostate-specific QoL and fear of progression. Interventions to reduce uncertainty and anxiety may enhance QoL for men with prostate cancer on AS.

Perspectives on Sexual Health and Function of Recent Male Combat Veterans of Iraq and Afghanistan.

BACKGROUND: U.S. veterans of recent wars in Iraq and Afghanistan may be at greater risk for sexual dysfunction due to injuries, mental health conditions, medications used to treat those conditions, and psychosocial factors. OBJECTIVE: To explore the perceptions of recent Veterans about sexual health and dysfunction, contributing factors, its impact and solutions. DESIGN: Qualitative study. PARTICIPANTS: Eight men who screened positive for sexual dysfunction at initial presentation to a postdeployment clinic at a Veterans Affairs medical center. APPROACH: Patients who screened positive for sexual dysfunction and indicated an interest in participating were contacted and scheduled for an in-person private interview with a researcher. Interviews were semistructured, utilizing open-ended and follow-up probe questions to elicit the individual's perspective about sexual dysfunction and its cause, impact and solutions. Interviews were recorded, transcribed and analyzed for themes. KEY RESULTS: These heterosexual men discussed a range of sexual dysfunction in their activities including lack of desire, erectile dysfunction, delayed orgasm, premature ejaculation, and distraction. They also discussed the importance of setting or context and changes over time to their sexual health and function. The men shared their ideas about contributory factors, including normal aging, medication side effects, injury and a possible role for combat deployment more generally. Reported solutions for sexual dysfunction included medications, herbal remedies, and new positions and approaches to sexual activity. Participants reported discussing sexual dysfunction with their health-care providers and what was helpful. Finally, the men expressed in their own words the significant impact of sexual dysfunction on their self-perception, their partners, and their relationships. CONCLUSIONS: Sexual dysfunction in recent combat veterans can have important negative effects on their health and relationships. Our findings elucidate perceived contributory factors and preferred solutions, which can be applied by health-care providers to improve the management of sexual dysfunction in these patients.

An Exploration of Returning Veterans' Sexual Health Issues Using a Brief Self-Report Measure.

INTRODUCTION: Sexual health is an integral aspect of quality of life with important implications for satisfaction with intimate relationships, emotional well-being, and life as a whole. Veterans returning from Iraq and Afghanistan frequently encounter a wide range of known risk factors for sexual health concerns. AIM: This article seeks to examine the overall frequency, important covariates associated with sexual difficulties, and the relevant domains of sexual dysfunction among a group of recent US veterans of Iraq and Afghanistan. METHODS: This is a retrospective chart review of 247 veterans of conflicts in Iraq and Afghanistan evaluated for an initial visit at the post-deployment clinic of a large veterans affairs medical center (VAMC). Patient demographic and medical characteristics were calculated using descriptive statistics. The prevalence and burden of sexual health issues in our patient sample were calculated using descriptive statistics from these veterans' responses to a self-report measure of sexual functioning. Item-level regression analyses were then conducted between sexual functioning responses and other patient data. MAIN OUTCOME MEASURES: The main outcome measures used were the responses to the Arizona Sexual Experience Scale (ASEX). RESULTS: Almost 18% of veterans screened positive for sexual functioning difficulties. Self-reported sexual dysfunction was most strongly associated with depression, posttraumatic stress disorder, female sex, and service connection rating. Co-occurring characteristics varied with specific areas of sexual functioning. CONCLUSIONS: Screening using an empirically validated self-report instrument indicates that there is a high prevalence of reported sexual dysfunction among recently deployed veterans. Analyses indicated that there are specific characteristics associated with both overall self-reported sexual dysfunction and specific subtypes of sexual dysfunction. Active assessment of specific aspects of sexual dysfunction concerns may allow providers to identify and implement more precise sexual functioning interventions. Beaulieu GR, Latini DM, Helmer DA, Powers-James C, Houlette C, and Kauth MR. An exploration of returning veterans sexual health issues using a brief self-report measure. Sex Med 2015;3:287-294.

Preparing Trainees to Deliver Patient-Centered Care in an Ambulatory Cancer Clinic.

The purpose of this paper is to describe how an interprofessional cancer care clinic at the Cleveland Veteran's Affairs Medical Center (VAMC) is training health care professionals in patient-centered care. Teaching strategies included patient huddle discussions pre- and post-clinic, role-play, noon "lunch and learn" conferences, and, most importantly, patient interactions, which were evaluated with the patient perception of patient centeredness (PPPC) instrument. This instrument is designed to capture patient and provider perceptions of the provider's patient centeredness. Early findings demonstrated that patient responses were overwhelmingly positive and lacked variability. In response to the lack of variability, the educator in the clinic participated in the evaluation and patient, provider, and trainer responses were compared. Discussion of the weekly evaluations provided helpful formative feedback on patient centeredness to the trainees rotating through this specialty care clinic.

Fear of recurrence: the importance of self-efficacy and satisfaction with care in gay men with prostate cancer.

OBJECTIVE: Limited research has investigated the psychosocial processes that underpin the effect of physical symptoms on fear of cancer recurrence. Additionally, despite evidence of increased vulnerability of marginalized populations to negative outcomes, few studies have examined the unique experience of gay men coping with the cancer process. The goals of this study were to determine whether disease-related self-efficacy and satisfaction with medical care mediated the relationship between greater physical symptoms and worse fear of recurrence among gay or bisexual prostate cancer survivors. METHODS: Participants were composed of 92 self-identified gay or bisexual men, who had received a diagnosis of prostate cancer in the past 4 years. Participants provided demographic information and completed self-report questionnaires that assessed symptom function, self-efficacy for prostate cancer symptoms, satisfaction with healthcare, and fear of recurrence. Bootstrapping procedures were used to assess for significant mediation. RESULTS: Results suggested significant mediation of the relationship between each of bowel, hormonal, and sexual function with fear of recurrence by self-efficacy and satisfaction with healthcare. Mediation was not significantly supported for the association between urinary function and fear of recurrence. CONCLUSIONS: Findings support the explanatory effects of self-efficacy for symptom management and satisfaction with healthcare on the relationship between symptom function and fear of recurrence. These results indicate that psychological processes, specifically psychological factors that hold particular relevance to gay or bisexual men, reflect a potential avenue for intervention to decrease fear of cancer recurrence.