Intimacy and sexuality in women with breast cancer: professional guidance needed.

BACKGROUND: Approximately 60-70% of breast cancer survivors experience sexuality problems resulting from treatment. This study investigated information and communication preferences with professionals on the topic intimacy and sexuality of women diagnosed with breast cancer. METHODS: Members of the Dutch Breast Cancer Patient Association were surveyed regarding their experiences and preferences about information on intimacy and sexuality. An online questionnaire was developed that included five close-ended and one open-ended question regarding: information received; type of professional preferred; method and timing of communication on the topics of intimacy and sexuality. Quantitative data were analysed using descriptive statistics. A deductive framework analysis was performed on the open-ended answers to enrich the data of the close-ended questions. RESULTS: In total, 667 female breast cancer (ex-)patients participated. In 46% of the women, the information received matched their needs. Most women preferred to receive information about the impact on intimacy and sexuality from a nurse (66.4%) or primary doctor (27.9%). The preferred method of communication was a conversation with a professional together with their partner (51.6%) or a personal conversation with a professional. Respondents emphasized the importance of appropriate timing of information, preferably at least shortly after the treatment started (45.1%). CONCLUSIONS: This study shows that intimacy and sexuality should be repeatedly included in consultations, at every stage of the disease but especially shortly after treatment started. Women with breast cancer expect that professionals (preferably nurse or primary doctor) initiate this subject via a personal conversation (alone or with their partner).

Impact of practice, provider and patient characteristics on delivering screening and brief advice for heavy drinking in primary healthcare: Secondary analyses of data from the ODHIN five-country cluster randomized factorial trial.

BACKGROUND: The implementation of primary healthcare-based screening and advice that is effective in reducing heavy drinking can be enhanced with training. OBJECTIVES: Undertaking secondary analysis of the five-country ODHIN study, we test: the extent to which practice, provider and patient characteristics affect the likelihood of patients being screened and advised; the extent to which such characteristics moderate the impact of training in increasing screening and advice; and the extent to which training mitigates any differences due to such characteristics found at baseline. METHODS: A cluster randomized factorial trial involving 120 practices, 746 providers and 46 546 screened patients from Catalonia, England, the Netherlands, Poland, and Sweden. Practices were randomized to receive training or not to receive training. The primary outcome measures were the proportion of adult patients screened, and the proportion of screen-positive patients advised. RESULTS: Nurses tended to screen more patients than doctors (OR = 3.1; 95%CI: 1.9, 4.9). Screen-positive patients were more likely to be advised by doctors than by nurses (OR = 2.3; 95%CI: 1.4, 4.1), and more liable to be advised the higher their risk status (OR = 1.9; 95%CI: 1.3, 2.7). Training increased screening and advice giving, with its impact largely unrelated to practice, provider or patient characteristics. Training diminished the differences between doctors and nurses and between patients with low or high-risk status. CONCLUSIONS: Training primary healthcare providers diminishes the negative impacts that some practice, provider and patient characteristics have on the likelihood of patients being screened and advised. Trial registration ClinicalTrials.gov. Trial identifier: NCT01501552.