A nurse-assisted screening and referral program for depression among survivors of colorectal cancer: feasibility study.

OBJECTIVE: To test the feasibility and acceptability of a telephone-based program to screen survivors of colorectal cancer (CRC) for distress, and to refer distressed patients to their treating health service. DESIGN, SETTING AND PARTICIPANTS: A prospective, multicentre study involving 59 patients with CRC recruited from six public and private health services in Melbourne, Victoria, from 15 June 2008 to 22 September 2009. Patients who had completed adjuvant chemotherapy for CRC were contacted (7-10 days after recruitment [outcall one] and again 4 weeks later [outcall two]) by the Cancer Council Victoria's helpline nurse, and screened for distress with the Distress and Impact Thermometer (DIT); participants were given tailored information and support and those with distress scores of > or = 5, and impact scores of > or = 4, were referred for follow-up. Telephone interviews were conducted 4 weeks after outcall two. Participating helpline and health service staff were surveyed on the feasibility and acceptability of the service. MAIN OUTCOME MEASURE: Anxiety and depression, measured by the Hospital Anxiety and Depression Scale (HADS). RESULTS: Of the 59 patients (87%) who agreed to participate, 63% were men; their mean age was 59 years (SD, 9.5 years). HADS depression decreased significantly from baseline (mean score, 4.93; SD, 4.22) to follow-up (mean score, 3.84; SD, 4.10; Z = -2.375; P = 0.02). However, there was no significant difference in HADS anxiety between baseline (mean score, 5.29; SD, 4.11) and follow-up (mean score, 4.78; SD, 3.65). Outcall one generated two referrals (4% of participants) and outcall two generated four referrals (8%); five of these six participants took up the referrals. Satisfaction with the program among participants was high; 82% found outcall one "quite or very helpful" and 79% found outcall two "quite or very helpful". Helpline and health service staff reported a straightforward process that did not adversely affect workloads. CONCLUSION: This model of care carries the potential to meet ongoing psychosocial needs of survivors of CRC.

Communicating about patient sexuality and intimacy after cancer: mismatched expectations and unmet needs.

OBJECTIVE: To explore the ways that patients and health professionals communicate about intimate and sexual changes in cancer and palliative care settings. DESIGN: A qualitative study using a three-stage reflexive-inquiry approach, with semi-structured, participant interviews (n = 82); textual analysis of national and international cancer and palliative care clinical practice guidelines (n = 33); and participant feedback at 15 educational forums for cancer patients or health professionals. SETTING: A large Australian public teaching hospital between 2002 and 2005. PARTICIPANTS: 50 patients diagnosed with cancer, and 32 health professionals who had worked in cancer and/or palliative care for a minimum of 12 months. MAIN OUTCOME MEASURES: Communication about intimacy and sexuality: patients' needs and experiences and health professionals' attitudes and experiences. RESULTS: There were mismatched expectations between patients and health professionals and unmet patient needs in communication about sexuality and intimacy. Most patients sought information, support and practical strategies about how to live with intimate and sexual changes after treatment for cancer, even if their cancer type did not affect fertility or sexual performance. In contrast, many health professionals assumed that patients shared their professional focus on combating the disease, irrespective of the emotional and physical costs to the patient. Health professionals overwhelmingly limited their understanding of patient sexuality to fertility, contraception, menopausal or erectile status. Many stereotypical assumptions were made about patient sexuality, based on age, sex, diagnosis, culture, and partnership status. There was a relationship between providing patient-centred communication about intimacy and sexuality and health professionals' understanding of their own attitudes and beliefs. CONCLUSION: Resources are needed to help health professionals engage in an exploration of their own definitions of intimacy and sexuality and understand how these affect interactions with patients with cancer.

Let's talk about sex: risky business for cancer and palliative care clinicians.

Few health professionals feel confident and comfortable when communicating with patients about the sexual and intimate changes that might occur after a diagnosis of cancer. Little research has focused on why health professionals find this type of patient communication so challenging. Drawing on data from a larger study examining issues of intimacy and sexuality from the perspectives of patients and health professionals in cancer and palliative care, this paper will present the health professional perspective. In the larger study a reflexive inquiry methodology enabled data to be collected through semi-structured participant interviews (n=82), a textual analysis of national and international clinical practice guidelines (n=33) and documented feedback from patients and health professionals attending educational forums where preliminary findings of the study were presented (n=15). In the part of the study reported here, a total of 32 health professionals recognised as members of a multidisciplinary team and working in cancer and or palliative care for a minimum of 12 months were interviewed. Results revealed that patient sexuality and intimacy was largely medicalised so that health professional discussions remained at the level of patient fertility, contraception, erectile or menopausal status. Many unchecked assumptions about patient sexuality were made by health professionals, based on the patient's age, diagnosis, culture, partnership and disease status. It was personally confronting and a 'risky' business to communicate about issues of patient intimacy and sexuality after cancer, particularly when the clinical setting emphasised medicalised, health professional driven and problem-based communication. Implications for practice will be discussed.

A patient-centred approach to sexuality in the face of life-limiting illness.

Sexuality is intrinsic to a person's sense of self and can be an intimate form of communication that helps relieve suffering and lessens the threat to personhood in the face of life-limiting illness. Health professionals struggle to accept that people with life-limiting illness, especially older people, continue to be sexual beings. People facing life-limiting illness may appreciate the opportunity to discuss issues of sexuality and intimacy with a trusted health professional. Practical strategies to assist health professionals to communicate effectively about sexuality and intimacy include creating a conducive atmosphere, initiating the topic, using open-ended questions and a non-judgmental approach, and avoiding medical jargon.