Breaking bad news of a breast cancer diagnosis over the telephone: an emerging trend.

PURPOSE: This study evaluated how breast cancer diagnoses were shared with patients. METHODS: Current members of the Dr. Susan Love Research Foundation's Army of Women cohort were sent one email with a link to a survey assessing how their breast cancer diagnosis was communicated, a description of their support system during treatment, basic demographic information, and breast cancer diagnosis details. RESULTS: Participants (n = 2896) were more likely to be given their diagnosis over the telephone in more recent years (OR 1.07, 95% CI 1.06-1.08). Up until about 10 years ago (1967-2006), breast cancer diagnoses were communicated in person more often than by telephone. Since 2006, more than half of participants learned about their diagnosis over the telephone. From 2015 to 2017, almost 60% of participants learned about their diagnosis over the telephone. Among those who heard the news in person, a steady 40% were alone. Characteristics of those who received the news over the telephone included having identified support members, heterosexual identity, and a diagnosis of in situ breast cancer. CONCLUSIONS: Receiving a telephone call about breast cancer diagnosis may be the norm rather than the exception in health care today. Trends in practice, as well as current best practices based primarily on expert opinion, may not provide optimal care for women diagnosed with breast cancer. Patient outcome research to guide future practice, such as the impact of modes of delivery of bad news, is urgently needed to determine appropriate patient-centered approaches for notification of breast cancer diagnoses.

Sexual Dysfunction in Primary Care: An Exploratory Descriptive Analysis of Medical Record Diagnoses.

BACKGROUND: The prevalence of sexual dysfunction (SDx) diagnoses in primary care settings is not well known, which is a concern because of the high prevalence of comorbid chronic health conditions in patients diagnosed with SDx. AIM: To explore the relation of SDx diagnosis, chronic health conditions, and prescription medications commonly associated with SDx for men and women in primary care using medical records diagnoses. METHODS: Exploratory descriptive analyses were used to interpret secondary data from a primary care patient database. The database included patient data from 3 family and internal medicine clinics in the St Louis metropolitan area from July 1, 2008 to June 30, 2015. Analysis included key demographic variables, chronic illness, and health conditions of hypertension, pain, prostate disorder, menopause, substance abuse, depression, anxiety, and associated medications. Analysis of the database yielded 30,627 adult patients (men: n = 12,097, mean age = 46.8 years, 65.6% white race; women: n = 18,530, mean age = 46.6 years, 59.2% white race) with significant comorbid associations between SDx and other chronic illness, health conditions, and medication prescription. RESULTS: Depression, anxiety, pain, hypertension, diabetes, and psychotropic medication use were significantly associated with SDx for men and women. Examination of specific SDx diagnoses showed erectile dysfunction to be significantly associated with all tested variables for men. For women, pain-related SDx diagnoses were associated more with chronic illness, health conditions, and medication use than were psychosexual SDx diagnoses (eg, orgasm), except for menopause. Prevalence varied by sex, with a higher prevalence rate of any SDx for men (13.5%) than for women (1.0%), although sex comparisons were not part of the analytics. CLINICAL TRANSLATION: This study suggests the diagnosis of SDx is closely associated with other common chronic illness and health conditions and could go underdiagnosed in women in primary care. STRENGTHS AND LIMITATIONS: The cross-sectional nature of the study limits the ability to draw causal conclusions related to the nature of the associated conditions with SDx diagnoses. The generalizability of the findings also might be limited given the specific demographic or health makeup of the St Louis area where the study was conducted. CONCLUSION: The high comorbidity of SDx with mental health, chronic pain and illnesses, and medication use adds to the growing evidence that sexual health and functioning are essential components of overall well-being and holistic care for men and women. Heiden-Rootes KM, Salas J, Gebauer S, et al. Sexual Dysfunction in Primary Care: An Exploratory Descriptive Analysis of Medical Record Diagnoses. J Sex Med 2017;14:1318-1326.

Therapists' Assessments in Treating "Sex Addiction" and Their Relationship to Clients' Gender, Relationship Status, and Exclusivity Status.

A total of 208 therapists and therapists-in-training were surveyed to better understand if clinical assessments and recommendations regarding "sex addiction" changed based upon a client's gender, relationship status, or exclusivity status. Using clinical vignettes, this study examined the clinical assessment and recommendations of licensed mental health providers (n = 92) and mental health providers in-training (n = 116). Results indicated that professional ratings differed based on relationship exclusivity and gender; specifically, female nonmonogamous behavior was rated more negatively than male nonmonogamous behavior, while male monogamous behavior was rated more negatively than female monogamous behavior. Recommendations for treatment varied, with higher addiction ratings leading to greater odds of recommending individual, group, and community support over relational therapy. Clinical and training implications are discussed. Video abstract accessible by clicking here.

Comparison of Medical Diagnoses among Same-Sex and Opposite-Sex-Partnered Patients.

BACKGROUND: Health disparities for gay and lesbian individuals are well documented in survey research. However, a limitation throughout the existing literature is the reliance on self-reported health conditions. This study used medical record diagnoses for gay and lesbian patients seen in primary care clinics. METHODS: This study used medical records of primary care patients (n = 31,569) seen at Midwestern, university-affiliated primary care clinics. First, all records with information about the sexual partnering of the patient were identified (n = 13,509). Then, opposite-sex-partnered and same-sex-partnered (SSP) patients were compared for prevalence of common chronic conditions and clinic utilization. RESULTS: Only 44.20% of medical records included information about patients' sexual partners. Both male and female SSP patients were more likely to be lower socioeconomic status, be a current or former smoker, and be diagnosed with substance abuse/dependence and depression. CONCLUSIONS: The findings suggest the need for more consistent screening of the sexual partnering of patients for identifying patients who are at greater risk of poorer health outcomes. However, identifying the sexual partnering of patients may not occur systematically in primary care, and there may be a lack of disclosure by SSP patients to their physicians given the social stigma about same-sex relationships.