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Sexuality post gynaecological cancer treatment: a qualitative study with South African women.

ABSTRACT: OBJECTIVES:This study investigated women's experiences of their sexuality post gynaecological cancer treatment. Using a holistic sexuality framework, the study explored how women felt their sexual functioning, sexual relationships and sexual identity had been affected by treatment. DESIGN:The study was qualitative in nature and made use of an interpretive descriptive design. Data were analysed using thematic analysis. SETTING:Data collection took place at a follow-up clinic within the gynaeoncology unit at a public-sector tertiary hospital in Cape Town, South Africa. PARTICIPANTS:Purposive sampling was used to recruit participants, and the final sample consisted of 34 women aged 29-70 ([Formula: see text]=52). All women had received a gynaecological cancer diagnosis and had been treated with either surgery, chemotherapy, radiation or a combination of these. On average, the participants were between 12 and 30 months post treatment. RESULTS:Women expressed how their sexual functioning post treatment was both nuanced and complex, how heteronormative gender expectations influenced their intimate relationships, and how they experienced a re-embodiment of their sexual subjectivity post treatment. Participants felt that more sexual functioning information from healthcare providers, as well as peer support groups, would assist them in navigating the sexuality changes they experienced. CONCLUSIONS:The findings of this study broaden conceptualisations of sexuality post treatment by detailing the ways that it is complex, nuanced, relational and ever shifting. More research is needed about how to incorporate holistic psychosexual support post treatment into the public healthcare system in South Africa.

SUBMITTER: Pitcher S

PROVIDER: S-EPMC7513640 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Sexuality post gynaecological cancer treatment: a qualitative study with South African women.

Pitcher Sorrel S Fakie Nazia N Adams Tracey T Denny Lynette L Moodley Jennifer J

BMJ open 20200923 9

<h4>Objectives</h4>This study investigated women's experiences of their sexuality post gynaecological cancer treatment. Using a holistic sexuality framework, the study explored how women felt their sexual functioning, sexual relationships and sexual identity had been affected by treatment.<h4>Design</h4>The study was qualitative in nature and made use of an interpretive descriptive design. Data were analysed using thematic analysis.<h4>Setting</h4>Data collection took place at a follow-up clinic ...[more]

PMID: 32967884

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Project description:ObjectiveThis study explored women's sexual experiences and coping strategies for sexual problems after gynaecological treatment.SettingThe research was carried out at Tikur Anbessa Specialized Hospital, one of the two cancer centre hospitals in the country.Study designA phenomenological qualitative study design was employed in this study.Study participantsParticipants were recruited using purposeful sampling. Thirteen eligible study participants were interviewed face to face. Data were collected from 2 February to 15 March 2019 and analysed at the same time. For data analysis, thematic analysis was used, which comprises three stages: data reduction, data display and data conclusion.ResultsFour themes resulted from the analysis of individual interview data, including treatment side effects, sexual issues following radiation therapy, lack of awareness regarding cancer treatment and sexual dysfunction, and coping strategies for sexual dysfunction following gynaecological cancer treatment. Three subthemes emerged as coping mechanisms for managing sexual issues and dysfunction among Ethiopian women with gynaecological cancer: avoiding sexual intercourse, praying for healing and seeking professional help. These themes were identified as the rich and detailed account of the experiences of sexually active women who have received treatment for their cervical cancer.ConclusionThis study has broadened the perspectives on sexuality in the setting of gynaecological cancer and challenged certain commonly held beliefs about sexuality after treatment. Researchers should look into how inclusive sexuality education and training may be better integrated into the training programmes of healthcare workers. More research is needed to learn how partners of women with gynaecological cancer cope with sexual changes after treatment, how the couple as a partnership negotiates changes after treatment, and the facilitators and barriers that healthcare providers face when discussing sexuality issues with patients.

Project description:BackgroundThere is a disparity in the burden of gynaecological cancer for Indigenous women compared with non-Indigenous women in Australia. Understanding how Indigenous women currently experience gynaecological cancer care services and factors that impact on their engagement with care is critical. This study explored Indigenous Australian women's experience of gynaecological cancer care at a major metropolitan hospital in Queensland.MethodsIndigenous women receiving care at a major metropolitan Queensland hospital for investigation or diagnosis of gynaecological cancer were invited to participate in a larger longitudinal study exploring women's experiences of gynaecological cancer care. This component was an in-depth, qualitative interview exploring the women's experiences of hospital care at approximately three-month post initial referral. A peer-approach was used to interview women. Hospital-based care providers involved in the care of Indigenous gynaecological cancer patients were invited to be interviewed. Interviews were transcribed and thematically analysed using an interpretative phenomenological approach enabling a multi-layered, contextualised understanding of the patients' experience and their interaction with tertiary cancer services.ResultsEight Indigenous patients and 18 care providers were interviewed. Analysis of all interviews revealed four broad issues affecting Indigenous patients' early experiences of care: (1) navigating the system, impacted by timely diagnosis, access to support services and follow up; (2) communication and decision-making, patients' decision-making, efficacy of doctor-patient communication, and patients' knowledge about cancer; (3) coping with treatment demands, was impacted by emotional stress, access to services and support by hospital staff; and (4) feeling welcome and safe in the hospital, impacted by patients' relationship with care providers and their access to culturally-safe services. The combination of factors impacting these women's' experience of gynaecological care commonly left these women at breaking point, often with limited access to information, resources or support.ConclusionsOur findings revealed that experiences of cancer care for Indigenous women are overlain by challenges associated with late referral, misdiagnosis, miscommunication, lack of information, logistics in accessing treatment and services and system cultural insensitivities. Our findings offer insights that can inform cancer care provision to more effectively support Indigenous women accessing gynaecological cancer services.

Project description:BackgroundTriage is a critical component of prehospital emergency care. Effective triage of patients allows them to receive appropriate care and to judiciously use personnel and hospital resources. In many low-resource settings prehospital triage serves an additional role of determining the level of destination facility. In South Africa, the Western Cape Government innovatively implemented the South African Triage Scale (SATS) in the public Emergency Medical Services (EMS) service in 2012. The prehospital provider perspectives and experiences of using SATS in the field have not been previously studied.MethodsIn this qualitative study, focus group discussions with cohorts of basic, intermediate and advanced life support prehospital providers were conducted and transcribed. A content analysis using an inductive approach was used to code transcripts and identify themes.Results15 EMS providers participated in three focus group discussions. Data saturation was reached and four major themes emerged from the qualitative analysis: Implementation and use of SATS; Effectiveness of SATS; Limitations of the discriminator; and Special EMS considerations. Participants overall felt that SATS was easy to use and allowed improved communication with hospital providers during patient handover. Participants, however, described many clinical cases when their clinical gestalt triaged the patient to a different clinical acuity than generated by SATS. Additionally, they stated many clinical discriminators were too subjective to effectively apply or covered too broad a range of clinical severity (e.g., ingestions). Participants provided examples of how the prehospital environment presents additional challenges to using SATS such as changing patient clinical conditions, transport times and social needs of patients.ConclusionsOverall, participants felt that SATS was an effective tool in prehospital emergency care. However, they described many clinical scenarios where SATS was in conflict with their own assessment, the clinical care needs of the patient or the available prehospital and hospital resources. Many of the identified challenges to using SATS in the prehospital environment could be improved with small changes to SATS and provider re-training.

Project description:BackgroundDespite concerns about dolutegravir use in pregnancy, most low- and middle-income countries are accelerating the introduction of dolutegravir-based regimens into national antiretroviral treatment programmes. Questions remain about the acceptability of dolutegravir use in women due to the potential risks in pregnancy. This study from South Africa and Uganda explored community values, preferences and attitudes towards the use of dolutegravir-based regimens in women.MethodsThis study employed a qualitative design involving in-depth interviews and focus group discussion conducted between August 2018 to March 2019. The study was conducted in the months following an announcement of a potential risk for neural tube defects with dolutegravir use among women during conception and the first trimester. Participants included HIV positive pregnant and lactating women and their partners. They were selected purposively from urban poor communities in South Africa and Uganda. Data was analysed thematically in NVivo.ResultsForty-four in-depth interviews and 15 focus group discussions were conducted. Most participants had positive views of dolutegravir-based regimens and perceived it to be more desirable compared with efavirenz-containing regimens. There was widespread concern about use of dolutegravir during pregnancy and among women of childbearing age due to publicity around the possible association with neural tube defects. Acceptability was gendered, with nearly all male participants preferring their female spouses of childbearing potential not to use dolutegravir, while most women not planning pregnancy wanted access to contraception alongside dolutegravir. Community awareness and knowledge of dolutegravir was low and characterised by negative information. Women were concerned about HIV-related stigma and wanted the privacy features of dolutegravir to be strengthened with modification of the pill appearance and disguised packaging.ConclusionsDolutegravir-based regimens were found to be generally acceptable for use in women except during pregnancy. Interest in a dolutegravir-based regimen was linked with its perceived potential to enhance health, privacy and reduce stigma while concerns about neural tube defects were the main potential barrier to dolutegravir uptake in women. In order to optimise the community acceptability and uptake of acceptability-based regimen among women it is critical to strengthen community awareness and understanding of dolutegravir treatment, improve contraception services alongside the introduction of dolutegravir, and engage with male partners.

Dataset Information

Sexuality post gynaecological cancer treatment: a qualitative study with South African women.

Publications

Sexuality post gynaecological cancer treatment: a qualitative study with South African women.

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