An interactive training module for health professionals: Addressing the psychosexual care of women affected by gynaecological cancers Workshop 2: Applying.

An interactive training module for health professionals: Addressing the psychosexual care of women affected by gynaecological cancers Workshop 2: Applying Principles for Psychosexual Care: Multi scenario focus P. Yates, K. Nattress, K. Hobbs, I. Juraskova, K. Sundquist, L. Carnew. Aim of the workshop this morning/this afternoon. Introduce you to the Psychosexual Care for gynaecological cancers (PSGC) website Provide some background on how and why it was developed Provide some tips to navigate around the site Update you on steps moving forward for this resource

Introduction Treatment for a gynaecological cancer (GC) can alter a woman’s behaviours, attitudes and feelings towards sexuality and intimacy. Health professionals require knowledge and skills to minimise the risk of these concerns, and to effectively treat them should they occur. The aim of this project was to develop a psychosexual care framework and educational resource to improve health professionals’ skills and confidence in providing effective psychosexual care. To begin with, women with gynaecological cancer can experience significant sexual dysfunction, yet information and support tailored for this area is often neglected or mistimed. Cancer Aust commissioned QUT to develop a psychosexual care framework and educational resource to improve Health Professional’s skills and confidence in providing psychosexual care

The home page of the PSGC resource on the Cancer Learning website. (www.cancerlearning.gov.au)
Point out to the audience the various highlights of the site: Modules 1 – 6 listed down the right hand side. These modules have been developed to work through in order and build on knowledge and confidence, by starting at module one (looking at definitions of sexuality) and progressing through to module 6, depending on the depth of knowledge required. Alternatively if the learner is already working in this area, or has specific learning needs, they are able to search for a particular topic and follow a path identified by their individual leaning needs and area of interest. Video case studies (centre page thumbnails) are highlighted on the home page and are used to consolidate your learning, by re enforcing the content of the modules and depicting real life scenarios. Throughout the resource, the video case studies are woven into the module content to create learning activities, thinking points and reflection to practice. The entire list of seven(7) video vignettes are available by clicking video on the navigation bar. The notebook facility (bottom left) is a useful tool to record your progress through the module and the accompanying learning activities. For first time users, you must first click on create an account, then every subsequent visit to the site you will be able to simply log in to your saved notebook Site Guide: (right side of the navigation bar) includes useful information on ‘how to use the PSGC resource’ as well as ‘how to use the modules’. Information on using the notebook are provided in the site guide. Professional development (navigation bar) includes useful information on how to gain Continuing professional development (CPD) for your individual health profession Supplement information for FAQ’s related to How to use the Notebook To access your notebook for the first time: Create an account: select this link either on the homepage or on the My notebook page. You'll see a registration page where you'll be asked to enter your name, address and a password. Make sure you've entered your address correctly. Submit your registration. A confirmation will be sent to your nominated address. Click the link in this message to confirm your registration and activate your notebook. You can log in to your notebook at any time using the same address and password you supplied. The notebook is a useful tool to record your progress through the module. Use it to: record your answers to the activities keep track of your reading save links to articles that are relevant to your practice. Remember to click 'update' each time you use your notebook to save your work. Each question within the activities usually requires a short answer of 50 words or less. Dot point format formulates clear concise answers. It's recommended, as part of your Continuing Professional Development (CPD) requirement, that you keep a record of how long you have spent working through the modules. We suggest you log in to your notebook every time you visit this site, and record your start and finish times. When you log in to the notebook at the start of each session, the notebook button will appear in all the learning activities to allow you easy access to record your answers. If you don't log in to the notebook, this notebook button will not appear. At the end of each session, save your notebook or print to your CPD file. When you have finished accessing the notebook, use the browser back button (back arrow top left corner of your page) to return to where you were in the module. By setting up the notebook function you will be able to record your progress through the modules, save each session as you log in and out of the resource, pick up where you left off, and then save your notes as a valuable psychosexual resource tool in your professional development portfolio.

Module development process
Phase 1 Scoping Phase 2 Development Phase 3 Piloting Phase 4 Implementing Literature review Web based review Framework Module outlines Case study and module development Review of materials by health professionals Web and content editors ensure a succinct and usable structure Piloting within test sites ensures usability of materials Implementation of the final resource after addressing pilot feedback The Module Development process occurred in 4 phases Scoping – extensive literature and web review Development – began with the framework – which underpins our approach to design the modules, modules once written were peer and consumer reviewed Piloting – once the modules were on a development site, we tested them on line as well as conducted some pilot workshops Implementation : the PSGC resource went live in March 2011 on the internet. Promotion of the resource for individual on-line learning as well as integrated workshops (face to face and online workshops) disseminated throughout 2012, including information stands at conferences; workshops and resource mail outs throughout Australia.

Project team and project working group guide development of the modules
The Project Team, a group of specialists developing the modules include: The Project Working Group provides feedback and comment on developed resources at each stage of the process. Patsy Yates Palliative care research and education Kath Nattress Registered nurse, and post-graduate educator Ilona Juraskova Lecturer in Health Psychology at The University of Sydney, and a clinical psychologist Kim Hobbs Social Worker, Westmead Hospital, Department of Gynaecological Oncology. Kendra Sundquist Educator, expertise in sexual and reproductive health, sexuality, and psychosocial care in cancer Background to the wide range of expertise and input into writing the modules… Patsy Yates is the project lead, and these are some of the members of the writing team and their expertise. Please note, the modules underwent the scrutiny and review of The Project Working Group, with valuable feedback and comments to guide the resource development.

Phase 1: Scoping Method All studies which explored, described and/or explained the psychosexual issues experienced by women affected by GC and their partners were included. The search strategy was limited to the years 1999 to mid October 2010. Databases searched included: CINAHL, PubMed, PsycINFO, and Medline Our scoping involved a search of all studies addressing the psychosexual issues.

Phase 1: Scoping Results
The literature searches identified 116 papers addressing: psychosexual sequelae, supportive care and quality of life health professional practices (including interventions) These topics were analysed to: identify competencies relevant to health professionals in various practice settings guide the development of the framework and educational resource Identified a number of papers which were used to guide the development of the framework and the educational resource.

Phase 2: Developing the framework
Caring for women affected by gynaecological cancers Universal All women with gynaecological cancer Extended Some women with gynaecological cancer Specialist A few women with gynaecological cancer Specialist Extended Universal Universal Appropriate for all health professionals who interact with women affected by gynaecological cancers. Framework Explanation: The framework is centred around the needs of experiences of women with gynaecological cancers. incorporates three tiers, with each tier representing differing levels of need. Also describes the capabilities required of health professionals to address these needs. Universal: The Universal tier is the broadest level of care relevant for all women affected by gynaecological cancers. The modules and supporting resources included at the Universal Care tier are appropriate for all health professionals who interact with women affected by gynaecological cancers.

Caring for women affected by gynaecological cancers Universal All women with gynaecological cancer Extended Some women with gynaecological cancer Specialist A few women with gynaecological cancer Specialist Extended Universal Extended Appropriate for health professionals who are involved with the treatment and care of women affected by gynaecological cancers. Framework Explanation: Extended: Topics and resources discussed in the Extended Care tier are designed to aid health professionals care for women with mild to moderate psychosexual effects from gynaecological cancers. The resources supplied at this tier are appropriate for health professionals who are involved with the treatment and care of women affected by gynaecological cancers. Use of the Framework: The framework will be used to guide the development of an interactive training resource for health professionals that enable health professionals to achieve the capabilities of the various levels. The training resource will comprise of an evidence-based module and supporting resources on the care of women affected by gynaecological cancers.

Caring for women affected by gynaecological cancers Universal All women with gynaecological cancer Extended Some women with gynaecological cancer Specialist A few women with gynaecological cancer Specialist Extended Universal Specialist Discussion of topics which will aid health professionals’ care for women with gynaecological cancer who are exhibiting severe distress. Due to the highly specialised and often sensitive nature of required care at this level, identification of cases and appropriate referral techniques are required, as well as strategies to resolve problems. Framework Explanation: Specialist Care: The Specialist Care tier will discuss topics which will aid health professionals’ care for women with gynaecological cancer who are exhibiting severe distress. Due to the highly specialised and often sensitive nature of required care at this level, identification of cases and appropriate referral techniques are required, as well as strategies to resolve problems. The framework is designed as a step model, where higher tiers building on capabilities and services in lower levels. For example, to adequately provide care at the Extended level, it is expected that health professionals have achieved the capabilities outlined in the Universal level

Reviewing modules 1,2 &3; successful completion of modules 4,5& 6 at an in depth level, accessing additional readings, activities, & supporting resources will develop specialist capabilities, confidence and skill, including identification of cases and appropriate referral techniques Reviewing modules 1, 2 and 3 and successful completion of modules 4, 5 and 6 will achieve an extended level of capability, knowledge, confidence and skill. Successful completion of modules 1, 2 and 3 will provide a broad level of capabilities and knowledge.

Phase 2: Developing the modules
A total of six modules have been developed to fit within the framework. Understanding sexuality Understanding the experience of the psychosexual effect of a gynaecological cancer Enquiring and responding to the psychosexual sequalae of gynaecological cancers Understanding psychosexual sequalae: pathophysiological, psychosocial and cultural aspects Undertaking a comprehensive sexual health assessment Evidence based approaches to the treatment of psychosexual sequelae of gynaecological cancers

Each module comprises…
Multiple Choice Q’s Key Concepts Thinking Points Case Studies Short Answer Q’s

Phase 3: Pilot testing Many health professionals expressed the need for a resource to guide/improve their ability to deal with psychosexual issues in gynaecological cancer Health professionals reported improved confidence and knowledge following the workshop The range of issues addressed in the modules, coupled with case studies and learning activities, provided an interactive environment beneficial for learning Results of our pilot testing..

Phase 4: Implementation www.cancerlearning.gov.au
Implementation phase – The PSGC resource is currently hosted on the Cancer Learning website. The resource is freely available for online self-directed learning as well as for interactive facilitator led workshops.

What are we doing at the moment?
website live on Freely available for online self-directed learning Workshop packages for group learning Self record option for CPD

Principles and Practices for Psychosexual Care of Women with Gynaecological Cancers
Funded by Cancer Australia Workshop 2: Applying principles of care / Multi scenario focus

Activity: Dispelling common myths about sexuality
Sex causes cancer Older people aren’t interested in having sex People with cancer don’t want to have sex Discussing sex isn’t nice People who want to know about sex will ask People who are dying are not interested in sex Sexuality is only about intercourse Ask the participants to brainstorm prior to providing the answers to ‘some common myths’

Session Objectives Identify dimensions of sexuality
Identify the common psychosexual effects of diagnosis and treatment for gynaecological cancer Describe principles for communicating about sexuality Outline a model for undertaking a psychosexual assessment List principles for psychosexual care The ‘Introduction to dimensions of sexuality’ content for this segment of the workshop is derived from Module 1 in the online PSGC resource housed on the cancer learning website at Participants at this workshop are encouraged to visit the online resource and complete module 1 as homework following the workshop.

Activity: What is sexuality?
How do you define sexuality? Who or what has shaped your definition of sexuality? Ask the participants to brainstorm their answers or if uncomfortable expressing out loud, ask them to write in down in their notes

What is sexuality? The term 'sexuality' has any number of meanings.
It be linked with loving relationships and intimacy It can be associated with physical appearance and interpersonal behaviours It can be associated with sexual activity

What is sexuality? a person's behaviours, desires, and attitudes related to sex and physical intimacy with others National Cancer Institute

Factors influencing an Individual’s Sexuality
Sexuality can be influenced by a range of social, cultural, psychological and biological factors Ask the participants to brainstorm some of the factors influencing an individuals sexuality

Activity: Factors influencing an Individual’s Sexuality
Identify clinical situations where you’ve cared for an individual from a different cultural group to your own. Reflect on ways in which culture may have influenced the meaning of sexuality for them In what ways is this similar and/or different to your own view of sexuality? Ask the participants to brainstorm thinking points: Reflect on in ways in which culture may have influenced the meaning of sexuality to them In what ways is this similar and/or different to your own view of sexuality

Defining Sexual Health and Sexual Dysfunction
Sexual health is a state of physical, emotional, mental and social well-being relating to sexuality. It's not merely the absence of disease, dysfunction or infirmity. Sexual dysfunction is 'the various ways in which an individual is unable to participate in a sexual relationship … he / she would wish'. World Health Organization

How common is sexual dysfunction?
Experiencing sexual dysfunction is relatively common in the community A survey of Australian women reported that 70% experienced sexual difficulties (including the inability to orgasm and not feeling like sex) in the year before the survey Richters J, Grulich, A.E., Visser, R.O., Smith, A.M., Rissel, C.E. (2003). Australian and New Zealand Journal of Public Health Volume 27, Issue 2 , pp

Identifying sexual dysfunction
DSM-IV identifies the following male and female sexual and gender identity disorders, which can have organic or psychogenic causes: sexual desire disorders sexual arousal disorders orgasmic disorders sexual pain disorders gender identity disorder sexual dysfunction due to a medical condition sexual dysfunction NOS (not otherwise specified)

Gynaecological cancer & sexual dysfunction
Sexual dysfunction can occur: in the months preceding a definitive diagnosis, due to: the onset of disease related symptoms including vaginal bleeding and discharge, pain and fatigue during treatments as a result of: functional and physiological effects of surgery, radiotherapy, chemotherapy or other treatment psychological and social effects of a diagnosis and bodily changes following completion of treatment, due to: longer term physiological, psychological and social sequelae of the disease and treatments

Causes of sexual dysfunction in gynaecological cancer
Anatomical changes to the vagina, resulting in vaginal stenosis, or decreased lubrication Hormonal changes, resulting in menopausal symptoms including dry vagina Alterations to reproductive function, resulting in changes to fertility Altered bowel and bladder function, resulting in concerns about incontinence Functional limitations, resulting from treatment related fatigue, or lymphoedema Psychosocial effects, for example concerns about body image, fear of pain, and altered roles and relationships

Norma’s story part 1 Ask participants to brainstorm some answers to the thinking point: What are the possible psychosexual effects associated with Norma’s cancer and cancer treatment? Go to the PSGC resource ( and play the recommended video segment from the selection of video vignettes Or alternatively download the video from the website; or from the PSGC usb and imbed into the power point prior to the workshop presentation.

Case Study: Norma What is the impact of Norma’s disease and treatment on her sexuality and body image What potential barriers are there to communicating with Norma about her sexuality? Ask participants to brainstorm some answers to the thinking point: What is the impact of Norma’s disease and treatment on her sexuality and body image What potential barriers are there to communicating with Norma about her sexuality?

Case Study: Norma Watch the video and consider..... What communication skills does the social worker use to facilitate discussion with Norma about her sexuality? Norma’s story part 2 After watching the video – ask participants to discuss and consider..... What communication skills does the social worker use to facilitate discussion with Norma about her sexuality? Go to the PSGC resource ( and play the recommended video segment from the selection of video vignettes Or alternatively download the video from the website; or from the PSGC usb and imbed into the power point prior to the workshop presentation.

Case Study: Jane 58 year old post-menopausal woman, married to Dave for 6 years Second marriage for both Recent TAHBSO and PLND for stage 2 endometrial cancer Adjuvant vault brachytherapy Jane has a consultation with the Radiation Oncology Nurse about her recovery from treatment

Case Study: Jane Watch the video and answer the following question:
What are the possible psychosexual effects associated with Jane’s cancer and cancer treatment? Jane’s Story part one Ask participants to brainstorm some answers to the thinking point: What are the possible psychosexual effects associated with Jane’s cancer and cancer treatment? Go to the PSGC resource ( and play the recommended video segment from the selection of video vignettes Or alternatively download the video from the website; or from the PSGC usb and imbed into the power point prior to the workshop presentation.

Jane’s story part 2 Go to the PSGC resource ( and play the recommended video segment from the selection of video vignettes Or alternatively download the video from the website; or from the PSGC usb and imbed into the power point prior to the workshop presentation.

Case study: Susan 37 year old woman married to Pete, 2 school-aged kids Teacher, working part-time Husband has demanding management job, long hours, frequent trips away Recurrent epithelial ovarian cancer Currently mid-way through chemotherapy with Carboplatin and Caelyx Parents-in-law staying in family home to help with kids During chemotherapy treatment Susan discloses to the nurse that she is concerned about the impact of the diagnosis and treatment on her marital relationship…

Case Study: Susan Watch the video and answer the following questions:
What are the possible psychosexual effects associated with Susan’s cancer and cancer treatment? How might this impact on her roles & relationships? Susan’s story part 1 Ask participants to brainstorm some answers to the thinking point: What are the possible psychosexual effects associated with Susan’s cancer and cancer treatment? How might this impact on her roles & relationships? Go to the PSGC resource ( and play the recommended video segment from the selection of video vignettes Or alternatively download the video from the website; or from the PSGC usb and imbed into the power point prior to the workshop presentation.

Case Study: Joan 65 year old woman married to George, aged 73
Presented to Emergency Department with symptoms of bowel obstruction Underwent emergency laparotomy. Findings: ovarian cancer, adherent to bowel resulting in formation of colostomy. Will require adjuvant chemotherapy

Case Study: Joan Watch the video and answer the following question:
What are the possible psychosexual effects associated with Joan’s cancer and cancer treatment? Joan’s story part 1 Ask participants to brainstorm some answers to the thinking point: What are the possible psychosexual effects associated with Joan’s cancer and cancer treatment? Go to the PSGC resource ( and play the recommended video segment from the selection of video vignettes Or alternatively download the video from the website; or from the PSGC usb and imbed into the power point prior to the workshop presentation.

Case Study: Joan The Stoma therapist discusses impact of colostomy on body image and sexual function Joan’s story part 2 Go to the PSGC resource ( and play the recommended video segment from the selection of video vignettes Or alternatively download the video from the website; or from the PSGC usb and imbed into the power point prior to the workshop presentation.

Managing Bladder and Bowel Dysfunction
Promoting urinary control Empty the bladder just before sex Try having sex in the shower or bath where any urine loss will be unnoticed Try having intercourse in a side-lying or woman-on-top position to help control the depth of thrusting that can stimulate the bladder If vaginal penetration causes bladder spasm or triggers incontinence ‘outercourse’ may be preferred Refer to a physiotherapist or continence specialist if problems are persistent

Managing Bladder and Bowel Dysfunction
Stoma Care – preventing leakage or inflation Avoid food and drinks that cause gas or odour When engaging in sexual activity: ensure bag is empty and seal is intact consider using garments to conceal the stoma using a belt or cummerbund will help stabilise the appliance consider using a mini bag or an opaque bag cover consider using alternative sexual positions to reduce discomfort and anxiety. Sexual difficulties in a woman with a stoma is often associated with concerns about body image. In addition to support and education, consider referral for specialist sexual counseling and allow access to the genitalia. Example: crotchless underwear, Teddies, peignoirs or a comfortable t-shirt can also help A smaller, closed pouch reduces the risk of leakage and is less bulky than the usual pouches - options available. The woman-on-top prevents pressure on the stoma or pouch. The side-lying position allows the pouch to fall away Consider referral for the woman and her partner

Principles for Communicating with People affected by Cancer about Sexuality

Case Study: Anna Watch the video and consider which communication skills the Health Professional uses to facilitate discussion with Anna about her sexuality? Anna’s story part 1 After watching the video – ask participants to discuss and consider..... which communication skills the Health Professional uses to facilitate discussion with Anna about her sexuality? Go to the PSGC resource ( and play the recommended video segment from the selection of video vignettes Or alternatively download the video from the website; or from the PSGC usb and imbed into the power point prior to the workshop presentation.

Anna’s story part 2 Go to the PSGC resource ( and play the recommended video segment from the selection of video vignettes Or alternatively download the video from the website; or from the PSGC usb and imbed into the power point prior to the workshop presentation.

1. Prepare for discussions
Recognise the difficulty of initiating discussion about sexuality Acknowledge how hard it is to talk about sensitive matters and reinforce that articulating the problems is the first step towards resolving them Take a positive stance, reinforce that sexual problems following cancer treatment are normal and expected, but are usually temporary Comfort in discussing sexuality improves with practice

2. Time your discussion Psychosexual assessment is not a one-off event. If not identified at the initial assessment, raise it later. Sexual difficulties may arise at different points in the recovery process. Women vary in their responses. Women need to develop rapport and trust with health care professionals before discussing sensitive matters. The timeframe for developing this trust is variable. Ensuring that sexuality is on a checklist of questions gives women permission to discuss concerns.

3. Use good communication skills
Find words and phrases that sound authentic and convey a non-judgmental value orientation. Ask clear, open-ended questions and allow adequate time for the woman to find words to respond. Check with the woman that she understands what you are asking and seek clarification that you understand. Be alert to non-verbal cues of discomfort or distress. Use bridging statements and then move from general to specific questions to facilitate discussion about sexuality.

3. Use good communication skills – Some examples
“Now that we’ve talked about how you are managing at home after the treatment, I would like to ask some questions about how things are going with your sexual relationship. Is that OK with you?” “I’m really pleased to hear that the treatment side-effects are settling down. I find for most women at this stage another area of concern may be sexual function. Are there any issues there that you would like to discuss?”

4. Use appropriate language
Don’t make assumptions about the person’s level of knowledge and understanding Check their understanding of sexual/reproductive anatomy and function and correct misunderstandings Use simple language rather than formal anatomical terms Check with the woman/couple that your terminology is understandable and try to use the terminology of the woman/couple Diagrams are often helpful

5. Normalise and validate
Sexuality concerns need to be normalised. Questions about sexual function should be as routinely asked as questions about pain, bladder and bowel function and all other treatment side-effects. Acknowledge verbally to the woman that sexuality is a sensitive and private matter that may be difficult to discuss. Seek permission from the woman to raise these matters and normalise the incidence of post-treatment sexuality changes.

5. Normalise and validate: An example
“I always ask how things are going with sexual relationships because it’s really very common to have difficulties after treatment. Is that something you would like to talk about?”

6. Sensitively address myths and misconceptions
Myths and misconceptions about sexuality are common and may impede resumption of sexual activity, e.g., Sex causes cancer Sex will be harmful Validation of concerns and encouragement to communicate with the partner and with health professionals may assist women in dispelling myths.

7. Determine preferences for involving partners in the discussion
Discuss involvement of the partner, and with whom ongoing sexual assessment and intervention will be arranged . Not all women will wish to involve their partner in this process, e.g., If there is a history of violence, infidelity or sexual abuse in the woman’s current or past relationships If there are cultural or religious taboos around discussing matters of sexuality, the woman may feel more comfortable discussing sexuality issues on her own

Undertaking a Psychosexual Assessment

Undertaking a Psychosexual Assessment
Comprehensive assessment of psychosexual concerns needs to include an understanding of all intimate behaviours and practices for giving and receiving sexual pleasure/satisfaction. Sexuality is multidimensional, encompassing concepts of body image, self-esteem, intimacy, emotional adjustment, interpersonal communication and a diverse range of sexual behaviours.

Ex-PLISSIT Model for Assessment
Permission: Give permission for the patient to have sexual feelings / relationships and normalise this. “Many women diagnosed with cancer find that it has an impact on their relationships and their interest in sex. Is it ok if we discuss this issue?”

Limited Information: Provide limited information to identify the effect of the cancer / treatment on sexuality. Correct any misconceptions, dispel myths, provide accurate information. “Treatment side effects often have a big impact on sexual activities. You mentioned that you started having intercourse again but it is still painful after treatment. How is this pain affecting your sex life?”

Specific Suggestions: Make specific suggestions to manage the sexual side effects they have identified. “There are many ways that couples can adapt their sex lives to adjust to the effect of the cancer and treatment. To address the issue of pain, you could consider which activities you can still enjoy when feeling sore from treatment, and focus on these instead of intercourse until you have recovered fully. How would you and your partner feel about focusing on other types of sexual activity?”

Intensive Therapy: Identify further support for the issues you have discussed, and refer them if appropriate. “Some women find it helpful to get more support for the issues we’ve discussed. You mentioned that you are feeling pressure to keep your sex life the way it has always been, and it is making you very distressed, but you can’t talk to your partner about it. Would you like to see a counsellor who is experienced in this area?”

Re-introducing Joan Joan and George are referred to the social worker
Watch the video and consider: What communication skills are utilised to undertake a discussion about psychosexual issues? Joan’s story part 3 After participants have watched the video, ask them to consider the following thinking point: What communication skills are utilised to undertake a discussion about psychosexual issues? Go to the PSGC resource ( and play the recommended video segment from the selection of video vignettes Or alternatively download the video from the website; or from the PSGC usb and imbed into the power point prior to the workshop presentation.

Interventions to Manage Specific Psychosexual Sequelae

Principles for intervention
Normalise the incidence of post-treatment sexuality changes and facilitate positive communication Treat the underlying cause where possible (physical, psychological, social) Minimise effects of anatomical changes, e.g. use of vaginal dilators Provide symptom relief Provide information and advice on alternative methods for showing intimacy, and for giving and receiving sexual pleasure; involve the partner if appropriate Refer to specialised services where required Facilitate positive communication with the partner, according to the patient’s preference

Managing vaginal dryness
The most effective solution for vaginal dryness is to use a product that adds moisture to the vaginal tissue Evidence suggests vaginal moisturisers and lubricants can increase vaginal moisture, vaginal fluid volume, vaginal elasticity and a return to premenopausal pH. There are 3 types of products for improving vaginal moisture Vaginal moisturisers Vaginal lubricants Vaginal oestrogens General suggestions include using unperfumed soaps and wearing cotton underwear

Sexuality in Palliative Care (Lemieux et al 2004)
Qualitative study to explore what ‘sexuality’ meant to 10 palliative patients and how their illness had affected their sexuality Emotional connection to others was integral component of sexuality and took precedence over physical expressions of sexuality Sexuality continues to be important at the end of life, even in the last weeks and days Lack of privacy, shared rooms, staff intrusion and single beds were considered barriers All felt sexuality should be addressed as an integral component of their care – only raised with one patient

Role Play In groups of three consider the following scenarios
Each scenario requires a patient, a health professional and an observer Rotate the roles for each of the three scenarios After all three scenarios have been considered be able to provide brief feedback to the larger group

Case Study: Maria Maria presents to her GP with intermenstrual bleeding. The GP discusses with Maria why she has never had a pap test Show participants Maria’s story part 1 to introduce the scenario Points to consider include possible psychosexual issues following Gynaecological cancer treatment for Maria. Go to the PSGC resource ( and play the recommended video segment from the selection of video vignettes Or alternatively download the video from the website; or from the PSGC usb and imbed into the power point prior to the workshop presentation.

Role play by participants
In groups of three, act out a subsequent scenario with a health professional; the patient and the observer Act out the role play in your groups and then come back together for discussion and feedback only (you are not being asked to do role play and act out in front of the whole group) Bring your observations and discuss how you felt/ what you discovered from the scenario Before commencing the role play: Stress to the participants it is Non confrontational Act out the role play in your groups and then come back together for discussion and feedback only (you are not being asked to do role play and act out in front of the whole group) Bring your observations and discuss how you felt/ what you discovered from the scenario. Group of three – rotate through the three scenarios and each has a turn of being the health professional; the patient and the observer

Maria’s story part 2 Discussion:
Work through feedback from each of the small groups and generate discussion. Some questions to consider: How did you find it when you were playing the part of the HP? Did you feel confident? Did you find it difficult to discuss psycho sexual issues? How did you find it when you were playing the part of the Patient? Did you feel uncomfortable discussing these sensitive issues? Did any possible future issues / considerations come up? Ask the observers for feedback – what did the HP do well? What could they do better? Reinforce that there are many different ways to approach the same situation, and we will each find our own style and comfort level in addressing these sensitive issues. We will also find it gets easier with practice, and we will find a language with which to communicate that we are comfortable with. Show participants the PSGC version of the scenario after feedback from the groups and discussion. Go to the PSGC resource ( and play the recommended video segment from the selection of video vignettes Or alternatively download the video from the website; or from the PSGC usb and imbed into the power point prior to the workshop presentation.

Case Study: Norma Norma is aged 78 and has been widowed for 15 years
She lives alone and is independent in ADL’s; she enjoys a close relationship with her 4 children and their families Active in her community; church, bowls, senior citizen’s Underwent wide local excision and bilateral groin node dissection for a stage 1 SCC of vulva. No adjuvant therapy required. Seen by Social Worker for routine psychosocial assessment....

Case Study: Norma Watch the video and consider..... What potential barriers are there to communicating with Norma about her sexuality? Norma’s story part 1 Show participants Norma’s story part 1 to introduce the scenario What potential barriers are there to communicating with Norma about her sexuality? Go to the PSGC resource ( and play the recommended video segment from the selection of video vignettes Or alternatively download the video from the website; or from the PSGC usb and imbed into the power point prior to the workshop presentation.

Case Study: Norma Watch the video and consider..... What communication skills does the social worker use to facilitate discussion with Norma about her sexuality? Norma’s story part 2 Brainstorm possible psychosexual issues following Gynaecological cancer treatment for Norma. Consider the following while watching Norma’s story part 2: What communication skills does the social worker use to facilitate discussion with Norma about her sexuality? Discussion: Work through feedback from each of the small groups and generate discussion. Some questions to consider: How did you find it when you were playing the part of the HP? Did you feel confident? Did you find it difficult to discuss psycho sexual issues? How did you find it when you were playing the part of the Patient? Did you feel uncomfortable discussing these sensitive issues? Did any possible future issues / considerations come up? Ask the observers for feedback – what did the HP do well? What could they do better? Reinforce that there are many different ways to approach the same situation, and we will each find our own style and comfort level in addressing these sensitive issues. We will also find it gets easier with practice, and we will find a language with which to communicate that we are comfortable with. Show participants the PSGC version of the scenario after feedback from the groups and discussion. Go to the PSGC resource ( and play the recommended video segment from the selection of video vignettes Or alternatively download the video from the website; or from the PSGC usb and imbed into the power point prior to the workshop presentation.

Case Study: Reintroducing Susan
Susan has had multiple recurrences and has now been referred to the community palliative care nursing service..... Susan’s story part 4 Show the participants Susan’s story part 4 to reintroduce the scenario. Consider the practical suggestions that could be given to Susan to facilitate intimacy with Pete Go to the PSGC resource ( and play the recommended video segment from the selection of video vignettes Or alternatively download the video from the website; or from the PSGC usb and imbed into the power point prior to the workshop presentation.

Case Study: Reintroducing Susan
Susan’s story part 5 Ask participants to brainstorm and discuss possible psychosexual issues and ways to address these in the palliative care setting and enhance intimacy at end of life. Discussion: Work through feedback from each of the small groups and generate discussion. Some questions to consider: How did you find it when you were playing the part of the HP? Did you feel confident? Did you find it difficult to discuss psycho sexual issues? How did you find it when you were playing the part of the Patient? Did you feel uncomfortable discussing these sensitive issues? Did any possible future issues / considerations come up? Ask the observers for feedback – what did the HP do well? What could they do better? Reinforce that there are many different ways to approach the same situation, and we will each find our own style and comfort level in addressing these sensitive issues. We will also find it gets easier with practice, and we will find a language with which to communicate that we are comfortable with. Show participants Susan’s story part 5: the PSGC version of the scenario after feedback from the groups and discussion. Go to the PSGC resource ( and play the recommended video segment from the selection of video vignettes Or alternatively download the video from the website; or from the PSGC usb and imbed into the power point prior to the workshop presentation.

Enhancing sexual intimacy at end of life
Give couples private time Remove extraneous equipment & make environment less clinical Reassure couple that kissing, stroking, massaging and embracing won’t cause physical harm and may lead to relaxation and decreased pain Fatigue can decrease a person’s ability to maintain personal grooming Mouth care is paramount Maintaining personal dignity is essential when providing intimate care Ensure symptoms are well managed Positioning using Do Not Disturb signs; knock and wait for response before entering room encourage them to bring items from home to make environment less clinical encourage taking medication before commencing sexual activity Positioning: where the person is on their back, supported by pillows will be more comfortable and less tiring

Find these topics on the PSGC resource….
What is sexuality? Go to Module 1 and complete the module Principles for Communicating with People affected by Cancer about Sexuality Go to Module 3 (section 3.1) and access the Psychosexual communication principles Ex-PLISSIT Model for Assessment Go to Module 3 (section 3.3.2) and access the assessment tools Case based resources – Jane; Joan; Anna; Norma; Susan – real life scenarios Go to ‘video’ on the navigation bar of the home page Where to find the relevant content in the online PSGC resource at cancerlearning.gov.au

Find palliative care in the PSGC resource….
Enhancing sexual intimacy at end of life Go to Module 6 (section 6.4.1) for ‘couples in palliative care’ Women with special needs Go to module 2 (section 2.1.6) for ‘understanding the experience’ of palliative care advanced disease Overcoming barriers Go to module 3 (section 3.5.2) for ‘enquiring and responding’ in the palliative care phase Where to find the relevant content in the online PSGC resource at cancerlearning.gov.au

Search function Use the search function for quick access to relevant topics Located top right hand corner all pages of the resource Direct the participants to go online following the workshop, OR alternatively if time permits, take participants on web tour during the workshop presentation to the PSGC site and navigate through some of the features. For example type ‘radiation’ into the search function. Select Google translate at the bottom of any page, choose your preferred language and convert the text to the language of your choice. This feature is particularly useful in providing information to Multi cultural groups, and where there is a lack of specific information in their language.

Acknowledgements www.cancerlearning.gov.au Funded by: Project team:
Cancer Australia Project team: Professor Patsy Yates Kath Nattress Kim Hobbs Ilona Juraskova Kendra Sundquist Project Officer: Lynda Carnew Project Working Group: Dr Margaret Davy (Chairperson) Disciplines represented in Project Working Group & module review : Consumer Gynaecological Oncologist General Practitioner Radiation Oncologist Gynaecological Clinical Nurse Specialist Gynaecological Clinical Nurse Consultant Psychologist Research Psychologist Social Worker Education Services Manager Patient Programs Officer Sexual Health Educator A/Professor Margaret Davy (Chair) - Gynaecological oncologist, Royal Adelaide Hospital Dr Jane Barker - General Practitioner, Australian College of Rural and Remote Medicine Dr David Bernshaw - Radiation oncologist, Peter MacCallum Cancer Centre, Gynaecology stream Helena Green - Clinical Nurse Specialist / Sexologist, King Edward Memorial Hospital WA Dr Clare Jukka - General Practitioner, Australian College of Rural and Remote Medicine Kath Mazzella - Consumer, Gynaecological Awareness Information Network Leslie McQuire - Consumer Dr Vivienne Milch - Clinical Leader, National Breast and Ovarian Cancer Centre Dr Linda Mileshkin - Medical Oncology Group of Australia Helen O’Brien - Education Services Manager, Royal College of Nursing Australia Dr Dagmara Poprawski - General Practitioner, Australian College of Rural and Remote Medicine Desiree Spierings - President, Australian Society Sex Educators Researchers and Therapists NSW Rebecca Steele - Patient Programs Officer, Ovarian Cancer Australia Dr Wendy Vanselow - General Practitioner, Sexual Counseling Clinic, Royal

An interactive training module for health professionals: Addressing the psychosexual care of women affected by gynaecological cancers Workshop 2: Applying.

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An interactive training module for health professionals: Addressing the psychosexual care of women affected by gynaecological cancers Workshop 2: Applying.

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Presentation on theme: "An interactive training module for health professionals: Addressing the psychosexual care of women affected by gynaecological cancers Workshop 2: Applying."— Presentation transcript:

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