1. BLISS Balancing Life, Intimacy, Sexuality and Survivorship
A Presentation for NCQA September 22, 2010

2. Communication barriers
Objectives
What is BLISS?
Why create BLISS?
Who is BLISS for?
When will BLISS happen?
Communication barriers
How will BLISS help?
BETTER model
Format of BLISS clinic
Evaluate BLISS

3. Objectives How do I get to BLISS? Who is involved with BLISS?
What is in the Tool Chest?
Interactive segment WHOO HOO 
Question and answers.
Evaluate the presentation

4. Sexuality Humour After your cancer treatment when:
Getting lucky means you find your car in the parking lot. OR
You can live without sex but not without glasses.
There is something wrong....
and we are here to help ;) :D

5. What is BLISS?
A multidisciplinary nurse led clinic to better meet the psychosocial, physical and educational needs of our patients including but not exclusive to sexuality.

6. More cancer survivors therefore more quality of life issues.
Why BLISS?
More cancer survivors therefore more quality of life issues.
Our cancer patients indicated that they needed and wanted more information on the areas of their life that has changed with respect to sexuality and survivorship.
Through the yearly survey, indicated by the patients and family advisors and the patients at their clinic visits.

7. Why Create BLISS?
Cancer and/or the treatment of cancer can alter sexual functioning through:
surgery (nerve damage, body image changes)
chemotherapy (chemical induced menopause, nerve damage, body image changes)
radiation therapy (skin changes, nerve damage, body image changes)
other (fear, worry, depression, pain)

8. Who Will We Offer It To? Primary Target Population
Gynaecologic cancer patients
Breast cancer patients
Prostate cancer patients
Colorectal cancer patients
Other cancer patients

9. When and Where Will It Be?
½ day a month on a Thurs pm.
3rd floor of the Cancer Centre.

10. Patient Communication Barriers
“My Oncologist saved my life, I don’t want to bother him or her with my sexual problems.”
“I just don’t know what questions to ask.”
“I don’t want to look stupid or look like a sex maniac to my doctor.”
“I’m too embarrassed to bring up the topic with my doctor.”
(You might be more comfortable to write down your concerns)

11. Health Care Provider Barriers
Some health care professionals just do not think to bring up the subject.
Sometimes health care professionals feel that if the patient is having problems with sexuality/intimacy they will start the conversation.
We do not always have the answer and don’t want to discuss things that are out of our comfort zone.
Did not have the resources to help deal with the concerns, until now with the BLISS clinic.

12. How will BLISS help our patients?
By the nature of the clinic we are already improving communication between health care providers, patients and their partners.
Sexuality issues are more readily discussed and openly shared.
We will be using the BETTER Model.1
‘This model was designed specifically for cancer nurses to assess and communicate about patient sexuality’

13. BETTER Model Bring up the topic
Explain that sexuality is a part of quality of life-we are open to discuss it
Telling the patient about resources and how we will assist them to find what they need.
Timing the discussion re: pt preference
Educate on the side effects of treatment and the impact on sexuality
Recording the topics discussed.

14. After the assessment, we will review some educational materials.
Format of BLISS
An assessment will be completed during the first visit by you and your nurse(s) to assess your needs and issues.
After the assessment, we will review some educational materials.
Some topics we may discuss might be things like, menopause, low libido, erectile dysfunction or coping.

15. Format continued
We have many educational tools to assist in the learning.
We will reinforce and evaluate the success of the teaching.
A referral may be required to other team members such as the Social Worker, GPO or back to the surgeon....

16. Evaluation
As with any new program, it is important to assess it’s value. We will be conducting self assessments before the clinic and then send another to your home a few months later.
This will provide the data we can use to be certain that we are addressing all your needs.

17. Will This Replace the Teaching we Do Now?
Not at all...we expect that the BLISS clinic will be another resource that our patients can go for education and guidance.
The staff, Oncologists and Surgeons will continue with their present teachings but BLISS will reinforce and augment the education.
BLISS helps to open dialogue for all the staff, to openly discuss the sexual side effects of cancer with our patients.

18. Who Can Refer to BLISS Anyone...even the patients themselves.
Just call the BLISS Clinic

19. When Will it Start?
Expect to see information including posters, pamphlets, presentations and articles about the BLISS Clinic and then we will start to see patients in the Fall. (Likely October).

20. Who is Involved?
The co-clinic nurses are Angela Saunders, Radiation Nurse and Karen Melenchuk, Systemic Therapy Nurse. Dr Simpson has offered to be our medical lead and Dr Anthes Radiation Oncologist, will be involved as required.

21. Who else?
Other multidisciplinary members might include Social Workers, Physiotherapist, Dietician, or the Surgeon.
Patient and family advisors have helped to review the materials and give input on the clinic structure and materials.

22. Things in the tool chest:
We have or will have interactive materials available for patients to see, experience and ask questions about.
Things in the tool chest:
Lubrications
Dilators/vibrators
Estring sample
Penile pump and rings (soon to be available)
Other erectile products
Pamphlets, and information leaflets
Lending library of books

23. Vaginal Dryness and Lubrication
Interactive segment
Topics
Vaginal Dryness and Lubrication
Erectile dysfunction.

24. Vaginal Dryness and Lubrication
Three key ideas to help with dryness:
Moisturize
Lubricate
Utilize

25. Supplies Moisturizers Lubricants
K-Y: Moisture Beads, SilkE Replens: Vaginal moisturizer
K-Y: Various products to lubricate and stimulate Astroglide: Lubricators Slippery Stuff: I.D.:

26. Injectable medications
Erectile Dysfunction
Treatment options
Oral medications
Manual pumps
Inserted medication
Injectable medications

27. Products- Erectaid Pump system

28. Products- Muse -Medicated Urethral System for Erections

29. Product- Penile Injection Therapy

30. Reliable Information Canadian Cancer Society American Cancer Society
Canadian Breast Cancer Network
Prostate Cancer Link
Many health related websites on the internet.

31. Thank You for Attending. Questions Or Suggestions. melenchk@tbh
Thank You for Attending. Questions Or Suggestions?

32. References
1)Amanda Hordern, Intimacy and Sexuality After Cancer A Critical Review of the Literature,Cancer NursingTM, Vol. 31, No. 2, 2008