Unravelling sexual care in chronically ill patients:The perspective of GP practice nurses

Background.  Assessment of sexual health is important in chronically ill patients, as many experience sexual dysfunction (SD). The general practice nurse (GPN) can play a crucial part in addressing SD. Objective.  The aim of this cross-sectional study was to examine to which extent GPNs discuss SD with chronically ill patients and what barriers may refrained them from discussing SD. Furthermore, we examined which factors had an association with a higher frequency of discussing SD. Methods.  A cross-sectional survey using a 48-item questionnaire was send to 637 GPNs across the Netherlands. Results.  In total, 407 GPNs returned the questionnaire (response rate 63.9%) of which 337 completed the survey. Two hundred and twenty-one responding GPNs (65.6%) found it important to discuss SD. More than half of the GPNS (n = 179, 53.3%) never discussed SD during a first consultation, 60 GPNs (18%) never discussed SD during follow-up consultations. The three most important barriers for discussing SD were insufficient training (54.7%), 'reasons related to language and ethnicity' (47.5%) and 'reasons related to culture and religion' (45.8%). More than half of the GPNs thought that they had not enough knowledge to discuss SD (n = 176, 54.8%). A protocol on addressing SD would significantly increase discussing during SD. Conclusions.  This study indicates that GPNs do not discuss SD with chronically ill patients routinely. Insufficient knowledge, training and reasons related to cultural diversity were identified as most important reasons for this practice pattern. Implementation of training in combination with guidelines on SD in the general practice could improve on the discussing of sexual health with chronic patients

The discussion of sexual dysfunction before and after kidney transplantation from the perspective of the renal transplant surgeon

Introduction: Sexual dysfunction (SD) is a common problem in chronic kidney disease (CKD) and endures in 50% of patients after kidney transplantation (KTx), diminishing patients' expectations of life after KTx. Unfortunately, SD is often ignored by renal care providers. Research questions as part of a research project among all renal care providers, transplant surgeons' perspectives were obtained on sexual health care for KTx recipients, including their opinion on who should be accountable for this care. In addition, surgeons' practice and knowledge regarding SD were evaluated. Design: A 39-item questionnaire was sent to all Dutch surgeons and residents specialized in KTx (n = 47). Results: Response was 63.8%. None of the respondents discussed SD with their patients, before or after surgery. Most important barrier was that surgeons do not feel accountable for it (73.9%); 91.7% thought this accountability should lie with the nephrologist. Another barrier was insufficient knowledge (39.1%). In 75% of the respondents, (almost) no knowledge regarding SD was present and 87.5% noticed education on SD was insufficient during residence training. Discussion: Dutch renal transplant surgeons rarely discuss SD with their patients with CKD, as they do not feel accountable for it; this accountability was appointed to the nephrologist. Knowledge and education regarding SD were found insufficient in enabling surgeons and for some it reflects in barriers toward discussing SD. Results emphasize that accountability for providing sexual health care to patients with CKD should lie elsewhere; however, surgeons could briefly provide information on sexual health after KTx, so unfulfilled expectations may be prevented. Keywords: practice patterns; quality of life; questionnaires; renal transplant surgeons; sexual dysfunctio

Sexual care for patients receiving dialysis: A cross-sectional study identifying the role of nurses working in the dialysis department

Aims: To explore the role of nurses in the dialysis department in providing sexual care to patients receiving dialysis. Background: Sexual health is not self-evident for patients undergoing dialysis; 70% experience sexual dysfunction. Nevertheless, sexual care is often not provided. Design: A national cross-sectional survey. Methods: Questionnaires (n = 1211) were sent to employees of 34 dialysis centres from January-May 2016. Descriptive statistics and statistical tests were used to describe and interpret data. Results: The response rate was 45.6%. Three-quarter of nurses discussed sexual dysfunction with less than half of their patients. Main barriers for discussing were based on language and ethnicity (57.3%), culture and religion (54.1%) and the older age of the patient (49.7%). Eighteen per cent of nurses had sufficient knowledge on sexual dysfunction, competence was present in 51.2% of nurses and 68.3% indicated a need for training. Forty-three per cent knew about guidelines on sexual care by renal care providers. Nurses who rated their knowledge or competence higher or who were aware of guidelines discussed sexuality more often. The accountability for discussing sexuality was appointed to nephrologists (82.8%) and their own group of professionals (66.3%). Nurses referred 1.16% of their patients to sexual care providers. Conclusion: Dialysis nurses do not consistently address patients' sexuality, although they feel accountable to do so. This seems due to self-imposed insufficient knowledge, cultural barriers and organizational problems. Study findings imply that current situation could benefit from guidelines, additional training, a private moment to discuss sexual dysfunction and adequate referral systems to specialized care providers

Investigating the effect of a symposium on sexual health care in prostate cancer among Dutch healthcare professionals

Development and application of statistical models for medical scientific researc

Investigating the effect of a symposium on sexual health care in prostate cancer among Dutch healthcare professionals

Aims and objectives To investigate whether a symposium aimed at healthcare professionals in the uro-oncological field changes knowledge, competence and general practice regarding sexual dysfunction after prostate cancer treatment. Background Sexual dysfunction is not frequently discussed by healthcare professionals; lack of knowledge and training are two of the most often reported barriers. Provision of additional training could improve knowledge, competence and general practice of healthcare professionals. Design Two questionnaires were used in this pre–post study to determine knowledge, competence and general practice at the time of the symposium and six months afterwards. Methods In order to perform repeated measures to analyse alterations among participating healthcare professionals (n = 55), the McNemar's test was used. A STROBE checklist was completed. Results Seventy-three per cent (n = 40) stated that not enough attention was paid to prostate cancer-related sexual dysfunction during their education. Nurses felt significantly less competent in discussing sexual function, advising on sexual dysfunction and actively inquiring sexual complaints compared to other healthcare professionals. After the symposium, sexual dysfunction was significantly more often discussed. No significant effects were found on knowledge on sexual dysfunction, knowledge on treatment of sexual dysfunction, competence in discussing sexual function, advising on sexual dysfunction, actively inquiring sexual complaints and rate of referral. Tools needed to address sexual dysfunction concerned written information materials (75.5%) and a website containing adequate information (56.6%). Conclusions The symposium had no significant influence on knowledge, competence and rate of referral in men with sexual dysfunction after prostate cancer treatment. However, sexual dysfunction was more frequently discussed after the symposium, so increase of awareness of consequences of prostate cancer treatment was achieved

Investigating the effect of a symposium on sexual health care in prostate cancer among Dutch healthcare professionals

Development and application of statistical models for medical scientific researc

What is the role of nephrologists and nurses of the dialysis department in providing fertility care to CKD patients?: A questionnaire study among care providers

Purpose This study evaluated current fertility care for CKD patients by assessing the perspectives of nephrologists and nurses in the dialysis department. Methods Two different surveys were distributed for this cross-sectional study among Dutch nephrologists (N = 312) and dialysis nurses (N = 1211). Results Response rates were 50.9% (nephrologists) and 45.4% (nurses). Guidelines on fertility care were present in the departments of 9.0% of the nephrologists and 15.6% of the nurses. 61.7% of the nephrologists and 23.6% of the nurses informed ≥50% of their patients on potential changes in fertility due to a decline in renal function. Fertility subjects discussed by nephrologists included “wish to have children” (91.2%), “risk of pregnancy for patients’ health” (85.8%), and “inheritance of the disease” (81.4%). Barriers withholding nurses from discussing FD were based on “the age of the patient” (62.6%), “insufficient training” (55.2%), and “language and ethnicity” (51.6%). 29.2% of the nurses felt competent in discussing fertility, 8.3% had sufficient knowledge about fertility, and 75.7% needed to expand their knowledge. More knowledge and competence were associated with providing fertility health care (p < 0.01). Conclusions In most nephrology departments, the guidelines to appoint which care provider should provide fertility care to CKD patients are absent. Fertility counseling is routinely provided by most nephrologists, nurses often skip this part of care mainly due to insufficiencies in self-imposed competence and knowledge and barriers based on cultural diversity. The outcomes identified a need for fertility guidelines in the nephrology department and training and education for nurses on providing fertility care