title: Beyond barriers: fundamental 'disconnects' underlying the treatment of breast cancer patients' sexual health.
abstract: Sexual health concerns represent one of the most frequently experienced and longest-lasting effects of breast cancer treatment, but research suggests that service providers rarely discuss sexual health with their patients. Existing research examining barriers to addressing patients' sexual health concerns has focused on discrete characteristics of the provider-patient interaction without considering the broader context in which these interactions occur. Drawing on the experiences of 21 breast cancer survivors, this paper explores three ways in which fundamental cultural and structural characteristics of the cancer care system in the USA may prevent breast cancer survivors from addressing their sexual health concerns, including: (1) when patients discussed sexual health with their providers, their providers approached sexuality as primarily physical, while participants experienced complex, multidimensional sexual health concerns; (2) specialisation within cancer care services made it difficult for patients to identify the appropriate provider to address their concerns; and (3) the structure of cancer care literally disconnects patients from the healthcare system at the time when sexual side effects commonly emerged. These data suggest that addressing breast cancer survivors' sexual health concerns requires a multifaceted approach to health systems change.
authors.affiliation: a Palo Alto Medical Foundation Research Institute , Palo Alto , CA , USA.
authors.forename: Meghan C
authors.initials: MC
authors.lastname: Halley
authors.forename: Suepattra G
authors.initials: SG
authors.lastname: May
authors.forename: Katharine A S
authors.initials: KA
authors.lastname: Rendle
authors.forename: Dominick L
authors.initials: DL
authors.lastname: Frosch
authors.forename: Allison W
authors.initials: AW
authors.lastname: Kurian
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000523:psychology* / Q000628:therapy; D004414:Dyspareunia / Q000523:psychology; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008875:Middle Aged; D036301:Qualitative Research; D060728:Reproductive Health; D012747:Sexual Partners; D019529:Sexuality / Q000523:psychology*; D017741:Survivors / Q000523:psychology*; D014481:United States
keywords: USA; biomedicine; breast cancer; disconnections; sexual health