|Title:||Living beyond gynecologic cancer : quality of life and sexuality among Chinese women|
|Subject:||Hong Kong Polytechnic University -- Dissertations|
Generative organs, Female -- Cancer -- Psychological aspects.
Women patients -- Sexual behavior
|Department:||School of Nursing|
|Pages:||x, 117 leaves : ill. ; 31 cm.|
|Abstract:||Background: Advances in the early detection and treatment of gynecologic malignancies have provided gains in patients' survival time. Better survival rates have driven the paradigm in the life-altering burden of cancer care from a medical illness model to a wellness model, which was concerned with the quality of life as well as the length of survival. Quality of life (QOL) is one of the health outcomes that enable healthcare providers to better address the ongoing concerns of gynecologic cancer survivors. Objectives: The objectives of this study were (1) to explore the meanings of QOL among Chinese cervical cancer survivors, and the impacts of cervical cancer survivorship on these Chinese women's QOL; (2) to explore the sexuality concerns of Chinese gynecologic cancer survivors; (3) to describe Chinese nurses' attitudes and beliefs with regard to discussing sexuality concerns with gynecologic cancer survivors, to investigate their current practice in addressing gynecologic cancer patients' sexuality concerns, and to explore the possible facilitators or barriers influencing these Chinese nurses' practice. Methods: This study was divided into 3 stages. Stage 1 was using a qualitative approach to explore QOL issues among Chinese cervical cancer survivors. Based on the first stage's findings, stage 2 of the study adopted a quantitative approach using a sexuality scale to measure the sexuality concerns of Chinese gynecologic cancer survivors. The final stage of this study also adopted a quantitative approach to explore Chinese nurses' attitudes and practice of sexuality care. Results: A total of 35 Chinese cervical cancer survivors participated in stage 1 of this study. The meanings of QOL perceived by these Chinese women include being free of disease, having a good living standard, having a harmonious family atmosphere, being able to work independently, and having a harmonious sexual life and sexual relationships with partners. The impacts of cervical cancer on Chinese women's QOL include physical and psychological sequelae, family distress, financial burden and disruptions in social function. The result of study stage 1 indicated that sexuality concerns had greatly impacted on the QOL of these women. Therefore, the stage 2 of this study was focused on the sexuality issues of this target population.|
Stage 2 of the study recruited 156 Chinese gynecologic cancer survivors from 3 hospitals in China. Study results revealed that the participants (63.9%) were generally positive towards their own body appearance. However, a large percentage (69.3%) of the women reported that cancer had influenced their overall quality of life in terms of sexuality and intimate relationships. Sexual dysfunction was an important concern among these women (62.2%). The rate of sexual inactivity (70.5%) was relatively high. Reasons for sexual inactivity were related to worry about possibly weakening the potency of treatment (46.5%), fear of cancer recurrence (41.1%), and lack of sexual interest (31%). Older age (>50 years old) was associated with the decrease of sexual desire/interest (OR 3.64, CI 1.19-11.16). Women who received radiation therapy suffered from more severe vaginal dryness (OR 2.27, CI 1.10-4.72) and were less sexually active than those who did not have radiation therapy. Stage 3 of the study recruited a sample of 202 nurses working in Gynecologic Cancer Units from 6 hospitals in China. Study results revealed that the majority of nurses (77.7%) held the attitude that 'sexuality is too private an issue to discuss with patients'. Only 34.2% 'make time to discuss sexual concerns with patients'. Regression analysis revealed that nurse' marital status and hospital type (these two variables accounting for 23.1% of the variance) in which they were working influenced their practice in sexuality care. Nurses' conservative attitudes toward sexuality, their prejudices regarding gynecological cancer, the lack of availability of private environment, the lack of sexuality care training, and the failure to include sexuality care in routine nursing care (these variables accounting for 31.1% of the variance), were found to be factors that significantly influence sexual care in nursing practice. Conclusions: The study stage 1 demonstrated the importance of considering the impact of cervical cancer survivorship on Chinese women's QOL. The study stage 2 indicated that Chinese gynecologic cancer survivors suffered from various sexuality concerns. Addressing sexuality concerns of this target population should offer relevant psychosexual education interventions to dispel these women's related fears and misconceptions. The study stage 3 revealed that Chinese nurses assumed sexuality concerns being not a priority issue for gynecologic cancer patients, and were less likely to make time to discuss sexuality issues with patients. There is a need to increase Chinese nurses' awareness of their roles and the need to equip themselves with relevant skills in providing sexuality care for patients.
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