A model to facilitate supportive care for men’s sexual health in patients receiving radiotherapy for prostate cancer

Abstract

Men receiving radiotherapy for prostate cancer often experience erectile dysfunction, which adversely affects their intimate relationships. Yet, few oncology settings provide supportive care for sexual health as a routine practice for patients treated for prostate cancer. Oncology health professionals often avoid discussing sexual health issues or overlook the sexual concerns of men during radiotherapy for prostate cancer as routine practice during patient counselling. This study claims that radiation therapists (RTTs) are frontline oncology health professionals and are well placed to deliver supportive care for men’s sexual health (SCMSH) in an oncology setting. The aim of this exploratory sequential mixed methods study was to develop a model to promote SCMSH in patients receiving radiotherapy for prostate cancer. Research sites were oncology departments at two academic hospitals (Hospitals A and B) in Gauteng province, South Africa. The research study was conducted in four phases. The primary objective of Phase 1 was to explore the experiences of patients of sexual health support they had received during radiotherapy for prostate cancer. The timeframe for the data collection for Phase 1 was from 1 January 2021 to 30 April 2021, which period included a pilot study. Phase 1 data collection was conducted at a single hospital (Hospital A) and involved men who had completed radiotherapy for prostate cancer in the past six months or more and were recruited with purposive sampling. The target sample for Phase 1 comprised 15 participants; however, data saturation was achieved after 12 face-to-face interviews. ATLAS.ti 23 software was utilised to organise and generate codes for the analysis of interview transcripts. Patient interview data were analysed using a six-step reflexive thematic analysis approach. Four themes and seven subthemes were identified and developed. The objective of Phase 2 was to explore the perspectives of RTTs on their role in facilitating SCMSH as part of routine care for patients treated for prostate cancer with radiotherapy. The Phase 2 quantitative survey was conducted at both selected hospitals from 1 September to 30 November 2021; a pilot study was done in the same period. A target population of 60 scarce-skilled RTTs was selected through purposive and convenience sampling. The sample size was calculated to be 50; ultimately, 48 respondents completed and returned the questionnaire. Descriptive analysis and cross-tabulations were performed using SPSS Version 29 to identify trends and compare key variables. Fisher’s exact test was used to determine the statistical significance of the relationships between variables of interest in this study. The findings of the Phase 2 survey indicate that 64.6% of RTTs attempted to address the sexual health concerns of men during radiotherapy for prostate cancer. Combined findings suggest that oncology health professionals seldom provide SCMSH during radiotherapy for prostate cancer. Moreover, it was found that RTTs lack the confidence and are not adequately prepared to address the sexual health challenges faced by men undergoing radiotherapy for prostate cancer. Statistical analysis revealed no significant association between the gender of respondents and avoidance of talking about sexual health issues (p=0.181). Similarly, no statistically significant association was found between the influence of culture on the approach to the sexual health topic and race (p = 0.201). Phase 3 involved the development of a model to facilitate SCMSH for men treated for prostate cancer in oncology settings in the South African context. To develop the proposed model, Dickoff’s theory was applied to classify the central concepts extracted from the integrated findings of Phases 1 and 2. The identified concepts were written into relationship statements to guide the development of a model framework. The development of this model followed Chinn and Kramer’s (2011) empirical knowledge development approach. In Phase 4, eight experts with relevant professional backgrounds and expertise in model development were invited to participate in a panel to evaluate the model’s clarity, simplicity, consistency and reliability. Additionally, operational guidelines were developed to support the implementation of the model in broader oncology settings. In conclusion, a model framework was developed, described, and evaluated. This model could potentially enable and support the involvement of RTTs in facilitating sexual health counselling for men receiving radiotherapy for prostate cancer. It is anticipated that the developed model could enhance whole-person care by promoting integration of sexual health counselling into routine patient care practices, leveraging the role of RTTs.