Implementation of a sexual health clinic in an oncology setting: patient and provider perspectives.

Sexual dysfunction is prevalent among cancer survivors yet sexual health clinics remain rare in cancer centres across Canada, representing a significant gap in survivorship care.

• The study was conducted at Princess Margaret Cancer Centre in Toronto, Canada, described as a large urban centre
• The gap prompted development of an innovative sexual health clinic (SHC) to address unmet survivorship care needs
• Cancer types represented included prostate, cervical, ovarian, testicular, bladder, kidney, and head and neck cancer

Both patients and providers described a lack of sexual health support in the oncology setting and emphasized the need for comprehensive and personalized care.

• Healthcare providers and patients from selected cancer types participated in semi-structured interviews
• Interviews were transcribed and analyzed using the Framework qualitative analysis protocol
• The Quality Implementation Framework was used to explicate patient and provider experience and identify barriers and facilitators
• The analysis identified three organizing domains and ten themes describing unique aspects of the sexual healthcare experience

Mutual silence between patients and providers due to discomfort in discussing sexual issues was identified as a key limitation of current care provision.

• Both patient and provider perspectives confirmed avoidance of sexual health conversations in the oncology setting
• This mutual silence was categorized as one of the critical barriers to integrating sexual healthcare into routine cancer care workflows
• The finding emerged from thematic analysis across both patient and provider interview groups

Insufficient provider confidence in delivering optimal sexual healthcare was identified as a significant limitation of current care provision.

• Provider lack of confidence was identified as a distinct theme separate from patient-provider communication barriers
• This finding suggests a training and education gap among oncology healthcare providers regarding sexual health
• Ongoing staff education was subsequently identified as a key factor for successful implementation of a sexual health clinic

Constraints related to space and time were identified as structural limitations to providing sexual healthcare in the oncology setting.

• Space and time constraints were named alongside provider confidence and mutual silence as the primary limitations of current care provision
• These structural barriers were identified through both patient and provider perspectives in semi-structured interviews
• The findings point to systemic and organizational-level challenges beyond individual provider attitudes

Key factors for successfully implementing a sexual health clinic in an oncology setting included having a dedicated clinic, flexibility in service delivery, proactive patient engagement, and ongoing staff education.

• These four factors were identified as critical facilitators through the Quality Implementation Framework analysis
• A dedicated clinic was emphasized as distinct from but integrated with routine oncology care
• Proactive patient engagement was highlighted, suggesting passive referral systems are insufficient
• Ongoing staff education was identified as necessary for sustained implementation success

The study underscores the necessity of conducting thorough implementation research involving multiple stakeholders prior to launching new sexual health programs in oncology settings.

• Both patient and provider stakeholders were included in the semi-structured interview process
• The Quality Implementation Framework was applied as the guiding methodology for understanding implementation factors
• The authors emphasize that multi-stakeholder involvement prior to program launch is necessary, not optional
• Findings support incorporating sexual healthcare into survivorship programs as a standard component