Catherine Mason

Talking about sex after cancer: A discourse analytic study of health care professional accounts of sexual communication with patients

There is consistent evidence that health care professionals (hcps) are not addressing the sexual information and support needs of people with cancer. Thirty-eight Australian hcps across a range of professions working in cancer care were interviewed, to examine constructions of sexuality post-cancer, the subject positions adopted in relation to sexual communication, and the ways in which discourses and subject positions shape information provision and communication about sexuality. Participants constructed sexual changes post-cancer in physical, psychological and relational terms, and positioned such changes as having the potential to significantly impact on patient and partner well-being. This was associated with widespread adoption of a discourse of psychosocial support, which legitimated discussion of sexual changes within a clinical consultation, to alleviate distress, dispel myths and facilitate renegotiation of sexual practices. However, this did not necessarily translate into patient-centred practice outcomes, with the majority of participants positioning personal, patient-centred and situational factors as barriers to the discussion of sex within many clinical consultations. This included: absence of knowledge, confidence and comfort; positioning sex as irrelevant or inappropriate for some people; and limitations of the clinical context. In contrast, those who did routinely discuss sexuality adopted a subject position of agency, responsibility and confidence.

An overview of depression-prone personality traits and the role of interpersonal sensitivity

A number of personality styles have been proposed as vulnerability traits to depression. In this paper methodological problems associated with identifying such traits are discussed. These include state effects contaminating personality scales and the issue of depressive heterogeneity. Potential depression- prone personality traits are then discussed, including obsessionality, neuroticism, dependency and cognitive dysfunction. High interpersonal sensitivity as a risk factor to depression is then discussed.

The Psychosexual Histories of Young Women with Bulimia

While it is known that anorexia nervosa patients show a wide range of sexual knowledge, attitudes and practices, the psychosexual histories of bulimia patients have not been studied. in this paper the psychosexual histories of 20 bulimic patients and 20 matched control subjects are presented. Bulimic patients were more likely to experience orgasm with masturbation, were more likely to have experimented with anal intercourse, and were more ilkely to describe their libido as ‘above average’. Control subjects were more likely to experience orgasm during sexual intercourse. Bulimic patients associated high body weights with unattractiveness, and tended to withdraw from social and sexual activity at high weights. In other aspects of their sexual behaviour, and in their attitudes to sexual matters, the two groups were similar.

Men's experiences of sexuality after cancer: a material discursive intra-psychic approach

Men can experience significant changes to their sexuality following the onset of cancer. However, research on mens sexuality post-cancer has focused almost exclusively on those with prostate and testicular cancer, despite evidence that the diagnosis and treatment for most cancers can impact on mens sexuality. This Australian qualitative study explores the experiences of changes to sexuality for 21 men across a range of cancer types and stages, sexual orientations and relationship contexts. Semi-structured interviews were analysed with theoretical thematic analysis guided by a material discursive intra-psychic approach, recognising the materiality of sexual changes, mens intrapsychic experience of such changes within a relational context and the influence of the discursive construction of masculine sexuality. Material changes included erectile difficulty, decreased desire, and difficulty with orgasm. The use of medical aids to minimise the impact of erectile difficulties was shaped by discursive constructions of ‘normal’ masculine sexuality. The majority of men reported accepting the changes to their sexuality post-cancer and normalised them as part of the natural ageing process. Mens relationship status and context played a key role managing the changes to their sexuality. We conclude by discussing the implications for clinical practice.

Comparative validity of two measures of psychomotor function in patients with severe depression

Psychomotor function is a key construct in depressed patients and two measures have been developed for systematic rating. Parker and colleagues utilise an observer-rated scale (CORE) while the scale (DRRS) developed by Widlöcher assesses motor and ideational aspects. Association between the scales and their relative capacity to predict ECT response were investigated in a sample of 81 depressed patients. Both predicted ECT response. While the CORE scale rates a wider variety of phenomena (including non-interactiveness and agitation) and does not rely on the subjects capacity to report aspects of their cognitive function, the study supports the predictive and comparitive validity of both scales.

Psychosocial oncology services in New South Wales

There is limited published evidence about how psychosocial services should be organised or routinely integrated into cancer services to ensure that cancer patients receive appropriate psychological, social and emotional support during periods of diagnosis, treatment and follow-up. This paper reports on a survey of 26 oncology services in New South Wales, Australia, to examine the current provision of psychosocial oncology services. The aim of the study was to gather baseline data and information about the provision of services and to identify significant challenges associated with the development and implementation of psychosocial oncology services. A total of 42% of staff at psycho-oncology services reported they could provide adequate psycho-oncology services, but 58% of sites said they could provide either only limited (27%) or very limited (31%) services. We found that services frequently identified challenges such as insufficient funding to employ skilled staff to provide psychosocial interventions, inadequate data to demonstrate the effectiveness of psychosocial interventions and, at times, lack of space to allow privacy for patient consultations. Future needs identified were strategic planning of psychosocial oncology services as part of broader cancer service plans, leadership of psychosocial oncology services, cohesive teams using agreed patient pathways or tools and integration into multi-disciplinary cancer teams.

Defining the personality disorders: description of an Australian database.

Objective: We seek to improve the definition and classification of the personality disorders (PDs) and derive a large database for addressing this objective. Method: The paper describes the rationale for the development of a large set of descriptors of the PDs (including all DSM-IV and ICD-10 descriptors, but enriched by an additional 109 items), the design of parallel self-report (SR) and corroborative witness (CW) measures, sample recruitment (of 863 patients with a priori evidence of personality disorder or disturbance) and preliminary descriptive data. Results: Analyses (particularly those comparing ratings on molar PD descriptions with putative PD dimensions) argue for acceptable reliability of the data set, while both the size of the sample and the representation of all PD dimensions of interest argue for the adequacy of the database. Conclusions: We consider in some detail current limitations to the definition and classification of the PDs, and foreshadow the analytic techniques that will be used to address the key objectives of allowing the PDs to be modelled more clearly and, ideally, measured with greater precision and validity.

A qualitative study of consumer attitudes to sharing psychosocial information within the multidisciplinary cancer care team

To the Editor, Psychologists are recognised as an essential part of the multidisciplinary cancer team (MDCT), and their interventions have been shown to improve patient outcomes [1]. However, little research to date has investigated best practice for written communication between psychologists and other clinical staff. This is a critical mode of communication that relays important psychosocial patient information, influences care planning, facilitates effective working relationships and becomes part of the patient’s formal written records. Existing guidelines for psychologists’ report writing are generic and often fail to address the specific requirements of the oncology setting. It has also been argued that clinical guidelines should consider patient-based data [2, 3]. International research exploring patients’ attitudes towards the sharing of electronic health records has demonstrated that patients felt strongly about the privacy, security and control over the information they provide [4–6]. In addition, Australian legal precedent suggests that some cancer patients may be reluctant for psychosocial information to be shared amongst all clinical staff [7]. Therefore, it is important to ensure that written communication by psychologists in oncology is consistent with consumer preferences. To better understand these preferences, we conducted a qualitative study exploring consumer attitudes towards the content and format of written communication between psychologists and clinical care providers in the MDCT.

The perils of a vanishing cohort: A study of social comparisons by women with advanced ovarian cancer

Objective: To examine the role social comparisons play in the experience of ovarian cancer patients and to consider the implications this may have for provision of supportive care services for ovarian cancer patients.

Beyond evidence: reappraising use of CA-125 as post-therapy surveillance for ovarian cancer

The Medical Journal of Australia ISSN: 0025729X 16 April 2012 196 7 440-441 ©The Medical Journal of Australia 2012 www.mja.com.au Perspective ovarian cancer in clinical complete remission and with a normal CA-125 following initial therapy. It found that using CA-125 surveillance every 3 months as the basis for recommencing treatment did not improve survival or quality of life. Importantly, it also found that women who received delayed treatment following the onset of symptoms reported a higher quality of life than those treated earlier.4 This study has been the subject of extensive analysis, Reconsidering the place of disease monitoring after treatment