Et fænomenologisk studie af brystkræftoverlevendes oplevelser af håndtering og italesættelse af deres seksualitet

Abstract

Baggrund: Antallet af kvinder med brystkræft er stigende, og hvert år rammes ca. 4.900 nye kvinder af brystkræft, hvilket udgør 27% af alle kræftramte. Kvinder, der rammes af brystkræft, kan opleve både fysiske og psykiske forandringer, som kan ændre deres selvopfattelse, identitet og seksualitet. Desuden er der mange seksuelle senfølger forbundet med diagnosen og behandlingen af brystkræft, hvilket kan indebære kunstig menopause, ændret kropsbillede, infertilitet m.m. Disse senfølger kan øge kvindernes risiko for at få en depression og nedsætte deres livskvalitet væsentligt. Seksuelle senfølger fremstår som et helt centralt problem, der kræver øget opmærksomhed. I Danmark er det uklart, hvilken praksis der eksisterer inden for inddragelse af seksualitet og samliv i behandlingen af brystkræftpatienter. Forskning tyder imidlertid på, at seksuelle emner ofte bliver overset i sundhedssektoren. Formål: Formålet med dette speciale er at undersøge, hvordan brystkræftoverlevende har oplevet håndteringen og italesættelsen af deres seksualitet under et brystkræftforløb. Endvidere om de oplever behov for forandringer i håndteringen og italesættelsen af deres seksualitet. Metode: Det fænomenologiske paradigme valgt som referenceramme, og det anvendes som specialets metodiske og analytiske tilgang. Gennem en systematisk litteratursøgning er der fundet litteratur om de brystkræftoverlevendes og det sundhedsfaglige personales håndtering og italesættelse af seksualitet. Der er genereret empirisk data gennem fire kvalitative semistrukturerede enkeltinterviews. Konklusion: Det konkluderes, at alle kvinderne oplever ændringer i deres krops- og selvopfattelse, og for hovedparten af kvinderne har det en betydning for den proces, som de gennemgår efter et endt sygdomsforløb. Gennem interviewene ses der forskellige oplevelser af, hvorledes det sundhedsfaglige personale har håndteret kvindernes seksualitet. Hovedparten af kvinderne vil gerne have, at det sundhedsfaglige personale har mere fokus på seksualitet. Det konkluderes, at kvinderne ser mulighed for forandring i form af, at sygeplejersken på onkologisk afdeling skal tage initiativet til at starte samtalen om seksualitet. Forslag til forandring: Det er en begrænsning, at ikke alle sygeplejersker på onkologisk afdeling taler med kvinderne om deres ændrede seksualitet. Derfor vil PLISSIT-modellen blive præsenteret som et muligt værktøj til sygeplejerskerne, da den fungerer som et systematisk redskab til at åbne op for samtalen om seksualitet. Desuden er de ti gode råd om sexologisk rådgivning i praksis præsenteret, som sammen med PLISSIT-modellen, kan være et muligt værktøj til, at sygeplejerskerne føler sig bedre fagligt klædt på til at starte samtalen med de brystkræftramte og –overlevende.

Introduction: The number of women with breast cancer is increasing. Each year about 4.900 women are diagnosed with breast cancer, which is 27 % of all cases of cancer. Women diagnosed with breast cancer can experience both physical and physiological challenges. These challenges may change their self-image, identity and sexuality. Furthermore, many late sexual complications are related to a breast cancer diagnose and the treatment of the cancer. The complications are e.g. artificial menopause, changed perception of self, infertility etc. These late complications may increase the women’s risk of getting a depression and significantly lower their quality of life. Late complications related to women’s sexuality are an essential problem that requires attention. In Denmark, it is unclear how sexuality and cohabitation is incorporated in the general practice of treating breast cancer. Research indicates that sexual topics often are neglected in the health sector. Aim: The aim of this thesis is to investigate how breast cancer survivors have experienced the handling and articulation of their sexuality in the course of their breast cancer treatment. Furthermore, this thesis raises the question to what extent, of whether the women experience any need for change in the treatment and articulation of their sexuality in relation to their breast cancer treatment. Methodology: The phenomenological paradigm has been chosen as a frame of reference, and it is used as the methodical and analytical approach throughout the thesis. Through a systematic literature search, literature about health professionals and breast cancer survivors handling and articulation of sexuality has been found. Empirical data has been generated through four qualitative semi-structured interviews. Conclusion: It is concluded that all the interviewed women experience changes in their body- and self-perception, and for the majority of the women it has had an impact on the process they have gone through after their treatment has ended. From the interviews it has become clear that the women experience the health professional’s handling and articulation of their sexuality differently. The majority of the women would like that the health professionals had more focus on their sexuality. It is concluded that the women see a potential change in treatment, and that the nurses on the oncological wards should initiate the talk related to sexuality. Suggestions for change: It is a limitation that not all nurses initiate a talk about the changed sexuality that the women experience. The PLISSIT- model is presented as a potential systematical tool to enable nurses to initiate the talk related to sexuality. Moreover, the “Ten good advice regarding sexual counseling in practice” is presented, which together with the PLISSIT model, may serve as a baseline for the nurses to feel more professionally competent to initiate the talk about sexuality with a women diagnosed with breast cancer or a breast cancer survivor.

A master thesis from Aalborg University

Et fænomenologisk studie af brystkræftoverlevendes oplevelser af håndtering og italesættelse af deres seksualitet

[A phenomenological study of breast cancer survivors’ experiences of handling and articulation of their sexuality]