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Examining Breast Cancer Patients' Use of Emotional Expressions in Clinic Discussions of Sexual Health: A Mixed-Methods Study.

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Τίτλος: Examining Breast Cancer Patients' Use of Emotional Expressions in Clinic Discussions of Sexual Health: A Mixed-Methods Study.
Συγγραφείς: Romeiro FB; Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA., Sorice K; Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA., Reese JB; Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA.; Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, Pennsylvania, USA.
Πηγή: Psycho-oncology [Psychooncology] 2026 Oct; Vol. 35 (10), pp. e70637.
Τύπος έκδοσης: Journal Article
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Wiley Country of Publication: England NLM ID: 9214524 Publication Model: Print Cited Medium: Internet ISSN: 1099-1611 (Electronic) Linking ISSN: 10579249 NLM ISO Abbreviation: Psychooncology Subsets: MEDLINE
Imprint Name(s): Original Publication: Chichester, W. Sussex, England : Wiley, c1992-
Ιατρικοί όροι (MeSH): Breast Neoplasms*/psychology , Sexual Health* , Emotions* , Communication* , Physician-Patient Relations*, Sexual Behavior/psychology ; Stress, Psychological/psychology ; Humans ; Female ; Middle Aged ; Adult ; Aged ; Psychological Distress
Περίληψη: Objective: Sexual concerns are reported by many women with breast cancer (BC) and are often highly emotionally distressing. However, little is known about how BC patients express negative emotions during sexual health discussions. We examined emotional expressions used by BC patients during clinical discussions of sexual health, including whether expressions were explicit versus implicit, and identified whether use of such expressions was associated with demographic/clinical factors, sexual health topics and length of discussion, level of sexual concerns, or psychological distress.
Methods: Using a mixed-methods design, we analyzed audio recorded clinic dialogue about sexual health from 75 BC outpatients participating in a patient-focused sexual health communication intervention for emotional expressions. Pearson's chi-square, t-tests, and Spearman's correlation were used to analyze associations between emotional expressions and the study variables.
Results: Nearly two-thirds of discussions (63%) contained emotional expressions (88% implicit; 74% raised by patient vs. clinician). Use of implicit expressions was associated with longer time since diagnosis (p = 0.03) but not with patient age. Loss of sexual interest/excitement and general sexual issues arose more commonly in discussions where emotional expressions were present versus when not present (p's ≤ 0.02). Compared to discussions with no emotional expressions, those with emotional expressions were 3 minutes longer (p < 0.01) and patients expressing emotions reported more severe sexual concerns (p = 0.003). The use of explicit expressions was associated with more severe depressive symptoms (p = 0.03), but not anxiety symptoms.
Conclusion: Emotional expressions are common in sexual health discussions, highlighting the potentially distressing nature of these discussions for BC patients.
(© 2026 John Wiley & Sons Ltd. All rights reserved, including rights for text and data mining and training of artificial intelligence technologies or similar technologies.)
References: L. S. Agrawal, L. O’Riordan, C. Natale, and L. C. Jenkins, “Enhancing Sexual Health for Cancer Survivors,” American Society of Clinical Oncology Educational Book 45, no. 3 (June 2025): e472856, https://doi.org/10.1200/EDBK‐25‐472856.
N. Jahan, E. Cathcart‐Rake, R. A. Vierkant, et al., “Sexual Dysfunction in Patients With Metastatic Breast Cancer,” Clinical Breast Cancer 24, no. 1 (January 2024): 72–78.e4, https://doi.org/10.1016/j.clbc.2023.09.018.
S. Vegunta, C. L. Kuhle, J. A. Vencill, P. H. Lucas, and D. M. Mussallem, “Sexual Health After a Breast Cancer Diagnosis: Addressing a Forgotten Aspect of Survivorship,” Journal of Clinical Medicine 11, no. 22 (November 2022): 6723, https://doi.org/10.3390/jcm11226723.
J. B. Reese, L. A. Zimmaro, S. McIlhenny, et al., “Coping With Changes to Sex and Intimacy After a Diagnosis of Metastatic Breast Cancer: Results From a Qualitative Investigation With Patients and Partners,” Frontiers in Psychology 13 (April 2022): 13, https://doi.org/10.3389/fpsyg.2022.864893.
T. Sanft, A. T. Day, S. M. Ansbaugh, et al., “NCCN Guidelines Insights: Survivorship, Version 2.2025,” Journal of the National Comprehensive Cancer Network 23, no. 6 (June 2025): 208–217, https://doi.org/10.6004/jnccn.2025.0028.
M. A. Franzoi, M. Aupomerol, J. Havas, et al., “Investigating Sexual Health After Breast Cancer by Longitudinal Assessment of Patient‐Reported Outcomes,” ESMO Open 9, no. 2 (February 2024): 102236: PubMed PMID: 38350335, https://doi.org/10.1016/j.esmoop.2024.102236.
J. B. Reese, K. A. Sorice, L. S. Porter, et al., “Associations Between Sexual Script Flexibility and Sexual Outcomes: An Investigation Among Breast Cancer Survivor Couples,” Psycho‐Oncology 34, no. 4 (April 2025): 70147, https://doi.org/10.1002/pon.70147.
J. B. Reese, K. A. Sorice, W. Pollard, et al., “Efficacy of a Multimedia Intervention in Facilitating Breast Cancer Patients’ Clinical Communication About Sexual Health: Results of a Randomized Controlled Trial,” Psycho‐Oncology 30, no. 5 (May 2021): 681–690, https://doi.org/10.1002/pon.5613.
M. Kim, J. Carter, A. B. Tadros, N. Abuhdra, J. A. Nelson, and C. S. Stern, “A Guide for Addressing Sexual Health in Breast Cancer Patients,” Journal of Surgical Oncology 129, no. 6 (May 2024): 1034–1040: PubMed PMID: 38385690, https://doi.org/10.1002/JSO.27602.
W. Z. Tang, E. Mangantig, Y. H. P. Iskandar, S. li Cheng, A. Yusuf, and K. Jia, “Prevalence and Associated Factors of Psychological Distress Among Patients With Breast Cancer: A Systematic Review and Meta‐Analysis,” BMJ Open 14, no. 9 (September 2024): e077067, https://doi.org/10.1136/bmjopen‐2023‐077067.
L. Schwab and C. Visovsky, “Psychological Distress and Quality of Life in Breast Cancer Survivors With Taxane‐Induced Peripheral Neuropathy: A Scoping Review,” Frontiers Oncology 12 (January 2023): 1005083, https://doi.org/10.3389/fonc.2022.1005083.
F. Gössi, A. Arpagaus, S. Gross, et al., “Physician Responses to Patients’ Emotional Cues and Concerns and Their Association With Patient‐Related Outcomes,” Patient Education and Counseling 142 (January 2026): 109386, https://doi.org/10.1016/j.pec.2025.109386.
F. B. Romeiro, V. G. Pais, G. Humphris, and M. Figueiredo‐Braga, “Patients’ Emotional Expressions and Clinicians’ Responses in Oncology – From Recognition to Exploration of Concerns,” PEC Innovation 6 December 2024 (June 2025): 100374, https://doi.org/10.1016/j.pecinn.2025.100374.
M. A. Ruben, M. D. Stosic, and D. L. Roter, “Emotion Dialogue in the Medical Encounter: When and How Often Does It Happen? Emotion in the Clinical Encounter,” In McGraw Hill Medical [Internet], R. Schwartz, J. A. Hall, and L. G. Osterberg, eds. (McGraw Hill, 2021): [cited 2026 Apr 5], https://accessmedicine.mhmedical.com/content.aspx?bookid=3088&sectionid=257488947.
L. Del Piccolo and A. Finset, “Chapter 6: Emotion Cues as Clinical Opportunities,” In Emotion in the Clinical Encounter, R. Schwartz, J. A. Hall, and L. G. Osterberg, eds. (McGraw Hill, 2021).
K. Kuchinad, J. R. Park, D. Han, S. Saha, R. Moore, and M. C. Beach, “Which Clinician Responses to Emotion are Associated With More Positive Patient Experiences of Communication?,” Patient Education and Counseling 124 (July 2024): 108241, https://doi.org/10.1016/j.pec.2024.108241.
T. Gustafsson, E. Lindberg, H. Maurin Söderholm, L. Hedén, S. van dulmen, and A. J. Sundler, “Exploring Emotional Communication Between Older Persons and Nursing Assistants in Home Care: A Qualitative Study,” International Journal of Older People Nursing 20, no. 5 (September 2025): e70048, https://doi.org/10.1111/opn.70048.
J. B. Reese, K. Sorice, S. J. Lepore, M. B. Daly, J. A. Tulsky, and M. C. Beach, “Patient‐Clinician Communication About Sexual Health in Breast Cancer: A Mixed‐Methods Analysis of Clinic Dialogue,” Patient Education and Counseling 102, no. 3 (March 2019): 436–442, https://doi.org/10.1016/j.pec.2018.10.003.
N. Arring, D. L. Barton, and J. B. Reese, “Clinical Practice Strategies to Address Sexual Health in Female Cancer Survivors,” Journal of Clinical Oncology 41, no. 31 (November 2023): 4927–4936, https://doi.org/10.1200/JCO.23.00523.
L. A. Zimmaro, K. A. Sorice, E. A. Handorf, M. B. Daly, and J. B. Reese, “Understanding Clinical Communication About Mood Disturbance Symptoms Among Breast Cancer Patients: A Mixed Methods Analysis,” Patient Education and Counseling 105, no. 7 (July 2022): 2089–2095: PubMed PMID: 35184908, https://doi.org/10.1016/j.pec.2022.02.004.
S. J. Falk and S. Bober, “Cancer and Female Sexual Function,” Obstetrics and Gynecology Clinics of North America 51, no. 2 (June 2024): 365–380: PubMed PMID: 38777489, https://doi.org/10.1016/j.ogc.2024.03.003.
J. B. Reese, K. C. Smith, E. Handorf, et al., “A Randomized Pilot Trial of a Couple‐Based Intervention Addressing Sexual Concerns for Breast Cancer Survivors,” Journal of Psychosocial Oncology 37, no. 2 (March 2019): 242–263, https://doi.org/10.1080/07347332.2018.1510869.
S. Munce, S. Fàbregues, Q. N. Hong, et al., “Updating the Good Reporting of a Mixed Methods Study (GRAMMS) Reporting Guidelines: Protocol for a Methodological Review and Modified Delphi Process,” JMIR Research Protocols 15 (March 2026): e82364, https://doi.org/10.2196/82364.
A. P. Abernethy, S. Y. Zafar, H. Uronis, et al., “Validation of the Patient Care Monitor (Version 2.0): A Review of System Assessment Instrument for Cancer Patients,” Journal of Pain and Symptom Management 40, no. 4 (October 2010): 545–558, https://doi.org/10.1016/j.jpainsymman.2010.01.017.
A. S. Zigmond and R. P. Snaith, “The Hospital Anxiety and Depression Scale,” Acta Psychiatrica Scandinavica 67, no. 6 (June 1983): 361–370, https://doi.org/10.1111/j.1600‐0447.1983.tb09716.x.
C. Zimmermann, L. Del Piccolo, J. Bensing, et al., “Coding Patient Emotional Cues and Concerns in Medical Consultations: The Verona Coding Definitions of Emotional Sequences (VR‐CoDES),” Patient Education and Counseling 82, no. 2 (2011): 141–148, https://doi.org/10.1016/j.pec.2010.03.017.
L. Del Piccolo, M. A. Mazzi, A. Mascanzoni, et al., “Factors Related to the Expression of Emotions by Early‐Stage Breast Cancer Patients,” Patient Education and Counseling 102, no. 10 (October 2019): 1767–1773: PubMed PMID: 30967297, https://doi.org/10.1016/j.pec.2019.04.002.
C. Lowe, M. C. Beach, S. Saha, A. R. Links, and E. F. Boss, “Parent Race and Communication During Elective Pediatric Surgery Consultations,” JAMA Network Open 8, no. 11 (November 2025): e2542758, https://doi.org/10.1001/jamanetworkopen.2025.42758.
C. D. Bergerot, P. G. Bergerot, E. J. Philip, et al., “Distress and Emotional Support Needs of Patients With Stage IV Cancer and Their Partners: A Biopsychosocial Assessment,” Psycho‐Oncology 34, no. 7 (July 2025): e70232: PubMed PMID: 40660497, https://doi.org/10.1002/PON.70232.
J. B. Reese, K. A. Sorice, L. A. Zimmaro, S. J. Lepore, and M. C. Beach, “Communication About Sexual Health in Breast Cancer: What can We Learn From Patients’ Self‐Report and Clinic Dialogue?,” Patient Education and Counseling 103, no. 9 (September 2020): 1821–1829, https://doi.org/10.1016/j.pec.2020.03.029.
L. A. Zimmaro, S. J. Lepore, M. C. Beach, and J. B. Reese, “Patients’ Perceived Barriers to Discussing Sexual Health With Breast Cancer Healthcare Providers,” Psycho‐Oncology 29, no. 7 (July 2020): 1123–1131: PubMed PMID: 32281174, https://doi.org/10.1002/PON.5386.
M. D. Stosic, M. A. Ruben, and D. Blanch‐Hartigan, “Perception of Emotion in the Medical Visit | Emotion in the Clinical Encounter,” In McGraw Hill [Internet], R. Schwartz, J. A. Hall, and L. G. Osterberg, eds. (McGraw Hil, 2021): [cited 2026 Apr 5], https://accessmedicine.mhmedical.com/content.aspx?bookid=3088&sectionid=257489040.
M. A. Perelman, A. Giraldi, S. Parish, et al., “How has the Biopsychosocial Model Fared in Sexual Medicine and Sex Therapy?,” Sexual Medicine Reviews 27, no. 4 (July 2025): 663–673, https://doi.org/10.1093/sxmrev/qeaf029.
L. L. Black, K. Conroy, M. Lustberg, R. Salani, B. L. Andersen, and K. M. Carpenter, “Association of Sexual Pain and Psychological Factors Among Gynecologic and Breast Cancer Patients: Application of Components of the Fear‐Avoidance Model of Chronic Pain,” Journal of Behavioral Medicine 48, no. 3 (June 2025): 536–543, https://doi.org/10.1007/s10865‐025‐00560‐3.
E. K. Arthur, B. Worly, K. M. Carpenter, et al., “Let’s Get It on: Addressing Sex and Intimacy in Older Cancer Survivors,” Journal of Geriatric Oncology 12, no. 2 (March 2021): 312–315, https://doi.org/10.1016/j.jgo.2020.08.003.
A. Katz, L. S. Agrawal, and B. Sirohi, “Sexuality After Cancer as an Unmet Need: Addressing Disparities, Achieving Equality,” American Society of Clinical Oncology Educational Book 42 (July 2022): 11–17, https://doi.org/10.1200/edbk&#95;100032.
S. Sheppard, D. Culliford, T. Glen, S. Lee, Z. A. Sheppard, and S. Porter, “Care for Sexual Health in Oncology Survey: A Regression Analysis of Variables Associated With the Likelihood of People With Cancer Having a Sexual Health Discussion With the Hospital Cancer Team,” European Journal of Oncology Nursing 78 (October 2025): 102977, https://doi.org/10.1016/j.ejon.2025.102977.
R. Kaufman, L. Agrawal, E. Teplinsky, L. Kiel, O. Abioye, and N. Florez, “From Diagnosis to Survivorship Addressing the Sexuality of Women During Cancer,” Oncologist 29, no. 12 (December 2024): 1014–1023, https://doi.org/10.1093/oncolo/oyae242.
C. Dicks, S. N. Rogers, A. Kanatas, D. Lowe, C. McHale, and G. Humphris, “Concerns Raised by People Treated for Head and Neck Cancer: A Secondary Analysis of Audiotaped Consultations in a Health Services follow‐Up Clinic,” Supportive Care in Cancer 31, no. 10 (October 2023): 608, https://doi.org/10.1007/s00520‐023‐08059‐w.
M. C. Beach, J. Park, D. Han, C. Evans, R. D. Moore, and S. Saha, “Clinician Response to Patient Emotion: Impact on Subsequent Communication and Visit Length,” Annals of Family Medicine 19, no. 6 (November 2021): 515–520, https://doi.org/10.1370/afm.2740.
G. W.‐J. Lau, A. M. Deal, A. B. Page, H. B. Muss, and Z. M. Nakamura, “Depressive and Anxiety Symptoms During Chemotherapy for Breast Cancer and the Potential Impact of Pre‐Treatment Health Behaviors,” Psycho‐Oncology 34, no. 6 (June 2025): e70204, https://doi.org/10.1002/pon.70204.
Grant Information: MRSG-14-031-CPPB American Cancer Society; P30CA006927 United States CA NCI NIH HHS
Contributed Indexing: Keywords: breast cancer; communication; emotional distress; oncology; sexual health
Entry Date(s): Date Created: 20261020 Date Completed: 20261020 Latest Revision: 20261020
Update Code: 20261021
DOI: 10.1002/pon.70637
PMID: 42899461
Βάση Δεδομένων: MEDLINE
Περιγραφή
ISSN:1099-1611
DOI:10.1002/pon.70637