Sexual health care provision in cancer nursing care: a systematic review on the state of evidence and deriving international competencies chart for cancer nurses

Background
Sexual health care should be an integral part of holistic, person-centred care for patients with cancer. Nurses can have a pivotal role, but nurse-led care in this context has been historically challenging.

Objectives
To update the state of scientific knowledge pertinent to nurses’ competencies in delivering sexual health care to patients with cancer; better understand moderating factors; and evaluate interventions developed/tested to enhance nurses’ competencies.

Design
Systematic literature review in line with published PRISMA Statement guidelines.

Data sources
Electronic bibliographic databases; journal content lists; reference lists of included studies; author/expert contact

Review methods
Nine electronic databases were searched (June 2008-October 2018) to identify studies employing diverse research methods. We applied pre-specified eligibility criteria to all retrieved records and integrated findings in a narrative synthesis.

Results
Of 2,614 returned articles, we included 31 unique studies. Five articles reported on two randomised controlled trials and three single-arm, before-and-after trials. Current evidence suggests that nurses’ knowledge and skill in providing sexual health care still varies widely across different settings, phases and cancers. A plethora of intra-personal, inter-personal, societal and organisational factors may hinder nurse-led care in this context. Nurses’ perceived professional confidence was repeatedly examined as influencing provision of care in this context; unfortunately, it was found lacking and complicated by unhelpful views and beliefs about SHC. Despite the magnitude of the problem, the few trials that tested, sexual health-targeted continuing professional development programmes for nurses, were of low-to-moderate methodological quality, while the associated high risk of methodological bias downgraded the evidence on the interventions’ effectiveness.

Conclusion
Our systematic review replicates previous findings and highlights a continuing problem: nurse-led provision of sexual health care in cancer care remains sub-optimal and challenging, due mainly to nurses’ assumptions and prejudices towards sexuality, lack of professional confidence in dealing with sensitive issues, and a complex health care system environment. To realistically deal with this problem, we propose a flexible, two-level chart to promote development of basic competence among all nurses caring for patients with cancer (entry-level), and facilitate subsequent transition to a more specialised, self-pursued role for a subset of nurses (champion-level). The chart itself can be relevant to an international audience, while it might be transferable to other long-term conditions. Accordingly, we propose additional rigorous research to test multi-component educational programmes, customised to meet entry-level and champion-level requirements to realise continuous nursing provision of sexual health care in cancer care.