Sexual Counseling for Patients With Cardiovascular Disease
Sexual Counseling for Patients With Cardiovascular Disease
Sexual counselling based on a psychosocial framework, including cognitive behavioural therapy and social support, can be a useful approach with CVD patients and their partners (Class IIa; Level of Evidence B).
It can be beneficial to provide sexual counselling through several meetings and to include partners/spouses, using a multidisciplinary team approach where possible (Class IIa; Level of Evidence B).
Only a small number of studies have used sexual counselling interventional approaches in patients with CVD. In all, we found 10 intervention studies with a focus on sexual counselling that spanned a 35-year period (1976–2012; Table 5). Of these 10 studies, sexual counselling was the main focus in 4 studies and a secondary focus in 2 studies, whereas the remaining 4 studies included a comprehensive sexual counselling intervention. Although a power calculation was performed in 2 studies, none of the 10 studies had a sufficient number of participants, either because of a small initial sample size or large drop-out rates during follow-up. Follow-up time was relatively short in most studies; in 6 studies, patients were followed up for <1 year, whereas in 4 studies, they were followed up for 1 to 2 years. In 3 studies, only men were enrolled, and 1 study did not indicate the sex of the participants.
The theoretical frameworks guiding the interventions were drawn from various perspectives, including physical, psychosocial, medical, or a mix of physical and psychosocial perspectives (Table 5). Three studies that included partner dyads focused specifically on sexual counselling interventions, such as physical exercise and social support, specific sexual counselling, and sexual counselling with cognitive behavioural therapy. The setting of sexual counselling interventions was either in-hospital or started in the hospital and then continued out of the hospital, whereas 2 interventions were implemented completely at home. All but 2 interventions provided comprehensive quality-of-life perspectives that included provision of verbal information (e.g. lecture, dialogue), written information (e.g. brochure, booklet), visual information (e.g. video, slide presentation), seminar discussions (e.g. lifestyle factors, risk factors), and practical training (e.g. cooking, physical training, relaxing, stress management). All but 2 studies used several didactic approaches, most commonly verbal information/dialogue (n = 9), followed by practical training (n = 7). Five interventions invited both patients and partners to participate. The meeting points and duration of the interventions varied between viewing a 15-minute video on demand, without healthcare professional participation, to participating in 120-minute sessions with the healthcare team twice a week during a 6-month period. A multidisciplinary team was involved (nurses, occupational therapists, physiotherapists, physician, social workers) in the interventions from 5 studies, whereas a single healthcare professional (nurse, physician, or physiotherapist) was involved in the remaining interventions.
Established (but not commonly used) instruments have been used to evaluate the effects of counselling interventions, such as sexual knowledge, activity, function, and satisfaction, as well as quality of life and partner satisfaction. The most commonly evaluated patient-focused outcome was sexual activity, with mixed results. Studies using a partner-focused outcome, such as partner satisfaction, demonstrated a positive result (Table 6). When the interventional approach involved >3 sessions, positive outcomes regarding sexual activity were demonstrated. Both short-term interventions (<3 months) and a long-term intervention (>3 months) yielded mixed results, as did short-term follow-up (<12 months), whereas long-term follow-up (>12 months) showed a more positive outcome. Interventions with a specific focus on sexual counselling resulted in positive outcomes, and similar outcomes were found with a team approach and spousal/partner participation in the counselling process. A main focus on exercise counselling related to sexual issues with cardiac patients showed mixed results, whereas positive outcomes were shown with a main focus on specific nonmedical sexual therapy (cognitive behavioural therapy) and social support that included partners/spouses.
Recommendations for Interventional Studies Using Sexual Counselling
Sexual counselling based on a psychosocial framework, including cognitive behavioural therapy and social support, can be a useful approach with CVD patients and their partners (Class IIa; Level of Evidence B).
It can be beneficial to provide sexual counselling through several meetings and to include partners/spouses, using a multidisciplinary team approach where possible (Class IIa; Level of Evidence B).
Study Quality and Methods
Only a small number of studies have used sexual counselling interventional approaches in patients with CVD. In all, we found 10 intervention studies with a focus on sexual counselling that spanned a 35-year period (1976–2012; Table 5). Of these 10 studies, sexual counselling was the main focus in 4 studies and a secondary focus in 2 studies, whereas the remaining 4 studies included a comprehensive sexual counselling intervention. Although a power calculation was performed in 2 studies, none of the 10 studies had a sufficient number of participants, either because of a small initial sample size or large drop-out rates during follow-up. Follow-up time was relatively short in most studies; in 6 studies, patients were followed up for <1 year, whereas in 4 studies, they were followed up for 1 to 2 years. In 3 studies, only men were enrolled, and 1 study did not indicate the sex of the participants.
Interventional Approaches
The theoretical frameworks guiding the interventions were drawn from various perspectives, including physical, psychosocial, medical, or a mix of physical and psychosocial perspectives (Table 5). Three studies that included partner dyads focused specifically on sexual counselling interventions, such as physical exercise and social support, specific sexual counselling, and sexual counselling with cognitive behavioural therapy. The setting of sexual counselling interventions was either in-hospital or started in the hospital and then continued out of the hospital, whereas 2 interventions were implemented completely at home. All but 2 interventions provided comprehensive quality-of-life perspectives that included provision of verbal information (e.g. lecture, dialogue), written information (e.g. brochure, booklet), visual information (e.g. video, slide presentation), seminar discussions (e.g. lifestyle factors, risk factors), and practical training (e.g. cooking, physical training, relaxing, stress management). All but 2 studies used several didactic approaches, most commonly verbal information/dialogue (n = 9), followed by practical training (n = 7). Five interventions invited both patients and partners to participate. The meeting points and duration of the interventions varied between viewing a 15-minute video on demand, without healthcare professional participation, to participating in 120-minute sessions with the healthcare team twice a week during a 6-month period. A multidisciplinary team was involved (nurses, occupational therapists, physiotherapists, physician, social workers) in the interventions from 5 studies, whereas a single healthcare professional (nurse, physician, or physiotherapist) was involved in the remaining interventions.
Measurement and Outcomes
Established (but not commonly used) instruments have been used to evaluate the effects of counselling interventions, such as sexual knowledge, activity, function, and satisfaction, as well as quality of life and partner satisfaction. The most commonly evaluated patient-focused outcome was sexual activity, with mixed results. Studies using a partner-focused outcome, such as partner satisfaction, demonstrated a positive result (Table 6). When the interventional approach involved >3 sessions, positive outcomes regarding sexual activity were demonstrated. Both short-term interventions (<3 months) and a long-term intervention (>3 months) yielded mixed results, as did short-term follow-up (<12 months), whereas long-term follow-up (>12 months) showed a more positive outcome. Interventions with a specific focus on sexual counselling resulted in positive outcomes, and similar outcomes were found with a team approach and spousal/partner participation in the counselling process. A main focus on exercise counselling related to sexual issues with cardiac patients showed mixed results, whereas positive outcomes were shown with a main focus on specific nonmedical sexual therapy (cognitive behavioural therapy) and social support that included partners/spouses.
Source...