Hematology/oncology fellowships provide little training on sexual, reproductive health
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Hematology/oncology fellowship programs provide insufficient training about how to address patients’ sexual and reproductive health concerns, according to a study led by researchers at Fox Chase Cancer Center.
Researchers surveyed 114 program directors of adult hematology/oncology fellowship training programs in the United States.
Although 75% of programs offered formal instruction on fertility issues, fewer programs provided instruction in the areas of sexual health (49%) and safe sex practices (37%), results showed.
Respondents cited a lack of experts to provide instruction, difficulty finding space within the curriculum, and a lack of training requirements as the primary barriers to incorporating this content in oncology training.
“Despite the fact that there are clinical guidelines that now recommend discussing sexual and reproductive health in routine discussions with patients, we know that it’s not happening as much as we would hope,” researcher Jennifer Barsky Reese, PhD, associate professor in the cancer prevention and control program at Fox Chase Cancer Center, told Healio. “We have become interested in the idea of intervening at the training level — in teaching fellows skills for talking to their patients about sexual health before they’ve started their own independent clinical practice post-training. The survey we conducted was the first step in learning more about the kind of training that current fellows are receiving in these topic areas in order to understand the current training landscape.”
Healio spoke with Reese about the study and how the findings may help improve communication in this area.
Healio: What motivated you to conduct this study?
Reese: We wanted to collect some state-of-the-science information on what kind of education is being offered on sexual and reproductive health happening within hematology/oncology fellowships. We hoped this information might help us brainstorm ideas for what could be done to intervene and improve education in these areas to ultimately enhance the care that patients receive, including potentially developing educational training programs for fellows.
Healio: How did you conduct the study and what did you find?
Reese: We sent an online survey to all of the hematology/oncology fellowship program directors in the United States. One big takeaway was that fertility topics tend to be covered to a greater extent than sexual health issues and related sexuality topics, such as safe sexual practices and sexual function. This is what we would have predicted based on findings of other studies as well, and the findings were confirmatory in that regard. About 60% of program directors said they were including some major fertility related topics for women, and a little bit less than that for men. We also learned about the types of informal training that fellows are receiving in sexual and reproductive health, which mostly seem to occur during direct clinical observation, as well as the barriers that program directors perceive as limiting the inclusion of education on these topics within their programs.
Healio: Why do you think fertility issues are more often addressed than other sexual health issues?
Reese: There have been efforts to incorporate reproductive health and fertility issues into training programs for clinical care for some time now. The term “oncofertility” has been part of the lingo for a while, and I think this area is likely further ahead than the sexual health side of things. Efforts to put these topics into training programs have trailed behind a bit.
Even so, sexual function has been a part of the NCCN guidelines for survivorship for many years, and yet it’s still not a part of routine discussions for many patients who have been diagnosed with and treated for cancer, especially women. I believe it might have to do with the fact that, as a society, we’re probably still more comfortable talking about sex when it comes to procreation as opposed to issues like sexual function, enjoyment, and well-being. We’ve known for decades that nearly all treatments for cancer affect sexual functioning. These issues have unfortunately not been taught to the extent that they could be within medical and oncology-specific training, so when clinicians are faced with discussing these issues with their patients, they often say they lack adequate preparation to do so effectively. Lately, I see signs that sexual health and functioning for cancer survivors are starting to receive more attention, and I am hopeful that things will continue to change to include these issues as a routine part of cancer care discussions.
Healio: What do you think will be the long-term implications of the findings?
Reese: If hematology/oncology fellows are not learning about these issues, they’re most likely not going to feel comfortable raising these topics in their practices. We also found that most fellowship programs that reported offering training in sexual health tended to rely on more idiosyncratic methods of informal training including clinical observation. However, when it comes to sexual function or sexual health, we know that many hematologists/oncologists may themselves not feel comfortable talking about these issues. In this setting, this could filter down to the trainees, so they won’t necessarily have much of a chance to learn about sexual health during fellowship if that is the main way they learn and the conversations are not routinely taking place during clinical encounters. In any case, the training would likely be variable and depend on who they are learning from — that is, the education is going to differ greatly from supervisor to supervisor. This is an issue, because we believe there should be standard basic information included on how to hold these routine discussions.
Healio: What are some potential strategies or solutions?
Reese: One of our major findings was that almost three-quarters of the program directors cited a lack of qualified individuals to teach these topics as a significant barrier to offering this training. In the long term, we need to facilitate further training so that we can have more experts to deliver this kind of training within institutions. Of course, that is going to take a good deal of time and effort.
In the meantime, we could look into offering virtual training. Our study found that formal virtual training tended to be minimal and brief — webinars that were an hour or less. I think supplementing that with more in-depth virtual training could help us get around the barrier of not having local experts to deliver education in this topic. Institutions could also support those individuals who do have knowledge about sexual and reproductive health within institutions and empower them to develop educational materials that could be disseminated to fellows.
Another aspect of this — and it’s probably the hard part — is the need to shift the mindset in terms of education on sexual health being important enough to figure out and prioritize. I don’t think it needs to take the form of weeks-long programs but given that sexual health is a multi-faceted area of health that includes physical, emotional, and interpersonal aspects, it is likely fellows could benefit from training that goes beyond a one-hour webinar.
Reference:
For more information:
Jennifer Barsky Reese, PhD, can be reached at Fox Chase Cancer Center, Cancer Prevention and Control Program, 333 Cottman Ave, Philadelphia, PA 19111; email: jennifer.reese@fccc.edu.
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