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Gewrichtsziekten --- gewrichtsziekten --- reumatologie --- 605.18 --- Academic collection --- 616.083 )* VERPLEEGKUNDE --- ergotherapie (bezigheidstherapie) --- heupprothese --- hulpmiddelen --- kinesitherapie (bewegingstherapie) --- knieprothese --- osteoartrose --- reumatoïde artritis --- spondylitis (Bechterew-ziekte) --- beender-, gewrichts- en spierziekten, reuma

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Inflammation

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Mirjam Hemker, A delicate subject: the perceived influence of physicians’ personal and professional attitudes regarding sexuality on (not) addressing the sexual health needs of patients with chronic rheumatic disease. Master thesis presented to obtain the degree of Master in de Seksuologie, August 2021. Promotor: prof. dr. Paul Enzlin This thesis explores how rheumatologists describe the formation of their personal and professional attitudes regarding sexuality and if and how they perceive any influence of these attitudes on the way they do or do not talk about sexuality with their patients. While chronic inflammatory rheumatic diseases can have a large impact on patients’ sexual well-being, sexual problems are not addressed in standard clinical rheumatology practice. To be able to provide better patient care, it is important to gain a better understanding of why rheumatologists rarely initiate conversations about sexuality. This study hopes to contribute to this aim. This qualitative study employed semi-structured interviews with a convenience sample of twelve rheumatologists who were recruited through snowball sampling. A conceptual framework, taking together key concepts from the literature, provided rationale for data-collection and guided the analysis and interpretation of data. Flexible pattern matching was used as a data-analysis technique, involving the comparison of a predicted theoretical pattern deducted from prior studies with actually observed empirical patterns. This way, our study tries to make explicit a pattern of difficulties and barriers that rheumatologists experience in choosing (not) to speak to their patients about sexuality in clinical care. Analysis of interview data showed that 11 out of 12 rheumatologists in this study rarely or never brought up the subject of sexuality in consultations with their patients unless there was an obvious, mostly medical reason. Most were uncertain whether patients want them to raise this topic and half of them were unsure if they will have something useful to offer to patients if they do. Seven discussed sexuality relatively comfortably with their patients as long as they brought it up. A combined influence of culture, upbringing, personal and professional attitudes, and their medical education was perceived to inhibit them in discussing sexuality proactively and comfortably. By not addressing sexuality, rheumatologists neglect an important factor in their patients’ sexual and overall well-being. Steps need to be taken on a structural, organisational, and individual level to ensure that sexuality becomes a structural part of rheumatologists’ assessment. Recommendations are firstly to incorporate guidelines to discuss sexuality in EULAR management recommendations, secondly to offer (screening) tools, training, and mentoring, and thirdly to acquire personal skills that facilitate discussing sexuality. Only then can the sexual health needs of patients with chronic rheumatic diseases be met.