Keywords
Sexual Health
Neoplasms
Nursing Education
Negotiating
Women's Health
How to Cite
Abstract
Introduction: It is important for women with cancer, especially younger ones, to receive counseling about contraception before and after treatment. However, only a minority among health professionals -most often nurse practitioners- has been trained to discuss cancer patients’ fertility. This study describes the negotiations between women with cancer and nurses, based on these women's contraception practices. Objective: to describe the negotiations between nurses and women diagnosed with cancer in a highly complex cancer care hospital in Colombia where women attend a contraceptive counseling consultation with a nursing professional before receiving radiotherapy treatment. Methodology: This is a qualitative descriptive study analyzing recorded counseling sessions in which 13 women with cancer and two nurses participated. From a naturalistic perspective, content analysis was carried out on the conversation sequences between the nurse and the woman during the consultation. Results: two categories were identified. 1) Joint construction of knowledge and 2) empowerment. The first category includes dialogue with experts, collaborative interactions, and negotiation of authority; the second one develops women's needs and their decision-making. In the counseling, the institutional protocol was followed, active listening was provided, allowing the expression of feelings and the negotiation of planning methods. The empowerment that nurses promote in women favors decision making. Conclusion: This study highlights the importance of nursing counseling on sexual and reproductive health aimed at women with cancer. It constitutes a contribution to comprehensive care strategies for women and to the promotion of better nursing practices.
References
Bray F, Laversanne M, Sung H, Ferlay J, Diegel R. Estadísticas mundiales de cáncer 2022: estimaciones de GLOBOCAN sobre la incidencia y la mortalidad en todo el mundo para 36 tipos de cáncer en 185 países. American Cancer Society Journals. 2024; 3: 229-263. doi: https://dx.doi.org/10.3322/caac.21834
Harris ML, Feyissa TR, Bowden NA, Gemzell K, Loxton D. Contraceptive use and contraceptive counselling interventions for women of reproductive age with cancer: a systematic review and meta-analysis. BMC Med. 2022; 20(1): 489. doi: https://doi.org/10.1186/s12916-022-02690-w
Bhatia S, Pappo AS, Acquazzino M, Allen-Rhoades WA, Barnett M, Borinstein SC, Casey R, et al. Adolescent and Young Adult (AYA) Oncology, Version 2.2024, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2023; 21(8): 851-880. doi: https://doi.org/10.6004/jnccn.2023.0040
Lakhdissi A, Berrada N, Bellahammou K, Akkar O, Mustapha EK, Akla S, et al. A prospective study on contraceptives used by reproductive-aged patients with breast cancer and the assessment of information. J Clin Oncol. 2017; 35(5): doi: https://doi.org/10.1200/JCO.2017.35.5_suppl.173
Vaz-Luis I, Partridge AH. Exogenous reproductive hormone use in breast cancer survivors and previvors. Nat Rev Clin Oncol. 2018; 15(4): 249-261. doi: https://doi.org/10.1038/nrclinonc.2017.207
Massarotti C, Lo Monaco L, Scaruffi P, Sozzi F, Remorgida V, Cagnacci A, et al. Contraception in cancer survivors: insights from oncofertility follow-up visits. Gynecol Endocrinol. 2021; 37(2): 166–70. doi: https://doi.org/10.1080/09513590.2020.1810658
Instituto Nacional del Cáncer. Píldoras anticonceptivas y el riesgo de cáncer publicada originalmente por el Instituto Nacional del Cáncer. 2028. Disponible en: https://www.cancer.gov/espanol/cancer/causas-prevencion/riesgo/hormonas/hoja-informativa-pildoras-anticonceptivas
Münstedt, K., Grant, P., Woenckhaus, J. Roth g, Tinneberg HR. Cancer of the endometrium: current aspects of diagnostics and treatment. World J Surg Onc. 2004; 24(2). doi: https://doi.org/10.1186/1477-7819-2-24
Kabirian R, Franzoi MA, Havas J, Coutant C, Tredan o, Levy C, et al. Chemotherapy-related amenorrhea and quality of life among premenopausal women with breast cancer. JAMA Netw Open. 2023; 6(11): e2343910. doi: https://doi.org/10.1001/jamanetworkopen.2023.43910
Zhao H, Jin L, Li Y, Zhang C, Wang R, Li Y, et al. Oncofertility: What can we do from bench to bedside? Cancer Lett. 2019; 442: 148-60. doi: https://dx.doi.org/10.1016/j.canlet.2018.10.023
Martins J, Vaz AF, Grion RC. Costa L, Baccaro LF. Topical estrogen, testosterone, and vaginal dilator in the prevention of vaginal stenosis after radiotherapy in women with cervical cancer: a randomized clinical trial. BMC Cancer. 2021; 21. doi: https://doi.org/10.1186/s12885-021-08274-w
Britton L. Unintended Pregnancy: A Systematic review of contraception use and counseling in women with cancer. Clin J Oncol Nurs. 2017; 21(2): 189-96. doi: https://dx.doi.org/10.1188/17.CJON.189-196
Beesley VL, Alemayehu C, Webb PM. A systematic literature review of trials of survivorship interventions for women with gynaecological cancer and their caregivers. Eur J Cancer Care. 2019; 28(3). doi: https://dx.doi.org/10.1111/ecc.13057
Ussher JM, Cummings J, Dryden A, Perz J. Talking about fertility in the context of cancer: health care professional perspectives. Eur J Cancer Care. 2016; 25(1): 99-111. doi: https://dx.doi.org/10.1111/ecc.12379
Vadaparampil ST, Gwede CK, Meade C, Kelvin J, Reich RR, Reinecke J, et al. ENRICH: A promising oncology nurse training program to implement ASCO clinical practice guidelines on fertility for AYA cancer patients. Patient Educ Couns. 2016; 99(11): 1907-10. doi: https://dx.doi.org/10.1016/j.pec.2016.05.013
Salazar A, Martínez C. Un sobrevuelo por algunas teorías donde la interacción enfermera-paciente es el núcleo del cuidado. Avances en Enfermería. 2008; 26(2): 107-115. Disponible en: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0121-45002008000200012&lng=es
Durán MM. La teoría, soporte de la ciencia y práctica de enfermería: tendencias. Avances en Enfermería. 2012; 30(1). Disponible en: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0121-45002012000100001&lng=en
Marques de Sousa M, Farias Almeida T de C, Da Costa Andrade SS, André Gouveia B de L, Dos Santos Oliveira SH. Teoría de la acción racional y sus características en investigaciones en la enfermería. Enferm Glob. 2018; 17(3): 575-612. doi: https://dx.doi.org/10.6018/eglobal.17.3.305911
Albers LF, Palacios LAG, Pelger RCM, Elzevier HW. Can the provision of sexual healthcare for oncology patients be improved? A literature review of educational interventions for healthcare professionals. Journal of Cancer Survivorship: Research and Practice. 2020; 14(6): 858–866. doi: https://doi.org/10.1007/s11764-020-00898-4
Tung TH, Chen HW, Chou HH, Tsai JL, Yang YC, & Lee JT. Does a one-session sexual health education program improve sexual confidence in patients with cervical cancer? A transtheoretical model-based clinical study. Archives of Gynecology and Obstetrics. 2024; 309(1): 249–258. doi: https://doi-org.ezproxy.unbosque.edu.co/10.1007/s00404-023-07141-2
Lubi K, Sildver K, Sokolova D, Savicka V, Nool I, Mets-Oja S, et al. Existing health practices in shaping the decision to participate during breast cancer screening among 50–69 years old women in Estonia. SAGE Open Nurs. 2022; 8:1-7. doi: https://doi.org/10.1177/23779608221124293
Ministro de Salud y Protección Social. Resolución 3280 de 2018: por la cual se adoptan los lineamientos técnicos y operativos de la Ruta Integral de Atención para la Promoción y Mantenimiento de la Salud y la Ruta Integral de Atención en Salud para la Población Materno Perinatal y se establecen las directrices para su operación. Diario Oficial No. 50674 ago 2, 2018. https://www.suin-juriscol.gov.co/viewDocument.asp?ruta=Resolucion/30039995
Soto Arroyave SI. Competencias del profesional de enfermería para el cuidado a pacientes con cáncer en Medellín - Colombia [Tesis de maestría]. [Medellín]: Universidad de Antioquia; 2018. Disponible en: https://bibliotecadigital.udea.edu.co/handle/10495/11250
Trihastuti N, Putri SA, Widjanarko B. The impact of asymmetric information in medical services: a study in progressive law. Syst Rev Pharm. 2020; 11(12): 850-5. doi: https://doi.org/10.31838/srp.2020.5.124
Biehl J. VITA. Life in a Zone of Social Abandonment. 2005. Berkeley University Press.
La-O-Jiménez Y, Camue-Torres VI. Empoderamiento, una herramienta en el desempeño profesional de Enfermería en la promoción y prevención de salud. Rev Cuba Enferm. 2023; 39(1). Disponible en: https://revenfermeria.sld.cu/index.php/enf/article/view/5441
Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care J Int Soc Qual Health Care. 2007; 19(6): 349-57. doi: https://doi.org/10.1093/intqhc/mzm042
Ministerio de Salud y Protección Social. Manual metodológico para la elaboración e implementación de las RIAS. MINSALUD; 2016. Disponible en: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/Manual-metodologico-rias.pdf
Ministerio de Salud y Protección Social, Profamilia, Organización Internacional para las Migraciones - OIM, Fondo de Población de las Naciones Unidas - UNFPA. Política Nacional de Sexualidad, Derechos Sexuales y Derechos Reproductivos; 2014. Disponible en: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE/LIBRO%20POLITICA%20SEXUAL%20SEPT%2010.pdf
Hernández-Sampieri R, Mendoza Torres CP. Metodología de la investigación: las rutas cuantitativa, cualitativa y mixta. McGraw-Hill Education; 2018.
Saunders B, Sim J, Kingstone T, Baker S, Waterfield J, Bartlam B, et al. Saturation in qualitative research: exploring its conceptualization and operationalization. Qual Quant. 2018; 52(4): 1893-907. doi: https://dx.doi.org/10.1007/s11135-017-0574-8
Schreier M. Qualitative Content Analysis. En: Flick U, editor. The SAGE Handbook of Qualitative Data Analysis. London: SAGE Publications, Inc.; 2014. https://doi.org/10.4135/9781446282243.n12
Collins HM, Evans R. The third wave of science studies: studies of expertise and experience. Soc Stud Sci. 2002; 32(2): 235-96. doi: https://doi.org/10.1177/0306312702032002003
Korstjens I, Moser A. Series: Practical guidance to qualitative research. Part 4: Trustworthiness and publishing. Eur J Gen Pract. 2018; 24(1): 120-4. doi: https://doi.org/10.1080/13814788.2017.1375092
Faubion J. Toward an anthropology of ethics: Foucault and the pedagogies of autopoiesis. Representations. 2001; 74(1): 83-104. doi: https://doi.org/10.1525/rep.2001.74.1.83
Ainsworth-Vaughn N. Claiming Power in Doctor-Patient Talk. Oxford, New York: Oxford University Press; 1998. doi: https://doi.org/10.1093/oso/9780195096064.001.0001
Agrazal García J, McLaughlin de Anderson MM, Gordón de Isaacs L. Beneficios del cuidado de enfermería con congruencia cultural en el bienestar y satisfacción del paciente. Rev Cuba Enferm. 2022; 38(2). Disponible en: https://revenfermeria.sld.cu/index.php/enf/article/view/4218
Hewitt SL, Mills JE, Hoare KJ, Sheridan NF. The process of nurses’ role negotiation in general practice: A grounded theory study. J Adv Nurs. 2023; 1-13. doi: https://doi.org/10.1111/jan.15938
Crawford T, Roger P, Candlin S. The interactional consequences of ‘empowering discourse’ in intercultural patient education. Patient Educ Couns. 2017; 100(3): 495-500. doi: https://doi.org/10.1016/j.pec.2016.09.017
Get rights and content 39. Boban S, Downs J, Codde J, Cohen PA, Bulsara C. Women diagnosed with ovarian cancer: patient and carer experiences and perspectives. Patient Relat Outcome Meas. 2021; 12: 33-43. doi: https://dx.doi.org/10.2147/PROM.S272688
McFarland DC, Blackler L, Hlubocky FJ, Saracino R, Masciale J, Chin M, et al. Decisional capacity determination in patients with cancer. Oncol Williston Park N. 2020; 34(6): 203-10. Disponible en: https://www.cancernetwork.com/view/decisional-capacity-determination-in-patients-with-cancer
Holt K, Kimport K, Kuppermann M, Fitzpatrick J, Steinauer J, Dehlendorf C. Patient-provider communication before and after implementation of the contraceptive decision support tool My Birth Control. Patient Educ Couns. 2020; 103(2): 315-20. doi: https://dx.doi.org/10.1016/j.pec.2019.09.003
Castro-Sánchez A, Martínez-Cannon B, Platas A, Mohar A, Fonseca A, Vega Y et al. Suboptimal use of effective contraceptive methods in young Mexican women with breast cancer. Journal of Global Oncology. 2018; 4,1-7. doi: https://dx.doi.org/10.1200/JGO.18.00064
Gutiérrez-Crespo H, Huaman-Carhuas L, Cehua-Alvarez EA, Matzumura-Kasano JP, Valdeiglesias-Ochoa D. Adherencia y barreras en el uso de anticonceptivos en mujeres adultas jóvenes atendidas en establecimientos de salud del primer nivel de atención, Perú. Rev Peru Med Exp Salud Publica. 2019; 36(1): 61-68. doi: https://dx.doi.org/10.52379/mcs.v7i2.283
Silva S, Boer R, Cruz L, Gozzo T. Fertility and contraception in women with cancer treatment undergoing chemotherapy. Escola Anna Nery. 2021; 25(1). doi: https://dx.doi.org/10.1590/2177-9465-EAN-2019-0374
Rivera-Galvan A, Ortega-Jiménez MC, García-Campos ML, Ramírez-Gómez XS. Barreras percibidas para el uso de métodos anticonceptivos por mujeres en edad fértil: revisión integrativa. Rev. Iberoam. Educ. Investi. Enferm. 2022; 12(1): 27-38. Disponible en: https://www.researchgate.net/publication/361486173
Black KZ, Eng E, Schaal JC, Johnson LS, Nichols HB, Ellis KR, et al. The other side of through: young breast cancer survivors’ spectrum of sexual and reproductive health needs. Qual Health Res. 2020; 30(13): 2019-32. doi: https://dx.doi.org/10.1177/1049732320929649
Coccia PF, Pappo AS, Beaupin L, Borges VF, Borinstein SC, Chugh R, et al. Adolescent and young adult oncology, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2018; 16(1): 66-97. doi: https://dx.doi.org/10.6004/jnccn.2018.0001
Johnson RH, Anders CK, Litton JK, Ruddy KJ, Bleyer A. Breast cancer in adolescents and young adults. Pediatr Blood Cancer. 2018; 65(12): e27397. doi: https://dx.doi.org/10.1002/pbc.27397
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Copyright (c) 2025 Marlin Téllez Pedroza, Diana Carolina Rubio León, Yenny Barreto Zorza, Ángela Fernanda Espinosa Aranzales, Juan Ricardo Aparicio Cuervo, Ángela Ibeth Piraján Aranguren