The results of the present study show that sexual nursing consultation and psychoeducation have a significant impact on the sexual function of patients after breast cancer treatment. The specific intervention types include multimedia intervention, WeChat continuity care, group problem solving therapy, WhatsApp counseling, mind body education, counseling under the PLISSIT or the BETTER model.
Multimedia intervention [17]focuses on clinical communication about sexual health of patients after active treatment of breast cancer. By distributing intervention materials to subjects, the intervention materials contain 20min video slides (explained by mobile phone or computer). 5 pages of work manual on how to communicate and skills training on sexual issues, 2 pages of resource guide on information about menopause and sexual health institutions and external resources. Then the focus group of the doctor informs the patient about the sexual knowledge, emphasizing that the patient is encouraged to establish self-efficacy and improve the result expectation by learning the skills of effective health.
WeChat continuous nursing [18]mainly intervenes in patients after modified radical mastectomy, establishes professional nursing teams, allows nurses to follow up on WeChat, and ensures that participants are online for 1 hour a day. It also carries out popular science on breast cancer and postoperative sexual life knowledge through WeChat platform, and carries out knowledge lectures, psychology expert lectures and breast cancer rehabilitation exercises. Patients and their spouses are encouraged to engage, speak out, listen to real feelings and concerns, and caregivers receive questions and answer them.
The group problem-solving therapy [19]corrects their misconceptions and improves their depression through sexual counseling and carries out 8*90-minute counseling sessions for patients after mastectomy within 1–5 years.
WhatsApp counseling[20] aims at improving patient sexual self-concept after breast cancer treatment. Researchers gave themselves personal account number to participants, communicated with patients in the WhatsApp platform, and the activities were conducted in the app. It was conducted in eight sessions of 45 min twice a week. By explaining the anatomy and sexual cycle of men and women, providing corrections after wrong concepts, enhancing self-esteem with confidence in patients' sexual intercourse, teaching sensory concentration skills and methods, and encouraging patients to evaluate self, express feelings about sexual behavior, and also train problem-solving skills and accept supportive relationships.
PLISSIT model[23][24]starts from the sexual troubles and lack of sexual knowledge of patients, through sexual psychoeducation and answers to sexual problems, makes patients have a comprehensive understanding of the concept of sex, to correct misunderstandings, increase sexual confidence and sexual life satisfaction. Whereas in the BETTER model[22], psychological counseling is carried out by issuing counseling manuals and CDs, interviewing participants in appropriate places and conducting psychological counseling.
Mind body education[22]aimed to improve the quality of life of patients, the intervention was conducted from both the spirit and appearance aspects, a group consultation meeting composed of oncology nursing experts and clinical psychology experts, using nine type personality as a tool for self-comprehension and development, to conduct research guidance and body image education, and to encourage patients to share their mood and think about the future. Aesthetic specialists explained the skin condition, health care, cosmetic techniques, hair care and encouraged patients to practice the techniques. This intervention focuses on the patient's spirit and appearance, improving the patient's mood of depression and anxiety. Thus, sexual function due to these emotions was also improved.
These methods of sexual counseling and psychological education discussed in this study provide inspiration for clinical practice. Nurses should pay more attention to the dynamic psychological process of female patients. Due to the change of appearance, women would think that they lose their female identity, their body image is damaged, and they lack sexual attraction. We should affect their self-esteem about sex. Nurses should give patients the anatomy and physiological structure of genitals, encourage patients to express emotions, establish a good sexual self-concept, and correct sexual misconceptions. Appropriate education should be given to breast cancer patients after discharge to improve sexual life treatment. In addition, the reaction of their sexual partners to the patients after treatment should also be considered, and the family members should receive common science education to enable the patients to obtain family support.[26][27]
4.1 Strengths and limitations
In the context of the times, doctors, nurses and patients themselves have neglected to pay attention to sexual life after sexual operation.[28]After receiving cancer treatment, women's body image disorder or other pain will cause psychological problems, which will affect their sexual function.[29]In the past three years, few articles have been published to study the impact of postoperative sexual function of cancer patients. The latest research direction is the meta-analysis of exercise intervention on the quality of life of breast cancer patients. Our research points are different from them.[30]This meta-analysis studied the impact of sexual counseling and psychological education on the quality of sexual life of cancer patients after treatment. In addition, it summarizes various forms of counseling models, which affect the sexual function of cancer patient post-treatment through psychological counseling, question-and-answer, sexual psychoeducation, sexual practice, establishment of sexual self-concept, change of self-image and other ways, and systematically analyzes the above intervention methods.
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Insufficient and mismatched study data, as well as inconsistent outcome measures.
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Few articles on the impact of sexual function post-treatment for breast cancer was included, small sample size was introduced
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Few intervention-types
The above limitations may result in this study having some impact on the outcome analysis. The disease and intervention variety were too few, the sample size was insufficient, and the data of included articles were insufficient to make the analysis of this study less comprehensive. Too few relevant articles would make the set subgroups insufficient and the corresponding data analysis difficult.
4.2 Future research
Recommendations for future research in this area of research are as follows:
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The types of studies can be extended to retrospective studies, case-control studies, uncontrolled before-after studies, double-arm clinical trials
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Expanding the sample sizes by the extraction and analysis of data from these studies, and there are sufficient data to supplement and justify this study.
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Taking sexual partner, patient self-perception, appearance change, psychological change into account. Above may also be one of the influencing factors affecting patients' sexual function.
In this way, the research field can be expanded to make the research more comprehensive and rigorous.