3 Module

Enquiring & responding

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3.3.3. BETTER model

The BETTER Model was developed to help health care providers include sexuality assessment in the care of patients with cancer. [1]

BETTER stands for:

  • Bringing up the topic of sexuality.
  • Explaining to the patient or partner that sexuality is a part of quality of life.
  • Telling the patient about resources available to them and the team's ability and willingness to help address concerns and questions.
  • Timing the discussion to when the patient prefers, not only when it's convenient for the health care practitioner.
  • Recording in the patient's notes that the conversation took place and any follow-ups to further address the person's concerns or questions.

This model may be an especially useful tool to guide health care practitioner documents, however this approach may not adequately emphasise the need for psychotherapeutic interventions or referrals to specialists, where additional assistance is needed.

The BETTER Model

Consider these questions / statements / facts against each stage:

Stage

Description

Example

Bring up…

Bring up issues of sexuality and sexual functioning.

Most women have questions or concerns about sexual function at some point during diagnosis, treatment or recovery.

We try to address these concerns as they arise, so please feel free to ask me anything.

Explain…

Explain that sexuality is integral to quality of life and important to discuss.

Many women find treatment changes their interest in and arousal during sex.

This can have a big impact on their life.

Is this something you and your partner have talked about?

Tell…

Tell patients about available resources and help them if the information they need isn't immediately available.

I'm not sure of the answer to that, but I have a colleague who has a lot of experience in this area.

With your permission, I'll ask them about this and get back to you when I see you next week.

Timing…

Timing is crucial - discussions should be encouraged as the patient / partner desires.

You may not feel like thinking about or resuming sexual activity yet, but you can always call me to ask any questions you or your partner may have.

I'll also give you some written information that you can read when you feel ready.

Educate…

Educate the patient / partner about any expected or potential changes in sexuality or sexual functioning.

It's important to keep the vagina open after radiation therapy, as you'll need to have regular pelvic examinations for years to come.

There is some evidence that vaginal dilators may be helpful in some circumstances.

Record…

Record important aspects of any discussions, assessments, interventions and / or outcomes in the patient’s record.

The need for vaginal dilation was discussed with the patient.

Some strategies to accomplish this were discussed.

References

1 Using the BETTER model to assess sexuality
Authors: Mick J, Hughes M & Cohen, MZ (2004).
In: Clin J Oncol Nurs, 8(1): 84–86.

 

Activities and examples