It must be that time of the year! Shop windows are festooned with heart balloons, cards proclaiming love for anonymous suitors and meal deals promising to satisfy romantic and indulgent appetites with prawn cocktails and meaty steaks.
This time every year, the life of a third century martyr is celebrated and the intimacy of our relationships, self, connections and sexuality is explored through the celebratory acts of giving roses and chocolates, among other things. Yet, when it comes to professional support, such expressions may not always be readily facilitated in palliative care.
For many patients, disease processes and their treatments can be deleterious, disabling and depressing. The changes wrought to their sexuality and its expression of feelings, thoughts and behaviours, whether emotional or sensual, physical or psychological, social or spiritual can be one of the most challenging aspects of the changes associated with their experience of illness and their overall wellbeing. Patients receiving palliative care often express a desire to discuss the impact of their illness on their sexuality (Lemieux et al, 2004; Wang et al, 2018). Taylor (2014) offered the insight that coupled relationships are ‘becoming apart’, as the relationship is experiencing an ending, further emphasising the need for inclusive care.
While compassionate and comprehensive palliative care should consider all intrinsic and dynamic qualities of humanity, including sexuality and intimacy, there is consistent and compelling evidence to suggest that pre-emptive or pro-active inclusion of discussions and assessment of such needs is not necessarily routine or regular practice (Dyer and das Nair, 2012; Leung et al, 2016; Kelemen et al, 2019; 2022). As a result, an important, if not inherent, element of holistic sense and sensibility may be neglected or overlooked.
There are many reasons why person-centred conversations with individuals who have chronic and life-limiting illnesses may be avoided or perceived as difficult, including the discomfort or uncertainty felt by nurses or doctors (Benoot et al, 2018; Camejo et al, 2024). The perceived social or sexual norm that it may not be an important or relevant consideration for certain populations, such as older adults, or those receiving palliative care, is also a factor (Annerstadt et al, 2019; Hjalmarsson and Lindoth, 2020). These limitations can be exacerbated further by an uncertainty about the role and responsibility for such discussions, a lack of knowledge and training, and other wider organisational factors such as time (Williams et al, 2017; Camejo et al, 2024).
There are various longstanding models for supporting the assessment of sexuality, such as PLISSIT, BETTER, ALARM or PLEASURE; however, the fact that such models have been developed and not implemented into routine practice may tell another story.
If the healthcare professionals want patients to share their stories, they should consider how to initiate conversations about such intimacies safely, suitably and symptomatically as part of routine palliative care. Doing so will require some thought and reflection on the personal changes and professional training required, as well as the service development or provision changes needed to improve care.
Freud once said, ‘Sex is something we do. Sexuality is something we are.’ People do not have to be as old as Valentine to be romantic, tender or passionate, all of which should remembered as valid manifestations of caring in and for a life.