Sex And Intimacy Part 3

Creativity, Courage, and Collaboration: How to Hold Sex- and Intimacy-Related Conversations in a Hospice Environment

“It’s about how we educate and support our clinicians to be courageous. To ask the questions, and to think about treatments in terms of traumatising someone else’s body. To really be there with that patient, and recognise them as a person; as a whole and complex human being. To realise that sex, like death, is a part of life, and address – not ignore – the elephant in the room. The more we have the courage to ask the questions, the easier it’ll become.”

Charlotte Mead, Clinical Nurse Specialist at ellenor

In this final part of our three-part series on sex and intimacy in hospice care, we explore how hospices like ellenor can facilitate these conversations. Building on previous discussions around the Total Pain model, trauma, and bodily autonomy, this article highlights innovative approaches that are helping open the door to these sensitive but essential topics.

Sex and intimacy: Starting the conversation

As part of her studies, apprentice Occupational Therapist Shania Allsopp is exploring the idea that sex is considered an activity of daily living (ADL), a key aspect of the human experience.

“Sexual activity is much more than just physical act,” Shania explains. “It involves so many senses: touch, taste, hearing. It’s also about intimacy and connection in relationships.”

For Charlotte, encouraging and facilitating conversations around sex and intimacy in a hospice setting comes down to three concepts: creativity, courage, and collaboration.

“If a patient still has the desire to be intimate with their partner, there are things we, as healthcare professionals, can do. It’s about creative thinking, about holistic thinking – we just need the courage to do it. It’s about using the Total Pain model as our guide, and working together between teams.”

Those teams include not only ellenor’s clinical functions – both in the Kent and Bexley communities, and at the hospice’s Northfleet inpatient ward – but its wellbeing and therapeutic  services, too: which include counselling, bereavement support, complementary therapy, occupational therapy, and spiritual care.

Complementary therapy can, for example, be used to teach massage techniques to partners doubling as carers, to help them turn a medical touch into a therapeutic touch. While counselling can help life-limited patients and their loved ones reframe their attitudes and approaches towards sex and intimacy.

The PLISSIT model and Shania’s cards: Holding the conversation

Another way to have these conversations is through the PLISSIT model of sex therapy which provides a structured way for clinicians to guide discussions around intimacy. It’s a tool, Shania explains, for safe communication that we should be using a lot more.”

That desire for clearer, more open conversations around sex and intimacy has led Shania to develop her own tool for this. She’s created cards that a patient or their carer can hand to a professional, that read:

“The person who is showing you this card needs advice and support. Please overcome any of your discomfort and blushes to help them.”

These cards offer a simple and discreet way for patients to kick-start those difficult discussions – either directly with the professional they’ve handed it to, or to be passed on to someone confident enough to have the conversation. The next step? Rolling these cards out throughout ellenor, and embedding them throughout the organisation.

It raises the question – how should ellenor, and hospices at large, proceed with these types of conversations going forward?

“I think we need to be sex-positive,” Shania says. “And not just towards sex, but around a whole host of other things: intimacy; self-pleasure; self-confidence. In occupational therapy, we’re very big on supporting patients; on giving them the tools to live their lives as independently as possible.

“Sex and intimacy is no different.

“It’s also about building relationships – working on yourself, and your body image, and your self-esteem. Everyone should be able to have it when they want to: it’s good for the body, alleviates anxiety; it relaxes you, helps you sleep. We talk a lot, in a hospice setting, about pain and pain management; distraction. Sex is one way of contributing to that.

“Sometimes, all it takes is asking the patient one question: ‘Is there anything else you’d like to be able to do that you can’t do already?’ It’s as simple as that. We need to be asking those questions.”

A “risky business”? An invitation to the conversation

The ultimate goal? For patient-centred conversations around sex and intimacy – that “risky business” – to be neither risky, nor a business. For them to be patient-centred, creative, and assumption-free. For them to take into account not only the sensitivities of sex and intimacy, but the nuances of sexuality and gender, too. And for them to always be tailored to the person, the partner, and the relationship.

So, Charlotte says, let this article be an invitation – to conversation.

“Let it go on record that ellenor wants to, and is ready to, have these conversations with you and your partner,” she says. And that sex and intimacy don’t have to be taboo topics – just like death doesn’t.

“It’s okay to speak to your counsellor, your clinician – to anyone here at ellenor – if you’re experiencing a problem with sex and intimacy. We’re here to hear those questions, and we aim to have the courage to answer them. Even if it’s something we can’t immediately fix, we’re here for creative solutions.

“And we’ll do everything we can to find them.”

This is the second article in a three-part series exploring sex and intimacy in hospice care. Part One focused on how sex and intimacy connect to Dame Cicely Saunders' 'Total Pain' model, while Part Three will address the age, disability, and sexuality-related stereotypes that often complicate these conversations.