“Are you sexually active?”: Unilateral informing patterns in communicating the sexual impact of prostate cancer treatment

Prostate cancer treatments can impact couples' sex lives; accordingly, the sexual impact of treatment is an important topic during clinical consultations. This study explores how the sexual impact of treatment is communicated to couples during consultations for people with low or intermediate risk prostate cancer. A conversation analysis of diagnostic and treatment consultations examined interactions where sexual impact was discussed. Two sequential patterns were identified, one with the polar question "are you sexually active" and one without. The polar question served as a conversational springboard for clinicians' information deliveries to inform couples of sexual treatment effects without addressing couples' responses. Sequences without the polar question also served to enable delivery of clinical information about sexual treatment effects; although clinicians would sometimes attempt to elicit acknowledgement from patients, clinicians and couples oriented to sexual activity as a taboo topic and there was no opportunity to explore the implications for the couple. In both patterns, talk which sought to inform inhibited couples' contributions. This is the first conversation analytic study to explore how the organisation of talk about the sexual impact of prostate cancer with couples enables and limits exploration of patients' priorities, values and sexual histories. By elucidating why lifeworld concerns around sex go unaddressed, this study offers insight into interactional barriers to shared decision-making about treatments. Further research to identify the range of conversational practices to facilitate exploration of patients' values about sex in prostate cancer consultations is essential to offer an evidence base to develop clinical communication skills training.