Themes from interviews with childhood sexual abuse survivors about cancer screening, January 2014
| Theme | Supporting quotation(s) |
|---|---|
| Holistic care | “Doctors aren't that great at attending to emotional or psychosocial issues they should know impact tremendously on health. Stress levels. The whole mind-body connection. Being more attentive to that …Help people make the mind-body connection. And doctors should become more aware of what is out there, the kind of help, not just [western] medicine—meditation, mindfulness, energy work that would be helpful to patients rather than just medicine.” (Int 12) |
| “I used to experience terror before seeing doctors or nurses. Now it is typically mild anxiety but if it were for an invasive test it's more likely to be extreme anxiety…”(Int 11) | |
| Dissociation and dissociative identity disorder | “When they put that metal thing inside myself, it brings up a lot.” (Int 4) “Is there anything that makes it easer? (Interviewer) “I go inside myself and I think of positive.” (Int 4) |
| “It was positive…there was a nurse in the room and [the Doctor] explained everything he was doing…for me it would have been easier if they wouldn't have talked to me because I could just “not be there”…it's hard to dissociate when someone's talking to you” (Int 3) | |
| “I might have a constant low to medium grade anxiety for the whole day before I go. Unless I dissociate the reason I am going and then I might be almost sort of okay until right when I get there and then I realize and I'm like $%&!! I forgot I was having that done today…. There have also been times that I have spaced out completely during the test and been unable to speak or respond and then she just works as quickly as she can, and that is probably the best thing for me at that point too. Theoretically she could see if she could get me grounded before continuing but I don't know that it would be possible at that point and I'd rather just finish the test than have to go back again. Actually I probably wouldn't be able to go back again at that point, it would be too hard.” (Int 11) | |
| Patient-provider relationship | “I am lucky to have had great doctors and nurses, and they get to know you pretty well…. I have been very reassured to see how providers do consider women in their practices.” (Int 8) |
| “During a pap test, what my doctor does that helps me the most is 1) she tells me what she is doing before she does it, and 2) she talks to me during it, about other things. Most often she asks me about my work, I think she knows that grounds me the most.” (Int 11) | |
| “What I liked about it is that she understood you were nervous. She talked through step by step what she was going to do. She respects your dignity. (Int 7) “How did you know she respects your dignity? (Interviewer) “By the way she treated me, and the way she explained everything and said, ‘Relax, it's going to be ok, it's going to be over in no time’. The way she spoke to me.” (Int 7) | |
| Appointment interactions | “I think nobody can go wrong if they treat patients with respect, which would be on everybody's list of recommendations. Just to be respectful, and just be aware. If someone seems to be especially anxious, just kind of, bring it out in the open….Most of the doctors that work on children, they work on their posture with their kids so they don't come across as intimidating to the kids. That kind of information would be helpful even with adults. Be aware of body language and body position. Whether it comes across as more intimidating or not.” (Int 10) |
| “If they have a sense of humor that would be nice too. But to be personable and a little light.” (Int 2) | |
| “…if they kind of acknowledge that maybe using a sense of humor” (Int 9) | |
| “It would be even better if, rather than just telling me what she is about to do, if she would ask me ‘Is it okay for me to do X now?’ ‘I am about to do Y, is that okay?’ It's a subtle difference but can be important, it would keep reminding me that I have some control with this.” (Int 11) | |
| Cancer screening environment | “It doesn't take any extra time to speak to someone with a kind voice or to smile at them. Even if it did take a few minutes to help someone feel safer, it may make the test itself go more smoothly, which could save time overall.” (Int 11) |
| “What helps me most is having female providers who are kind and open with a good sense of humor. Sadly, it may be safe to assume that at least some patients will have a trauma history with anxiety around physical issues and medical visits, but a quiet and compassionate demeanor for me is a great help, as is the framing of health care as caring for oneself.” (Int 8) | |
| Provider assumptions | “I think they should have that same regard for everybody. Then they wouldn't have to worry about making exceptions or treating us differently. They would have that regard and respect for everyone…If it's good for people who've been abused, it's good for everyone. It's a win-win situation. Everybody would benefit.” (Int 6) |
| “Every doctor whether you've been abused or not should take time to listen, to ask certain questions, how they're feeling. Develop a bit more rapport… The whole tenet of compassionate care.” (Int 12) |