communication & sensitive topics

What are sensitive topics in healthcare?

Sensitive topics include bowel & bladder function, mental health disorders, trauma & abuse, substance abuse, and sexual health. 

Why are sensitive topics challenging for providers?

HCPs often feel discomfort, lack training, or fear making patients uncomfortable. Many believe patients prefer to initiate these conversations. 

Why are sensitive topics not as uncomfortable for patients as HCPs think?

Patients are more comfortable discussing sensitive topics than HCPs assume and often prefer the provider to initiate. 

What is the “comfort gap”?

A mismatch: HCPs think patients don’t want these conversations, but patients do—they are just afraid the provider is uncomfortable. 

What are the four steps to approaching sensitive topics?

Prepare, Environment, Explain, Consent. 

What does “Prepare” involve?

Reflect on your assumptions, beliefs, biases, gender-based comfort differences, and comfort using anatomical/sexual terms. 

What assumptions commonly affect these conversations?

Assumptions about sexual activity, partner status, sexual orientation, and patients’ knowledge of anatomy. 

Percentage of adults age 65–80 reporting sexual activity?

Up to 40%, depending on the population (interactive slide question). 

Why is environment important when discussing sensitive topics?

Privacy, comfort, and safety influence a patient’s willingness to share sensitive information. 

Why should providers explain why they ask sensitive questions?

It increases patient comfort and shows questions are for whole-person care, reducing disparities and improving outcomes. 

What does the “Explain” step involve?

Clarifying why information is needed and how it helps guide treatment and care quality. 

What does “Consent” require?

Respecting the answer, being mindful of environment, avoiding judgment/surprise, giving permission to end the conversation, and thanking them. 

Why is patient information valuable?

It guides action: referrals, treatment planning, and individualized care. 

Terms clinicians should be comfortable using

Penis, vagina, vulva, clitoris, bladder, intercourse, penetration, feces, constipation, diarrhea, etc. 

Goal of sensitive-topic communication

Deliver whole-person care, reduce disparities, build trust, and improve outcomes.