On Wednesday, May 29, 2019, I conducted an in-person interview with my 76-year-old grandfather. My grandfather suffers from Heart Disease, COPD, and Peripheral Artery Disease. My grandfather has been a smoker since he was twenty years old and used to be very active. Since his diagnosis, he had been able to remain fairly active, until last summer when he had to have a partial amputation of his right foot. The amputation was due to his peripheral artery disease. My grandfather still lives on his own, but he now walks with a cane and is only semi-active.
Prior to sitting down to interview my grandfather, I conducted background research on the chronic illnesses he has, as well as gather some pertinent information from my mom. In my research, I looked at the pathophysiology of the diseases, as well as some of the common symptoms so I was better prepared to address the concerns of my patient.
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Heart Disease is associated with the development of heart failure, which my grandfather now has. Heart Disease is the leading cause of death for men and women in the United States (CDC, 2017). Heart Disease, also known as cardiovascular disease generally refers to conditions that involve narrowed or blocked blood vessels that lead to heart attacks, chest pain, or stroke (Heart Disease, 2018). Common symptoms of heart disease include chest pain or tightness, shortness of breath, weakness or coldness in limbs, and pain in the jaw or neck.
COPD results from blockages of tubes in the lungs from swelling or excess mucus which can cause difficulty breathing. The sacs in the lungs called alveoli, become less flexible which can cause the airways to collapse, making it even harder to breathe normally. The main cause of COPD is smoking, but other factors such as dust, pollution, and chemicals can contribute (COPD, 2013). Symptoms of COPD include constant coughing, shortness of breath while completing daily activities, and the inability to take deep breaths.
Peripheral Artery Disease is a circulatory issue in which narrowed arteries reduce blood flow to the body’s limbs (PAD, 2018). People who develop peripheral artery disease usually don’t receive enough blood flow in their limbs, usually their legs to keep up with demand. The most common symptoms of PAD are leg pain and sores on the toes and feet that won’t heal.
For my interview, I used the PLISSIT model. Prior to asking any questions regarding sexuality, I just discussed my grandfather’s chronic illnesses with him and talk about some of the symptoms he experiences on a regular basis.
The PLISSIT model consists of four phases. The first phase of the model is the permission-giving phase. The permission-giving phase opens the discussion, to give the patient a safe space to discuss sexual concerns. For the permission-giving phase, I used the statement “It’s common for people with Heart Disease and COPD to experience difficulties regarding sexuality. I’m going to ask you some questions about this private aspect of your life; feel free to ask me questions in return.” to open the discussion. This allowed a platform for my grandfather to open up and discuss any concerns he was having with permission from me.
The next phase in the model is the limited information phase. During this phase I allowed my grandfather to open up and discuss his sexuality. During this phase, my role was to simply just listen as my grandfather told me about concerns he had and how his chronic illness affected his sexuality. My grandfather chose to focus on his physical appearance and self-efficacy, rather than the problems he may be having during intercourse. My grandfather stated that since he was diagnosed with chronic illnesses, he now feels weak and fragile. Due to his peripheral artery disease, he had to have a partial amputation of his right foot. He stated that he now feels “worthless, embarrassed, and cheated”. Since having his foot amputated he has had to cut back on activities he normally partakes in and finds that it takes more energy to get around and do things. He stated he gets tired and winded very quickly, so he often finds it easier to just sit inside and watch television, rather than go out to do things like mow the lawn or fish, which he loves to do.
The third phase in the model is the specific suggestion phase. In this phase, I explained to my grandfather how his chronic illness affects his body. I explained the side effects of each and gave him a little background in physiology to help enhance his knowledge of his diseases. I gave my grandfather some suggestions such as riding his four-wheeler to the pond rather than walking and taking breaks between doing things rather than trying to do them back to back. I explained to him that he was not worthless and that he was lucky that he only lost part of his foot because with his disease healing often takes a long time and many people lose more. I believe this helped him look at the brighter side of things.
The last phase in the PLISSIT model is the intensive therapy phase. During this phase, providers often refer patients to a sexual health specialist, therapist, or psychologist for more comprehensive support and guidance. Since I am not a medical professional and do not have any certifications, I directed my grandfather to other resources. I suggested that he discuss any problems or concerns that he has with his primary care provider and suggested that they look into motivational interviewing to help build his self-efficacy and hopefully set a plan to help him stop smoking.
After completing thorough research on COPD, Heart Disease, and Peripheral Artery Disease, and talking to my mom about my grandfather I felt as if I was well prepared to go into my interview. During the interview, I found it easy to discuss the background physiology and symports that come along with these diseases. I feel as if because of this knowledge my grandfather was a little more at ease going into this interview, knowing that I at least knew what I was talking about in regard to his diseases. Surprisingly, the easiest thing for me was being so close to the person I was interviewing. My grandfather has always been a big part of my life and I see him multiple times a week. He is one of my biggest supporters and I think this allowed me to be confident during the interview process.
Although sexuality is a broad term and encompasses many things such as biology, physical traits, beliefs, etc. my grandfather chose to only discuss concerns regarding physical traits and psychological traits such as how the disease made him feel. In the first week of class, we discussed barriers that prevent healthcare providers from discussing sexuality with clients, and I experienced several of them during my interview, including the patient feeling embarrassed and an age gap between the provider and the patient. My grandfather was born in 1943, nearly fifty-seven years before me. This created a large age gap between us, which before going into my interview I believe could be a problem. Another challenge I found during my interview was beliefs due to generations. I grew up in the 21st century, where sexuality became a topic that people discuss openly, and people are proud of who they are and what they believe in. When my grandfather was growing up, sexuality was not something that was openly discussed, and men and women didn’t even have equal rights. Due to this, I believe my grandfather was a little surprised by the topic of the interview which made it hard for him to open up and truly discuss the problems and concerns he was having regarding his sexuality.
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