For Teachers & Professionals

PEARLS model to talk about Sexuality

PEARLS is a method that doctors can use to communicate with patients. Whilst there are different approaches to speaking with and guiding patients, PEARLS offers a framework that addresses patients' feelings and emotions and the patient-doctor relationship. When talking about sexuality, openness is reported as a fundamental point. The PEARLS model provides a useful structure to facilitate open communication. Essential clinical competencies for communication about sexual health concerns also include the ability to initiate a direct and concise conversation about sexual health in a space that ensures privacy and comfort. For example, the health care practitioner and the patient should both be seated face-to-face with the patient clothed. The HCP should complete a brief sexual health history, discuss any concerns, and close the conversation with shared decision-making and a suggestion for a follow-up appointment to further assess and treat. Alternatively, the HCP can provide a referral to a sexual medicine expert or sex therapist who can address more complex concerns. 

PEARLS is an acronym that means:

P Partnership

E Empathy

A Apology/Acknowledgment

R Respect

L Legitimation

S Support

P for Partnership

According to different dictionaries, a partnership is defined as the state of being a partner, an agreement, and a relationship in which two or more people work together. In another sense, it is a working relationship where both parties are participating and are involved with each other. Partnership in terms of patient care shows the willingness to work with the patient in all areas of diagnosis, treatment and aftercare.

It is based on clear communication and cooperation, it is not the mere communication of what a clinician will do without any feedback and it is not about being clear about the possible and actual diagnoses, prognoses and treatment options by saying, for example, “I’m a doctor, you are the patient, so I know what is better”.

Examples of what reflects a good partnership are saying “whatever sexual problems you are having, we can work on them together” or “please feel free to tell me anything and everything that is going on with you, okay?", "what you say to me is confidential.”

A partnership should be established as early as possible, preferably at the start of the first meeting with a patient. It should always be continued throughout the relationship, whether it is short-term or long-term.

E for Empathy

There are different definitions of what is framed as empathy. Empathy is showing a shared sense of feeling; the ability to share and understand the feelings of another person. It is conveying to the patient that you understand them. Empathy is not showing pity, instead, it is 1) listening; 2) asking questions, avoiding “I” questions that put the attention on the clinician instead of the patient; 3) showing care and understanding.

Examples of things one can say are: “I understand that what you are going through is very depressing” or “Please take your time. I am here to listen to you”, “You are going to get better, and we are here to help”.

A for Apology

Acknowledge any wrongdoing. Apology and acknowledgement go hand in hand. When you say you are sorry, you are acknowledging a mistake that you or your institution has made regarding your patient’s care and/or experience. A mistake that is made by you – or by another member of the clinic or hospital staff – impacts the mental and physical well-being of the patient. Saying sorry might make the patient feel as if he or she will have more attention in the future. An example of a mistake is being late for an appointment. Simply saying “I'm sorry you had to wait so long to see me” is enough to make the patients feel validated if they experienced frustration in waiting.

R for Respect

Reflect and Reinforce. Acknowledge and validate what the patient is going through. Respect is the regard for the feelings, wishes, or rights of others. Using the patient’s name is the first and perhaps most important step. Ask them how they want to be addressed if you are not sure what to call them. This is true with cultures that rely on several different given names and surnames or ask for names and pronouns with people from the LGBT community. Another form of respect is respecting their fears and concerns. 

Show appreciation for the patient's proactive behaviours by saying things like, “You have obviously researched this problem quite well” or “You have obviously worked hard on this”. Avoid presumption and arrogance, even if you are at the top of your field: the patient is there for their problem, not for being in awe of you and deference to you.

Repeating is another way to show respect, if you repeat what you heard, it shows that you are listening. Use Filler words like “I see. Okay. I understand. Yes. Uh-uh”

L for Legitimation

Legitimate means able to be defended with logic or justification, valid. Legitimate means to be real. In other words, what the patient is experiencing is real, tangible, and needs addressing. Acknowledge the legitimacy of the complaint: “What you complain of is a real medical condition”. Reassure patients that their feelings are appropriate: “Anyone would be confused by this situation.” 

The patient may be hesitant to speak up about pain, discomfort or worry about a medical issue. Talking about sexual health issues might be more problematic. That’s why talking about sexuality, for example, while stating that the patient is not the only one experiencing that problem, validates what the patient is going through. An example of what can be said may be: “After the surgery, you might experience these symptoms. We will do everything we can to face them”. 

S for Support

Support is generally thought to be providing help to someone. Be there for someone. Help someone by doing something, offering something, or guiding someone.

In terms of the patient-centred approach, support here means providing not only physical support – treatment, hospitalization, surgery, medication, etc. – but also emotional and mental support. As a doctor, you can focus on the physical – tangible or visible – aspects of the condition. It is easy because there are standard procedures that you do not have to think about. When dealing with emotional support, it becomes more difficult because a doctor has to deal with more invisible things. Just telling patients that you are there to help them might be a great start. There are several other ways to convey support: listen, comfort, offer resources like videos or articles, smile, and visit the patient if they are in the hospital. Understandably, you will be busy. If you are a surgeon, you probably have several procedures to do and not enough time to meet everyone. But if you visit them, you’ll let them know that they are important and not just someone on their list of things to do. 

The PEARLS model is great for improving relationship-building skills and establishing the patient's trust.

REFERENCES

Home. (2018, December 5). YouTube. Retrieved September 23, 2022, from https://usmdpedia.com/patient-care-in-the-us/skills-for-patient-communication-pearls

Kingsberg S. A., Schaffir J., Faught B. M., Pinkerton J. V., Parish S. J.,  Iglesia C. B., Gudeman J., Krop J, Simon J. A. (2019). Female Sexual Health: Barriers to Optimal Outcomes and a Roadmap for Improved Patient–Clinician Communications Journal of Women's Health 28:4, 432-443