Assessing self-help issues for patients with prostate cancer, interstitial cystitis, erectile dysfunction and urinary diversion

"In My Mind, It Was Just Temporary": A Qualitative Study of the Impacts of Cancer on Men and Their Strategies to Cope

Individuals who are diagnosed and treated for cancer use a variety of strategies to manage its impacts. However, there is currently a lack of research on men's experience with managing cancer impacts, which is necessary to better support them throughout the cancer care continuum. This study explored the experience of men diagnosed with cancer, focusing on the impacts of the illness and its treatment and men's strategies to cope. A qualitative descriptive design was used. Thirty-one men (Mage = 52.7 [26-82] years) diagnosed with various cancer types were recruited to take part in individual telephone interviews (n = 14) or online focus groups (n = 17) addressing the impacts of cancer and strategies they used to cope with these impacts. Directed content analysis was performed, using Fitch's (2008) supportive care framework to guide the analysis. Cancer impacts and strategies used to cope were classified into six categories: physical, psychological, interpersonal, informational, practical, and spiritual. Results indicate that the cancer experience is diverse and multifaceted rather than homogeneous. Medical and supportive care services could be more effectively personalized to meet the diversity of men's needs by adopting a comprehensive and holistic approach to supportive care. Working in partnership with patients, it appears promising to recognize and identify men's needs and match them to appropriate resources to provide truly supportive care.

Evidence for benefits and risks of tadalafil as a non-prescription medicine: review and evaluation using the Group Delphi technique to achieve consensus amongst clinical experts

An evidence-based consensus meeting was held with urologists, a pharmacist and a cardiologist to perform a structured benefit-risk analysis of reclassifying tadalafil, a phosphodiesterase type 5 (PDE5) inhibitor for treatment of erectile dysfunction (ED), to be available without prescription in Germany. As per the Brass process endorsed by regulatory authorities, an evidence-based Brass value tree was developed, which identified the incremental benefits and risks that should be considered above the safety and efficacy evidence required for prescription medicines. During the Group Delphi consensus meeting, the expert panel rated the likelihood and clinical impact of each benefit and risk on a scale of 0 (none) to 3 (high). Overall attribute scores were calculated from the product of the mean likelihood and mean clinical impact scores giving a possible score of 0-9. The overall benefit attribute scores ranged from 2.8 to 5.4. The overall risk attribute scores ranged from 0.2 to 2.2 though most were 1.0 or less (3 or more is generally considered to be of concern). On balance, the independent meeting scored the benefits of reclassification of tadalafil higher than the risks and considered the risk mitigation strategies of the packaging label and patient information leaflet (PIL) sufficient.

Development of a Prehabilitation Multimodal Supportive Care Interventions for Men and Their Partners Before Radical Prostatectomy for Localized Prostate Cancer

BACKGROUND

An important question revolves around when the most opportune time is to introduce recovery-optimizing behaviors for men opting for radical prostatectomy (RP) for localized prostate cancer (PCa). An emerging field of research describes the role of preoperative strategies to improve treatment tolerance and overall physical and psychological recovery.

OBJECTIVE

The aim of this study was to explore the perceptions of a multimodal prehabilitation intervention for men and their partners before RP for localized PCa.

METHODS

Thirty-four patients who opted for RP for localized PCa and their partners (19) were identified and recruited into the study. The multimodal intervention was composed of educational materials, physiotherapy instruction, and a self-management group-based seminar.

RESULTS

The multimodal prehabilitation intervention was perceived as overall helpful with demonstrated acceptability (91.9%). Beneficial themes related to the quality of the information provided to support self-management, open forum questions with multidisciplinary healthcare professionals, and increased knowledge among partners to help with their understanding of how to look after their partners.

CONCLUSION

The intervention was feasible and beneficial for the PCa dyad. A future pilot randomized controlled trial study is needed to provide sufficient evidence on the long-term physical and psychological outcomes and cost-effectiveness.

IMPLICATIONS FOR PRACTICE

Oncology nurses play a key role in the development of prehabilitation care delivery. Prehabilitation interventions can have a positive effect on improving health outcomes for cancer patients and their partners after surgery and into survivorship.

What Are the Experiences of Men Affected by Prostate Cancer Participating in an Ecological Momentary Assessment Study?

BACKGROUND

Within the cluster of self-report methodologies, ecological momentary assessment (EMA) is a method used in health services research whereby a participant repeatedly reports on affect, behaviors, symptoms, and cognitions as they occur in real time in the participant's natural environment. However, little is known about the impact of participating in an EMA study on individuals' experiences who are affected by prostate cancer.

OBJECTIVES

The aims of this study were to explore the lived experiences of men affected by prostate participating in an EMA study and assess whether their participation in EMA alters their representation of their condition.

METHODS

Participants (n = 12) were purposively recruited from 2 university teaching hospitals in Scotland. Semistructured interviews were conducted with men affected by prostate cancer following the completion of EMA data collection. Data were analyzed using thematic analysis.

RESULTS

The lived experience of prostate cancer included 6 superordinate themes: isolation in the healthcare system, lack of shared care plans, informational support, coping with prostate cancer, fear of death and dying, and vocational rehabilitation. The organizing theme electronic diary as an intervention included 4 superordinate themes: changing self-management behaviors, habitual experience, changing perceptions, and diary in daily life.

CONCLUSION

We observed that men participating in the EMA study described several methodological complexities, which need to be addressed through future research.

IMPLICATIONS FOR PRACTICE

Importantly, there is a need for the health system to prioritize research and develop a more holistic approach to prostate cancer care in line with men's preferences and needs in the future.

[Shared decision-making in prostate cancer patients]

BACKGROUND

Shared decision-making (SDM) is becoming increasingly important in medical care. The relevance of SDM after diagnosis is especially noticeable in the care of prostate cancer patients, since affected patients can choose from different treatment strategies.

OBJECTIVES

What are the experiences of patients regarding SDM in the treatment of prostate cancer?

METHODS

Interviews with qualitative-exploratory study design were carried out and evaluated. The interviews were recorded with the help of audio tapes and literally transcribed and pseudonymized based on Kuckartz. The evaluation was done by theoretical coding according to Glaser and Strauss. This enabled the development of an object-based theory of interview data.

RESULTS

The study shows that all interviewees experienced SDM and were able to reflect on this process. The interviewed patients had a high level of information regarding their disease status and treatment options, in which individual preferences played a key role. Some patients saw potential for optimization in the physician-patient conversation, taking personal preferences into account.

CONCLUSIONS

Patients are not limited to medical information only, but have taken an active role in their treatment decision. Many of the participants consulted several physicians to obtain second opinions. Since the survey focuses on the patients' perspective, it remains unclear whether a joint exchange of information and decision-making has taken place from a medical point of view.

Identifying the self-management behaviours performed by prostate cancer survivors: a systematic review of the evidence

Purpose

Prostate cancer survivors are keen to engage as active partners in the management of their condition but have voiced a number of unmet support needs that make effective self-management problematic. Identifying self-management behaviours and evaluating how self-management changes over time may provide valuable insights into how men can be better supported to self-manage. Our systematic review aimed to identify the self-management behaviours for prostate cancer survivors and to evaluate whether these change over time.

Methods

Using the PRISMA statement we performed a systematic review of studies that identified the self-management behaviours of prostate cancer survivors. Databases searched included: DARE, CDSR, Medline, CINAHL, PsycINFO and ASSIA. Studies were classified by levels of evidence and quality assessment.

Results

111 publications were retrieved from the search and 5 publications were included. Men performed a variety of self-management behaviours for psychological and physical problems. Only one study assessed changes in self-management behaviours over time and was limited to men treated by radiotherapy.

Conclusion

Despite the recent political drive for cancer survivors to self-manage, this review has demonstrated the evidence base is under-developed and a wide range of research is needed to address the unmet supportive care needs of prostate cancer survivors. Practically, this review has identified that Dodd’s Self-Care Log was found to have the strongest psychometric properties for additional research in this area.

Men's and carers' experiences of care for prostate cancer: a narrative literature review

OBJECTIVE

To review studies of patients' and carers' experience of prostate cancer care.

DESIGN

Narrative literature review.

METHODS

Search strategies were developed for the following databases: MEDLINE (1966-2006), EMBASE (1980-2006), CINAHL (1982-2006) and PsycINFO (1987-2006). A search of SIGLE (System for Information on Grey Literature in Europe) was also undertaken. Experience was defined as patients' and carers' reports of how care was organized and delivered to meet their needs. A narrative summary of the included papers was undertaken.

RESULTS

A total of 90 relevant studies were identified. Most studies reported on experiences of screening, diagnosis, the treatment decision, treatment and post-initial treatment. Few studies reported on experiences of the stages of referral, testing, and further treatment and palliative care, and no studies reported on monitoring or terminal care.

CONCLUSIONS

Although some phases of care have not been investigated in detail, there is evidence that: (i) many patients have a low level of knowledge of prostate cancer; (ii) patients with prostate cancer and their carers need information throughout the care pathway to enable them to understand the diagnosis, treatment options, self-care and support available; and (iii) increasing patient knowledge and understanding of prostate cancer (e.g. through interventions) are often associated with a more active role in decision making (e.g. screening, treatment decision).

What it would take for men to attend and benefit from support groups after prostatectomy for prostate cancer: a problem-solving approach

Twenty-nine incontinent prostate cancer patients learned Pelvic Floor Muscle Exercises through biofeedback and were randomly assigned to a control group or a support group entailing six meetings over 3 months. The obtained consent rate (50%) is much higher than the previously reported rate for men (13%). The reasons for refusal were mainly due to actual barriers (48%) and less frequently due to psychological concerns (10.3%). Most support group participants (71.5%) attended five to six group meetings. The findings suggest that men are willing to attend support groups that focus on solving problems and that social supports help men improve continence and quality of life.

Sensory bladder disorders

Sensory bladder disorders include disorders involving abnormal sensations resulting from many diseases of the urinary bladder. In a proportion of patients no cause can be found and if pain or pelvic pressure is a part of the symptomatology, they are labelled as having painful bladder syndrome (PBS). In a subgroup of these patients abnormal findings can be demonstrated at cystoscopy and/or by histological examination of bladder biopsies. These patients are categorised as having interstitial cystitis (IC). This paper looks into the differential diagnosis, evaluation and treatment of patients with PBS.

An Improved Approach to Followup Care for the Urological Patient: Drop-in Group Medical Appointments

PURPOSE

To increase prompt access to routine office visits the concept of the group appointment was developed in the primary care setting. Drop-in group medical appointments have been piloted at our department. We hypothesized that 1) efficiency could be improved by seeing 6 to 14 patients at 1 appointment, 2) access to appointment times would increase and 3) patient satisfaction would be enhanced with 60 minutes of didactic contact and discussion with the urologist.

MATERIALS AND METHODS

Patients were invited to participate in a drop-in group medical appointment. Appointments were made based on sex and not on diagnosis. A 60-minute group teaching session was followed by a private 2 to 5-minute physical examination or further testing, as indicated. Confidential satisfaction surveys were administered to drop-in group medical appointment participants and patients seen at traditional individual (solo) appointments. Results were compared.

RESULTS

From September 22, 2003 to August 30, 2004, 279 patients attended a drop-in group medical appointment. Mean patient age was 63 years and 142 patients were 65 years or older. Most diagnoses were prostate cancer, erectile dysfunction, benign prostatic hyperplasia, incontinence, neurogenic bladder and chronic discomfort syndromes. Of the patients 287 were surveyed, including 177 at drop-in group medical appointments and 110 at solo appointments. Patient satisfaction with the drop-in group medical appointment format was as high as that of solo patients with 87% of drop-in group medical appointment patients rating their experience as excellent or very good vs 88% by solo patients.

CONCLUSIONS

Drop-in group medical appointments can be implemented successfully in a urological practice with high patient satisfaction despite the sensitive nature of topics discussed. Ideal patients are those with chronic or complex conditions and those requiring repetitive discussions, such as elderly individuals.

Interstitial cystitis: how should we diagnose it and treat it in 2004?

PURPOSE OF REVIEW

During the last 2 years, two international and two European meetings have taken place and a European Society formed dealing only with interstitial cystitis. A separate committee for interstitial cystitis was formed during the last WHO International Consensus Meeting on urinary incontinence. As a consequence, new concepts and recommendations are evolving, for example the nomenclature is changing from interstitial cystitis to painful bladder syndrome/interstitial cystitis.

RECENT FINDINGS

At an international meeting in Kyoto, the scientific basis for diagnosis and treatment of painful bladder syndrome/interstitial cystitis was reviewed, confirming the poor evidence for many diagnostic procedures and treatments. There are two main reasons for this: an internationally accepted definition is lacking and the disease is rare, making clinical trials difficult. A meeting in Copenhagen resulted in a standardization of the procedures for evaluation and the creation of a European Society for the Study of Interstitial Cystitis. Increased concentration of nitric oxide in the urine of patients with Hunner's ulcer may help to separate ulcer from non-ulcer patients. A prospective, randomized, placebo-controlled multicenter study failed to show a statistically significant effect of the antihistamine hydroxine or pentosan polysulfate sodium compared with placebo. The study confirmed the difficulties in recruiting patients for large-scale trials, which could be one of the reasons for the negative result. The effect of the traditional treatment with amitriptyline was confirmed in a prospective, placebo-controlled study.

SUMMARY

Standardized evaluation of patients with painful bladder syndrome/interstitial cystitis will benefit both patients and science. An internationally accepted definition of the condition appears to be in sight, which will make epidemiological and research studies easier.