Carole Pinnock

A systematic review of psychosocial interventions for men with prostate cancer and their partners

OBJECTIVE To systematically review interventions aiming to improve adjustment in men with prostate cancer and their partners. METHODS Medline, EMBASE, CINAHL and PsycINFO databases were searched. Inclusion criteria were: randomized controlled trials; relevant to specified clinical questions; included men who had prostate cancer (at least 80% prostate cancer patients or prostate cancer sub-group analysis); published in English between December 1999 and December 2009. Trial quality was assessed. RESULTS 21 studies met inclusion criteria. Trial quality was low; had not improved over the study timeframe; men with advanced disease were not targeted; minority groups were seldom included. Group cognitive-behavioral and psycho-education interventions appear helpful in promoting better psychological adjustment and QOL for men with prostate cancer; coping skills training for patient-spouse dyads improved QOL for partners. CONCLUSION There are limitations in the research on effective ways to improve adjustment for men with prostate cancer of any stage and their partners; and scant research targeting minority groups and the concerns of men with advanced disease. PRACTICE IMPLICATIONS Interventions for men with advanced prostate cancer could usefully target the implications of advancing disease and caregiver burden. There is an urgent need for researchers to focus efforts specifically on such men and their families.

Older men?s concerns about their urological health: a qualitative study

While there has been widespread recent interest in mens health issues, and prostate cancer in particular, there have been tew studies to determine which issues are important from the viewpoint of men themselves. This study was undertaken to identify genitourinary issues of concern to older men. A series of 19 focus groups involved 137 men and 14 women from a broad demographic background. Men expressed consistent concern about urinary symptoms, prostate cancer and sexual function. They revealed misunderstanding and a desire for more information about all issues. Urinary symptoms had a high impact on quality of life that could be made worse by environmental constraints such as working conditions and availability of toilets. Prostate cancer was a concern in all groups, even those at low risk, and men believed that screening for prostate cancer should be offered. Men believed sexuality was not recognised as an issue of concern to older people. Potential barriers to health action included stoicism, not talking about health issues and poor relationships with doctors. The study suggests a substantial need for community and professional education and for health promotion focused on preventable morbidity.

Evaluating peer support for prostate cancer: the Prostate Cancer Peer Support Inventory

To develop and test a measure for assessing peer support for men attending prostate cancer support groups, and to describe socio‐demographic, medical and adjustment characteristics of Australian men who attend these support groups.

Does Evaluation With the International Prostate Symptom Score Predict the Outcome of Transurethral Resection of the Prostate

PURPOSE We determined the reliability of the International Prostate Symptom Score (I-PSS) in predicting the outcome of transurethral prostatectomy and, therefore, how useful it can be in patient selection for surgery. MATERIALS AND METHODS A prospective trial was done of 105 consecutive patients undergoing transurethral prostatectomy at our institution. Patients were assessed with the I-PSS before and 3 months after surgery. Flow rates and preoperative residual volumes also were measured. RESULTS There was significant postoperative improvement in all parameters of the symptom score and a change in symptom profile. Symptoms remaining with the greatest scores at 3 months postoperatively were frequency, urgency and nocturia. A significant correlation was found between I-PSS and quality of life before and after transurethral prostatectomy, and between postoperative improvement in flow rates and change in I-PSS. Patients with a greater preoperative I-PSS gained the most symptomatic benefit. The positive predictive value of a significant postoperative improvement of at least 7 I-PSS points depended on the preoperative I-PSS criteria applied. With a preoperative I-PSS of more than 17 the positive predictive value was 87% with a corresponding negative predictive value of 71%. CONCLUSIONS The preoperative I-PSS predicted a symptomatic improvement of more than 7 points with high sensitivity. The predictive value depends on the definition of significant improvement (magnitude of I-PSS change) and the level of I-PSS symptoms defined as sufficient to warrant transurethral prostatectomy.

Preoperative urodynamic and symptom evaluation of patients undergoing transurethral prostatectomy: analysis of variables relevant for outcome.

To assess the value of preoperative symptom score assessment and pressure‐flow measurement in men undergoing transurethral prostatectomy (TURP).

Clinicians’ attitudes to prostate cancer peer-support groups

To assess clinicians’ knowledge and attitudes to prostate cancer peer‐support groups, essential in improving support services for men with prostate cancer, as patients’ perceptions of their clinicians’ attitudes to such groups predict patients’ positive and negative perceptions of their experiences at such groups.

Prostate cancer testing in SA men: influence of sociodemographic factors, health beliefs and LUTS

This study investigates the prevalence and determinants of prostate cancer screening in the South Australian community. An interview‐based survey of a probability sample of the SA population (N=3,016) in 1995 addressed previous PSA testing, beliefs about vulnerability to prostate cancer and efficacy of screening, presence of uncomplicated lower urinary tract symptoms (LUTS) and sociodemographic variables. Of 736 men, 40 years and over with no history of prostate cancer, 24.7% (182/736) reported ever having had a test and 53.9% (397) reported an intention to test; 74% (547) agreed that prostate cancer could be cured if detected early, while only 14.9% (109) believed they were unlikely to suffer from prostate cancer. In a logistic regression model, visit to a doctor for (but not presence of) LUTS was a strong, independent predictor of participation in PSA testing (OR 9.0, 95% Cl 5.0, 16.0). Beliefs, occupation and education were not. In a similar model examining intention to test, belief in vulnerability to prostate cancer was the strongest predictor (OR 3.32, 95% Cl 1.9, 5.9), followed by doctor visit for urinary symptoms. These data are consistent with widespread PSA testing and with seeking treatment for LUTS being a major determinant of previous testing. NHMRC Clinical Guidelines for LUTS recommend against PSA testing for investigation of uncomplicated LUTS. Implementation of those guidelines may therefore have a significant effect on PSA testing rates. Belief in personal vulnerability to prostate cancer remains a significant component of reported future testing, suggesting a focus for community education.

Meeting the information needs of Australian men with prostate cancer by way of the internet

OBJECTIVES To assess the information preferred by Australian men for a prostate cancer website, to establish such a website, and to assess whether the first 2 years of use of the website reflected those needs. Successful patient information programs must be relevant to the target groups needs. METHODS In phase 1, we surveyed Australian prostate cancer support group members asking for the preferred functions and content of an Australian website. In phase 2, a website was developed (http://www.prostatehealth.org.au) with the requested content derived from a urology service, state Cancer Councils, and medical directory and support group organizations. In phase 3, usage patterns of the site were analyzed using Web-Trends software for the first 2 years (2000 to 2002). RESULTS The phase 1 survey of 54 men (response rate 69.2%) showed the most preferred pages were understanding diagnosis/understanding treatment (59%), on-line help-line (49%), and news sections (44%) with listings of Australian support groups (22%). Credible, up-to-date Australian-oriented content was requested. In phase 2, the site developed had five searchable databases with requested medical content from a urology service, support group and treatment center listings, and an on-line help-line run by a cancer council. In phase 3, after 2 years of operation, the site averaged 150,000 hits and 15,000 page views per month, with 46% of visitors from Australian domains. Most visited sections closely followed the needs assessment. CONCLUSIONS Needs assessment is an important precursor to targeted web-based education programs. Nonmedical, community-based information is important to men with prostate cancer, as is information on diagnosis and treatment.

Attitudes to evidence-based practice in urology: results of a survey.

Background: The advantages of promoting evidence‐based care through implementation of clinical guidelines are well established. Clinical practice guidelines have been developed for lower urinary tract symptoms (LUTS) and prostate cancer screening. Aspects of the delivery of care by urologists or specialist registrars relevant to the guidelines were assessed.

Comparative analysis of three risk assessment tools in Australian patients with prostate cancer

Whats known on the subject? and What does the study add?