Daniela Wittmann

Patient Preoperative Expectations of Urinary, Bowel, Hormonal and Sexual Functioning Do Not Match Actual Outcomes 1 Year After Radical Prostatectomy

PURPOSE We studied patient expectations of post-prostatectomy recovery from urinary incontinence, and urinary irritable, hormonal, bowel and sexual function symptoms after preoperative counseling. MATERIALS AND METHODS Patients undergoing radical prostatectomy, recruited between June 2007 and November 2008, were extensively counseled preoperatively regarding expected outcomes. They were assessed at baseline and 1 year after surgery using the short form of the Expanded Prostate Index Composite. Their baseline expectations of functional outcomes 1 year after surgery were assessed using the Expanded Prostate Index Composite-Expectations. Pearsons correlation coefficient and a multiple linear regression were used to assess the associations between Expanded Prostate Index Composite-Expectations and Expanded Prostate Index Composite-Short Form at baseline and 1 year. RESULTS A total of 152 consenting patients completed all questionnaires. Baseline sexual function score predicted significantly expectations of sexual function (p<0.0001) and urinary incontinence (p<0.0001) scores. Expanded Prostate Index Composite-Expectations predicted Expanded Prostate Index Composite-sexual function at 1 year (p<0.0001). Of the patients 36% and 40% expected the same as baseline function at 1 year in urinary incontinence and sexual function, respectively, and 17%, 45%, 39%, 15% and 32% expected worse than baseline function at 1 year in urinary incontinence, urinary irritable symptoms, bowel function, hormonal function and sexual function, respectively. One year after prostatectomy fewer than 22% of patients attained lower than expected urinary irritable symptoms, and bowel and hormonal function. However, 47% and 44% of patients attained lower than expected function for urinary incontinence and sexual function, respectively. Surprisingly 12% and 17% of patients expected better than baseline urinary incontinence and sexual function at 1 year after surgery. CONCLUSIONS Men have unrealistic expectations of urinary and sexual function after prostatectomy despite preoperative counseling. We hypothesize potentially responsible psychological mechanisms. These data provide a baseline for further preoperative educational interventions.

A Pilot Study of Potential Pre-operative Barriers to Couples’ Sexual Recovery after Radical Prostatectomy for Prostate Cancer

Prostate cancer affects couples’ sexual intimacy, but men rarely use recommended proerectile aids. This mixed-methods study aimed to identify couples’ preprostatectomy barriers to sexual recovery. Interviews about anticipated sexual recovery were paired with surveys: the Dyadic Assessment Scale, the Protective Buffering Scale, the Expanded Prostate Cancer Index Composite, the Sexual Experience Questionnaire (men), and the Female Sexual Function Index. Potential barriers were derived using Grounded Theory. Quantitative data triangulated qualitative findings. Heterosexual couples (N = 28) participated. Mens average age was 62 years and their partners’ average age was 58 years. Preexisting and diagnosis-related barriers included aging-related sexual dysfunction, inadequate sexual problem-solving skills, stressors, worry, avoidance of planning for sexual recovery, and dislike of artificially assisted sex. Participants endorsed moderate/high marital satisfaction (DAS: for men, M = 110.0, SD = 11.4; for partners, M = 114.1, SD = 12.1) and communication (PBS: for men, M = 24.5.2, SD = 6.1; for partners, M = 25.1, SD ± 6.2). Men reported mild erectile dysfunction and incontinence (EPIC sexual function M = 76.6, SD = 21.5, urinary incontinence M = 88.4, SD = 18.2). Mens couple sexual satisfaction was lowest (Sexual Experience Questionnaire: M = 60.1, SD = 26.9). Mean total Female Sexual Function Index was low (M = 21.6, SD = 7.8). Heterosexual couples face prostatectomy-related sexual side-effects having experienced developmental sexual losses. Couples use avoidant strategies to defend against worry about cancer and anticipated prostatectomy-related sexual changes. These potential barriers are modifiable if couples can learn to cope with sexual losses and accept sexual rehabilitation strategies.

Similarities and differences between children with asthma wnd children with cancer: Implications for preventive intervention

A substantial increase in the prevalence of chronic health conditions among children in the U.S. has led to growing concern with preventing the psychosocial and economic problems engendered by such illness. This exploratory study examined the validity of the recently proposed non-categorical approach to physical illness versus the traditional disease-specific perspective as the basis for the content and organization of preventive services for children with chronic illness. No significant disease-specific differences were found in measures of psychological and social adaptation between children with asthma and children with cancer, lending support to a non-categorical approach to the provision of preventive services.A substantial increase in the prevalence of chronic health conditions among children in the U.S. has led to growing concern with preventing the psychosocial and economic problems engendered by such illness. This exploratory study examined the validity of the recently proposed non-categorical approach to physical illness versus the traditional disease-specific perspective as the basis for the content and organization of preventive services for children with chronic illness. No significant disease-specific differences were found in measures of psychological and social adaptation between children with asthma and children with cancer, lending support to a non-categorical approach to the provision of preventive services.

Aging Sexuality: Knowledge and Perceptions of Preparation Among U.S. Primary Care Providers

Primary care providers are expected to address the sexual health concerns of older adults. This study aimed to assess knowledge of aging sexuality and adequacy of formal sexual health education in a sample of U.S. physicians and nurse practitioners in primary care. Response rate was 24.9% (N = 278). Knowledge scores reflected good knowledge; however, only 3% of the sample felt that they had adequate knowledge of older adult sexuality. Training was found to be adequate for 11% of the sample. U.S. providers in primary care are interested in learning more about aging sexuality but feel ill-prepared for it.

Quality of life and satisfaction among prostate cancer patients followed in a dedicated survivorship clinic

Integrating quality‐of‐life (QOL) outcomes into clinics may assist providers in identifying and responding to problems experienced by cancer survivors. To date, however, patient‐reported outcomes (PROs) such as QOL are used infrequently to guide care. We integrated QOL assessments into a prostate cancer survivorship clinic and compared recovery and satisfaction among men managed in the survivorship clinic with those followed with more routine care.

Multilingual Self-Management Resources for Prostate Cancer Survivors and Their Partners: Results of a Long-Term Academic-State Health Department Partnership to Promote Survivorship Care

OBJECTIVE To provide innovative, evidence-based self management information and supportive care for prostate cancer survivors and their partners. We describe how an academic-public partnership facilitated the broad dissemination of evidence-based, multilingual survivorship educational materials via a state-managed prostate cancer website. METHODS We outline the steps of an academic-public partnership leading to dissemination of online, survivorship materials as a resource for prostate cancer survivors and their partners. We examined the 5-year utilization of the materials from January 2011 to December 2015 according to 14 content areas (e.g., urinary, bowel, and sexual problems, fatigue, communication, cancer stress) and across 3 languages (English, Spanish, Arabic). RESULTS The total number of prostate cancer survivorship materials downloaded from January 2011 to December 2015 was 89,348. The number of downloaded materials increased over time from 6,421 in 2011 to 17,496 in 2015. The most commonly downloaded content area was urine problems (27.5%), followed by bowel problems (23.4%) and sexual side effects (16.2%). The majority of downloaded materials was in English (86.3%), followed by Spanish (9.8%) and Arabic (3.9%). CONCLUSION The academic-public partnership facilitated broad dissemination of evidence-based informational materials for prostate cancer survivors and their partners through a state-managed website from 2011 to 2015. Given the increasing role of academic-public partnerships in funding and development of robust, sustainable prostate cancer survivorship resources, this work serves as an introduction to these evidence-based materials and highlights a successful model of engagement between practitioners, research scientists, and public health administration.

Providing prostate cancer survivorship care in Japan: Implications from the USA care model.

Despite an increasing number of prostate cancer survivors in Japan, the current delivery of prostate cancer survivorship care is insufficient and lacks a multidisciplinary approach. We carried out a study to characterize prostate cancer survivorship care in Japan, examine the Japanese workforce available to deliver survivorship care, introduce a conceptual framework for survivorship and identify opportunities to improve Japanese survivorship care. We systematically searched PubMed for prostate cancer survivorship care studies, including those from Japan. We also searched the internet for prostate cancer guidelines relevant to survivorship care. We found 392 articles, of which 71 were relevant, read in detail and reported here. In Japan, survivorship care is mostly provided by urologists. Primary care as a specialty does not exist in Japan, and there are no independent nurse practitioners or physician assistants to assist with survivorship care. Japanese quality of life studies characterize the long‐term effects of prostate cancer treatment, but routine use of patient‐reported outcomes is not common in Japan. In the USA, in light of a growing comprehensive awareness of challenges facing survivors and their providers, the American Cancer Society prostate cancer survivorship care guidelines serve as a tool for optimizing the management of long‐term treatment effects and coordination of care. In order to deliver high‐quality survivorship care in Japan, urologists need to establish collaborations with other disciplines within the delivery system. A multidisciplinary guideline for prostate cancer survivorship care in Japan appears warranted.

Developing and sustaining a practice-based research infrastructure in a hospital social work department: Why is it important?

ABSTRACT The future of hospital social work departments depends on their ability to demonstrate their effectiveness, efficiency, and consequently, their value to their host organizations. In order to demonstrate and enhance social work’s contribution, research activities of various kinds must be encouraged. These include research consumption as well as production and utilization by clinicians, supervisors, managers, and administrators. The authors sought to develop a sustainable research environment in a large social work department of an academic health system. Continued work is needed to understand practice-research “best practices” within hospitals and how to ensure their sustainability within an ever changing health care environment.

Re: Neil E. Martin, Laura Massey, Caleb Stowell, et al. Defining a Standard Set of Patient-centered Outcomes for Men with Localized Prostate Cancer. Eur Urol 2015;67:460–7

In a recent European Urology article, Martin and colleagues [1] defined a minimum data set for localized prostate cancer to guide treatment and survivorship care. This is a critical step for improving prostate cancer care across the globe. The data set includes a patient-reported outcome measure, the Expanded Prostate Cancer Index Composite-Short Form (EPIC). Following EPIC scores over time is important because the measure provides feedback about patient outcomes and documents the effects of treatments for localized prostate cancer and their impact on fundamental patient outcomes. However, the use of only the EPIC and a few other sexual health questions in the standard set limits patient-reported health assessment in survivorship. From a patient perspective, much more than functional status contributes to well-being, such as the actual impact of survival and treatment-related toxicities on the self-reported ability to confidently manage symptoms after treatment, and how patients manage fear of prostate cancer recurrence. In their Letter to the Editor, MacLennan and colleagues [2] recommend giving equal weight to the preferences of patients and health care professionals in the choice of outcomes to be measured. We agree with this approach as described below. Measuring patient-reported outcomes has become highly prevalent in health care on the basis that patients are the best reporters on their own quality of life. However, what we measure under this rubric is not always related to what matters to patients and may not inform patient-centered care. Little and colleagues [3] found that patients in primary care endorsed three main patient-centered preferences: communication, partnership, and health promotion. This suggests a desire for mutual understanding between health care providers and patients about what is meaningful about the disease, its treatment, and healthful outcomes. The best use of patient-reported outcomes in prostate cancer survivorship will guide care suitable to meet survivors’ needs. We therefore endorse the

Telemedicine and prostate cancer survivorship: a narrative review

Prostate cancer survivors have unique needs that encompass diagnosis and treatment-related side effects. The provision of services for prostate cancer survivors is often limited by resources, time constraints in traditional clinic visits, payment, and patient and provider comfort with discussion of sensitive topics including sexual and urinary health, both of which are largely impacted by treatment. Telemedicine, the remote delivery of health care services using telephone, mobile, web, and video platforms, allows for potential cost savings, in addition to ease and comfort as patients can engage in telemedicine-based resources in the comfort of their homes. Furthermore, survivors prefer to seek information online making telemedicine approaches for prostate cancer survivorship care an ideal combination. A majority of the telemedicine-based interventions used the web, followed by telephone, mobile, and video platforms. In limited studies, telemedicine delivery of survivorship care has equal efficacy to traditional care delivery. In addition, although older patients did not use the Internet regularly, they were willing to adapt to Internet usage if it had the potential to increase their quality of life. Telemedicine delivery of prostate cancer survivorship care is acceptable, feasible, cost-effective, and potentially preferred by prostate cancer survivors. Additionally, it emphasizes knowledge, self-management and self-monitoring serving to increase self-efficacy. This specialized care allows for greater access and reaches a wider catchment area compared to traditional clinic visits. This is especially important as the number of prostate cancer survivors increases and healthcare systems incorporate alternatives to traditional in-person care.