Karl Witty

Patients' Experiences of Penile Cancer

Penile cancer is a rare but destructive disease in Western populations. In the United Kingdom, penile cancer accounts for <1% of all new cases of cancer and <1% of deaths due to cancer every year (see Table 1). [Table 1] Surgical removal of the cancer is the primary form of treatment. This involves surgical excision of the primary tumour and of involved inguinal lymph nodes. Chemotherapy and radiotherapy are rarely helpful, with their use restricted either to adjuvant use or for palliative treatment of extensive disease. In treating the primary tumour, the standard of care is to provide a surgical cure (ie, excising the tumour and a margin of normal penile tissue) while maintaining the function of the penis. The traditional view was that at least a 2-cm margin of normal tissue should be removed, but recent publications suggest that more conservative surgery may be safe [1], and [2]. The advantage of such organ-preserving surgery is intuitively advantageous to the patient in that penile function can be better preserved, but the evidence to support this view is limited at present.

The impact of surgical treatment for penile cancer – Patients' perspectives

PURPOSE OF THE RESEARCH Penile cancer is a rare but highly treatable condition. Whilst over 80% survive for over five years, treatment can have a significant impact on quality of life. There has been little research conducted to date on mens experiences of treatment for penile cancer. The Patients Experiences of Penile Cancer study (PEPC) aimed to redress this shortfall by exploring mens experiences of surgical treatment for penile cancer. METHODS AND SAMPLE The study used a narrative history design in which data were collected using one-on-one semi-structured interviews. Maximum variation sampling was used to acquire the widest possible range of experiences. Twenty-seven interviews of around one hour were conducted with men with an average age of 63 years at diagnosis (range = 41-82). The data were analysed using constant comparison analysis. KEY RESULTS The physical impact of surgery was inter-connected with broader events in the lives of the men experiencing treatment. These experiences cover urinary function, sexual function and sexual relationships, healing and recovery, masculinity, mental well-being, coping and support. CONCLUSION A key area for the development of care is to devise and evaluate procedures for ensuring that men are well-informed about the extent and potential consequences of their treatment. Mens experiences of penile cancer surgery will be informed by a complex web interlaced with their broader lives, making it difficult for health professionals to judge how surgery will impact on a men presenting to them. Further research is required to ascertain the most appropriate strategies for rehabilitation of men experiencing penile cancer surgery.

‘Straight to the GP; that would be where I would go’: An analysis of male frequent attenders’ constructions of their decisions to use or not use health-care services in the UK

An important consideration that needs adding to discussions of patient choice and whether or not men are reluctant to use primary care services is that many frequent attenders are male. The aim of this article is to explore how male frequent attenders construct decisions to use or not use health-care services. This is achieved through secondary analysis of baseline interviews with male frequent attenders from the Self Care in Primary Care study. As this was a complex study, a three-step analytic process was employed to incorporate the involvement of multiple researchers working together over a number of years. First, the interviewer summarised each interview and second, the summaries were read as a group to find themes across them. Subsequently, we returned to the interviews to add detail that would further illustrate or challenge the analysis. Participants talked of ‘engaging health and avoiding ill-health’, constructing themselves as embodied, health conscious and rational in a similar vein to constructions of feminine interactions with health. While participants talked of ‘choosing health services’ as if they were drawing upon a range of choices, the dominance of the image of the GP was such that seeing a GP was the only legitimate health choice.

Engaging men with penile cancer in qualitative research: reflections from an interview-based study

AIM To explore the challenges of engaging men with penile cancer in qualitative interview research. BACKGROUND Qualitative interviewing offers an ideal tool for exploring mens experiences of illness, complementing and providing context to gendered health inequalities identified in epidemiological research on men. But conducting interviews with men can be challenging and embarking on a qualitative interview study with males can feel like a daunting task, given the limited amount of practical, gender-sensitive guidance for researchers. Reflecting on a researchers experience of conducting qualitative research on men with penile cancer, this paper explores the potential challenges of interviewing this group, but also documents how engagement and data collection were achieved. REVIEW METHODS This is a reflective paper, informed by the experiences of a male researcher (KW) with no nurse training, who conducted 28 interviews with men who had been treated for penile cancer. The researchers experiences are reported in chronological order, from the methodological challenges of recruitment to those of conducting the interview. IMPLICATIONS FOR PRACTICE/RESEARCH The paper offers a resource for the novice researcher, highlighting some advantages and disadvantages of conducting qualitative interview research as a nurse researcher, as well as recommendations on how to overcome challenges. CONCLUSION Engaging men with penile cancer in qualitative interview raises practical, methodological, ethical and emotional challenges for the researcher. However, when these challenges are met, men will talk about their health. Methodological procedures must enable an open and ongoing dialogue with clinical gatekeepers and potential participants to promote engagement. Support from colleagues is essential for any interviewer, no matter how experienced the researcher is.

'It's coming at things from a very different standpoint': evaluating the 'Supporting Self-Care in General Practice Programme' in NHS East of England.

AIM To undertake a service evaluation of the NHS East of England Supporting Self-Care in General Practice programme. BACKGROUND The number of people purported to live with long-term conditions continues to rise generating increasing policy emphasis on the importance of self-care. Previous work has highlighted barriers to implementing self-care interventions in general practice, including a lack of organisational approaches to providing self-care and limited engagement and training of healthcare professionals. In response to these barriers and policy drivers, NHS East of England Strategic Health Authority developed and commenced the Supporting Self-care in General Practice (SSCiGP) programme, which seeks to transform the relationships between people with long-term conditions and primary care practitioners. METHODS This was a mixed methods study, carried out over two phases, which included interviews, survey work and practice-based case studies. RESULTS This paper focuses on findings related to clinician and practice level change. Clinicians reported changes in their perceptions and in consultation practices following attendance on the SSCiGP programme. These changes were linked to empathy and patient-centredness that mirrored what patients valued in interactions with clinicians. There were qualitative and descriptive differences, but no statistically significant differences between clinicians who had and had not attended the SSCiGP programme. Time was recognised as a significant barrier to implementing, and sustaining skills learnt from the SSCiGP programme. Greater impact at practice level could be achieved when there was whole practice commitment to values that underpinned the SSCiGP programme. There was evidence that such approaches are being incorporated to change practice systems and structures to better facilitate self-care, particularly in practices who were early programme adopters. CONCLUSION This evaluation demonstrates that training around clinician change can be effective in shifting service delivery when sat within a cultural framework that genuinely situates patients at the centre of consultations and practice activity.

An evaluation of a toothbrushing programme in schools

Purpose – The purpose of this paper is to assess the effectiveness of a toothbrushing intervention delivered in primary schools in Yorkshire and the Humber, a Northern district of England. The toothbrushing intervention was designed with the intention of improving the oral health of young children. The paper reports the effectiveness of the intervention and explores process issues related to its co-ordination and delivery. Design/methodology/approach – The evaluation had three data gathering approaches. These were: in-depth case studies of three selected schools participating in the toothbrushing programme; interviews with oral health promoters responsible for the programme in the district; and a small scale questionnaire-based survey which was sent to the 18 schools participating in the intervention. Findings – The intervention was accepted by children and they enjoyed participating in the toothbrushing scheme. Children had often become more knowledgeable about toothbrushing and the consequences of not regularly cleaning their teeth. The scheme was contingent on key staff in the school and the programme was more successful where schools embraced, rather than rejected the notion of improving childrens health alongside educational attainment. Whether the intervention made differences to brushing in the home requires further investigation, but there is a possibility that children can act as positive “change agents” with siblings and other family members. Practical implications – This paper suggests that schools can be an effective setting for implementing toothbrushing interventions. Originality/value – Toothbrushing in schools programmes are a relatively new initiative that have not been fully explored, especially using qualitative approaches or focusing on the views of children. This paper makes a particular contribution to understanding the process and delivery of toothbrushing interventions delivered in primary schools. The implications for programmes outside of the UK context are discussed.

Helping men cope with penile cancer

Because penile cancer is rare, affected men are unlikely to meet anyone outside their clinical team who has had direct or indirect experience of their cancer. Resources about the condition and the experiences of other patients will help men learn how to adapt to the changes that they will experience. Alongside …