Peter Heathcote

The supportive care needs of men with prostate cancer (2000)

The diagnosis and subsequent treatment of prostate cancer is followed by a range of significant disease specific and iatrogenic sequelae. However, the supportive care needs of men with prostate cancer are not well described in the literature. The present study assesses the supportive care needs of men with prostate cancer who are members of prostate cancer self‐help groups in Queensland, Australia. In all, 206 men aged between 48 and 85 years (mean=68) completed the Supportive Care Needs Survey (SCNS) (62% response). The SCNS is a validated measure assessing perceived need in the domains of psychological needs, health system and information needs, physical and daily living needs, patient care and support, and sexuality. Items assessing need for access to services and resources were also included.

Making decisions about treatment for localized prostate cancer.

Objective To describe the decision‐making processes used by men diagnosed with localized prostate cancer who were considering treatment.

Adverse effects of androgen-deprivation therapy in prostate cancer and their management

To provide an up‐to‐date summary of current literature on the management of adverse effects of androgen‐deprivation therapy (ADT).

Development of Indicators to Assess Quality of Care for Prostate Cancer

BACKGROUND The development, monitoring, and reporting of indicator measures that describe standard of care provide the gold standard for assessing quality of care and patient outcomes. Although indicator measures have been reported, little evidence of their use in measuring and benchmarking performance is available. A standard set, defining numerator, denominator, and risk adjustments, will enable global benchmarking of quality of care. OBJECTIVE To develop a set of indicators to enable assessment and reporting of quality of care for men with localised prostate cancer (PCa). DESIGN, SETTING, AND PARTICIPANTS Candidate indicators were identified from the literature. An international panel was invited to participate in a modified Delphi process. Teleconferences were held before and after each voting round to provide instruction and to review results. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Panellists were asked to rate each proposed indicator on a Likert scale of 1-9 in a two-round iterative process. Calculations required to report on the endorsed indicators were evaluated and modified to reflect the data capture of the Prostate Cancer Outcomes Registry-Australia and New Zealand (PCOR-ANZ). RESULTS AND LIMITATIONS A total of 97 candidate indicators were identified, of which 12 were endorsed. The set includes indicators covering pre-, intra-, and post-treatment of PCa care, within the limits of the data captured by PCOR-ANZ. CONCLUSIONS The 12 endorsed quality measures enable international benchmarking on the quality of care of men with localised PCa. Reporting on these indicators enhances safety and efficacy of treatment, reduces variation in care, and can improve patient outcomes. PATIENT SUMMARY PCa has the highest incidence of all cancers in men. Early diagnosis and relatively high survival rates mean issues of quality of care and best possible health outcomes for patients are important. This paper identifies 12 important measurable quality indicators in PCa care.

Does teaching affect outcome with major open surgery

The Royal Australasian College of Surgeons has introduced surgical education and training (SET) with the aim of streamlining and thus reducing the duration of surgical training.1 As a consequence, it is possible that trainees will enter specialist training at an earlier stage in their career with limited experience and exposure to all aspects of surgery and with less time to acquire technical surgical skills. Current operative teaching is a combination of a modular curriculum and an apprenticeship model whereby mentors teach skills to help the trainee’s gain competency in all components of core operative procedures. Effective training requires not only observation and assistance during surgery but also the opportunity to be actively involved. Appropriate supervision must be available to ensure no compromise to patient safety. Furthermore, operative outcomes have become subject to increasingly rigorous scrutiny and public expectation that may potentially influence training opportunities. Wide-ranging resources are now available as adjuncts to surgical training outside of the operating theatre. These include animal and cadaver workshops, inanimate bench models, computer-based learning and most recently virtual reality stimulators.2 An ongoing challenge is to match the appropriate resource to a particular skill being taught. These resources need to serve training needs and should occur within a sound educational framework.3 Although these resources have an evolving role, they cannot replace direct ‘hands on’ experience, which accommodates the numerous anatomical and pathological variations that exist in surgical practice. Operative competence implies the ability to carry out the operation in its entirety. Successful surgery incorporates both technical and cognitive abilities. Early identification of strengths and weaknesses in an individual trainee provides efficiency in training by maintaining a positively accelerating trajectory in acquiring competency.4 Mentor and trainee fatigue can both compromise surgical training. Focusing on all components of a procedure within a teaching environment can be difficult, particularly in the later stages of an operation and may prolong operating time. Most complex important surgical procedures may be defined by several steps, all of which are critical to the success of the operation. Published work in surgical education supports acquiring surgical expertise through deliberate practice, whereby the trainee focuses on a defined task rather than undirected time spent within the operating theatre.5 Improvements in performance occur when clear objectives and focused practice on defined tasks are combined with immediate correction and feedback.6 Urological surgery, like most other surgical specialties, requires a diverse set of skills, including endoscopic, laparoscopic and open techniques. As a consequence of this evolving diversity, the acquisition of operative skills in particular is becoming increasingly difficult to achieve within current training programmes. To address these issues, we developed a structured modular operative teaching programme for radical retropubic prostatectomy (RRP) similar to a model by Stolzenburg et al.7,8 (Table 1). By carrying out selected components of the operation, each module establishes a clearly defined objective for the trainee. The number of components an individual trainee carries out per procedure is variable and depends on the trainee’s experience and progress throughout his/her rotation in a particular post. Because of anatomical and time considerations, not all components are always carried out by the trainee in consecutive order of degree of difficulty or by operation sequence. When the trainee carries out more advanced components, particularly when these are in the later stages of an operation, the consultant surgeon carries out components of lesser difficulty. Thus, the trainee is not distracted or fatigued by preliminary steps, providing them with the best opportunity to meet the specific objectives of the task. In our experience, a first-year advanced trainee (SET three equivalent) carries out four components per operation not exceeding difficulty grade 3. A second-year advanced trainee carries out nine components of all grades with the consultant surgeon completing lower degree of difficulty components to maintain operative momentum. Our modular teaching programme for RRP has now been incorporated into training in a private practice setting. In all specialties, many important procedures because of their elective nature are more commonly carried out within the private sector compared with public hospitals, which are overburdened by trauma and emergency surgery. Eighty per cent of RRP are carried out within private hospitals.9 Using trainees in this setting provides an opportunity to enhance trainee exposure and experience in both RRP and open surgery. To evaluate any compromise in patient or economic needs, after 12 months of follow up, we have independently and prospectively collected and compared 75 consecutive RRP carried out by a single consultant urologist and the remaining 63 RRP carried out involving a urological trainee following a modular operative framework. Preoperatively, patients are counselled regarding the K. Gray MB BS; P. HeathcoteMB BS, FRACS (Urol); D. Nicol MB BS, FRACS (Urol).

MP18-11 EXPLORING THE CLINICAL UPTAKE AND USE OF PSMA PET MRI HYBRID IMAGING IN PROSTATE CANCER PATIENTS AT AN ACADEMIC CENTER IN AUSTRALIA

planar scintigraphies was carried out by a twin head gamma camera (Siemens, ECAM and Symbia S) and indirect body contouring. Additionally, we subsequently performed SPECT/CT of the abdomen und inguinal regions using a twin-head hybrid camera system (Siemens Symbia T and Symbia Intevo). Imaging data of both modalities were prospectively evaluated by two experienced physicians in consensus reading in 52 groins of 26 patients with this tumor entity. RESULTS: A total of 71 SLNs in 37 groins were identified by planar scintigraphy. Non-visualization was observed in 15 (28.8%) inguinal basins using planar scans. 82 SLNs in 42 groins were detected by SPECT/CT (non-visualization in 10 (19.2%) groins). SPECT/CT revealed 8 inguinal hotspots as shown by planar imaging in 7 groins as false positive. 19 inguinal SLNs in 16 groins were missed on planar imaging and could be detected by SPECT/CT only. In contrast to 2D planar scintigraphy, SPECT/CT allowed to determine the precise anatomical localization of the SLNs in all 42 groins. CONCLUSIONS: SPECT/CT is capable of detecting SLNs missed by planar imaging, it reduces the number of false positive findings and shows the morphological location of SLNs more accurately. If available, SPECT/CT should be used for preoperative SLN imaging in penile cancer patients with non-palpable inguinal lymph node status.