Australian men’s long term experiences following prostatectomy: A qualitative descriptive study.
Thomas A Laws
Lecturer, Division of Health Science, School of Nursing and Midwifery, University of South Australia, Adelaide SA
Peter ‘Kevin’ O’Shaughnessy
Peter Kevin O’Shaughnessy
PhD Candidate
School of Nursing and Midwifery,
University of South Australia - City East Campus
ADELAIDE SA, Australia
PP: 98 - 109
Abstract
The experiences of men in the immediate postoperative period following surgery for prostate cancer are well reported in the literature. Recognition of the unresolved morbidity encountered in the medium term suggests that a better understanding of how men cope in the long term is needed. Health professionals are deserving of a more complete literature for the purpose of i) promoting informed consent ii) evaluating unresolved surgical morbidity and iii) supporting the acquisition of empathy for men living with the diagnosis of prostate cancer.
This qualitative study aims to describe men's long term recovery following prostatectomy and identify the effects of unresolved post surgical morbidity. Content analysis of focus group interviews revealed that incontinence and erectile dysfunction were a major source of emotional tension affecting the men's social interactions and sense of self-worth. The men expressed substantial regret over the lack information provided to them for evaluating the level of risk and nature of long term problems. The thick description gathered from this study identifies the need for empathetic assessment of men with ongoing post surgical issues and alerts the reader to the inadequacies of information provided prior to consent to prostatectomy.
Keywords
Prostate, Cancer, Prostatectomy, Nursing, Men, Qualitative, Long term, Focus group
References
Australian Bureau of Statistics (ABS) (2006) Cancer in Australia: A Snapshot, 2004-2005, 4822.0.55.001
AHRQ (2008) Comparative Effectiveness of Therapies for Clinically Localized Prostate Cancer: Executive Summary, Agency for Healthcare Research and Quality, February 2008 Pub. No. 08-EHC010-1.
AIHW (2008) Australia's Health 2008, Australian Institute of Health and Welfare, Australia
Albaugh J and Hacker E (2008) 'Measurement of quality of life in men with prostate cancer, Clinical Journal of Oncology Nursing Vol. 12, No. 1, pp. 81-86
American Cancer Society (2007) Cancer facts and figures. American Cancer Society, Atlanta.
Arora, NK McHorney CA (2000) Patient Preferences for Medical Decision Making: Who Really Wants to Participate? : Brief Report, Medical Care. March 2000, 38(3):335-341,
Baade PD Coory MD Aitken JF (2004) International trends in prostate-cancer mortality: the decrease is continuing and spreading, Cancer Causes Control 15 pp. 237-241.
Baade PD, Steginga SK, Pinnock CB, et al. (2005) Communicating prostate cancer risk : what should we be telling our patients? Medical Journal of Australia 182:472-475.
Bermejo C, Kristal A, Zeliadt S, Ramsey S and Thompson I (2004) Localized prostate cancer: Quality of life meets Whitmore's legacy, Journal of the National Cancer Institute, Vol. 96, pp. 1348-1349.
Bokhour B, Clark J, Thomas S, Silliman R and Talcott J 2001. Sexuality after treatment for early prostate cancer: Exploring the meanings of "erectile dysfunction, Journal of General Internal Medicine, Vol. 16, No. 10, pp.649-655
Britten N, Jones R, Murphy E, Stacey R 1995. 'Qualitative research methods in general practice and primary care,' Family Practice, Vol. 12, No. 1, pp.104-114.
Burns, S. M., & Mahalik, J. R. (2007) Understanding how masculine gender scripts may contribute to men's adjustment following treatment for prostate cancer. American Journal of Men's Health 1(4):250-261.
Burns SM & Mahalik J.R (2008) Sexual functioning as a moderator of the relationship between masculinity and men's adjustment following treatment for prostate cancer, American Journal of Men's Health 2 (1), pp. 6-16.
Burt J, Caelli K, Moore K and Anderson M (2005) Radical prostatectomy: men's experiences and postoperative needs, Journal of Clinical Nursing Vol. 14, pp. 883-890.
Butler L, Downe-Wamboldt B, Marsh S, Bell D and Jarvi K (2001) Quality of life post radical prostatectomy: a male perspective, Urologic Nursing Vol. 21, pp. 283-288.
Buston K, Parry-Jones W, Livingston M, Bogan A, Wood S. Qualitative research. British Journal of Psychiatry 1998; 172: 197 - 199.
Caelli, K., Ray, L., & Mill, J. (2003) Clear as mud: Toward greater clarity in generic
qualitative research. International Journal of Qualitative Methods 2(2): 1-24 Article 1.
URL: http://www.ualberta.ca/~iiqm/backissues/pdf/caellietal.pdf
Chambers S, Schover L, Halford K, Clutton S, Ferguson M, Gordon L, Gardiner R, Occhipinti S and Dunn J (2008) 'ProsCan for couples: Randomised controlled trial of a couples based sexuality intervention for men with localised prostate cancer who receive radical prostatectomy, BioMed Central Cancer Vol. 8, pp. 226-234.
Chapple A & Ziebland S (2002) Prostate cancer: Embodied experience and perceptions of masculinity, Sociology of Health and Illness 24 (6), pp. 820-841.
Cohen M (2002). Introduction to qualitative research, in LoBiondo-Wood G and Haber J (eds.) Nursing Research; methods, critical appraisal and utilization. Mosby, St. Louis.
Crapp G (1998) You have prostate cancer, in Laws T 1998. Promoting men's health: An essential book for nurses, Ausmed, Melbourne.
Crowe H and Costello A (2003). Prostate cancer: Perspectives on quality of life and impact of treatment on patients and their partners, Urologic Nursing Vol. 23, No. 4, pp. 279-285.
Davis J, Kuban D, Lynch D, and Schellhammer P (2001) Quality of life after treatment for localized prostate cancer. Differences based on treatment modality. Journal of Urology Vol. 166, 947-952.
Davison J, Goldenberg L, Gleave M and Degner L (2003) Provision of individualized information to men and their partners to facilitate treatment decision making in prostate cancer, Oncology Nursing Forum Vol. 30, No. 1, pp. 107-114.
DeFrank, J.T., Mehta, C.C., Stein, K.D., Baker, F. (2007) Body image dissatisfaction in cancer survivors. Oncology nursing forum 34 (3), pp. E36-41
Denzin N and Lincoln Y (2000) Handbook of qualitative research. 2nd edition, Sage Publications, Thousand Oaks.
Department of Human Services (2008) Victorian Government Cancer Initiative: Patient Management Frameworks; State Government of Victoria, Department of Human Services, Australia. http://www.health.vic.gov.au/cancer/pmfsnew.htm
Drummond M, Laws T and Polijak-Fligic (2001) Knowledge of and attitudes towards prostate cancer among Italo-Australian men, Australian Journal of Primary Health Vol. 7, No. 3, pp. 9-16
Drummond M (2002) Men, body image and eating disorders. International Journal of Men's Health Vol. 1, pp.79-93.
Drummond M (20050 Men's bodies: Listening to the voices of young gay men. Men and Masculinities Vol. 7, No. 3, pp. 270-290.
Elmberger, E., Bolund, C., & Lutzen, K. (2002) Men with cancer: Changes in attempts to master the self-image as a man and as a parent. Cancer Nursing 25(6), 477-485.
Fossey, E., C. Harvey, F. McDermott, and L. Davidson. (2002) Understanding and evaluating
qualitative research. Australian and New Zealand Journal of Psychiatry 36:717-32.
Geertz C (1973) The interpretation of cultures: Selected essays, Basic Books, New York.
Gheiler, E. L., Lovisolo, J. A., Tiguert, R., Tefilli, M. V., Grayson, T., Oldford, G., Powell, I. J., Famiglietti, G., Banerjee, M., Pontes, J. E., & Wood, D. P. Jr. (1999) Results of a clinical care pathway for radical prostatectomy patients in an open hospital - multiphysician system. European Urology 35(3): 210-6.
Goss G (1998) Focus group interviews: a methodology for socially sensitive research. Clinical Excellence for Nurse Practitioners Vol. 2, pp.30-34.
Harden J, Schafenacker A, Northouse L, Mood D, Smit D, Pienta K, Hussain M and Baranowski K (2002) Couples' Experiences with prostate cancer: focus group research.' Oncology Nursing Forum, 29 (4); 701-709.
Helgeson, V. S., & Lepore, S. J. (2004) Quality of life following prostate cancer: The role of agency and unmitigated agency. Journal of Applied Social Psychology 34: 2559-2585.
Hu JC, Wang Q, Pashos CL, Lipsitz SR, Keating NL (2008) Utilization and outcomes of minimally invasive radical prostatectomy. Journal of Clinical Oncology 26(14):2278-2284.
Kelly D (2004) Male sexuality in theory and practice, Vol. 39, No. 2, pp. 341-356.
Kitzinger J (1994) The methodology of focus groups: the importance of interactions between research participants. Sociology of Health and Illness Vol.16, pp.103-121.
Kitzinger J (1996) Introducing focus groups, in Mays N and Pope C 1996 Qualitative research in health care BMJ, London.
Krane, R. J. (2000) Urinary incontinence after treatment for localized prostate cancer. Molecular Urology, 4, 279-286.
Krueger R (1994) Focus Groups: A practical guide for applied research, 2nd edition, Sage, Thousand Oaks.
Laws TA (2004) Exploring the complexities of prostate cancer screening with a view to supporting informed consent, Contemporary Nurse Vol.17, No. 3, pp 223-230.
Laws TA & Drummond M, (2002) The Complexities of interviewing Italo-Australian men, Contemporary Nurse 12(2): 144-154.
Laws T, Drummond M and Polijak-Fligic (2000) 'On what basis do Australian men make informed decisions about diagnostic and treatment options for prostate cancer.' Australian Journal of Primary Health Vol. 6, No. 2, pp. 87-93.
Lee H (1960) To kill a mockingbird, Heinnemann, New York
Lim A, Brandon A, Fiedler J, Brickman A, Boyer C, Raub W, et al. (1995) Quality of life: Radical prostatectomy versus radiation therapy for prostate cancer. Journal of Urology Vol.154, pp.1420-1425.
MacDougall C, Fudge E. (2001) Planning and recruiting the sample for focus groups and in-depth interviews. Qualitative Health Research, 11: 117 - 126.
Milne J, Spiersb J and Moore K (2008) Men's experiences following laparoscopic radical prostatectomy: A qualitative descriptive study, International Journal of Nursing Studies Vol. 45, pp. 765-774.
Morgan D (1996) Focus Groups, Annual Review of Sociology, Vol. 22, pp. 129-152.
Moore K and Estey A (1999) The early post-operative concerns of men after radical prostatectomy, Journal of Advanced Nursing Vol. 29, No. 5, pp. 1121-1129.
Moul JW (2009) Post-radical prostatectomy management options for positive surgical margins: Argument for observation Urologic Oncology: Seminars and Original Investigations 27 (2009) 92-96.
National Health and Medical Research Council (NHMRC) (2002) Human Research Ethics Handbook, Commonwealth of Australia.
Nelson B, Kaufman M, Broughton G, et al: (2007) Comparison of length of hospital stay between radical retropubic prostatectomy and robotic assisted laparoscopic prostatectomy. Journal of Urology, 177:929
Oliffe, J. L. (2004). Constructions of masculinity following prostatectomy-induced impotence. Social Science and Medicine, 60: 2249-2259.
Parker & Tritter, (2006) Focus group method and methodology: current practice and recent debate International Journal of Research & Method in Education, April 2006, 29 (1): 23-37
Parkin DM Bray F Ferlay J Pisani P (2005) Global cancer statistics, 2002, CA Cancer Journal for Clinicians 55(2):74-108.
Patel VR, Shah K, Palmer KJ, Thaly R, Coughlin G (2007) Robotic - assisted laparoscopic radical prostatectomy: a report of the current state. Expert Review Anticancer Therapy 7(9):1269-1278 Review.
Patton M (1987) How to use qualitative methods in evaluation, Sage, Newbury Park
Patton M (1990) Qualitative evaluation and research methods, Sage, Newbury Park.
Pirl, W. F., Siegel, G. I., Goode, M. J., & Smith, M. R. (2002) Depression in men receiving androgen deprivation therapy for prostate cancer: A pilot study. Psychooncology 11: 518-523.
Ponterotto J (2006) 'Brief notes on the origin, evolution and meaning of the qualitative research concept "thick description," Qualitative Report, Vol. 11, No. 3, pp. 538-549.
Pope C, Mays N, eds.(1999) Qualitative research in health care, 2nd edn. London: BMJ,
http://www.bmj.com/cgi/content/full/320/7227/114?.../200 (viewed 16 nov. 2009)
Powel, L. L., & Clark, J. A. (2005) The value of the marginalia as an adjunct to structured questionnaires: Experiences of men after prostate cancer surgery. Quality of Life Research,14: 827-835.
Quinn D, Henshall S, Haynes A, Brenner P, Kooner R, Golovsky D, Mathews J, O'Neill G, Turner J, Delprado W, Finlayson J, Sutherland R, Grygiel J, and Stricker P 2001. 'Prognostic Significance of Pathologic Features in Localized Prostate Cancer Treated With Radical Prostatectomy: Implications for Staging Systems and Predictive Models.' Journal of Clinical Oncology, Vol.19, No. 6, pp. 3692-3705.
Rice PL, Ezzy D. (1999) Qualitative research methods, a health focus. Melbourne: Oxford University Press
Richards H and Schwartz L (2002) Ethics of qualitative research: are there special issues for health services research, Family Practice, Vol. 19, pp.135-139.
Robinson N (1999) The use of focus group methodology with selected samples from sexual health research. Journal of Advanced Nursing, Vol. 29, No. 4, pp. 905-913.
Roesch S, Adams L, Hines A, Palmores A, Vyas P, Tran C, Pekin S and Vaughn A (2005) Coping with prostate cancer: A meta-analytic review, Journal of Behavioural Medicine Vol. 8, No. 3, pp. 281-293.
Sandelowski M (2000) Focus on research methods; whatever happened to qualitative description, Research in nursing and health Vol. 23, pp. 334-340.
Sandelowski M (1998) Writing A Good Read: Strategies for Re-Presenting Qualitative Data, Research in Nursing & Health, 21: 375-382.
Sharpley C and Christie D (2007) 'An analysis of the psychometric profile and frequency of anxiety and depression in Australian men with prostate cancer,' Psycho-Oncology, Vol. 16, pp. 660-667.
Smith J, Braunack-Mayer A and Wittert G (2006). What do we know about men's help-seeking and health service use? Medical Journal of Australia, Vol. 184, No. 2, pp. 81-83.
Smith TJ Hillner BE (2001) Ensuring quality cancer care by the use of clinical practice guidelines and critical pathways, Journal of Clinical Oncology 19:2886-2897.
Smithson, J. (2000) Using and Analysing Focus Groups: Limitations and Possibilities, International Journal of Social Research Methodology: Theory and Practice 3(2): 103-121.
Spradley J 1980. Participant Observation, Holt, Rinehart and Winston, New York.
Stanford JI, Feng Z, Hamilton AS, et al. (2000) Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer: the prostate cancer outcomes study. Journal of the American Medical Association. 2000;283:354-360.
Steidle, C. P., Stecher, V. J., Pace, C., & Tseng, L. J. (2006) Correlation of improved erectile function and rate of successful intercourse with improved emotional well-being assessed with the Self-Esteem and Relationship questionnaire in men treated with sildenafil for erectile dysfunction and stratified by age. Current Medical Research and Opinion, 22, 939-948.
Steineck G Helgesen F Adolfsson J Dickman P. W Johansson J.-E Norlen B. J. Holmberg L. for the Scandinavian Prostatic Cancer Group Study Number (2002) Quality of Life after Radical Prostatectomy or Watchful Waiting New England Journal of Medicine 347(11): 790-796.
Steginga S, Turner E and Donovan J (2008) The decision-related psychosocial concerns of men with localized prostate cancer: targets for intervention and research, World
Stewart DW & Shamdasani PN (1990) Focus groups: theory and practice, Newbury Park, CA,Sage.
Strauss A and Corbin J 1998. Basics of qualitative research; techniques and procedures for developing grounded theory. Sage, Thousand Oaks.
SugarmanJ, McCrory DC, Hubal RC (19980 Getting meaningful informed consent from older persons: a structured literature review of empirical research. Journal of American Geriatric Soc 1; 46: 517-24.
Tewari AK Jhaveri JK Surasi K Patel N Tan GY (2008)
Benefit of Robotic Assistance in Comparing Outcomes of Minimally Invasive Versus Open Radical Prostatectomy, Journal Clinical Oncology, October 20, 2008; 26(30): 4999 - 5000.
Tuckett A (2004) Qualitative research sampling: the very real complexities. Nurse Researcher; 2004, Vol. 12(1): 47-61.
Wall D and Kristjanson L 2005. 'Men, culture and hegemonic masculinity: understanding the experience of prostate cancer,' Nursing Inquiry, Vol. 12, No. 2, pp. 87-97.
Yoshimoto S, Ghorbani S, Baer J, Cheng K, Banthia R, Malcarne V, Sadler G, Ko C, Greenbergs H and Varni J 2006. 'Religious coping and problem-solving by couples faced with prostate cancer,' European Journal of Cancer Care, Vol. 15, No. 5, pp. 481-488.
eContent Home
