Australian men's long term experiences following prostatectomy: A qualitative descriptive study
Tom Laws
School of Nursing and Midwifery, Division of Health Sciences, University of South Australia, Adelaide SA
Peter 'Kevin' O'Shaughnessy
School of Nursing and Midwifery, University of South Australia, City East Campus, Adelaide SA
PP: 098 - 109
Abstract
The experiences of men in the immediate postoperative period following surgery for primary prostate cancer are well reported in the literature. Recognition of the unresolved morbidity encountered by men in the medium term suggests that a more complete understanding of how men cope in the long term is needed.
Health professionals are deserving of a more complete literature for the purpose of providing holistic care for this group of men, providing informed advocacy and better support for men living with the diagnosis of prostate cancer. Emerging literature reveals that men's knowledge of the long term problems associated with prostatectomy was inadequate at the time they consented to treatment; the likely outcomes at all phases of recovery should be taken into account when deciding on choice of treatment or no treatment.
This qualitative study aims to describe men's long term recovery following prostatectomy for the purpose identifying the effects of unresolved post surgical morbidity. The content analysis of focus group interviews revealed that incontinence and impotence were a major source of emotional tension affecting the men's social interactions and sense of self-worth. The men expressed great regret over the lack of information accessible to them for evaluating the risk and nature of long term problems. The thick description provided in this study identifi es 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
AHRQ (2008) Comparative effectiveness of therapies for clinically localized prostate cancer: Executive summary, agency for healthcare research and quality. Pub. No. 08-EHC010-1, February 2008.
AIHW (2008) Australia's Health 2008. Canberra, Australia: Australian Institute of Health and Welfare.
Albaugh J and Hacker E (2008) Measurement of quality of life in men with prostate cancer. Clinical Journal of Oncology Nursing 12(1), 81-86.
American Cancer Society (2007) Cancer facts and figures. Atlanta: American Cancer Society.
Arora NK and McHorney CA (2000) Patient preferences for medical decision making: Who really wants to participate? Brief Report, Medical Care 38(3), 335-341.
Australian Bureau of Statistics (ABS) (2006) Cancer in Australia: A snapshot, 2004-2005, 4822.0.55.001.
Baade PD, Coory MD and Aitken JF (2004) International trends in prostate-cancer mortality: The decrease is continuing and spreading. Cancer Causes Control 15, 237-241.
Baade PD, Steginga SK, Pinnock CB and Aitken JF (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 96, 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 16(10), 649-655.
Britten N, Jones R, Murphy E and Stacey R (1995) Qualitative research methods in general practice and primary care. Family Practice 12(1), 104-114.
Burns SM and Mahalik JR (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 and Mahalik JR (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), 6-16.
Burt J, Caelli K, Moore K and Anderson M (2005) Radical prostatectomy: Men's experiences and postoperative needs. Journal of Clinical Nursing 14, 883-890.
Buston K, Parry-Jones W, Livingston M, Bogan A and Wood S (1998) Qualitative research. British Journal of Psychiatry 172, 197-199.
Butler L, Downe-Wamboldt B, Marsh S, Bell D and Jarvi K (2001) Quality of life post radical prostatectomy: A male perspective. Urologic Nursing 21, 283-288.
Caelli K, Ray L and 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, et al (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 8, 226-234.
Chapple A and Ziebland S (2002) Prostate cancer: Embodied experience and perceptions of masculinity. Sociology of Health and Illness 24, 820-841.
Cohen M (2002) Introduction to qualitative research. In G LoBiondo-Wood and J Haber (Eds) Nursing research; methods, critical appraisal and utilization (pp.125-137). St Louis: Mosby.
Crapp G (1998) You have prostate cancer. In T Laws (Ed) Promoting men's health: An essential book for nurses (pp.193-200). Melbourne: Ausmed.
Crowe H and Costello A (2003) Prostate cancer: Perspectives on quality of life and impact of treatment on patients and their partners. Urologic Nursing 23(4), 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 166, 947-952.
DeFrank JT, Mehta CC, Stein KD and Baker F (2007) Body image dissatisfaction in cancer survivors. Oncology Nursing Forum 34(3), E36-E41.
Denzin N and Lincoln Y (2000) Handbook of qualitative research 2nd edn. Thousand Oaks: Sage.
Department of Human Services (2008) Victorian government cancer initiative: Patient management frameworks; state government of Victoria. Victoria, Australia: Department of Human Services.
Drummond M (2002) Men, body image and eating disorders. International Journal of Men's Health 1, 79-93.
Drummond M, Laws T and Polijak-Fligic J (2001) Knowledge of and attitudes towards prostate cancer among Italo-Australian men. Australian Journal of Primary Health 7(3), 9-16.
Elmberger E, Bolund C and 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, Harvey C, McDermott F and Davidson L (2002) Understanding and evaluating qualitative research. Australian and New Zealand Journal of Psychiatry 36, 717-732.
Geertz C (1973) The interpretation of cultures: Selected essays. New York: Basic Books.
Gheiler EL, Lovisolo JA, Tiguert R, Tefilli MV, Grayson T, Oldford G, et al (1999) Results of a clinical care pathway for radical prostatectomy patients in an open hospital-multiphysician system. European Urology 35(3), 210-216.
Goss G (1998) Focus group interviews: A methodology for socially sensitive research. Clinical Excellence for Nurse Practitioners (2), 30-34.
Harden J, Schafenacker A, Northouse L, Mood D, Smit D, Pienta K, et al (2002) Couples' Experiences with prostate cancer: Focus group research. Oncology Nursing Forum 29(4), 701-709.
Helgeson VS and Leporei SJ (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 and 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. Nursing Clinics of North America 39(2), 341-356.
Kitzinger J (1994) The methodology of focus groups: The importance of interactions between research participants. Sociology of Health and Illness 16, 103-121.
Kitzinger J (1996) Introducing focus groups. In N Mays and C Pope (Eds) Qualitative research in health care (Vol. 16, pp.103-121). London: BMJ.
Krane RJ (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 edn. Thousand Oaks: Sage.
Laws T, Drummond M and Polijak-Fligic J (2000) On what basis do Australian men make informed decisions about diagnostic and treatment options for prostate cancer. Australian Journal of Primary Health 6(2), 87-93.
Laws TA and Drummond M (2002) The complexities of interviewing Italo-Australian men. Contemporary Nurse 12(2), 144-154. http://www.contemporarynurse.com/archives/vol/12/issue/2/article/1817/the-complexities-of-interviewing-italoaustralian
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 154, 1420-1425.
MacDougall C and 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 45, 765-774.
Moore K and Estey A (1999) The early post-operative concerns of men after radical prostatectomy. Journal of Advanced Nursing 29(5), 1121-1129.
Morgan D (1996) Focus groups. Annual Review of Sociology 22, 129-152.
Morse JM (1994) Designing Funded Qualitative Research. In NK Denzin and YS Lincoln (Eds) Handbook of Qualitative Research. Thousand Oaks: Sage.
Moul JW (2009) Post-radical prostatectomy management options for positive surgical margins: Argument for observation. Urologic Oncology: Seminars and Original Investigations 27, 92-96.
National Health and Medical Research Council (NHMRC) (2002) Human research ethics handbook (pp.1-426). Commonwealth of Australia.
Nelson B, Kaufman M, Broughton G, Cookson S, Chang S, Herrell R, et al (2007) Comparison of length of hospital stay between radical retropubic prostatectomy and robotic assisted laparoscopic prostatectomy. The Journal of Urology 177, 929.
Oliffe JL (2004) Constructions of masculinity following prostatectomy-induced impotence. Social Science and Medicine 60, 2249-2259.
Parker A and Tritter J (2006) Focus group method and methodology: Current practice and recent debate. International Journal of Research and Method in Education 29(1), 23-37.
Parkin DM, Bray F, Ferlay J and Pisani P (2005) Global cancer statistics, 2002. CA Cancer Journal for Clinicians 55(2), 74-108.
Patel VR, Shah K, Palmer KJ, Thaly R and Coughlin G (2007) Robotic-assisted laparoscopic radical prostatectomy: A report of the current state. Expert Review of Anticancer Therapy 7(9), 1269-1278 (Review).
Patton M (1987) How to use qualitative methods in evaluation. Newbury Park: Sage.
Patton M (1990) Qualitative evaluation and research methods. Newbury Park: Sage.
Patton M (2002) Qualitative evaluation and research methods 3rd edn. Newbury Park: Sage.
Pirl WF, Siegel GI, Goode MJ and Smith MR (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 11(3), 538-549.
Pope C and Mays N (Eds) (1999) Qualitative research in health care 2nd edn. London: BMJ. Retrieved November 16 2009 from http://www.bmj.com/cgi/content/full/320/7227/114?.../200
Powel LL and Clark JA (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, et al (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 19(6), 3692-3705.
Rice PL and 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 19, 135-139.
Robinson N (1999) The use of focus group methodology with selected samples from sexual health research. Journal of Advanced Nursing 29(4), 905-913.
Roesch S, Adams L, Hines A, Palmores A, Vyas P, Tran C, et al (2005) Coping with prostate cancer: A meta-analytic review. Journal of Behavioural Medicine 8(3), 281-293.
Sandelowski M (1998) Writing a good read: Strategies for re-presenting qualitative data. Research in Nursing & Health 21, 375-382.
Sandelowski M (2000) Focus on research methods; whatever happened to qualitative description. Research in Nursing and Health 23, 334-340.
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 16, 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 184(2), 81-83.
Smith TJ and 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.
Stanford JI, Feng Z, Hamilton AS, Gilliland FD, Stephenson RA, Eley JW, 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 283, 354-360.
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 Journal of Urology 26(5), 469-474.
Steidle CP, Stecher VJ, Pace C and Tseng LJ (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 PW, Johansson J-E, Norlen BJ, et al (2002) Quality of life after radical prostatectomy or watchful waiting. New England Journal of Medicine 347(11), 790-796.
Stewart DW and Shamdasani PN (1990) Focus groups: Theory and practice. Newbury Park: Sage.
Strauss A and Corbin J (1998) Basics of qualitative research; techniques and procedures for developing grounded theory. Thousand Oaks: Sage.
Sugarman J, McCrory DC and Hubal RC (1998) Getting meaningful informed consent from older persons: A structured literature review of empirical research. Journal of American Geriatrics Society 46, 517-524.
Tewari AK, Jhaveri JK, Surasi K, Patel N and Tan GY (2008) Benefit of robotic assistance in comparing outcomes of minimally invasive versus open radical prostatectomy. Journal Clinical Oncology 26(30), 4999-5000.
Tuckett A (2004) Qualitative research sampling: The very real complexities. Nurse Researcher 12(1), 47-61.
Wall D and Kristjanson L (2005) Men, culture and hegemonic masculinity: Understanding the experience of prostate cancer. Nursing Inquiry 12(2), 87-97.
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