IMPROVER (Involving Men with Prostate Cancer in Engaged Research): Assessing Patient Experience With Testing, Diagnosis, And Surveillance.

BACKGROUND: Our understanding of patient experiences with prostate cancer testing for diagnosis and surveillance is limited. The aim of this study was to collaborate with patients and clinicians to understand their lived experience and unmet needs around the early detection, diagnosis and monitoring (active surveillance) of prostate cancer. METHODS: Two focus groups were held with patients (n = 20) and healthcare professionals (n = 16), to identify the main challenges in prostate cancer detection, diagnosis, and monitoring. This information formed the basis of an online questionnaire for broader dissemination. RESULTS: A total of 1138 analyzable responses were obtained from people tested for prostate cancer (69% tested positive) in Europe and the US. Only 29 healthcare professionals completed the survey. Almost one-third of people reported knowing very little/nothing about prostate cancer prior to testing. Prior disease awareness was significantly higher in those who tested negative (P < .0001). Most respondents (n = 857; 75%) felt informed about the steps involved in testing. Receiving written information was a key factor; 91% of those who felt uninformed were not given any written information. Overall, most people felt "satisfied" with the typical prostate cancer tests: PSA, DRE, mpMRI, and biopsy. However, dissatisfaction for prostate biopsy (12%) was almost double that of other tests (P < .0001). Most patients understood why each test was done, and felt that their results and next steps were clearly explained to them; though PSA scored lowest in all of these fields. Apart from PSA, test satisfaction was lower when used repeatedly for surveillance, compared to once-off detection/diagnosis. CONCLUSIONS: Greater public awareness and education around prostate cancer, as well as clear and accessible written information for patients at the beginning of their cancer journey is needed. Further research is needed into alternative, less invasive tests, particularly when used repeatedly in the surveillance population.

A pragmatic dialogue amongst stakeholders on the impact of COVID-19 on Irish cancer patients and healthcare services and lessons learned.

PURPOSE: COVID-19 disrupted cancer care services in Ireland, from screening and diagnostics to treatments, possibly impacting physical health outcomes owing to delayed diagnosis and treatment changes. This study explores how cancer care and patients in Ireland were affected by COVID-19 from the perspective of Irish policy, clinical and patient stakeholders using a qualitative approach. The findings could inform future strategic and implementation plans for the current challenges faced and lessons learned will be identified. METHODS: A thematic analysis of a multi-stakeholder online workshop representing policy and clinical and patient stakeholders was completed. RESULTS: The pandemic exasperated prior challenges including under-resourced services, access barriers, staff shortages and lack of interoperability in information technology (IT) systems. Overall, the measures implemented protected cancer patients from COVID-19; however, some groups were more vulnerable, with apparent demographic and socio-economic inequalities. Many hard-fought gains from the previous decade, in terms of cancer screening, diagnosis and survivorship, were eroded. As we transition to the peri-COVID-19 period, staff burnout, poor IT infrastructure and lack of good quality data must be addressed to minimise further disruptions and restore and enhance cancer services. CONCLUSIONS: Overall, innovations and measures adopted during the pandemic protected cancer patients; however, some groups were particularly vulnerable, and inequalities may have widened further. Only proven effective and efficient innovations introduced during the pandemic should be retained and enhanced. Good quality data is needed to inform such decisions when choosing amongst them.

Counting the social, psychological, and economic costs of COVID-19 for cancer patients.

PURPOSE: Cancer patients were particularly vulnerable to the adverse impacts of the COVID-19 pandemic given their reliance on the healthcare system, and their weakened immune systems. This systematic review examines the social, psychological, and economic impacts of COVID-19 on cancer patients. METHODS: The systematic search, conducted in March 2021, captures the experience of COVID-19 Wave I, when the most severe restrictions were in place globally, from a patient perspective. RESULTS: The search yielded 56 studies reporting on the economic, social, and psychological impacts of COVID-19. The economic burden associated with cancer for patients during the pandemic included direct and indirect costs with both objective (i.e. financial burden) and subjective elements (financial distress). The pandemic exasperated existing psychological strain and associated adverse outcomes including worry and fear (of COVID-19 and cancer prognosis); distress, anxiety, and depression; social isolation and loneliness. National and institutional public health guidelines to reduce COVID-19 transmission resulted in suspended cancer screening programmes, delayed diagnoses, postponed or deferred treatments, and altered treatment. These altered patients' decision making and health-seeking behaviours. CONCLUSION: COVID-19 compounded the economic, social, and psychological impacts of cancer on patients owing to health system adjustments and reduction in economic activity. Identification of the impact of COVID-19 on cancer patients from a psychological, social, and economic perspective following the pandemic can inform the design of timely and appropriate interventions and supports, to deal with the backlog in cancer care and enhance recovery.

Mitigating the Impact of the COVID-19 Pandemic on Adult Cancer Patients through Telehealth Adoption: A Systematic Review.

During the first wave of the COVID-19 pandemic, the delivery of life-saving and life-prolonging health services for oncology care and supporting services was delayed and, in some cases, completely halted, as national health services globally shifted their attention and resources towards the pandemic response. Prior to March 2020, telehealth was starting to change access to health services. However, the onset of the global pandemic may mark a tipping point for telehealth adoption in healthcare delivery. We conducted a systematic review of literature published between January 2020 and March 2021 examining the impact of the COVID-19 pandemic on adult cancer patients. The review's inclusion criteria focused on the economic, social, health, and psychological implications of COVID-19 on cancer patients and the availability of telehealth services emerged as a key theme. The studies reviewed revealed that the introduction of new telehealth services or the expansion of existing telehealth occurred to support and enable the continuity of oncology and related services during this extraordinary period. Our analysis points to several strengths and weaknesses associated with telehealth adoption and use amongst this cohort. Evidence indicates that while telehealth is not a panacea, it can offer a "bolstering" solution during a time of disruption to patients' access to essential cancer diagnostic, treatment, and aftercare services. The innovative use of telehealth has created opportunities to reimagine the delivery of healthcare services beyond COVID-19.

Cumulative financial stress as a potential risk factor for cancer-related fatigue among prostate cancer survivors.

INTRODUCTION: Cancer-related fatigue (CRF) is the most commonly reported treatment-related side effect of prostate cancer (PCa). Recognition of financial hardship among cancer survivors is growing. We investigated, for the first time, associations between levels of financial stress and CRF among PCa survivors. METHODS: We used data from PCa survivors who had been identified through two population-based cancer registries covering the Republic of Ireland and Northern Ireland and had completed a postal questionnaire. CRF was measured by the fatigue subscale of the EORTC QLQ-C30. Financial stress was assessed as household ability to make ends meet (i) pre-diagnosis and (ii) at questionnaire completion (post-diagnosis). Multivariable logistic regression was used to relate financial stress to clinically important CRF (fatigue subscale score ≥ 39 of a possible 100). RESULTS: Two thousand four hundred fifty-eight PCa survivors were included. Of these, 268 (10.9%) reported pre-diagnosis financial stress only, 317 (12.9%) post-diagnosis stress only and 270 (11.0%) both pre- and post-diagnosis stress (cumulative stress); 470 (19.1%) reported clinically important CRF. After controlling for confounders, survivors with cumulative financial stress exposure were significantly more likely to have CRF (OR = 4.58, 95% CI 3.30-6.35, p < 0.001), compared with those without financial stress. There was a suggestion of a dose-response relationship (OR = 1.83, 95% CI 1.27-2.65, p = 0.001 for pre-diagnosis financial stress only; and OR = 4.11, 95% CI 3.01-5.61, p < 0.001 for post-diagnosis financial stress only). CONCLUSIONS: Financial stress may be an independent risk factor for CRF. IMPLICATIONS FOR CANCER SURVIVORS: There may be benefits in targeting interventions for reducing CRF towards survivors with financial stress, or developing strategies to reduce financial stress.

A cost analysis of a community-based support centre for cancer patients and their families in Ireland: the EVeCANs study.

Cancer patients and their families experience a range of physical, psychological and financial adverse effects. Community-based cancer centres offer a range of services and interventions, free of charge, to support those affected by cancer. While shown to be effective, there is a lack of information on the costs of these services. Our aim was to estimate the resource impact of a community-based cancer support centre. Over a 7-month period, there were 2032 contacts with 238 clients whose average age was 60 years. The most frequently used services were transport to treatment (20%), complementary therapies (48%), exercise classes (10%) and counselling (9%). This cost analysis estimated total annual cost to provide all services was €313,744. Average annual cost per person was €1138. Current uptake at the centre represents 8% of all cancer incidences in seven counties surrounding the centre. If uptake increases by 10%, scenario analyses predict an increase in total costs increase to €429,043 and a decrease in costs per patient to €915. As cancer incidences increase, the need for supportive care is growing. Community-based services have been established to meet these needs and fill this gap in national health services. Long-term sustainability of these centres is uncertain as they are entirely reliant on donations and volunteers. This analysis estimates the costs of one such community-based cancer support centre, for the first time in Ireland. Findings can be used to inform future planning of cancer supportive care services, including establishing links between tertiary and community-based centres, and cost effectiveness analyses, nationally and internationally.

Pain, fatigue and depression symptom cluster in survivors of prostate cancer.

PURPOSE: Pain, fatigue and depression are common sequelae of a cancer diagnosis. The extent to which these occur together in prostate cancer survivors is unknown. We (i) investigated prevalence of the pain-fatigue-depression symptom cluster and (ii) identified factors associated with experiencing the symptom cluster among prostate cancer survivors. METHODS: Men in Ireland diagnosed with prostate cancer 2-18 years previously were identified from population-based cancer registries and sent postal questionnaires. Cancer-related pain and fatigue were measured using the EORTC QLQ-C30 and depression using the DASS-21. Cut-offs to define 'caseness' were pain ≥ 25, fatigue ≥ 39 and depression ≥ 10. Associations between survivor-related factors, clinical variables and specific prostate cancer physical symptoms and the symptom cluster were assessed using multivariate logistic regression. RESULTS: A total of 3348 men participated (response rate = 54%). Twenty-four percent had clinically significant pain, 19.7% had clinically significant fatigue, and 14.4% had depression; 7.3% had all three symptoms. In multivariate analysis, factors significantly associated with the symptom cluster were living in Northern Ireland, experiencing back pain at diagnosis and being affected by incontinence, loss of sexual desire, bowel problems, gynecomastia and hot flashes post-treatment. There was a strong association between the cluster and health-related quality of life. CONCLUSIONS: The pain-fatigue-depression symptom cluster is present in 1 in 13 prostate cancer survivors. Physical after-effects of prostate cancer treatment are associated with this cluster. More attention should be paid to identifying and supporting survivors who experience multiple symptoms; this may help health-related quality of life improve among the growing population of prostate cancer survivors.

Health Literacy Influences Men's Active and Passive Cancer Information Seeking.

BACKGROUND: For cancer prevention information to be effective, it must be accessible to its target populations. Prevalence of inadequate health literacy (HL) is high, but there is a dearth of information on the impact of HL on men's cancer information seeking. OBJECTIVE: We investigated (1) men's cancer information seeking behaviors, (2) the effect of HL on men's cancer information seeking behavior, and (3) men's preferences for cancer information, considering their HL level. From a national perspective, we investigated men's information seeking behavior from the Irish Cancer Society (ICS), the largest provider of cancer information in Ireland. METHODS: Men from adult literacy classes and men's groups were invited to complete a questionnaire. General and ICS-specific cancer information seeking behavior was investigated. Univariate and multivariate logistic regression models were conducted with "ever" seeking cancer information from any source, and actively seeking and passively acquiring ICS information as dependent variables. KEY RESULTS: Overall, 259 men completed the questionnaire and 44% had inadequate HL. About one-half of responders reported "ever" actively looking for cancer information. In the study group, 19% actively sought and 67% passively acquired ICS-specific information. In multivariate analysis, the odds of actively seeking (2.93; 95% CI [1.05, 8.15]) or passively acquiring (4.7; 95% CI [1.99, 11.05]) ICS-specific cancer information was significantly higher among those with adequate versus inadequate HL, respectively. HL was not significantly associated with odds of "ever" cancer information seeking in multivariate analysis (odds ratio 1.81; 95% CI [0.90, 3.63]). Men want information about cancer prevention. Suggested future cancer information sources differed by HL levels. General practitioners and the Internet were the preferred source for men with inadequate (53.3%) and adequate HL (57%), respectively. CONCLUSIONS: Men both passively acquire and actively seek cancer prevention information. Multimodal dissemination of cancer prevention information is necessary to reach a wide cross-section of men, including those with inadequate HL. This could potentially lower men's cancer burden and reduce gender inequalities in cancer mortality. [HLRP: Health Literacy Research and Practice. 2019;3(3):e147-e160.]. PLAIN LANGUAGE SUMMARY: Most men get cancer prevention information by coming across it passively in their daily lives, instead of actively looking for this information. Men with low health literacy are less likely to obtain cancer information both passively and actively. Men want this information. Organizations need to make this information available in many places and formats (e.g., Internet, doctor, television, sports clubs).

Developing outcome, process and balancing measures for an emergency department longitudinal patient monitoring system using a modified Delphi.

BACKGROUND: Early warning score systems have been widely recommended for use to detect clinical deterioration in patients. The Irish National Emergency Medicine Programme has developed and piloted an emergency department specific early warning score system. The objective of this study was to develop a consensus among frontline healthcare staff, quality and safety staff and health systems researchers regarding evaluation measures for an early warning score system in the Emergency Department. METHODS: Participatory action research including a modified Delphi consensus building technique with frontline hospital staff, quality and safety staff, health systems researchers, local and national emergency medicine stakeholders was the method employed in this study. In Stage One, a workshop was held with the participatory action research team including frontline hospital staff, quality and safety staff and health systems researchers to gather suggestions regarding the evaluation measures. In Stage Two, an electronic modified-Delphi study was undertaken with a panel consisting of the workshop participants, key local and national emergency medicine stakeholders. Descriptive statistics were used to summarise the characteristics of the panellists who completed the questionnaires in each round. The mean Likert rating, standard deviation and 95% bias-corrected bootstrapped confidence interval for each variable was calculated. Bonferroni corrections were applied to take account of multiple testing. Data were analysed using Stata 14.0 SE. RESULTS: Using the Institute for Healthcare Improvement framework, 12 process, outcome and balancing metrics for measuring the effectiveness of an ED-specific early warning score system were developed. CONCLUSION: There are currently no published measures for evaluating the effectiveness of an ED early warning score system. It was possible in this study to develop a suite of evaluation measures using a modified Delphi consensus approach. Using the collective expertise of frontline hospital staff, quality and safety staff and health systems researchers to develop and categorise the initial set of potential measures was an innovative and unique element of this study.

Problems sleeping with prostate cancer: exploring possible risk factors for sleep disturbance in a population-based sample of survivors.

PURPOSE: This study aimed to investigate the prevalence of sleeping problems in prostate cancer survivors and to explore the role of predisposing, precipitating and perpetuating factors in this process. METHODS: Using a cross-sectional design, 3348 prostate cancer survivors between 2 and 18 years post diagnosis reported experiences of insomnia using the QLQC30, along with their sociodemographic characteristics, health status and treatment(s) received. The EQ5D-5L and QLQPR25 assessed survivors' overall and prostate cancer-specific health-related quality of life. A hierarchical multiple regression analysis was constructed with three blocks: (1) predisposing (e.g. demographics at diagnosis), (2) precipitating (e.g. disease extent, treatment) and (3) perpetuating factors (e.g. side effects). RESULTS: Nineteen percent of survivors reported significant problems sleeping. The final model accounted for 31% of the variance in insomnia scores (p < .001). In order of magnitude, associates of sleep disturbance were urinary symptoms (ß = 0.22; p < .001), experiencing symptoms of depression/anxiety (ß = 0.18; p < .001), hormone treatment-related symptoms (ß = 0.12; p = .001), pain (ß = 0.10; p < .001) and bowel symptoms (ß = 0.06; p = .005). Having a lower education and more comorbidities at diagnosis also predicted sleep problems. CONCLUSION: Results suggest that it is the ongoing adverse effects of prostate cancer and its treatment (e.g. urinary symptoms) that put survivors most at risk of sleep problems. Strong associations with symptoms of depression/anxiety were also observed. Findings highlight the need for health care practitioners to treat and manage adverse effects of prostate cancer treatment in order to mitigate sleep disturbance in survivors.

Promoting men's knowledge of cancer risk reduction: A systematic review of interventions.

OBJECTIVE: To critically appraise and discuss evidence from interventions designed to increase men's knowledge about cancer risk reduction. METHODS: A systematic review was conducted. Six electronic databases were searched for interventions published between January 1st 2006 and May 30th 2016 in English. Studies were included if they used an experimental design, included adult males (≥18 years), and had a primary focus on the acquisition and utilisation of information on cancer risk reduction. The methodological quality of the included studies was appraised. RESULTS: A total of 25 studies met the inclusion criteria, 23 of which involved prostate cancer risk reduction. Twenty-one studies reported knowledge gain among the men. Three studies found that knowledge gain was associated with health literacy. CONCLUSIONS: Interventions aiming to improve men's knowledge about cancer risk reduction require a multimodal approach. Findings highlight the need to design and measure the impact of interventions for men on wider cancer risk reduction topics, while accounting for different socio-demographic and ethnic groups, literacy and health literacy levels. PRACTICE IMPLICATIONS: More research is warranted into the development and evaluation of theoretically-driven multimodal community-based approaches to information dissemination for men taking into account their daily information spheres such as workplaces and community environs.

Expecting the worst? The relationship between retrospective and prospective appraisals of illness on quality of life in prostate cancer survivors.

OBJECTIVE: Despite a generally good prognosis, many prostate cancer survivors have poor quality of life (QOL). A greater understanding of how psychological appraisals influence QOL is merited given their potentially modifiable nature. In this study, we considered how elements of survivors' retrospective and prospective appraisals relate to QOL. METHODS: A total of 1229 prostate cancer survivors between 2 and 5 years post-diagnosis, identified from a population-based National Cancer Registry, were asked questions on their socio-demographics, health, treatment received, and adverse-effects using a cross-sectional design. QOL was assessed using the EORTC QLQ-C30. Retrospective appraisals were assessed by asking survivors to reflect on their experience of treatment-related adverse-effects compared with their prior expectations. A fear of recurrence scale assessed prospective appraisals of future disease course. A multiple regression model explored the impact of psychological appraisals on QOL, after controlling for socio-demographic, treatment, and health-related factors. RESULTS: The model was significant explaining 37% of variance in QOL. The strongest associate with QOL was fear of recurrence (ß = -.29; P < .001). Survivors who experienced side effects that were worse than expected had significantly lower QOL (ß = -.10; P = .002). Other significant correlates of lower QOL were presence of comorbidities, having undergone a less invasive treatment, and having more advanced disease. Working at diagnosis and having a higher level of education were significantly associated with higher QOL. CONCLUSIONS: Results suggest both retrospective and prospective appraisals are independently related to QOL in prostate cancer. Providing survivors with more information about possible adverse effects of treatment, as well as providing appropriate information regarding future disease progression, may improve QOL.

The psychological impact of prostate biopsy: Prevalence and predictors of procedure-related distress.

OBJECTIVE: Many men undergo prostate biopsies each year. Most data on consequences of prostate biopsy for men pertain to physical after-effects and/or come from clinical trial populations. We quantified prevalence of, and identified factors associated with, procedure-related distress in men having prostate biopsies in routine clinical practice. METHODS: Men who had undergone prostate biopsy for follow-up of a raised prostate specific antigen test result and/or abnormal digital rectal examination in 6 centres in Ireland completed questionnaires. Biopsy-related psychological distress was measured using the Impact of Event Scale. An Impact of Event Scale score ≥ 9 was considered significant biopsy-related distress. Logistic regression was used to identify predictors of significant distress. RESULTS: Three hundred thirty-five men completed questionnaires. Overall, 49% had significant biopsy-related distress; this was higher in men whose biopsy result indicated cancer (59%) and those who did not have a definitive result (54%) than those with a negative result (35%; P < .001). In multivariable analyses, the odds of significant distress were 3 times higher in men with cancer (OR = 3.33, 95% CI, 1.83-6.04) and more than twice as high in men without a definitive result (OR = 2.61, 95% CI, 1.43-4.78) compared to men with a negative result. Men with intermediate (OR = 3.19, 95% CI, 1.85-5.53) or high (OR = 7.10, 95% CI, 3.45-14.57) health anxiety (propensity to worry about one's health) also had significantly increased odds of biopsy-related distress. CONCLUSIONS: Significant distress is common after prostatic biopsy. Some men, including those who are highly health anxious and those awaiting definitive results, may benefit from additional support around the time of and/or following prostate biopsy.

Men's information-seeking behavior regarding cancer risk and screening: A meta-narrative systematic review.

OBJECTIVE: Preventive strategies are known to reduce cancer risk and incidence and improve prognosis. Men seldom seek medical information about cancer prevention and risk reduction. The aim of this meta-narrative systematic review was to critically appraise evidence from qualitative, quantitative, and mixed-methods studies that explored men's information-seeking behaviors in relation to cancer prevention and risk reduction. METHODS: MEDLINE, CINAHL Plus with Full Text, PsycINFO, PsycARTICLES, Psychology and Behavioral Sciences Collection, Education Full Text, and ERIC were systematically searched for studies published in English between January 1, 2006 and May 30, 2016. A total of 4117 titles were identified; of which, 31 studies were included (21 qualitative studies, 9 quantitative studies, and 1 mixed-methods study). The methodological quality of the studies was appraised by using different tools. RESULTS: Most studies focused on screening for prostate (n = 18) and colorectal cancer (n = 7). Most men were passive information-gatherers rather than active information-seekers. Key sources of information included the Internet for active information-seekers and health care professionals for passive information-gatherers. Barriers to information-seeking included information overload, embarrassment, and fear. Low literacy and health literacy levels were addressed in 3 studies and were identified as impediments to active information-seeking. Facilitators to information-seeking included family support, media, celebrity endorsements, and targeted information. CONCLUSIONS: Men's information-seeking behavior regarding cancer risk reduction, prevention, and screening is influenced by several factors. This necessitates targeted interventions aimed at raising awareness of cancer prevention and screening, while accounting for men's informational needs, preferred learning strategies, and literacy levels.

GREB1 genetic variants are associated with bone mineral density in Caucasians.

Gaining an understanding of factors contributing to bone quality is key to the development of effective preventative treatments for osteoporosis and reduction in osteoporotic fractures. Oestrogen is a strong regulator of bone remodelling which maintains skeletal structural integrity. The growth regulation by oestrogen in breast cancer 1 (GREB1) gene, with an as yet undefined function, is an early response gene in the oestrogen-regulated pathway. Suggestive evidence of linkage with bone mineral density (BMD) variation has been reported with D2S168, located telomeric of GREB1. The aim of this study was to determine if genetic variation within GREB1 was associated with BMD variation at two sites with high fracture rates-the lumbar spine (LS) and the femoral neck (FN). Informative GREB1 single-nucleotide polymorphisms (SNPs) (n = 12) were selected for genotyping and tested for association in a family-based dataset (n = 508 individuals from 229 families). Significantly associated SNPs were tested further in a postmenopausal dataset from the same geographic region (n = 477 individuals). One intronic SNP, rs5020877, was significantly associated with LS and FN BMD in the family-based dataset (P ≤ 0.005). The association was not observed in the postmenopausal dataset (P > 0.017); however, rs10929757 was significantly associated with FN BMD (P = 0.006). Markers, rs5020877 and rs10929757, were constituent SNPs in one GREB1 linkage disequilibrium block, although not historically correlated (r 2 = 0.07). Our findings suggest that GREB1 is a novel gene target for osteoporosis genetics and needs to be investigated further.

Incongruence in treatment decision making is associated with lower health-related quality of life among prostate cancer survivors: results from the PiCTure study.

PURPOSE: We investigated associations between treatment decision making (TDM) and global health-related-quality-of-life (gHRQoL) among prostate cancer (PCa) survivors. METHODS: Postal questionnaires were sent to 6559 PCa survivors 2-18 years post-diagnosis, identified through population-based cancer registries in Ireland. The Control Preference Scale was used to investigate respondents' 'actual' and 'preferred' role in TDM. The TDM experience was considered 'congruent' when actual and preferred roles matched and 'incongruent' otherwise. The EORTC QLQ-C30 was used to measure gHRQoL. Multivariate linear regression was employed to investigate associations between (i) actual role in TDM, (ii) congruence in TDM, and gHRQoL. RESULTS: The response rate was 54% (n = 3348). The percentages of men whose actual role in TDM was active, shared or passive were 36, 33 and 31%, respectively. Congruence between actual and preferred roles in TDM was 58%. Actual role in TDM was not associated with gHRQoL. In multivariate analysis, after adjusting for socio-demographic and clinical factors, survivors whose TDM experience was incongruent had significantly lower gHRQoL than those who had a congruent experience (- 2.25 95%CI - 4.09, - 0.42; p = 0.008). This effect was most pronounced among survivors who had more involvement in the TDM than they preferred (- 2.69 95%CI - 4.74, - 0.63; p = 0.010). CONCLUSIONS: Less than 6 in 10 PCa survivors experienced congruence between their actual and preferred roles in TDM. Having an incongruent TDM experience was associated with lower gHRQoL among survivors. These findings suggest that involving patients in TDM to the degree to which they want to be involved may help improve PCa survivors' gHRQoL.

Physical after-effects in men undergoing prostate biopsy in routine clinical practice: Results from the PiCTure study.

BACKGROUND: As the incidence of prostate cancer has, until recently, increased in most developed countries, the rates of prostate biopsies, required for histological diagnosis, will also have increased. Little is known about the physical after-effects of prostate biopsy outside randomised control trials. We investigate reports on the physical effect of prostate biopsy undertaken in men in routine practice. METHODS: A self-completed questionnaire was given to men living in the Republic of Ireland (RoI) or Northern Ireland 4 to 6 weeks after prostate biopsy. Men were asked about whether they experienced specific physical after-effects postbiopsy (raised temperature/pain/bleeding/erectile dysfunction/urinary retention) and, if so, their severity and duration, and any associated health care uses. Binomial and ordinal logistic regression was used to investigate factors associated with postbiopsy after-effects (presence/absence) and number of after-effects reported, respectively. RESULTS: Postbiopsy after-effects were common with 88.1% of 335 respondents reporting at least 1 after-effect; 21% reported at least 3. The odds of increasing number of after-effects was over 2-fold in men with both intermediate (odds ratio [OR] = 2.59, 95% CI: 1.52-4.42) and high (OR = 2.52, 95% CI: 1.28-4.94) levels of health anxiety and for men who had had multiple previous biopsies (adjusted OR = 2.02, 95% CI: 1.20-3.41). A total of 21.3% of men who experienced after-effects reported that they were worse than expected, 11.5% with after-effects reported contacting their doctor or local pharmacy, 14.6% contacted hospital services, and 3.1% of men with after-effects were admitted to hospital with an average stay of 5.4 nights (standard deviation = 6.3). CONCLUSION: Physical after-effects following prostate biopsy in routine practice are common, and in some men, serious enough to warrant contacting hospital or community services. Men with increased health anxiety or who undergo multiple biopsies might benefit from additional support.

The effect of adult Early Warning Systems education on nurses' knowledge, confidence and clinical performance: A systematic review.

AIMS: This review aims to determine the effect of adult Early Warning Systems education on nurses' knowledge, confidence and clinical performance. BACKGROUND: Early Warning Systems support timely identification of clinical deterioration and prevention of avoidable deaths. Several educational programmes have been designed to help nurses recognize and manage deteriorating patients. Little is known as to the effectiveness of these programmes. DESIGN: Systematic review. DATA SOURCES: Academic Search Complete, CINAHL, MEDLINE, PsycINFO, PsycARTICLES, Psychology and Behavioral Science Collection, SocINDEX and the UK & Ireland Reference Centre, EMBASE, the Turning Research Into Practice database, the Cochrane Central Register of Controlled Trials (CENTRAL) and Grey Literature sources were searched between October and November 2015. REVIEW METHODS: This is a quantitative systematic review using Cochrane methods. Studies published between January 2011 - November 2015 in English were sought. The risk of bias, level of evidence and the quality of evidence per outcome were assessed. RESULTS: Eleven articles with 10 studies were included. Nine studies addressed clinical performance, four addressed knowledge and two addressed confidence. Knowledge, vital signs recording and Early Warning Score calculation were improved in the short term. Two interventions had no effect on nurses' response to clinical deterioration and use of communication tools. CONCLUSION: This review highlights the importance of measuring outcomes using standardized tools and valid and reliable instruments. Using longitudinal designs, researchers are encouraged to investigate the effect of Early Warning Systems educational programmes. These can include interactive e-learning, on-site interdisciplinary Early Warning Scoring systems training sessions and simulated scenarios.

Regret and fear in prostate cancer: The relationship between treatment appraisals and fear of recurrence in prostate cancer survivors.

OBJECTIVE: Fear of recurrence (FOR) is a key concern among survivors of all cancers. In prostate cancer, FOR varies with health and treatment type, but little is known about how survivors' appraisals of their treatment, and in particular, their level of regret over treatment decisions may affect this. METHODS: A total of 1229 prostate cancer survivors between 2- and 5-years postdiagnosis were invited to complete a postal questionnaire including a FOR scale, Decisional Regret Scale, and the European Organization for Research and Treatment of Cancer QLQ C30 health-related quality of life (HRQoL) instrument. Multiple regression analysis explored the impact of 3 blocks of factors on FOR: (1) demographic characteristics and disease extent, (2) primary treatment received and health status (treatment side effects and HRQoL), and (3) treatment appraisals, specifically satisfaction with information received regarding treatment and level of regret experienced over treatment decisions. RESULTS: The final multivariable model explained 27% of variance on FOR. Significant correlates of lower FOR included having localised disease, having undergone an invasive treatment, as well as health status (higher HRQoL and fewer ongoing side effects). Beyond this, appraisals of treatment significantly contributed to the model: More decisional regret and lower satisfaction with information received were associated with higher FOR. CONCLUSION: These findings suggest that FOR may be mitigated by providing survivors with more information regarding treatment choices and the treatment itself so that men can make well-informed decisions and experience less future regret. Sensitivity analysis for variables predicting FOR among prostate cancer survivors is not suspected of having a recurrence.