Uncertainty and perception of danger among patients undergoing treatment for prostate cancer.

UNLABELLED: Study Type - Therapy (attitude prevalence) Level of Evidence 2a What's known on the subject? and What does the study add? Marked differences in uncertainty among patients have been found relating to race and social environment indicating that as uncertainty increases, social functioning declines. Correlations have been found between uncertainty and patients' coping, psychological adjustment and perceptions of their health and illness. Studies suggest the detrimental effect of uncertainty among patients with prostate cancer in the perception of their quality of life. These studies underline the potential benefit of targeted intervention. The study provides a unique insight into the impact of uncertainty and perception of danger on overall satisfaction with treatment outcomes in men with prostate cancer. Its results suggest that possible disparities related to patient racial background and education may exist in the perception of cancer-related uncertainty. Racial and educational disparities, coupled with a mild to moderate association of uncertainty or danger perception and overall outcome satisfaction, suggest an unmet need for healthcare and nursing services for men undergoing treatment for prostate cancer. OBJECTIVES: To investigate patient uncertainty and perception of danger regarding prospects for clinical prostate cancer control. To determine the impact of these factors on satisfaction with overall prostate cancer treatment outcome. PATIENTS AND METHODS: Men who had undergone primary treatment for early stage prostate cancer and who were participants in the Prostate Cancer Outcomes and Satisfaction with Treatment Quality Assessment (PROSTQA) prospective cohort study of prostate cancer outcomes (the parent study) were offered the opportunity to participate in the present study. Centralized phone interviews were conducted to determine patient-reported uncertainty regarding cancer status (measured by the Mishel Uncertainty in Illness Scale-Community Form), perception of danger (measured by Folkman and Lazarus' Appraisal Scale) and satisfaction with treatment outcome (measured by the Service Satisfaction Scale for Cancer Care). The study used the same centralized telephone interview centre as was used in the parent study. Data were collected at 48, 60 or 72 months after the completion of prostate cancer treatment. Relationships among measures were characterized by Spearman rank correlation coefficients (r). RESULTS: A total of 338 agreed to participate, representing 76% of those who were invited. Younger patients experienced less uncertainty (r = 0.20, P < 0.001), yet reported greater perception of danger (r = -0.12; P = 0.03) concerning their previously treated prostate cancer. African-American patients showed greater uncertainty than other ethnic groups (P = 0.005) but did not have a greater perception of danger (P = 0.36). Education played a major role in uncertainty; patients with lower levels of education tended to report higher degrees of uncertainty (r = -0.25; P < 0.001). There was a mild to moderate general association between the three outcomes. A greater sense of uncertainty was associated with a greater perception of danger (r = 0.34, P < 0.001), and as danger and uncertainty increased, satisfaction with treatment outcome tended to decrease (r was between -0.30 and -0.34, P < 0.001). CONCLUSIONS: Results suggest that possible disparities related to patient racial background and education may exist in the perception of cancer-related uncertainty. Racial and educational disparities, coupled with a mild to moderate association of uncertainty or danger perception and overall outcome satisfaction, suggest an unmet need for healthcare and nursing services for men undergoing treatment for prostate cancer.

How to take a sample for cervical screening.

This article aims to update nurses who are experienced in obtaining cervical samples and stimulate interest in health professionals who wish to undertake the procedure in the future. It also provides information on the NHS cervical screening programme and its relevance in the reduction of cervical cancer. It should help the reader to understand the nature, importance and prevention of cervical cancer, and the techniques for detection and treatment of pre-cancer.

Partners' long-term appraisal of their caregiving experience, marital satisfaction, sexual satisfaction, and quality of life 2 years after prostate cancer treatment.

BACKGROUND: Partners of men treated for prostate cancer report more emotional distress associated with a diagnosis of prostate cancer than the men report; the duration of distress for partners is seldom examined. OBJECTIVES: The purpose of this study was to determine the long-term effects of prostate cancer treatment on partners' appraisal of their caregiving experience, marital satisfaction, sexual satisfaction, and quality of life (QOL) and factors related to these variables. METHODS: This exploratory study evaluated QOL among spouses of prostate cancer survivors at 24 months after treatment. Partners completed a battery of self-report questionnaires in a computer-assisted telephone interview. RESULTS: The sample consisted of 121 partners with average age of 60 years. There was a significant relationship between partners' perceptions of bother about the man's treatment outcomes and negative appraisal of their caregiving experience and poorer QOL. Younger partners who had a more negative appraisal of caregiving also had significantly worse QOL. CONCLUSIONS: Men's treatment outcomes continued to bother the partner and resulted in more negative appraisal and lower QOL 2 years after initial prostate cancer treatment. Younger partners may be at greater risk of poorer QOL outcomes especially if they have a more negative view of their caregiving experience. IMPLICATIONS FOR PRACTICE: Findings support prior research indicating that prostate cancer affects not only the person diagnosed with the disease but also his partner. Partners may benefit from tailored interventions designed to decrease negative appraisal and improve symptom management and QOL during the survivorship period.

Survivorship after prostate cancer treatment: spouses' quality of life at 36 months.

PURPOSE/OBJECTIVES: To determine the long-term effects of prostate cancer treatment on spouse quality of life (QOL) at 36 months following treatment. DESIGN: Descriptive-exploratory; community-based study. SETTING: Telephone interviews. SAMPLE: 95 female spouses of men treated for early-stage prostate cancer. METHODS: A computer-assisted telephone interview was used to evaluate QOL among spouses of prostate cancer survivors at 36 months after initial prostate cancer treatment. MAIN RESEARCH VARIABLES: Lymphedema, demographic information, self-reported comorbid diseases or medical issues, and medication usage. FINDINGS: Spouses who had more negative appraisal of caregiving had lower sexual satisfaction, poorer cancer-specific QOL, and poorer mental QOL. Spouses who perceived bother related to the patient's sexual or hormone function reported more threatening appraisals of caregiving, less sexual satisfaction, and poorer QOL. CONCLUSIONS: Spouses continued to experience negative appraisal of caregiving, which affected QOL 36 months after their husbands' treatment for prostate cancer. Additional studies related to factors that influence spouse QOL during survivorship will help guide clinical practice. IMPLICATIONS FOR NURSING: Healthcare providers must help spouses find strategies that promote positive coping and lessen negative appraisal. Giving caregivers information early in the treatment process will help them understand what to expect over time. Supporting caregivers and helping them manage stress will enhance QOL during survivorship. KNOWLEDGE TRANSLATION: Spouses who experienced more bother related to urinary, sexual, and hormonal function experience more stress and worse QOL at 36 months post-treatment. Spouse appraisal can have a significant effect on QOL. Offering counseling to couples following treatment for prostate cancer may improve QOL by helping couples manage relationship intimacy.

The experiences of unpartnered men with prostate cancer: a qualitative analysis.

PURPOSE: The purpose of this study was to examine how men without partners make decisions about prostate cancer treatment, manage treatment side effects, and obtain information and support. BACKGROUND: In 2009, it was projected that over 230,000 men were diagnosed with prostate cancer. While treatment options vary, these options result in changes within the man that can affect his quality of life. Research has shown that often spouses play a central role in men's choice of treatment and in maintaining men's quality of life. In addition, spouses are the major providers of emotional support and physical care. However, little is known about how men without partners cope with prostate cancer. Prior research seldom addresses how diagnosis and treatment for prostate cancer affects the quality of life of men without partners. METHODS: Because very little is known about the needs of men without partners managing prostate cancer, qualitative analysis of data obtained during semi-structure interviews provided respondents with an opportunity to share the lived experience of prostate cancer. A semi-structured interview was conducted with selected, consenting men. The sample was drawn from the ongoing R01 study of men with prostate cancer (PROSTQA). RESULTS: The sample for this study included 17 unpartnered prostate cancer survivors. The ages of participants ranged from 47 to 72 with a mean age of 63. The participants had between zero and two co-morbidities with an average of one co-morbidity per participant. The sample was 82% Caucasian and 17% Black. A total of 35% of the participants reported "some college" (n = 6), 30% graduated from college (n = 5), and 23% went to graduate school (n = 4). One participant reported that he was a high school graduate and one had less than a high school education. Five themes emerged from the data: going it alone, diagnosis and prostate cancer treatment decision-making, sources of information and support, the aftermath of prostate cancer, and coping strategies. CONCLUSIONS: This study provides information about unpartnered men's prostate cancer experience. This information will help health care professionals to meet the needs of unpartnered more effectively and help them to assist men as they adapt to living with this chronic illness.