Psychological distress and lifestyle disruption in low-risk prostate cancer patients: Comparison between active surveillance and radical prostatectomy.

OBJECTIVE: To quantify distress in men treated with radical prostatectomy (RP) or active surveillance (AS). METHODS: In a retrospective cross-sectional design, we assessed men through questionnaire and investigator-designed questions. RESULTS: RP patients worried more about cancer spread than AS patients. RP patients were influenced by friends for treatment decision, whereas AS patients were influenced by urologists. RP group report declines in intimacy and instrumental. AS men worried more about future health and dying than post-RP men. CONCLUSION: Fear of disease progression may be a motivating factor in choosing RP. AS patients adhere to their treatment decision in spite of distress.

Exploring gay couples' experience with sexual dysfunction after radical prostatectomy: a qualitative study.

This exploratory study examines the experience of three gay couples managing sexual dysfunction as a result of undergoing a radical prostatectomy. Semi-structured interviews were conducted as part of a larger study at an urban hospital in Toronto, Ontario, Canada. Interview transcripts were transcribed verbatim, and analyzed using interpretative phenomenological analysis. The authors clustered 18 subordinate themes under 3 superordinate themes: (a) acknowledging change in sexual experience (libido, erectile function, sexual activity, orgasmic function); (b) accommodating change in sexual experience (strategies: emphasizing intimacy, embracing plan B, focus on the other; barriers: side-effect concerns, loss of naturalness, communication breakdown, failure to initiate, trial and failure, partner confounds); and (c) accepting change in sexual experience (indicators: emphasizing health, age attributions, finding a new normal; barriers: uncertain outcomes, treatment regrets). Although gay couples and heterosexual couples share many similar challenges, we discovered that gay men have particular sexual roles and can engage in novel accommodation practices, such as open relationships, that have not been noted in heterosexual couples. All couples, regardless of their level of sexual functioning, highlighted the need for more extensive programming related to sexual rehabilitation. Equitable rehabilitative support is critical to assist homosexual couples manage distress associated with prostatectomy-related sexual dysfunction.

Health-related quality of life following radical prostatectomy: long-term outcomes.

PURPOSE: To identify the health-related quality of life (HRQoL) domains that radical prostatectomy (RP) impacts most negatively and to define the recovery of these domains over 30 months of observation. PATIENTS AND METHODS: A total of 1,200 RP patients completed the Patient-Oriented Prostate Utility Scale-Psychometric (PORPUS-P; range 0-100, higher is better), a prostate cancer-specific HRQoL measure, prior to RP and at 0-3 (T1), 3-9 (T2), 9-18 (T3) and 18-30 (T4) months post-RP. HRQoL changes were examined using paired t tests and a mixed-effect growth curve model. Multivariable analyses were performed to investigate demographic and treatment factors predicting the change in HRQoL. RESULTS: Mean baseline PORPUS-P score, 83.1, fell to 66.5 (p < 0.001) at T1. Over time HRQoL improved but did not return to baseline (T4 mean 76.4, p < 0.001). Domain analysis revealed that sexual function (p < 0.001), sexual drive (p < 0.001), energy (p = 0.001) and bladder control (p < 0.001) failed to return to baseline at T4. Sexual function demonstrated the greatest impairment overall. The multivariable model revealed Black men experienced greater losses in global HRQoL compared with White men (coefficient -2.77, 95% CI -5.00 to -0.54, p = 0.015). High baseline HRQoL, pro-erectile aid use and bilateral nerve-sparing were significantly associated with smaller reductions in HRQoL post-RP. CONCLUSION: Overall HRQoL, sexual drive, sexual function, energy and bladder control do not return to preoperative levels within 30 months post-RP. Black patients experience the greatest reductions in HRQoL. HRQoL losses may be ameliorated by use of pro-erectile aids. These findings help to identify at-risk patient populations and inform survivorship programs.

An evaluation of the impact for healthcare professionals after a leadership innovation fellowship program.

BACKGROUND: Leadership among healthcare professionals is required to address important healthcare challenges. The TAHSNp Health Professions Innovation Fellowship program ("Program") supports health professionals' leadership development by offering them an opportunity to lead a quality improvement project and participate in a curriculum focused on leading change. OBJECTIVE: As part of an outcome evaluation of the program, our objective was to determine the program's impact on leadership activities and roles undertaken by alumni. METHODS: A questionnaire was administered to participants who completed the program in 2019 and 2020 at 6 and 18 months post-program to assess their leadership activities, leadership roles and the program's impact. Prospectively, we conducted internal and LinkedIn searches to identify current roles and obtained personal statements from program alumni of medical imaging health professions as complementary data sources for our program evaluation. RESULTS: At 6 and 18 months post-program, 47% - 59% of alumni respondents reported participation in hospital/organization committees, mentoring fellows or students, and presenting scholarly work inside or outside their organizations (6 months: N = 25, response rate = 39.1%; 18 months: N = 17, response rate = 26.6%). Additionally, at 18 months post program, 35% - 41% of alumni reported leading a new quality improvement initiative, pursuing formal education, and having a new leadership role. Most alumni reported their leadership activities were influenced by the program, with the largest impact occurring after 18 months post-program for leading a new quality improvement initiative (100%), career plans for the next five years (94%), mentoring fellowship staff (91%), presenting at their healthcare organization (91%) and a new leadership role (90%). Alumni reported the program helped build their confidence, create networking opportunities, leadership skill-building and interest in pursuing other roles beyond their clinical role. More specifically, alumni reported that leadership skills gained from the program were used in subsequent roles and responsibilities. CONCLUSION/IMPLICATIONS: The program evaluation demonstrates engaged alumni who undertake informal and formal leadership activities and roles. Our results are illustrative of the value-add as a result of healthcare organizations' investment in developing leadership among healthcare professionals. As continued engagement and career development are known to be important for staff retention and succession planning strategies, our findings are highly relevant given the current staffing challenges in healthcare.

Serial personal digital assistant data capture of health-related quality of life: a randomized controlled trial in a prostate cancer clinic.

BACKGROUND: In clinical and research practice linked to prostate cancer treatment, frequent monitoring of patient health-related quality of life (HRQOL) is essential. Practical and analytic limitations of paper questionnaire data capture may be overcome with the use of self-administered personal digital assistant (PDA) data collection. The objective of this study was to assess the reliability, validity, and feasibility of using PDA in place of paper versions of the International Prostate Symptom Score (IPSS), the Patient Oriented Prostate Cancer Utility Survey (PORPUS), and the International Index of Erectile Function-5 (IIEF-5) in a prostate cancer clinic setting. METHODS: 152 participants were randomly assigned to one of three conditions: 1) paper followed by PDA survey; 2) PDA followed by paper survey; or 3) PDA followed by PDA survey. Evaluation included an assessment of data quality (internal consistency, test-retest reliability, response correlation, completeness of data), and feasibility (participation rates, time to completion, preference and difficulty/ease of using PDA). RESULTS: Internal consistency was similar for both PDA and paper applications. Test-retest reliability was confirmed for PDA repeated administration. Data from paper and PDA questionnaires were strongly correlated. Lower missed item rates were found in PDA administration. 82.8% of participants preferred using the PDA or had no preference. Mean difficulty/ease ratings indicated that participants found the PDA easy to use. Age did not significantly correlate with preference or difficulty. CONCLUSION: The results confirm the adaptability of the IPSS, IIEF-5, and the PORPUS to PDA administration. Similarly, the findings of this study support the feasibility of using PDA technology for HRQOL serial data capture in the prostate cancer patient population.

Examining risk perception among men with a family history of prostate cancer.

OBJECTIVE: This paper explores factors that influence the formulation of risk perception among men with a family history of prostate cancer who are currently attending a prostate cancer screening clinic. METHODS: Semi-structured interviews were conducted with fifteen participants. Interview transcripts were analyzed using interpretative phenomenological analysis. RESULTS: The following themes were identified: Risk Information Pathways, Experience with Other Prostate Disease, Exposure to Prostate Cancer Screening, Exposure to Affected Relatives, Lifestyle Factors, Illness Beliefs, and Health-Based Risk Comparisons. CONCLUSION: Understanding the contributors to risk perception and applying this knowledge during screening visits and genetic counselling may help to reduce risk distortion and result in increased adherence to screening programs and reduced psychological distress. PRACTICE IMPLICATIONS: Prostate cancer screening should incorporate counselling to address patient-specific risk concepts in order to increase the accuracy and maintain the stability of risk perceptions.

Personal digital assistant data capture: the future of quality of life measurement in prostate cancer treatment.

PURPOSE: This article examines the potential use of personal digital assistant (PDA) data capture systems for real-time linear monitoring of health-related quality of life (HRQOL) in prostate cancer research and clinical care. METHODS: We discuss the benefits and potential issues of using PDA data capture in the clinical health care setting. In addition, we describe the development and potential use of a PDA data capture system specific to managing HRQOL in prostate cancer treatment. CONCLUSION: Follow-up health care clinics require a practical and systematic process of HRQOL data capture and analysis. Traditional paper questionnaire data capture is problematic. Data manipulation required for clinical decision-making is impractical for patient feedback on same-day clinic visits. Furthermore, the process of transforming paper questionnaire data to analysis-quality data can compromise data integrity. In contrast, research findings confirm the acceptability, ease of use, and reliability of PDAs in capturing data across health care settings, including the collection of serial HRQOL data. The main concern for PDA capture systems is the ability to compare respondent's answers between the paper and PDA questionnaire. Other challenges included patients reporting a lack of computer literacy and/or poor eyesight, as well as initial start-up costs. If issues are successfully addressed, the use of a PDA data capture system, such as the PDA HRQOL system at Princess Margaret Hospital's Prostate Centre, allows for valid and economical data collection with the possibility of linear real-time measurement of changes in HRQOL. Accordingly, there appears to be significant potential for PDA data collection of serial HRQOL in prostate cancer clinic settings.