91 - 8039591919
info@healtho5.com

Patient Engagement After Radical Prostatectomy

Patient Engagement After Radical Prostatectomy

Prostate cancer (PCa) is the second most common cause of cancer and sixth leading cause of cancer mortality among men worldwide. The worldwide prostate cancer burden is expected to grow to 1.7 million new cases and 499 000 deaths by 2030 (Ferlay et al., 2010). Previous it was assumed that prevalence of prostate cancer in India is scanty as compared to the developed nations but with changing lifestyles, easy access to the medical facility and urban migration, high cases of prostate cancer are being reported nowadays.

Prostate cancer is one of the top ten leading cancers in India. Prostate cancer is the second most common cancer among males in large Indian cities like Delhi, Kolkata, Pune and third common cancer in cities like Bangalore and Mumbai. According to cancer projection data, the number of prostate cancer in India will double by 2020.(Epidemiology of prostate cancer in India, Aug 2014)

One of the standard therapy for prostate cancer is Radical prostatectomy (RP), a surgical procedure for removing the prostate gland and surrounding tissue. The post-discharge period after radical prostatectomy is often full of anxiety for both patients and their families. They have to deal with physical and emotional challenges associated with surgery.

Lack of knowledge about predicted recovery and non-coordinated self-care significantly reduces postoperative recovery.

The importance of nursing support in the later months after radical prostatectomy has been well described (Gregoire, Kalogeropoulos, & Corcos, 1997; Montie, 1994; Sharp, Blum, & Aviv, 1993). Healthcare professionals recognize the importance of providing self-care information prior to discharge from the hospital, but it is often not incorporated into practice or are ineffective. Empowering surgical patients with the necessary information to make informed decisions and to cope after surgery may be hindered by many factors such as timing of information (Valanis & Rumpler, 1985), inability to retain information (Krupat, 1986), unfamiliar medical terminology (Estey, Kemp, Allison, & Lamb, 1993), and a perceived or real lack of support (Taylor, Bandura, Ewart, Miller, & DeBusk, 1985). Out of which lack of knowledge is considered to be the most important hindrance to self-care.

Men who had undergone a prostatectomy felt they had not been properly informed even though the health care professionals believed they had provided comprehensive information both pre and postoperatively. Anxiety related to hospitalization, fatigue, and postoperative pain often makes it difficult for the patient to absorb all self-care information they are provided while in hospital. Gray, Fitch, Phillips, Labrecque, and Klotz (1999) identified notable differences between what health care professionals expected patients level of knowledge to be prior to having a prostatectomy, and what the patient said he understood when interviewed after surgery. Similar inconsistency was noted by Moore and Estey (1999).

Phillips et al. (2000) also found that even after 8 to 10 weeks of prostatectomy, patients identified level of activity as the most important indicator of satisfactory recovery. These findings demonstrate the need for continuous engagement to ensure that patient understands variation in the length of recovery time and have a realistic attitude toward activity levels. Patients seek constant support and guidance post surgery. On-call postoperative nursing interventions promote physical recovery, emotional well-being, and satisfaction in self-management after discharge (Langwade, 2000). Follow-up telephone calls after discharge, psychological consultation, and engagement with support groups are recognized valuable for rapid recovery.

“According to Gallup survey, over the first year of surgery, follow-up telephone calls made to each patient the morning after discharge to answer questions and to remind patients to call for follow-up visits with their physicians or specialists resulted in 100% attendance at follow-up appointments and an increase of 11% in patient satisfaction.

Partners of prostatectomy patients also experience emotional difficulties (Oberst & Scott, 1988), but they also provide positive social support (Carlson, Ottenbreit, St. Pierre, & Bultz, 2001; Harrison, Maguire, & Pitceathly, 1995; Phillips et al., 2000) and want to be involved in all aspects of their partner’s care (Butler, Downe-Wamboldt, Marsh, Bell, & Jarvi, 2000). Post-operative education and engagement should be designed to provide collaborative and holistic support to not only the patients but their families too.

References:

  1. Epidemiology of prostate cancer in India, Shalu Jain, Sunita Saxena and Anup Kumar, Meta Gene. 2014 Dec; 2: 596–605. Published online 2014 Aug 29. doi: 10.1016/j.mgene.2014.07.007, PMCID: PMC4287887
  2. The role of the clinical nurse specialist in caring for patients with prostate cancer: a narrative review. Authors de Moraes Lopes M, Higa R , dop: 18 July 2014 , Volume 2014:4 pages 77-89 DOI: https://doi.org/10.2147/NRR.S36752
  3. Telephone follow-up of patients after radical prostatectomy: a systematic review. Rev. Latino-Am. Enfermagem 2014 Mar.-Apr.;22(2):337-45 DOI: 10.1590/0104-1169.3314.2421 www.eerp.usp.br/rlae