Public perceptions of the harms and benefits of testicular cancer education: a qualitative study

[Knowledge and early detection of testicular germ cell cancer among adolescents and young adults]

INTRODUCTION

Malignant testicular germ cell tumors are the most common tumor disease in young men, affecting not only the period of his reproductive phase but also creating a complex life situation. Therapy includes the risk of development of second neoplasia and sequelae. However, particularly in this age group, knowledge about this disease and risk factors is sparse, and preventive examinations are not available or are not or insufficiently used.

MATERIALS AND METHODS

In order to evaluate the state of knowledge on testicular tumors in adolescents, a knowledge survey was conducted at 6 high schools in Hamburg from January to April 2019 among pupils of grades 11 and 12. This was carried out with a questionnaire comprising 15 items, which was analyzed and also evaluated on a gender-specific basis. Only fully completed questionnaires were considered.

RESULTS

The overall proportion of correctly answered questions was 60.04%. Broken down by gender, the proportion was 60.18% for female pupils and 59.14% for male pupils, while the gender ratio was 52.2 and 47.8% for female pupils. Special questions on testicular tumors were answered correctly by 59.71% of the female students and 54.8% of the male students, while general questions on the structure and function of the male sexual organs were answered 4.51% better by the male students with 64.9%. These were statistically significant in both cases.

CONCLUSION

The survey shows a gender-specific knowledge deficit on testicular tumors, which is more pronounced among boys. As intensified knowledge transfer on this topic alone is insufficient, a preventive examination should be established especially for boys. This would enable individual, risk-commensurate and needs-adapted monitoring and early detection of testicular tumor disease, but also of other health issues in male adolescents.

[Awareness of clinical relevance of malignant testicular cancer among university students : The value of ​prevention campaigns]

BACKGROUND

Early detection of localized testicular cancer is associated with a significantly better prognosis compared to advanced tumor stages. Testicular cancer prevention campaigns like "Hodencheck.de" launched by the German Society of Urology or the international campaign "Movember Foundation" want to inform and raise awareness about testicular cancer and other male cancers. This study aimed to evaluate to which extent public prevention campaigns may influence the behavior of young men and women in Germany.

OBJECTIVES

Questionnaires were used to ask students at the University of Frankfurt, Germany, whether they are familiar with the currently most widespread testicular cancer prevention campaigns and whether testicular examinations for cancer screening were performed by themselves, a partner or a physician.

RESULTS

Only a minority of the students were aware of the testicular cancer prevention campaigns "Hodencheck.de" and/or "Movember Foundation"; 79.9% of the male and 83.6% of female students had not heard of the two mentioned prevention campaigns. Significantly more male (35.2%) compared to female students (28.9%) knew that testicular cancer is the most common cancer in young men. Of the men, 48.9% had already palpated their testicles, while only 12.4% of the women had already palpated the partner's testicles for cancer screening. Students knowing about the testicular cancer prevention campaigns performed significantly more testicular examinations for screening purposes.

CONCLUSIONS

Our study demonstrates that current testicular cancer prevention campaigns are little known amongst German university students. However, the knowledge of testicular cancer prevention campaigns resulted in an increased awareness and an increased willingness for testicular (self-) examinations.

Developing the "Control Identity" Typology to Create More Effective Testicular Health Promotional Messaging

Testicular self-examination (TSE) promotional interventions historically operate without a theoretical framework, which negatively influences their effectiveness. As TSE is critical to the early detection of testicular cancer, this behavior is an essential component to improving overall male well-being. To address this need, the Control Identity personality typology was developed to assist in creating more effective TSE promotional interventions. Four outcome control dispositions were defined a priori based on the dimensions of illusions of control and locus of control. An original 41-item survey, the Control Identity Assessment Scale, was used to assess perceived vulnerability, value of health promotion, and health outcome control among a convenience sample of 300 university males aged 18 to 35 years via a cross-sectional research design. Factor and cluster analyses were employed to extract salient factors in the data and to identify subgroups within the sample. A consistent five-factor structure matrix (~70% explained variance) served as the foundation from which a k-means cluster analysis was employed to classify four types of individuals. Significant differences were detected between clusters on primary variables, including behavioral intentions to conduct TSE. The Control Identity typology aims to provide the needed mechanism for health practitioners to create more effective preventive health messaging to promote TSE. Future implications on employing this typology to segment audiences in order to increase overall effectiveness are offered. Application of this typology could ultimately lead to increasing TSE knowledge retention, behavioral intentions, actual performance, and adherence.

Has increasing public health awareness influenced the size of testicular tumours among adult populations over the last 40 years?

Background

Testicular cancer is the commonest malignancy in young men. Improvements in survival rates have led to campaigns to raise awareness in at-risk men. We assessed the changing size of testicular tumours given the public health initiatives promoting testicular self-examination (TSE).

Methods

Retrospective analysis of men (≥16 years) undergoing orchidectomy for testicular cancer at our institution over two time periods (1975-85 and 2007-12) were identified using our cancer registry. Histopathology reports were used to record testicular tumour size as the maximum measured dimension. Significance was indicated by P < 0.05.

Results

Of 305 orchidectomies performed, 215 had histopathology reports available. Median age was 34 years (16-75 years). Mean tumour size was 7.2 cm in 1975-85 and 4.1 cm in 2007-12 showing a significant reduction (P = 0.02). Significant reduction was seen in all age groups except >60 years. Furthermore there was a significant increase in proportion of men presenting in the youngest age group (16-29 years) in the 2007-12 cohort (43 versus 29%, P = 0.02).

Conclusion

The trend in reduction of tumour size at presentation and increased proportion of younger men presenting with testicular cancer supports an increased awareness. Promotion of TSE and public education should remain important initiatives given the increasing incidence of testicular cancer. Awareness still needs addressing in older men.

Patient experience and perceived acceptability of whole-body magnetic resonance imaging for staging colorectal and lung cancer compared with current staging scans: a qualitative study

OBJECTIVE

To describe the experience and acceptability of whole-body magnetic resonance imaging (WB-MRI) staging compared with standard scans among patients with highly suspected or known colorectal or lung cancer.

DESIGN

Qualitative study using one-to-one interviews with thematic analysis.

SETTING

Patients recruited from 10 hospitals in London, East and South East England between March 2013 and July 2014.

PARTICIPANTS

51 patients (31 male, age range 40-89 years), with varying levels of social deprivation, were recruited consecutively from two parallel clinical trials comparing the diagnostic accuracy and cost-effectiveness of WB-MRI with standard scans for staging colorectal and lung cancer ('Streamline-C' and 'Streamline-L'). WB-MRI was offered as an additional scan as part of the trials.

RESULTS

In general WB-MRI presented a greater challenge than standard scans, although all but four patients completed the WB-MRI. Key challenges were enclosed space, noise and scan duration; reduced patient tolerance was associated with claustrophobia, pulmonary symptoms and existing comorbidities. Coping strategies facilitated scan tolerance and were grouped into (1) those intended to help with physical and emotional challenges, and (2) those focused on motivation to complete the scan, for example focusing on health benefit. Our study suggests that good staff communication could reduce anxiety and boost coping strategies.

CONCLUSIONS

Although WB-MRI was perceived as more challenging than standard scans, it was sufficiently acceptable and tolerated by most patients to potentially replace them if appropriate.

TRIAL REGISTRATION NUMBER

ISRCTN43958015 and ISRCTN50436483.

Promoting Testicular Cancer Awareness and Screening: A Systematic Review of Interventions

BACKGROUND

Testicular cancer (TC) is a relatively curable malignancy that predominantly affects young males. Key decision makers discourage TC screening because of lack of evidence about the benefits of this practice, whereas others argue that men must be aware of normal versus abnormal testicular findings. Despite the debate on TC surveillance, a number of research efforts are still being made to increase men's awareness of TC and its screening.

OBJECTIVE

The aim of this study was to systematically review studies that were conducted to enhance men's knowledge and awareness regarding TC and its screening and increase their TC screening intentions and practices.

METHODS

Studies published in English between 2004 and 2014 were reviewed using 3 e-databases, and interventions that were in line with the review aims were selected.

RESULTS

A total of 3076 records were screened for eligibility, and 11 studies met the inclusion criteria. The majority of the reviewed interventions successfully enhanced men's awareness of TC and its screening and increased their intentions to perform testicular self-examination. Examples include videos about TC, shower gel sachets, stickers, and posters, a television show, a university campaign, and high self-efficacy messages about TC screening. Men at risk of health disparities were underrepresented in the reviewed literature.

CONCLUSIONS

A number of interesting channels through which men can learn about TC were identified. Examples include social media and mass media.

IMPLICATIONS FOR PRACTICE

Given the controversy that surrounds TC screening, nurses can play a key role in increasing men's awareness of TC rather than advising periodical TC self-examination.

Attitudes Toward Testicular Cancer and Self-Examination Among Northern Irish Males

Testicular cancer incidence rates are increasing worldwide making it the most common malignancy in males aged 15 to 45 years. Without a known way to prevent the disease health professionals must promote awareness and early detection. A literature review identified a scarcity of information regarding awareness and knowledge of, and attitudes toward, testicular cancer and testicular self-examination among men in Northern Ireland. This study aimed to establish baseline data for Northern Ireland using a convenience sample of 150 men, aged 18 to 45 years. The sample was recruited from across the country and so represents a range of education and area deprivation levels. An online survey was used to collect data. Results showed that while 39% of respondents correctly identified the age group at highest risk for testicular cancer, only 17% of respondents had ever heard of a testicular self-examination. Analysis revealed knowledge, awareness, and attitudes differed by age groups and area deprivation quintiles. It is recommended that health promoters in Northern Ireland and elsewhere use these findings to tailor health promotion initiatives to engage men and raise testicular cancer and self-examination awareness.

Exploring awareness and help-seeking intentions for testicular symptoms among heterosexual, gay, and bisexual men in Ireland: A qualitative descriptive study

BACKGROUND

The incidence of malignant and benign testicular disorders among young men is on the rise. Evidence from three reviews suggest that men's knowledge of these disorders is lacking and their help-seeking intention for testicular symptoms is suboptimal. Qualitative studies have addressed men's awareness of testicular cancer, with none exploring their awareness of non-malignant diseases such as epididymitis, testicular torsion, and varicocele and none including sexual minorities.

OBJECTIVE

To explore, in-depth, heterosexual, gay, and bisexual men's awareness of testicular disorders and their help-seeking intentions for testicular symptoms in the Irish context.

DESIGN

This study used a qualitative descriptive approach. Data were collected via face-to-face individual interviews and focus groups.

SETTINGS

Participation was sought from a number of community and youth organisations and one university in Southern Ireland.

PARTICIPANTS

Maximum variation and snowball sampling were used to recruit a heterogeneous sample. A total of 29 men partook in this study. Participants were men, aged between 18 and 50 years, and residents of the Republic of Ireland.

METHODS

All interviews were audio-recorded and transcribed verbatim. Reflective field notes were taken following each interview. A summary of the interview was shared with selected participants for member-check. Data were analysed and validated by three researchers. Inductive qualitative analysis of manifest content was used. Latent content was captured in the field notes. Data analysis yielded two key themes.

RESULTS

The themes that emerged from the interviews were: Awareness of testicular disorders and their screening, and help-seeking intentions for testicular symptoms. Although most participants heard of testicular cancer, most did not know the different aspects of this malignancy including its risk factors, symptoms, treatments, and screening. Several men had a number of misconceptions around testicular disorders which negatively impacted their intentions to seek prompt help. Intentions to delay help-seeking for testicular symptoms were often linked to a number of emotional factors including fear and embarrassment, and social normative factors such as machoism and stoicism. In this study, culture was perceived by some participants as a barrier to awareness and help-seeking. In contrast, many believed that young men, especially those who self-identify as gay, are becoming increasingly interested in their own health.

CONCLUSION

Findings suggest the need to educate young men about testicular disorders and symptoms. This could be achieved through conducting health promotion campaigns that appeal to younger men, drafting national men's health policies, and normalising open discussions about testicular health at a young age.

Testicular Cancer Awareness and Screening Practices: A Systematic Review

PURPOSE/OBJECTIVES

To critically appraise empirical evidence gathered from studies that (a) explored men's knowledge, awareness, and attitudes toward testicular cancer (TC) and its screening; (b) addressed their testicular self-examination (TSE) practice; and/or (c) highlighted barriers and facilitators to this practice.
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DATA SOURCES

MEDLINE®, CINAHL®, and EMBASE®.
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DATA SYNTHESIS

25 articles met the inclusion criteria. Knowledge deficits regarding TC and its screening were seen. Participants who did not perform TSE often were uninformed about this practice. The majority of men perceived TC education as a positive step toward raising awareness about this malignancy.
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CONCLUSIONS

Very few men were informed about TC and TSE. Future studies should include valid and reliable tools to assess TC knowledge and screening, address the means through which TC knowledge is delivered, explore the individual's experience with TC screening, and focus on TC awareness and screening among minority groups. 
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IMPLICATIONS FOR NURSING

Although regular screening for TC is a controversial issue, nurses should encourage young men to seek medical attention in the event of discovering scrotal abnormalities.

Educating young men about testicular cancer: support for a comprehensive testicular cancer campaign

Despite the prevalence of testicular cancer among men 15-39 years of age, little has been done to increase awareness of this disease or educate males about its prevention. To fill this gap, the Standard Model of Health Communication was incorporated to design and implement a comprehensive testicular cancer campaign among male college students. To test the effectiveness of these messages, college students (N = 220) completed measures before and after the campaign. In addition, the authors obtained a control group of male college students (N = 52) who were not exposed to the messages. Survey items assessed awareness of testicular cancer and behaviors related to testicular cancer. Participants' knowledge of testicular cancer and likelihood of conducting a testicular self-exam increased significantly after being exposed to the campaign information. Men who were exposed to testicular cancer messages were more knowledgeable about testicular cancer and were more likely to conduct testicular self-examinations than were men in the control group.

Cancer information and anxiety: applying the extended parallel process model

There is concern that public education about testicular cancer (TC) may cause unnecessary anxiety. Psychological theory suggests that if threat (eg, TC) information is accompanied with threat control strategies (eg, testicular self-examination; TSE) anxiety is less likely. Male students (N=443) were randomized to either a TC or TC +TSE information group or a no information control group, and assessed at three time points. Anxiety levels did not differ between the groups and exposure to TC+TSE resulted in greater perceived message benefit, increased intention to self-examine and lower message denigration. This suggests TC information is not anxiogenic, but inclusion of TSE information may improve acceptance of disease awareness information.