A Model of Consultation in Prostate Cancer Care: Evidence From a Systematic Review

Patient Experiences of Patient-Clinician Communication Among Cancer Multidisciplinary Healthcare Professionals During "Breaking Bad News": A Qualitative Systematic Review

PURPOSE

To explore patient experiences of patient-clinician communication during the critical moments of "breaking bad news" in cancer care.

METHODS

A qualitative systematic review followed the Joanna Briggs Institute methodology and has been reported according to PRISMA guidelines. Databases, including APA PsycINFO, CINAHL, MEDLINE, and Scopus, were searched from the beginning of their date range coverage to April 2023. Data extraction and quality assessment were performed, and a meta-aggregation approach was used for data synthesis.

RESULTS

Twenty-eight studies were included and represented 976 patients. Key themes included (1) sensing something is wrong (prior to diagnosis), (2) reaction to the diagnosis, (3) information (during breaking bad news), (4) communication with health care professionals, (5) specialist versus nonspecialist centers, (6) decision-making, and (7) feeling supported. The review underscores the need for health care professionals to adeptly navigate and respond to individual patient needs during confronting and distressing times.

CONCLUSIONS

The complexity and individuality of patient-clinician communication suggest that further education is needed among the cancer multidisciplinary team to develop personalized, empathetic communication strategies in clinical practice, catering to diverse patient preferences. The findings call for more inclusive research across different cultures and languages, and a need to understand evolving communication needs, especially in the context of increasing digital communication modalities in health care.

IMPLICATIONS FOR CANCER SURVIVORSHIP

This review provides valuable new insights into developing effective communication strategies that are responsive to the diverse needs of patients undergoing cancer treatment. Its findings emphasize the importance of empathy, flexibility, and a personalized approach in delivering bad news and supporting patients throughout survivorship.

The Experiences and Unmet Supportive Care Needs of Partners of Men Diagnosed With Prostate Cancer: A Meta-aggregation Systematic Review

BACKGROUND

Partners of men diagnosed with prostate cancer face their own emotional struggles as they navigate additional caregiver responsibilities while concurrently adjusting to the diagnosis and coping with greater illness uncertainty for their loved one.

OBJECTIVE

This qualitative systematic review examined the unmet supportive care needs of partners affected by prostate cancer.

INTERVENTIONS/METHODS

A meta-aggregation was conducted. Four electronic databases were searched using key words. The methodology followed the Joanna Briggs Institute for qualitative evidence synthesis. The review process followed a registered priori review protocol and was reported using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines. Data extraction and quality assessment were conducted in parallel.

RESULTS

Twenty-one publications were included. A total of 239 findings and 32 categories were synthesized into 7 domains of unmet needs as experienced by partners. The domains of needs expressed by the participants included interpersonal/intimacy, physical/daily living, healthcare service, family-related, psychological/emotional needs, and spiritual and social needs.

CONCLUSIONS

There are gaps in clinical service support, despite routine clinical consultation with healthcare professionals. Partners may diminish their social networks to protect their husband at the cost to their own self-preservation and well-being.

IMPLICATIONS FOR PRACTICE

Cancer organizations, policy makers, healthcare care professionals, and researchers are slowly making progress to acknowledge the unique support needs of partners affected by cancer. Healthcare professionals should encourage partners to be included in models of prehabilitation to access timely support to address informational, intimacy, spiritual, and daily living needs support.

Providing Leadership Through Patients as Partners: Improving Australian Colorectal Survivorship Care Through Perspectives from a Nurse Who Became a Cancer Patient

OBJECTIVE

To provide contemporary real-world, real-life insights into gaps in supportive care experiences for people affected by colorectal cancer. For the first time, this article includes a patient as a coauthor, with the aim to identify future priorities to improve care and recovery in colorectal cancer survivorship.

DATA SOURCES

Electronic databases, peer-reviewed literature, and real-life professional and personal experiences were used.

CONCLUSION

There are several problematic areas in providing supportive care for people affected by colorectal cancer that could be improved by wider access to colorectal specialist nurses, coordinated multidisciplinary teams, patient collaboration, linking survivorship care outcomes to national standards, and developing supported self-management care plans.

IMPLICATIONS FOR NURSING PRACTICE

A patient-led insight has underscored some fundamental failings in current service delivery among people affected by colorectal cancer. Partnering with consumers in research and service redesign is essential to stratify future priorities to optimize care and person-centered recovery.

Exploring the impact of uro-oncology multidisciplinary team meetings on patient outcomes: A systematic review

PURPOSE

Multidisciplinary team (MDT) meetings are mainstay clinical management globally. Clinical guidelines state that patients should be considered for MDT review, but evidence has identified that within the specialty of uro-oncology not all patients are reviewed by an MDT. This systematic review aimed to understand the impact of uro-oncology MDT meetings on patient outcomes, to explore how patient engagement is incorporated in the process, and to identify the barriers and facilitators within an MDT.

METHODS

A systematic review was reported according to PRISMA guidelines. Electronic databases (MEDLINE, CINAHL and PsychINFO) were searched in EBSCOhost from January 2010 to March 2021, using a range of key search words. Studies were assessed for inclusion according to a pre-defined eligibility criteria. Data extraction and quality assessment was undertaken. The findings were tabulated, and a narrative synthesis undertaken.

RESULTS

373 articles were screened, and seven studies were included. The studies were conducted in a range of international countries which provided an overview of uro-oncology MDTs in different healthcare contexts. The following themes were identified: 1) MDT and clinical outcomes, 2) structure and format, 3) patient engagement in the process, and 4) barriers and facilitators.

CONCLUSION

Cancer care is constantly being challenged due to complex newer therapies, including multimodality treatments, and newer emergent broader considerations such as, oncogeriatrics, genetic counselling, and survivorship issues which should have a central place for consideration in the MDT.

Identifying the unmet supportive care needs of people affected by kidney cancer: a systematic review

PURPOSE

To synthesize existing evidence on the unmet supportive care needs of people affected by kidney cancer, across the cancer care continuum.

METHODS

A systematic review was conducted according to the PRISMA Statement Guidelines. Electronic databases (CINAHL, MEDLINE, and PsychINFO) were searched using key search terms. Articles were assessed according to pre-specified eligibility criteria. Data extraction and quality appraisal were conducted. The findings were integrated in a narrative synthesis.

RESULTS

One thousand sixty-three publications were screened, and 18 publications met the inclusion criteria. The following domains of unmet needs in order of frequency included psychological/emotional needs (17/18: 94%), physical needs (10/18: 56%), social needs (4/18: 22%), interpersonal/intimacy needs (4/18: 22%), patient-clinician communication needs (3/18: 17%), family-related needs (3/18: 17%), health system/information needs (3/18: 17%), spiritual needs (3/18: 17%), daily living needs (2/18: 11%), practical needs (1/18: 6%), and cognitive needs (1/18: 6%).

CONCLUSIONS

There was a wide range of unmet supportive care needs experienced by people diagnosed with kidney cancer. A prominent focus was on psychological and physical needs. Further research is needed to understand how clinical (stage/treatment) and demographic (age/socio-economic/ethnicity) variables may moderate or mediate the relationship with unmet needs over time. With many unmet needs identified, this review provides a starting place to inform future work to address the complex unmet supportive care needs of people affected by kidney cancer.

IMPLICATIONS FOR CANCER SURVIVORS

Individuals living with kidney cancer have many unmet supportive care needs, and future research is needed to learn about what are the most pressing needs and how to best address these concerns to ensure holistic person-centered care is delivered.

An exploration of the Role of the Prostate Cancer Specialist Nurse from Two International Perspectives

OBJECTIVE

A diagnosis of prostate cancer is a major life-changing event that brings social, psychological, physical, financial, and spiritual challenges. In both the United Kingdom (UK) and Australia, prostate cancer specialist nurses (PCSNs) have a unique role in the care of men and their families. Prostate cancer specialist nursing roles are described from the UK and Australian perspective.

DATA SOURCES

Government regulations, peer-reviewed journal articles, nursing society and government websites.

CONCLUSION

Specialist nursing roles have developed within different frameworks and in response to very different political drivers in the UK and in Australia. An evidence base has developed demonstrating that PCSNs offer positive outcomes for men and their families. Despite some differences in the scope of international roles, there are common aspects. Both health care settings have challenges in terms of education, role definition, and capacity. Yet both PCSN roles have delivered innovative models of specialist care in terms of service delivery and patient support and education.

IMPLICATIONS FOR NURSING PRACTICE

PCSNs have the potential to significantly decrease the burden on the public health system and influence change. For men with prostate cancer and their families, PCSNs can improve care through holistic nursing models focussing on what is important to individuals: support, education, management of side effects, rehabilitation, and by delivering and improving access to high-quality care.

Experiences of Unmet Need and Access to Supportive Care for Men Receiving Androgen Deprivation Therapy for Prostate Cancer: A Bi-national Study

OBJECTIVE

The number of men affected by incurable prostate cancer is expected to increase worldwide. Research is needed to enable men to share their experiences of unmet supportive care needs in current care delivery. We aimed to identify the most frequently reported domains of unmet supportive care needs, levels of anxiety, depression, distress, health-related quality of life, and to identify any perceived barriers to receiving supportive care.

DATA SOURCES

Men diagnosed with prostate cancer who had received a minimum of 6 months of ADT were recruited into a cross-sectional study. Participants completed standardised questionnaires; clinical and demographic data was also collected.

CONCLUSION

Two hundred seventy-two patients were invited, and 102 participated. No statistically significant differences were found between participant scores from Australia and UK in relation to anxiety and depression, exercise, health-related quality of life, or distress scores. Perceived barriers include service delivery related to information provision and difficulties in the navigation of complex care systems.

IMPLICATIONS FOR NURSING PRACTICE

Men affected by prostate cancer receiving ADT reported unmet supportive care needs, specifically related to sexual, informational, and psychological aspects of care. Mapping future trajectories of needs and identifying men at high risk can significantly improve timely and tailored interventions.

Prostate Cancer Prehabilitation and the Importance of Multimodal Interventions for Person-centred Care and Recovery

BACKGROUND

Prostate cancer is the second most commonly diagnosed cancer globally. Cancer prehabilitation is defined as a process on the continuum of care that occurs between the time of a cancer diagnosis and the beginning of acute treatment. This article will discuss the importance of prostate cancer prehabilitation interventions in optimising physical and psychological recovery to enhance person-centred care.

DATA SOURCES

Electronic databases including CINAHL, MEDLINE, PsychINFO, Scopus, professional websites, and grey literature were searched using Google Scholar.

CONCLUSION

Prehabilitation in cancer care aims to enhance perioperative care and recovery. An emerging field of research suggests that the preoperative period may be physically and psychologically salient to introduce modifiable self-management behaviours to optimise overall recovery.

IMPLICATIONS FOR NURSING PRACTICE

Prostate cancer specialist nurses provide the hub of person-centred care across the entire cancer care continuum embedded within the multidisciplinary team. Individually tailored interventions such as exercise and pelvic floor muscle training programmes, nutritional advice, anxiety and depression reduction, and sexual well-being interventions should be considered in the prehabilitation phase of the cancer care continuum.

Improving Physical and Mental Health in Patients with Prostate Cancer Undergoing Androgen Deprivation Therapy: Strategies to Promote and Improve Physical Activity Quality and Quantity

OBJECTIVE

Prostate cancer continues to be one of the highest-incident cancers among men. Reducing serum testosterone with androgen deprivation therapy (ADT) is a common effective treatment. While well-demonstrated for cancer suppression, there are numerous adverse effects caused by ADT that can contribute to short- and long-term prognosis. Increased levels of physical activity (PA) during treatment may reduce these side effects. However, uptake of PA is low. The purpose of this review is to identify and evaluate the current literature on strategies to promote and increase the levels of PA in patients with prostate cancer undergoing ADT.

DATA SOURCES

Electronic databases including CINAHL, MEDLINE, PsychINFO, Scopus, and grey literature were searched using Google Scholar up until April 2020.

CONCLUSION

At present the most appropriate modes and dosages of PA for specific ADT toxicities is not known. It is established that some PA in the form of exercise, whether aerobic or resistance, is better than being sedentary for improvements in physical health, but beyond this prescription specifics have not been established. Further research is required to understand the impact of PA on the mental and physical health of men with prostate cancer undergoing ADT.

IMPLICATIONS FOR NURSING PRACTICE

Being physically active and avoiding sedentary behaviour is important for men with prostate cancer undergoing ADT, especially the implementation of strength training. PA in the form of exercise can assist in reducing the adverse physical side effects in the short- and long-term, with limited understanding of the effects on mental health. PA improves mental health outcomes across populations, which may also translate to men with prostate cancer, although further research is required. An important strategy to improve PA within the prostate cancer population is to provide an early referral to an exercise professional, such as an accredited exercise physiologist/clinical exercise physiologist or physical therapist/physiotherapist, and is supported by research as best practice for people affected by cancer undergoing active treatment.

An Exploration of the Rs of Radiobiology in Prostate Cancer

OBJECTIVES

To explore the four Rs of radiobiology (Repair, Reoxygenation, Reassortment, and Repopulation) as a means to understand the effects of ionising radiation on biological tissue and subsequently as the basis for conventional fractionated treatment schedules. These radiobiological principles will form a rationale for combined regimens in prostate cancer treatment involving androgen deprivation therapy and radiation therapy and the associated toxicities of this approach will be discussed.

DATA SOURCES

Electronic databases including CINAHL, MEDLINE, Scopus, professional websites, books and grey literature were searched using Google Scholar.

CONCLUSION

It is important for nurses to understand the four Rs of radiobiology to grasp the effects of ionising radiation on biological tissue as the basis for conventional fractionated treatment schedules in prostate cancer. Men can experience a sequalae of physical and psychological side effects of treatment that can negatively impact quality of life.

IMPLICATIONS FOR NURSING PRACTICE

Men can experience a range of unmet supportive care needs particularly related to informational, sexual, and psychological needs. For men affected by prostate cancer opting for radiation therapy (+/-) androgen deprivation therapy, nurses should ask targeted questions based on the Common Terminology Criteria for Adverse Events related to urinary and bowel function, potency and fatigue, and sexual health. We also recommend the use of holistic needs assessments to tailor self-management care plans. Evidence-based self-management advice should be provided in response to each man's unique needs.

Development of a Prehabilitation Multimodal Supportive Care Interventions for Men and Their Partners Before Radical Prostatectomy for Localized Prostate Cancer

BACKGROUND

An important question revolves around when the most opportune time is to introduce recovery-optimizing behaviors for men opting for radical prostatectomy (RP) for localized prostate cancer (PCa). An emerging field of research describes the role of preoperative strategies to improve treatment tolerance and overall physical and psychological recovery.

OBJECTIVE

The aim of this study was to explore the perceptions of a multimodal prehabilitation intervention for men and their partners before RP for localized PCa.

METHODS

Thirty-four patients who opted for RP for localized PCa and their partners (19) were identified and recruited into the study. The multimodal intervention was composed of educational materials, physiotherapy instruction, and a self-management group-based seminar.

RESULTS

The multimodal prehabilitation intervention was perceived as overall helpful with demonstrated acceptability (91.9%). Beneficial themes related to the quality of the information provided to support self-management, open forum questions with multidisciplinary healthcare professionals, and increased knowledge among partners to help with their understanding of how to look after their partners.

CONCLUSION

The intervention was feasible and beneficial for the PCa dyad. A future pilot randomized controlled trial study is needed to provide sufficient evidence on the long-term physical and psychological outcomes and cost-effectiveness.

IMPLICATIONS FOR PRACTICE

Oncology nurses play a key role in the development of prehabilitation care delivery. Prehabilitation interventions can have a positive effect on improving health outcomes for cancer patients and their partners after surgery and into survivorship.

What are students' needs and preferences for academic feedback in higher education? A systematic review

OBJECTIVE

Feedback is a fundamental factor within the learning process for students. However, it is widely known that students generally report that feedback is done sub-optimally in higher education. Therefore, this systematic review aims to identify students' needs and preferences for academic feedback in higher education. Design, data sources, review methods. A systematic review was conducted according to the PRISMA Statement Guidelines. Electronic databases were searched using a range of keywords and the findings were integrated in a narrative synthesis. Quality appraisal was undertaken.

RESULTS

5884 articles were retrieved, and 36 papers included. Three themes emerged across a wide range of academic disciplines which included: 1) preferences for feedback, 2) multimodality feedback and 3) emotional impact. Overall, quality feedback was related to the timeliness of feedback; balance between positive and constructive comments; direct feedback on content; linguistic clarity and legibility; grade justification and feeding forward.

CONCLUSION

This review has informed several important implications for practice uniquely from the students' perspectives. Educators are encouraged to implement the evidence-based preferences for student feedback in their daily practice. Students value multimodality feedback which is personalised to enable students to feed forward in their own individual learning journeys. Future research should explore whether demographic variables influence student feedback needs over time. We would recommend that future studies need to employ a rigorous methodology to avoid the shortcomings in the studies already conducted in this area.

An ecological momentary assessment of self-management in prostate cancer survivors

PURPOSE

To assess the 'real-time' self-management strategies employed by prostate cancer survivors to inform personalised supportive care interventions in the future.

METHOD

A purposive sampling framework was used to recruit men with different stages of cancer and treatment to an ecological momentary assessment (capturing experiences in real time) study. Each participant was prompted by an audio alert to complete self-report questionnaires three times per day (93 data entries in total) for a total duration of 31 days. The personal digital assistant (PDA) and pocket interview software were used.

RESULTS

Prostate cancer survivors experienced a wide range of after-effects of therapy for which they used various self-management strategies. Many of the men experienced sexual dysfunction but did not perform any self-management.

CONCLUSION

Our findings reinforce the importance of having access to tailored, timely and person-centred supported self-management care plans. Real-time monitoring data can provide helpful information to facilitate tailored recommendations for self-management.

IMPLICATIONS FOR CANCER SURVIVORS

Prostate cancer survivors can experience unmet supportive care needs which may increase men's demands to perform self-management of their condition. Future clinical intervention studies aimed at utilising the remote exchange of real-time data serves to optimise tailored supported self-management.

A pilot randomised controlled trial of a multimodal supportive care (ThriverCare) intervention for managing unmet supportive care needs in men with metastatic prostate cancer on hormonal treatment and their partner/caregivers

PURPOSE

Men with metastatic prostate cancer experience high levels of unmet supportive care needs in current healthcare delivery. We set out to determine the effectiveness of a multimodality supportive care (ThriverCare) intervention on the prevalence of unmet supportive care needs for men and their partner/caregivers.

METHODS

A prospective parallel group, pilot randomised controlled pilot trial in 4 hospitals in Scotland. 38 participants with radiologically proven metastatic prostate cancer disease and 10 partners/caregivers were recruited into the study. A two arm 1:1 study design compared the usual standard of care (SC) approach to SC plus ThriverCare intervention. The primary outcome was the Supportive Care Needs Survey at 3 months of intervention.

RESULTS

There was no statistical significant difference in the prevalence of unmet supportive care needs between the intervention group and the usual SC group at baseline p = 0.112, however a statistically significant difference was observed at 3 months, indicating that the prevalence of unmet supportive care needs were less in the intervention group (1.13, SD 2.5) compared to the usual SC (6.17, SD 7.05), p = 0.002.

CONCLUSION

ThriverCare appears to improve the supportive care experience of men with metastatic prostate cancer on hormonal treatment and their partner/caregivers. Our results accentuate that no longer one size of care delivery fits all, care must be responsive and adaptable to meet the individual needs of people affected by cancer to thrive.

Unmet informational and supportive care needs of patients with muscle invasive bladder cancer: A systematic review of the evidence

BACKGROUND

Little is known about the unmet supportive care needs of patients affected by muscle invasive bladder cancer (MIBC). We set out to determine the different domains of unmet supportive care needs for patients affected by MIBC.

LITERATURE SEARCH

A systematic review was conducted according to the PRISMA Statement Guidelines. A sensitive search was performed in electronic databases (DARE, Cochrane, MEDLINE, BNI, PsychINFO, EMBASE and CIHAHL) from the earliest date available to January 2017.

DATA EVALUATION

1405 references were retrieved, 8 articles met the eligibility criteria and were appraised and ranked by strength using the levels of evidence.

SYNTHESIS

Individual unmet needs were classified into the following domains: patient-clinician communication, daily living needs, health system/information needs, practical needs, family-related needs, social needs, psychological needs, physical needs and intimacy needs. Patients reported high unmet needs at diagnosis and into survivorship.

CONCLUSIONS

This review contributes to a greater understanding of the unmet supportive care needs of patients affected by MIBC. Findings reflect a paucity of research, but existing studies indicated needs commonly related to intimacy, informational, physical and psychological needs. Despite the emerging evidence-base, the current within study limitations precludes our understanding about how the needs of patients evolve over time.