Prostate cancer survivorship priorities for men and their partners: Delphi consensus from a nurse specialist cohort

A Vanguard Approach to the Design and Delivery of Nurse-Led Survivorship Care

OBJECTIVES

Survivorship care is an essential component of quality cancer care. Although nurses are uniquely positioned to deliver effective and efficient nurse-led survivorship care, they report that their experiences of survivorship care provision are fragmented, under-resourced, and often distressing for the patient.

DATA SOURCES

Here we report the culmination of a 4-year program of research and more than a decade of nurse-led work, to improve the survivorship care experience for men with prostate cancer comprising of: (1) the evolution of a national specialist prostate cancer nursing service; (2) a nursing Delphi study to determine prostate cancer survivorship care experiences and priorities; (3) the development of the Prostate Cancer Survivorship Essentials Framework, which provides a road map for improving quality prostate cancer survivorship care across a variety of settings; and (4) the translation of the framework into nursing practice through the development of My Personal Plan, a person-centered, evidence-informed survivorship care plan.

CONCLUSION

Through the leadership of a national prostate cancer specialist nursing service, the provision of a coordinated, evidence-informed person-centered survivorship care service is now achievable. This program of work has demonstrated that irrespective of the setting or mode of delivery, specialist nurses involved in the care of men with prostate cancer and their families are leading best practice through the translation of evidence into everyday clinical practice.

IMPLICATIONS FOR NURSING PRACTICE

There is an urgent need to address the significant challenges that a prostate cancer diagnosis can bring, and nurses are at the forefront and lead survivorship care delivery, which includes: (1) routine distress screening and referral to tailored evidence-based psychological care; (2) the provision of person-centered care that connects to effective symptom management; (3) self-management support; and (4) signposting to additional services which extend beyond the acute care setting.

International consensus on the initial diagnostic workup of cancer of unknown primary

BACKGROUND

Although the incidence of Cancer of Unknown Primary (CUP) is estimated to be 1-2 % of all cancers worldwide, no international standards for diagnostic workup are yet established. Such an international guideline would facilitate international comparison, provide adequate incidence and survival rates, and ultimately improve care of patients with CUP.

METHODS

Participants for a four round modified Delphi study were selected via a CUP literature search in PubMed and an international network of cancer researchers. A total of 90 CUP experts were invited, and 34 experts from 15 countries over four continents completed all Delphi survey rounds.

FINDINGS

The Delphi procedure resulted in a multi-layer CUP classification for the diagnostic workup. Initial diagnostic workup should at least consist of history and physical examination, full blood count, analysis of serum markers, a biopsy of the most accessible lesion, a CT scan of chest/abdomen/pelvis, and immunohistochemical testing. Additionally, the expert panel agreed on the need of an ideal diagnostic lead time for CUP patients. There was no full consensus on the place in diagnostic workup of symptom-guided MRI or ultrasound, a PET/CT scan, targeted gene panels, immunohistochemical markers, and whole genome sequencing.

INTERPRETATION

Consensus was reached on the contents of the first diagnostic layer of a multi-layer CUP classification. This is a first step towards full consensus on CUP diagnostics, that should also include supplementary and advanced diagnostics.

Experiences of female partners of prostate cancer survivors: A systematic review and thematic synthesis

The purpose of this systematic review and synthesis of studies reporting qualitative data was to understand the gendered experiences of female partners of prostate cancer survivors to inform psychosocial support for women. We searched Medline, PsycINFO, EMBASE, AMED, CINAHL, Cochrane Database of Systematic Reviews, and Sociological Abstracts for articles on 15 and 16 April 2019, and again on 30 November 2020. English language articles published in peer-reviewed journals were included if they reported solely on findings describing the perspectives of the female partners. Extracted data were analysed using line-by-line coding, organisation of codes into descriptive themes, and development of analytical themes. A theoretical framework was then selected to organise the relationships between issues that were found to be central to the experiences of female partners. Of 4839 articles screened, 14 met inclusion criteria, reporting 13 studies with a total sample of 359 female partners. Ussher and Sandoval's theory to describe the gendered positionings of cancer caregivers accommodated the thematic findings. The overarching theme reflected the substantive psychosocial impact of prostate cancer on female partners. Women's experiences were influenced by self-positioning (as part of a couple; provider of support to their male partner; resilient; and guided by faith and spirituality), being positioned by their partners' response (manager of male partner's psychological distress or strengthened by male partner's positive response) and by their broader contexts (family members and social networks; clinicians and the health system; and cultural values and customs). Findings highlight the need to avoid reductionist approaches to gender. Greater consideration of 'contextualised femininities', or conceptualising the influence of gender roles, relations, and identities within the wider life course contexts of female partners is required in the design and delivery of psychosocial support services.

Prostate cancer survivorship essentials framework: guidelines for practitioners

OBJECTIVE

To develop contemporary and inclusive prostate cancer survivorship guidelines for the Australian setting.

PARTICIPANTS AND METHODS

A four-round iterative policy Delphi was used, with a 47-member expert panel that included leaders from key Australian and New Zealand clinical and community groups and consumers from diverse backgrounds, including LGBTQIA people and those from regional, rural and urban settings. The first three rounds were undertaken using an online survey (94-96% response) followed by a fourth final face-to-face panel meeting. Descriptors for men's current prostate cancer survivorship experience were generated, along with survivorship elements that were assessed for importance and feasibility. From these, survivorship domains were generated for consideration.

RESULTS

Six key descriptors for men's current prostate cancer survivorship experience that emerged were: dealing with side effects; challenging; medically focused; uncoordinated; unmet needs; and anxious. In all, 26 survivorship elements were identified within six domains: health promotion and advocacy; shared management; vigilance; personal agency; care coordination; and evidence-based survivorship interventions. Consensus was high for all domains as being essential. All elements were rated high on importance but consensus was mixed for feasibility. Seven priorities were derived for immediate action.

CONCLUSION

The policy Delphi allowed a uniquely inclusive expert clinical and community group to develop prostate cancer survivorship domains that extend beyond traditional healthcare parameters. These domains provide guidance for policymakers, clinicians, community and consumers on what is essential for step change in prostate cancer survivorship outcomes.

Are National Cancer Control Indicators for patient experiences being met in regional and remote Australia? A cross-sectional study of cancer survivors who travelled for treatment

OBJECTIVE

To examine the health services experience of patients with cancer from regional and remote Australia using the Australian National Cancer Control Indicators (NCCI) guidelines as an assessment framework.

DESIGN

Cross-sectional.

SETTING

Queensland non-for-profit cancer accommodation lodges.

PARTICIPANTS

Participants were patients with cancer who travelled for treatment from rural and remote Queensland to major urban centres (n=518; age mean=64.6, SD=11.18).

OUTCOME MEASURES

Assessments included NCCI patient indicators, quality of life (QoL), psychological distress and unmet supportive care needs.

RESULTS

The frequency at which NCCI indicators were met ranged from 37.5% for receiving an assessment and care plan to 97.3% for understanding explanations about diagnosis. Geographical considerations did not impact patient experience, whereas middle school educated participants were more likely than those with senior-level education or higher to receive an assessment and care plan (OR=1.90, 95% CI 1.23 to 2.91) and to report having their views on treatment taken into account (OR=2.22, 95% CI 1.49 to 3.33). Patients with breast or prostate cancer reported better communication and patient involvement and information and services provision (r=p<0.001) compared with those with skin and head and neck cancer. When compared with information and service provision, communication and patient involvement showed stronger positive associations with QoL (z=2.03, p=0.042), psychosocial (z=2.05, p=0.040) and patient care (z=2.00, p=0.046) outcomes.

CONCLUSION

The patient care experience varies across the NCCI indicators by sociodemographic and clinical factors that likely reflect healthcare system biases. Perceptions about communication and involvement appear most critical for optimal outcomes and should be a priority action area for cancer control.

Nursing and Allied Health Research Priorities in the Care of Patients With Thoracic Malignancies: An International Cross-Sectional Survey

Background

There is currently no evidence of research priorities from nurses and allied health professionals working in the field of thoracic malignancies, which could provide strategic directions for funders, policy makers, and researchers.

Objective

The aim of this study is to identify the priorities for lung cancer and other thoracic malignancies research and practice in nurses and allied health professionals.

Methods

Descriptive cross-sectional web-based international survey conducted through international societies’ membership lists.

Results

Participants included 152 nurses and allied health professionals. Key priority categories were related to developing and evaluation interventions; symptom management interventions; health care system issues; treatment-related research (immunotherapy; targeted therapies); persistent/late effects management (fatigue; pulmonary toxicity); risk reduction, and screening research. The specific topic with the highest endorsement (80.9%) was the development of interventions to improve quality of life. Symptom management interventions, particularly for pain, dyspnea, and fatigue, were also highly endorsed. Health care system topics were related to delivery of care and included nurse-/allied health-led care (67.5%), working with the multidisciplinary team (67.5%), continuity of care (69.2%), and access to care (67.5%). Topics around screening/early detection research were highly endorsed too.

Conclusion

A clear focus (and need) for research in interventions to improve quality of life and symptom management, particularly for pain, dyspnea, and fatigue was also established, alongside healthcare system issues and screening research.

Implications for practice

International societies and funding bodies could consider these topics in their funding decisions and in shaping their strategic directions in the care of patients with thoracic malignancies.

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.

Distress Screening for Men with Prostate Cancer

OBJECTIVE

Although screening for distress and referral to evidence-based psychosocial support is a well-endorsed standard of cancer care, the extent to which this standard has been implemented varies widely. Lack of awareness, knowledge and skills in screening for distress in this patient group are likely key barriers to psychosocial care provision. The objective therefore was to discuss the development, design and evaluation of the effectiveness of the Distress Screening for Prostate Cancer (DSPC) module in targeting the perceived challenges and barriers to distress screening and psychological care by healthcare professionals.

DATA SOURCES

The DSPC module was piloted with five senior prostate cancer specialist nurses prior to the planned implementation with 50 prostate cancer nurses. Their average age was 49.8 years (range 43 to 57 years); there were three females and two males. Results from the Satisfaction with the Distress Screening Prostate Cancer E-Learning Module instrument indicated a high level of overall satisfaction with individual participants' scores ranging from 83-125/125 (mean 108.2).

CONCLUSION

Distress screening is an essential component of prostate cancer care and based on the information collected from stakeholders an e-learning module was designed and developed as an interactive and engaging evidence-based, pedagogically sound educational platform. The preliminary results from piloting the e-learning module indicated a high level of learner satisfaction and a measurable improvement in pre-post knowledge acquisition scores. These results suggest that this approach has the potential to increase screening for distress in men with prostate cancer and lead to more timely referral to psychosocial and supportive care to improve men's quality of life after diagnosis and over the illness trajectory.

IMPLICATIONS FOR NURSING PRACTICE

Specialist nurses and other healthcare professionals play an important role in screening men with prostate cancer for distress. This newly designed educational resource supports nurses in their practice of screening men with prostate cancer and the appropriate referral process.