Presentation on theme: "Results Treatment Prescriptions for Postoperative Erectile Dysfunction: Following a postoperative recovery period, each participant was prescribed a number."— Presentation transcript:
Results Treatment Prescriptions for Postoperative Erectile Dysfunction: Following a postoperative recovery period, each participant was prescribed a number of treatment options for both penile rehabilitation and aiding sexual intercourse; typically PDE5 treatment combined with vacuum erectile devices (VEDs) application. Intracavernous injection treatments (ICIs) were only suggested for participants who had experienced PDE5-related adverse effects or ineffective PDE5 therapy. Postoperative Treatment Intentions and Treatment Satisfaction: Questionnaire data Participant responses to the EDITS questionnaire, revealed a clear dichotomy in treatment satisfaction levels and PTED future intentions between those participants who received specialist sexual medical advice for postoperative erectile dysfunction (n=10) and those who did not (n=7). Participants who received specialist advice for their postoperative erectile dysfunction were more likely to report being very satisfied (n=6) and were very likely to continue treatment (n=7). By comparison, no members of the ‘without-specialist’ group reported levels of treatment satisfaction above somewhat satisfied (n=1) with the majority of participants (n=4) either being non-committed towards continuing treatment or having ceased treatment altogether. An investigation of factors that affect adoption and compliance with post-prostatectomy treatments for erectile dysfunction Introduction Despite many prostate cancer survivors pre-operatively reporting an interest in receiving treatment for post-radical prostatectomy-related erectile dysfunction, studies have shown that as many as 50% of men freely decide from the outset not to proceed with any form of post-prostatectomy treatments for erectile dysfunction (PTED). Of those that commence therapy, it is estimated that almost 75% will discontinue treatment within 18 months. Given the reported success and benefits of PTED, the question remains as to why adoption and continuance rates amongst prostate cancer survivors are not higher. Using qualitative research approach, this study aimed to identify and conceptualize those factors influencing prostate cancer survivors to either adopt and/or continue with PTED regimes. Conclusions Our findings suggest that male sexual identity and sex drive form the principal motivating drivers of PTED adoption; however continuing treatment is more likely to be influenced by numerous additional factors including: treatment efficacy and ease of use, level of partner support and treatment acceptance, access to specialist care and instruction; and the dynamics of sexual relationships and activities. Existing forms of medical treatment appear to be overlooking many of the important behavioural, social and psychological factors that influence PTED adoption and continued use. Our study has found that patients require on-going counselling, as well as increased levels of instruction and education as to treatment options and their application, in order to increase long term use of PTED. Methods Participants: Seventeen men aged 40 to 60 years who had undergone radical prostatectomies were recruited from patient lists of two Sydney-based physicians. Participants were excluded if they had medical complications preventing uptake of PTED treatments. Procedure: Each man participated in a semi-structured interview. Interpretative Phenomenological Analysis was used to gain a phenomenological understanding of the factors affecting decisions towards adopting and/or continuing with PTED. The International Index of Erectile Function, The Self Esteem and Relationship index and the Erectile Dysfunction Inventory of Treatment Satisfaction measures were used to assess levels of erectile and orgasmic functioning, sexual desire, intercourse and overall sexual satisfaction. Patrick Lumbroso 1, Phyllis Butow 1, Michael Lowy 2 & Henry Woo 3 1 Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, NSW, Australia 2 Sydney Men's Health, Bondi Junction NSW, Australia 3 Sydney Adventist Hospital Clinical School, The University of Sydney, NSW, Australia No. 026 Posters Proudly Supported by: Practice Implications For those patients seeking the recovery of erectile functioning it is recommended that physicians extend the biomedical approach towards PTED to also incorporate sexual, social and psychological elements. Preferably, partners need to be included in treatment discussions, choices, education and training. Problems relating to relationship issues, the incorporation of treatments within sexual dynamics, and treatment- related sex-spontaneity issues need to be acknowledged and addressed. Physicians without specialist training in sexual dysfunction need to become more amenable towards referring patients to specialist treatment providers and professionally trained psycho-sexual counsellors in order to improve PTED outcomes. Treatment benefits and costsPartner influenceSexual dynamicNature & scope of medical treatment Participants reported a correlation between treatment efficacy, ease of use and continuing PTED use. Generally where treatments were perceived to be working, relatively easy to use and without physically debilitating side effects, men continued to use them. However, if any of these factors were negative, treatment use declined and in some cases ceased. Research indicates that patients who receive detailed instruction (preferably in the presence of a sexual partner), sexual counselling and medical follow ups every three months, are likely to experience higher levels of PTED satisfaction and continued use. In comparison, many participants complained that they had received minimal levels of treatment advice, no recommendations regarding psychological assistance, and limited instruction in PTED use and application within a sexual dynamic. Participants reported that physical, psychological and social adaptation to life with postoperative erectile dysfunction, and their need for PTED, were highly influenced by the strength and nature of relationships they had with their partners. PTED compliance was influenced by partner support and involvement in the penile rehabilitation process, partner acceptance of treatment selection, and the importance partners placed on maintaining an active sexual relationship. Apart from sexual communication, relationships in which partners had demonstrated a willingness to actively assist participants in incorporating PTED treatments within sexual activities were more likely to lead to higher levels of PTED satisfaction and compliance. In contrast, participants reporting low levels of sexual communication and involvement in treatment selection and acceptance were less likely to maintain PTED and more likely to withdraw from treatment use. Given many sexual activities required participants to use PTED, there was a positive relationship between levels of participant and partner sex drive, the frequency of sexual activity and PTED usage. Factors that made sexual activity more desirable, satisfying and accessible, were more likely to lead to continued use of PTED. Factors that resulted in lower levels of sexual desire, that impeded sexual activity or made sex physically problematic or psychologically distressing, were more likely to lead to discontinued use of PTED. Participants reported receiving almost no instruction in addressing problems with psychosexual distress, poor sexual communication, incorrect treatment application or interruption to sexual syntax. This was somewhat surprising given that research into counselling within these areas has not only resulted in increased levels of treatment efficacy, sexual interest and satisfaction, it was also shown to be effective in decreasing PTED cessation. Whilst the decision to commence PTED primarily depended on factors relating to male sexuality, the decision to maintain treatment was heavily dependent upon a participant’s receipt of specialist medical advice. Of the seven participants who exclusively received non-specialist assistance, six continued to experience severe erectile problems, three of whom quit PTED altogether. In comparison, seven of nine participants who received specialist treatment reported being very satisfied with treatment outcomes, with all nine affirming their commitment to continuing treatment. These outcomes are consistent with research findings that show that men who receive more detailed treatment instruction, follow up, and more extensive assessment of penile rehabilitation progress, are more likely to experience higher levels of treatment efficacy and PTED adherence.