Optimizing psychosocial support in prostate cancer patients during active surveillance

Article summary: International Journal of Urological Nursing, July 2020

Kim Donachie, Erik Cornel, Marian Adriaansen, Rosa Mennes, Inge van Oort, Esther Bakker, Lilian Lechner

DOI: 10.1111/ijun.12242

“Active surveillance is a conservative treatment approach that involves close monitoring of prostate cancer. During surveillance patients do not undergo active treatment but remain under close surveillance. Active surveillance has the potential to minimize treatment-related toxicity and complications and reduce health care costs without compromising survival. This has resulted in an increased active surveillance adoption in the United States, Australia and Europe during the last decade.

Although psychosocial support plays an important role during active surveillance, follow-up visits often focus on physical well-being and early detection of disease progression. Nurses often adopt a more holistic view of care by addressing physical, psychosocial and emotional well-being. However, they are not always involved during active surveillance follow up. If provided with the time and opportunity, nurses are well suited to deliver acceptable, accessible and cost-effective psychosocial support during active surveillance. Nurse-led psychosocial support might be a feasible intervention to reduce anxiety and uncertainty and improving adherence.

This research used a qualitative research design to conduct 17 semi-structured interview to acquire new insights on patient perspectives regarding this sensitive topic. Results of the study provided an insight in the psychosocial support needs of active surveillance patients during various stages. It emphasized the importance of providing reliable, relevant information to the patients on disease characteristics and mortality risk, immediately after diagnosis. A positive patient-caregiver relationship seemed to play an important role in active surveillance adoption during the first months.

This study recommends that transparent, unbiased, proactive information on treatment options and procedures is provided consistently, and that information is adjusted to health literacy level and socio-economic status. The use of an enclosed website or digital application to access this information is recommended. According to the participants in the study, this website or digital application should also facilitate PSA self-monitoring and contact with caregivers and peers.

Regular assessment of coping strategies might be crucial in the detection of ineffective coping strategies. Upon the detection of ineffective coping strategies, psychoeducation should promote adoption of effective coping strategies and disease acceptation. Since anxiety is most present during the first year, comprehensive evaluation of active surveillance within this first year should reaffirm the patient’s preference. Further research should focus on the development of a psychosocial support program. This program should consist of evidence-based elements, based on the needs of the active surveillance population, designed in collaboration with experts and patients.”

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