Abstract
BackgroundStrong evidence exists to support preoperative pelvic floor muscle training (PFMT) to reduce the severity and duration of urinary incontinence after radical prostatectomy. Receipt of preoperative PFMT amongst men having radical prostatectomy in Western Sydney, however, is suboptimal. This study was undertaken to investigate barriers and enablers to provision/receipt of preoperative PFMT from the perspectives of potential referrers to and providers of PFMT, and of men having radical prostatectomy.MethodsA qualitative research design was used. Semi-structured, one-to-one interviews were conducted with participants from three groups: (i) current and potential referrers to PFMT, including urological cancer surgeons, urological cancer nurses and general practitioners (n = 11); (ii) current and potential providers of PFMT across public and private sector hospital and outpatient settings, including physiotherapists and continence nurses (n = 14); and (iii) men having had radical prostatectomy at a specific public and co-located private hospital in Western Sydney (n = 13). Interview schedules were developed using Michie’s theoretical domains for investigating the implementation of evidence-based practice, and allowed participants to identify potential and actual barriers and enablers to preoperative PFMT. Transcribed interview data were analysed using a framework approach, and key themes were identified.ResultsParticipant groups concurred that a recommendation for PFMT from the urological cancer surgeon, accompanied with a referral to a specific provider, was a key enabler of preoperative PFMT. Perceived barriers varied between participant groups and across public and private healthcare settings. Perceptions of financial cost of private sector PFMT, limited knowledge amongst referrers of public sector providers of PFMT, and limited awareness amongst patients of the benefits of PFMT were all posited to contribute to suboptimal PFMT provision and receipt.ConclusionsThis study has provided valuable data on barriers and enablers to preoperative PFMT, with implications for the planning of a behaviour change intervention to improve provision and receipt of preoperative PFMT in Western Sydney.
Highlights
Strong evidence exists to support preoperative pelvic floor muscle training (PFMT) to reduce the severity and duration of urinary incontinence after radical prostatectomy
While guidelines for choice of treatment are not ‘clear-cut’, radical prostatectomy may be preferentially indicated for patients with a greater life expectancy and who are fit for surgery [4]
We investigated local barriers and enablers to preoperative PFMT amongst potential referrers, providers and patients in both public and private healthcare sectors
Summary
Strong evidence exists to support preoperative pelvic floor muscle training (PFMT) to reduce the severity and duration of urinary incontinence after radical prostatectomy. Receipt of preoperative PFMT amongst men having radical prostatectomy in Western Sydney, is suboptimal. Prostate cancer is the most common form of malignancy in Australian men, with more than 20,000 new cases diagnosed in 2008 [1]. Conventional treatments for localised prostate cancer include active surveillance, radical prostatectomy and radiotherapy (external beam and seed brachytherapy) [3]. Advantages of radical prostatectomy over active surveillance and radiotherapy include improved long-term cancer control and ability to determine prognosis according to pathologic cancer features [3]. PPUI, whether transient or persistent beyond twelve months, reduces health-related quality of life, and may delay return to work and/or normal physical and social activity [9]
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