Abstract
6126 Background: Little is known about the actual constraints of doing so in the distinctive geographic context of Alaska. We performed a survey of primary care providers (PCPs) within the Alaska Tribal Health System (ATHS) to learn more about their attitudes and practices surrounding prostate cancer (PC) survivorship care. Methods: We surveyed primary care physicians, nurse practitioners, and physician assistants practicing in the ATHS. We administered surveys to assess attitudes about PSA monitoring, responsibility for long-term surveillance, supporting emotional health and medical needs, their degree of confidence in managing patients on androgen deprivation therapy (ADT), as well as their comfort level in managing common side effects of treatment. Results: Of the 221 providers surveyed, 114 responded (52%). Most PCPs indicated a preference for annual PSA monitoring (69%), but several (27%) indicated monitoring every 6 months, and a few (4%) indicated monitoring every 24 months. Most (60%) thought PCPs should manage cancer surveillance, but many (40%) thought a specialist (urologist or medical oncologist) should perform that function. When asked about supporting patients’ emotional needs, PCPs indicated that support groups (63%) followed by survivorship clinics (16%) or on-site specialist visits (14%) were the most appropriate venues to address these concerns. Most respondents thought that medical needs of PC survivors could be addressed locally with appropriate specialty input (71%) or potentially through dedicated survivorship clinics (14%). Only 46% indicated being "moderately" or "very" confident managing ADT. Most PCPs indicated being moderately or very comfortable monitoring for recurrence (59%), managing erectile dysfunction (66%), addressing urinary incontinence (63%), and addressing emotional needs (61%). Conclusions: PCPs practicing in the ATHS express comfort with monitoring for PC recurrence, but express some concerns about the full range of issues in PC survivorship. Constructing cancer survivor care models in geographically dispersed and resource-limited contexts for Alaska Natives is an ongoing clinical and policy challenge.
Highlights
Little is known about the constraints of optimizing health care for prostate cancer survivors in Alaska primary care
None of the respondent characteristics included in our analyses were found to distinguish those lacking confidence in managing men receiving Androgen Deprivation Therapy (ADT), addressing urinary incontinence, or emotional needs (Table III). In this survey of primary care providers in the Alaska Tribal Health System (ATHS), we found general agreement about the frequency of posttreatment Prostate Specific Antigen (PSA) monitoring and the preferred individual in charge of life-long prostate cancer surveillance for a hypothetical prostate cancer survivor described in a clinical scenario
This finding is important since PSA monitoring is essential following primary therapy for localized prostate cancer given the lifelong risk for biochemical recurrence
Summary
Little is known about the constraints of optimizing health care for prostate cancer survivors in Alaska primary care. In late October 2011, we emailed a 22-item electronic survey to 268 ATHS primary care providers regarding the frequency of Prostate Specific Antigen (PSA) monitoring for a hypothetical prostate cancer survivor; who should be responsible for the patient’s life-long prostate cancer surveillance; who should support the patient’s emotional and medical needs as a survivor; and providers’ level of comfort addressing recurrence monitoring, erectile dysfunction, urinary incontinence, androgen deprivation therapy, and emotional needs. Most providers reported feeling either ‘‘moderately’’ or ‘‘very’’ comfortable addressing topics such as prostate cancer recurrence (59%), erectile dysfunction (64%), urinary incontinence (63%), and emotional needs (61%) with prostate cancer survivors. These results varied somewhat by provider characteristics including female sex, years in practice, and the number of prostate cancer survivors seen in their practice. We found that large minorities of providers do not feel confident in their ability to manage common issues in prostate cancer survivorship, implying that continued access to specialists with more expert knowledge would be beneficial
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