Helping Men Adhere to Sexual Rehabilitation Following Prostate Cancer Surgery

 描述(由申请人提供)医学研究所强调了解决癌症幸存者性功能障碍的明显需要。性功能障碍在前列腺癌中尤为突出。前列腺癌是男性最常见的癌症，2014年约有23.3万新确诊病例。前列腺癌治疗的一个主要副作用是勃起功能障碍(ED)，多达85%的男性报告有勃起问题。患有勃起功能障碍的男性报告说，他们明显感到沮丧，抑郁症状增加，总体生活幸福感降低。手术(根治性前列腺切除术)是早期前列腺癌的金标准治疗方法，医学界在治疗术后勃起功能障碍方面取得了重要进展。目前的最佳实践是“勃起康复”的概念，这有助于增加手术后勃起恢复的机会。然而，男性很难遵守这些程序。我们的数据表明，只有10%的男性接到积极的护士从业者电话，符合勃起康复的要求。我们开发了一种新的干预措施，旨在提高勃起康复计划的依从性。这项干预使用接受和承诺疗法(ACT)，帮助男性专注于康复的长期目标，接受与勃起功能障碍相关的挫折，识别和克服障碍，并致力于勃起康复计划。在我们的试点工作中，有更大比例 在干预组中，与护士从业者相比，加强监测控制的男性坚持勃起康复计划的比例(44%比10%，p=0.02)。我们提出了一个更大的，两个手臂的RCT来确定在手术后24个月，干预依从性增加是否导致勃起功能的改善。155名受试者将被随机分配到每一组：ARM 1-标准护理加ACT干预；ARM 2-标准护理加护师加强监测和教育。我们相信这种干预是创新的，因为它：1)描述了避免康复的概念性框架，并概述了这如何导致依从性差；2)将主要治疗重点从增加教育转移到减少回避；3)将ACT概念应用于基于性的干预；4)将心理干预整合到勃起康复计划中；以及5)积极主动地 注重康复，增加康复机会，减少与勃起功能障碍相关的负面生活质量问题。

 DESCRIPTION (provided by applicant) The Institute of Medicine highlights the distinct need to address sexual dysfunction in cancer survivors. Sexual dysfunction is especially prominent in prostate cancer. Prostate cancer is the most common cancer in men, with approximately 233,000 new cases diagnosed in 2014. A primary side effect of prostate cancer treatment is erectile dysfunction (ED), with as many as 85% of men reporting problems with erections. Men who have ED report significant frustration, increased depressive symptoms, and reduced general happiness with life. Surgery (radical prostatectomy) is a gold standard treatment for early stage prostate cancer, and the medical field has made important advances in treating ED following surgery. The current best practice is the concept of "erectile rehabilitation," which helps increase the chance of recovering erections following surgery. However, men have difficulty complying with these programs. Our data suggest that only 10% of men who receive proactive nurse practitioner phone calls are compliant with erectile rehabilitation. We developed a novel intervention designed to increase compliance with an erectile rehabilitation program. This intervention uses Acceptance and Commitment Therapy (ACT) and helps men focus on the long-term goals of rehabilitation, accept the frustration related to ED, identify and overcome barriers, and commit to an erectile rehabilitation program. In our pilot work, a greater percentage of men in the intervention group, compared to a nurse practitioner enhanced monitoring control, adhered to the erectile rehabilitation program (44% vs.10%, p = 0.02). We propose a larger, two arm, RCT to determine if increased compliance in the intervention leads to improved erectile function at 24 months following surgery. One hundred and fifty-five subjects will be randomized to each arm: Arm 1- Standard care plus the ACT intervention; Arm 2 - Standard care plus nurse practitioner enhanced monitoring and education (EME). We believe this intervention is innovative as it: 1) describes a conceptual framework for avoidance of rehabilitation and outlines how this leads to poor compliance, 2) shifts the primary treatment focus from increasing education to reducing avoidance, 3) applies ACT concepts to a sexual-based intervention, 4) integrates a psychological intervention into an erectile rehabilitation program, and 5) proactively focuses on rehabilitation, increasing the chance of recovery and reducing the negative quality-of-life issues related to ED.