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独特需要。性功能障碍在前列腺癌中尤为突出。前列腺癌是男性中最常见的癌症，2014年诊断出约233，000例新病例。前列腺癌治疗的主要副作用是勃起功能障碍（艾德），多达85%的男性报告勃起问题。患有艾德的男性报告说，他们有明显的挫折感，抑郁症状增加，对生活的总体幸福感降低。手术（根治性前列腺切除术）是早期前列腺癌的金标准治疗，并且医学领域在治疗手术后的艾德方面取得了重要进展。目前最好的做法是“勃起康复”的概念，这有助于增加手术后恢复勃起的机会。然而，男子很难遵守这些方案。我们的数据表明，只有10%的男性谁收到积极的护士执业电话是符合勃起康复。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。这种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，接受与艾德相关的挫折感，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， 干预组中的男性，与护士执业加强监测控制相比，坚持勃起康复计划（44% vs.10%，p = 0.02）。我们提出了一个更大的，两个手臂，随机对照试验，以确定是否增加干预的依从性导致改善勃起功能在术后24个月。将155例受试者随机分配至每组：第1组-标准治疗加ACT干预;第2组-标准治疗加执业护士加强监测和教育（EME）。我们认为这种干预是创新的，因为它：1）描述了避免康复的概念框架，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）将心理干预纳入勃起康复计划，5）主动 重点是康复，增加康复的机会，减少与ED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.