Prostate cancer is the most common form of visceral malignancy in men (1), and its incidence, particularly early stage prostate cancer, has increased markedly in the past 10 years. Available effective treatment means that most men will live a long time after treatment. Subsequently, the ranks of prostate cancer survivors has grown dramatically. Although researchers have begun to document the often extensive and long term physical complications of treatment, including urinary, bowel, and sexual dysfunction, the focus on the psychosocial effects of these physical changes among men with prostate cancer has been limited. Although much is known about the psychosocial sequelae of other cancers, particularly breast cancer, very little is know about the psychosocial impact of male malignancies. In particular, we know little about how men respond to the diagnosis of prostate cancer and how they adjust to the sequelae of treatment in the long term: how they live with prostate cancer. Moreover, physicians who care for these men after treatment do so regularly for many years, and while they are monitoring the status of the cancer, the care they provide is almost exclusively counseling. And yet physicians who care for patients after treatment are likely to know more about patients' physical symptoms and sequelae than the psychosocial implications of these sequelae. It may be important to assess whether physicians could make use of more in-depth psychosocial information when counseling survivors. In this study we propose to examine men's perceptions of the meaning of early prostate cancer and its effects on their lives and explore the ways in which this may inform physician practice when working with these survivors. We will examine personal transitions associated with diagnosis and treatment for early prostate cancer, determine how men integrate the physical changes they experience into the ways in which they experience their daily lives and examine the impact of prostate cancer on how men see themselves as men. Further we will examine ways in which physicians might use additional information provided by men in narratives in their clinical practice. The study will rely on qualitative methods. We will draw on an existing database of interviews with men with early prostate cancer and conduct narrative analyses to examine personal transitions men experience. We will then conduct focus groups with physicians likely to be caring for men after treatment for prostate cancer, primary care physicians and urologists, from two sites (Harvard Vanguard Medical Associates and Boston VA Medical Center). The focus groups will be semi-structured to elicit physicians' responses to men's narratives of surviving with prostate cancer. The transcripts of these focus groups will be analyzed using grounded theory methodology to identify themes of caring for patients with prostate cancer and identify ways in which physicians may utilize men's stories for their clinical practice.
| Bokhour, Barbara G; Powel, Lorrie L; Clark, Jack A (2007) No less a man: reconstructing identity after prostate cancer. Commun Med 4:99-109 |
