Prostate cancer is the most frequently diagnosed malignant solid tumor in U.S. males and is the second leading cause of male cancer-related death. In concert with the increased incidence of prostate cancer, the number of prostatectomies performed in the United States has escalated over the past few decades. The trend towards increasingly limited hospitalization has led to earlier discharge of this population, requiring patients to manage complex post-surgical issues in the home setting. Preliminary studies have indicated that selected clinical outcomes can be improved in this population when Advanced Practice Nurses (APN) provide care following discharge; however, reasons for this have not been clearly explicated. The proposed descriptive quantitative study will explore this issue by examining how the process of APN care provided to men following prostatectomy affects selected clinical outcomes. A recently completed clinical trial examining the effects of APN interventions in men with clinically localized prostate cancer who have undergone radical prostatectomy provides a unique opportunity to investigate this issue. The proposed secondary analysis has two specific aims: The first of these is to determine the level of consistency between interventions recorded in the documentation logs maintained by APNs during the parent study and core elements of the Agency for Healthcare Research and Quality Clinical Practice Guidelines (CPGs) on three intermediate clinical outcome variables of interest (pain, depressive symptoms, and incontinence). Documentation logs will be examined, subject to content analysis, coded, and compared to core elements of established CPGs. The level of consistency (i.e., """"""""consistent,"""""""" """"""""partially consistent,"""""""" """"""""not consistent"""""""") between documented interventions and core CPG elements will be established. The second specific aim will determine if APN interventions that are """"""""consistent"""""""" or """"""""partially consistent"""""""" with core elements of CPGs result in better intermediate clinical outcomes (i.e., less pain, fewer depressive symptoms, less incontinence). Regression techniques that control for age, race, level of education, number of preoperative symptoms, and Gleason score will be used to determine if higher levels of consistency resulted in differential outcomes. The three intermediate outcome variables will be investigated at two different post-operative time points. Pain outcomes will be evaluated at four weeks post surgery, and pain, depressive symptoms, and incontinence outcomes will be studied at eight weeks following surgical intervention.
