Results

1. An investigation of factors that affect adoption and compliance with post-prostatectomy treatments for erectile dysfunction No. 026 Patrick Lumbroso1, Phyllis Butow1, Michael Lowy2 & Henry Woo3 1 Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, NSW, Australia 2 Sydney Men's Health, Bondi Junction NSW, Australia 3 Sydney Adventist Hospital Clinical School, The University of Sydney, NSW, Australia Posters Proudly Supported by: Methods Participants:Seventeen men aged 40 to 60 years who had undergone radical prostatectomies were recruited from patient lists of two Sydney-based physicians. Participants were excluded if they had medical complications preventing uptake of PTED treatments. Procedure:Each man participated in a semi-structured interview. Interpretative Phenomenological Analysis was used to gain a phenomenological understanding of the factors affecting decisions towards adopting and/or continuing with PTED. The International Index of Erectile Function, The Self Esteem and Relationship index and the Erectile Dysfunction Inventory of Treatment Satisfaction measures were used to assess levels of erectile and orgasmic functioning, sexual desire, intercourse and overall sexual satisfaction. Introduction Despite many prostate cancer survivors pre-operatively reporting an interest in receiving treatment for post-radical prostatectomy-related erectile dysfunction, studies have shown that as many as 50% of men freely decide from the outset not to proceed with any form of post-prostatectomy treatments for erectile dysfunction (PTED). Of those that commence therapy, it is estimated that almost 75% will discontinue treatment within 18 months. Given the reported success and benefits of PTED, the question remains as to why adoption and continuance rates amongst prostate cancer survivors are not higher. Using qualitative research approach, this study aimed to identify and conceptualize those factors influencing prostate cancer survivors to either adopt and/or continue with PTED regimes. Results Treatment Prescriptions for Postoperative Erectile Dysfunction:Following a postoperative recovery period, each participant was prescribed a number of treatment options for both penile rehabilitation and aiding sexual intercourse; typically PDE5 treatment combined with vacuum erectile devices (VEDs) application. Intracavernous injection treatments (ICIs) were only suggested for participants who had experienced PDE5-related adverse effects or ineffective PDE5 therapy. Postoperative Treatment Intentions and Treatment Satisfaction: Questionnaire data Participant responses to the EDITS questionnaire, revealed a clear dichotomy in treatment satisfaction levels and PTED future intentions between those participants who received specialist sexual medical advice for postoperative erectile dysfunction (n=10) and those who did not (n=7). Participants who received specialist advice for their postoperative erectile dysfunction were more likely to report being very satisfied (n=6) and were very likely to continue treatment (n=7). By comparison, no members of the ‘without-specialist’ group reported levels of treatment satisfaction above somewhat satisfied (n=1) with the majority of participants (n=4) either being non-committed towards continuing treatment or having ceased treatment altogether. • Practice Implications • For those patients seeking the recovery of erectile functioning it is recommended that physicians extend the biomedical approach towards PTED to also incorporate sexual, social and psychological elements. Preferably, partners need to be included in treatment discussions, choices, education and training. Problems relating to relationship issues, the incorporation of treatments within sexual dynamics, and treatment-related sex-spontaneity issues need to be acknowledged and addressed. • Physicians without specialist training in sexual dysfunction need to become more amenable towards referring patients to specialist treatment providers and professionally trained psycho-sexual counsellors in order to improve PTED outcomes. • Conclusions • Our findings suggest that male sexual identity and sex drive form the principal motivating drivers of PTED adoption; however continuing treatment is more likely to be influenced by numerous additional factors including: treatment efficacy and ease of use, level of partner support and treatment acceptance, access to specialist care and instruction; and the dynamics of sexual relationships and activities. Existing forms of medical treatment appear to be overlooking many of the important behavioural, social and psychological factors that influence PTED adoption and continued use. Our study has found that patients require on-going counselling, as well as increased levels of instruction and education as to treatment options and their application, in order to increase long term use of PTED.