Surgery for prostate cancer has a large impact on quality of life. In Germany the current management of prostatectomy patients is based primarily on medical needs. This study sought to investigate urotherapy experts opinions on the complex needs of men before and after radical prostatectomy in German health care settings outlining strategies of care optimization. Aim was to identify specific non-medical needs of men at different stages of recovery thus highlighting the need for a specific urotherapeutic expertise offering ongoing support throughout the whole rehabilitation process.
A problem-centred guided group interview with 7 urotherapy expert practitioners consisting of 6 nurses and 1 physiotherapist was conducted. A qualitative research design was used. The Data was subjected to a Thematic Analysis by Braun & Clarke focusing on the identification of latent themes.
Two main themes and 1 subtheme were established: Theme 1 - Incongruity Theme 2 - Dialogue → Subtheme - Interdisciplinarity. Urotherapy experts identify an incongruity between patient needs and health care input offered to them before and after surgery. This incongruence is noted throughout all stages of the rehabilitation process, sometimes more or less pronounced. Urotherapy experts report same perceptions of patient needs which can be summarized as a 'sequence of needs' of prostatectomy patients: (1) the need of emotional and communicative support before the operation due to existential crisis, (2) the need of information and support while coping with urinary incontinence (often stress incontinence immediately after the operation, augmented by an urge component often occurring 2-3 months after the operation), (3) the need of information and support on coping with erectile dysfunction due to an emerging awareness of a decline or lack of erectile function, (4) the need for continued information and support after completion of the formal rehabilitation process while re-entering community life. According to urotherapy experts the existing discrepancies between patient needs and health care input can only be overcome by thorough interdisciplinary communication. A change in thinking is required. It is felt that a new and more holistic understanding of affected men's experiences, sensations and perceptions is required. Health care practitioners must orientate and adjust their health care measures according to patients needs based on an inductive understanding rather than a deductive conception.
At present health care measures provided to men before and after radical prostatectomy in Germany are structurally influenced rather than needs-based. A re-evaluation is required. Measures must be synchronised with actual needs at different stages of rehabilitation for which the concept of Urotherapy offers appropriate expertise.