Patient-centred pathology reporting improves patient experience and understanding of disease in prostate cancer care.

Introduction and Objectives: Patient-centred (PC) and holistic care improves patient satisfaction and health outcomes. We sought to investigate the benefit of utilising a PC pathology report in patients undergoing radical prostatectomy (RP) for prostate cancer (PCa). Our study aimed to evaluate and compare patient understanding of their PCa diagnosis after RP, upon receiving either a standard histopathology report or a personalised and PC report (PCR). Moreover, we evaluated knowledge retention at 4 weeks after the initial consultation. Methods: We invited patients undergoing RP at three metropolitan Urology clinics to participate in our randomised controlled study. Patients were randomised to receive either a PCR or standard pathology report. Patient satisfaction questionnaires (Perceived Efficacy in Patient-Physician Interactions [PEPPI], Consultation and Relational Empathy [CARE] and Communication Assessment Tool [CAT]) and a knowledge test were conducted within 72 h of the initial appointment and again at 4 weeks. Accurate recollection of Gleason grade group (GGG) and extracapsular extension (ECE) were classified as 'correct'. Baseline demographic data included age, education, marital and employment status, pre-op prostate specific antigen (PSA) and clinical stage. Baseline data were tested for differences between groups using the Student's t test, chi-squared test or Fisher's exact test depending on whether data were continuous, categorical or sparse. Comparison of correctly answered 'knowledge' questions was analysed using chi-squared test. A significance level of p ≤ 0.05 was used. Results: Data from 62 patients were analysed (30 standard vs. 32 PCR). No significant differences in baseline demographics were found between groups. Both groups reported high levels of satisfaction with their healthcare experiences in all domains of patient-physician rapport, empathy and communication. There were no significant differences between groups in PEPPI (p = 0.68), CAT (p = 0.39) and CARE (p = 0.66) scores, at baseline and 4 weeks. Ninety-three per cent of patients who received the PCR understood the report while 90% felt the report added to their understanding of their PCa. Regarding patient knowledge, the PCR group had significantly more correct answers on GGG and ECE as compared with the standard report group at baseline and 4 weeks (p < 0.001 and 0.001, respectively). Conclusions: Our findings demonstrate that PC pathology reports improve patient knowledge and understanding of their PCa that is retained for at least 4 weeks after initial receipt of results.

Developing and evaluating Robocare; an innovative, nurse-led robotic prostatectomy care pathway.

PURPOSE: A Robotic Prostatectomy Care Pathway ("Robocare"), aiming to prepare men for robotic-assisted radical prostatectomy (RARP) and manage side-effects and long-term follow-up in a multidisciplinary fashion was established. The pathway enhances patient care by providing adequate information and support and optimizes efficiency by reducing length of stay and minimizing hospital visits. Our study assesses the pathway for patient satisfaction, co-ordination of care between disciplines, length of stay and readmission rates. METHOD: We analysed our database of all patients undergoing RARP with Robocare between July 2012 and December 2013 at Peter MacCallum Cancer Centre, Australia (PMCC). Compliance, Length of Stay and Postoperative Course were analysed. Patient satisfaction was assessed. RESULTS: Overall 124 patients underwent RARP with 105 (85%) being discharged day 1 post-op (mean 1.3 days). Post-operative support phone calls were received by >95% of patients. Thereafter, 74 patients (60%) were followed in the long-term follow-up phone clinic. Twenty-nine complications were identified of which 19 (66%) were resolved by the nurse specialist. Eighteen patients had psychologist, 44 sexual health and 44 physiotherapist referral. Patient satisfaction in 74 (60%) returned surveys revealed 71 (96%) being well/very well supported. CONCLUSIONS: The Robocare pathway is safe with high patient satisfaction. It contributes to reducing post-operative length of stay and readmission rates as well as the outpatient follow-up. A true multidisciplinary approach that is nurse-led likely improves care and outcomes for RARP patients and may lower impact on hospital resources.

Early experience and operative technique of robotic-assisted partial nephrectomy.

BACKGROUND: The adoption of robotic-assisted partial nephrectomy (RAPN) is increasing in Australia; however, to date no Australian RAPN series has been reported. This paper describes a single-surgeon initial experience with RAPN and evaluates perioperative, pathological and oncological outcomes. METHODS: Data on the first 50 consecutive patients to undergo RAPN by a single surgeon were reviewed. Demographic, perioperative, tumour characteristics and Clavien complications were collected in addition to oncological follow-up and renal function monitoring. RESULTS: Mean age was 58.2 ± 10.4 years, body mass index was 28.8 ± 4.5 kg/m(2) and Charlson Co-morbidity Index was 4.6 ± 1.2. Tumour diameter was 31 ± 13 mm and RENAL score was 6.8 ± 1.5. Average total operative time was 151 ± 32.7 min, estimated blood loss was 171.1 ± 185.8 mL, warm ischaemia time was 17.8 ± 6.7 min and length of hospital stay was 3 ± 0.9 days. There were seven Clavien complications and no deaths. Estimated glomerular filtration rate did not decrease significantly post-operatively (P = 0.8); and there was 14.6% upstaging of chronic kidney disease scoring although no patient required dialysis. There were no positive malignant surgical margins, and to date no patient has evidence of disease recurrence. Of 50 patients, 54% had a minimum follow-up of 6 months and 28% had a minimum follow-up of 1 year. CONCLUSION: We report the largest RAPN study in Australia or New Zealand to date. Initial results suggest that RAPN can be safely introduced into the Australian public and private health systems, and has been effective in oncologic control and renal function preservation.

Early urinary continence recovery after robot-assisted radical prostatectomy in older Australian men.

OBJECTIVE: To compare the recovery of urinary continence (UC) after robot-assisted radical prostatectomy (RARP) in men aged ≥70 and <70 years at 1-year follow-up and to assess for preoperative predictors of UC recovery, as older, healthy men with localised prostate cancer are often denied curative surgical treatment on the grounds of worse UC recovery. PATIENTS AND METHODS: In all, 262 patients with prostate cancer having undergone RARP between May 2008 and September 2012, under the care of two consultant urological surgeons at three Melbourne hospitals, were identified. Patients were categorised based on their age ≥70 and <70 years and compared with regards to two endpoints; percentage fully continent and mean pads/day at 4-6 weeks, and 3, 6, 9 and 12 months after RARP. RESULTS: Of the 262 men, 9% (24) were aged ≥70 years. Older men had higher PSA levels (P = 0.007) and clinical stages (P < 0.001) compared with the younger cohort. There were more non-nerve sparing procedures in the older group (P = 0.009) and a shorter mean operative time (P = 0.004). At 4-6 weeks after RARP, the number of pads used per day was greater in older men (P = 0.03) and there was a trend towards fewer older men being fully continent (P = 0.08) than their younger counterparts; however, by 3 months and all time-points thereafter there was no difference. The 12-month UC rates were 89% and 92% for men aged <70 and ≥70 years, respectively. Neither age, body mass index, D'Amico risk group, nerve sparing nor use of Rocco suture were predictors of time to UC recovery. CONCLUSION: UC recovery after RARP in men aged ≥70 years appears comparable to younger men and therefore not a reason to deny older men with a reasonable life-expectancy curative surgical treatment of localised prostate cancer.