Levitra (vardenafil) Info

Pretreatment Education and Counseling
As part of the counseling of men diagnosed with prostate cancer, healthcare practitioners (physicians, practice nurses and health educators/navigators) need to provide good information about the relative benefits and risks of the treatments advocated, including their likely influence on subsequent QOL, and then incorporate patient preferences into the therapeutic decision. In doing so, it should be appreciated that whereas some patients will want to maximize their chances for a “cure” and will accept the risk of post-treatment complications, such as urinary and sexual dysfunction, others will opt for a higher risk of prostate cancer recurrences to retain their present urinary and sexual function. It also needs to be realized that patients may receive conflicting information about the benefits and risks of treatment from different sources and that there may be considerable uncertainty regarding cure rates, the likelihood of complications occurring and the degree to which their lives will be affected by these complications. Although it might be assumed that a patient’s treatment decision will be based on a rational assessment of the available information, this may not be the case as his interpretation of potential outcomes may be based on the personal context of a particular complication. Generic Zithromax 500mg

While some patients may consider the information they receive from the physician during the critical “options talk” following the diagnosis of prostate cancer sufficient to make a decision, most will gather information from various sources ranging from books, pamphlets, friends and/or coworkers (influential others) and the Internet before either accepting or rejecting the physician’s recommendation. Often, spouses or partners will be highly involved in the decision-making process, which emphasizes the importance of their inclusion in treatment-related discussions. Patients of low socioeconomic status with low literacy pose a particular problem for healthcare practitioners in this regard, as incomplete comprehension of the information they receive can prove a barrier to the shared decision-making process and, hence, in securing patient acceptance and satisfaction with the recommended treatment. Buy Strattera

Thus, a challenge facing healthcare practitioners is to seek ways of enhancing patients’ participation in this process, and this is especially relevant for those of low socioeconomic status and low literacy in view of the later diagnosis of prostate cancer, differing treatment patterns and worse outcomes in this population. Educational programs specifically tailored to this group need to be developed and incorporated into regular clinical practice to help these patients better understand prostate cancer and the benefits and risks of the treatments advocated, and as a result, improve levels of communication. Practice nurses and health educators/navigators can play an important role in developing and disseminating such programs and in providing support for patients and their families to allay fears and concerns about the diagnosis. As these issues may be difficult for some men to discuss and a low educational level may exacerbate this problem, help can be found from support groups and practitioners who are knowledgeable about prostate cancer. dutasteride generic

As yet, no specific educational interventions have been proven to assist patients and their spouses or partners in the decision-making process, and precisely how nurses can best assist patients in this regard cannot be conclusively answered. Nevertheless, efforts to improve patients’ knowledge and deal with preconceived biases that may influence the treatment decision seem likely to be beneficial. Wellbutrin SR antidepressant

Posttreatment Follow-Up

As well as pretreatment counseling and education, patients with prostate cancer require careful follow-up after treatment to ensure they have recovered well, are not experiencing a recurrence of the cancer, and not encountering any undue physical or psychological problems that diminish their QOL. Monitoring recommendations for ongoing PSA tests, DREs, bone scans and other investigations are beyond the scope of this review, but it is important to note that each therapeutic approach has its own requirements and potential complications. Practice nurses and health educators/navigators can play an important role in monitoring patients who are unable to attend specialist appointments (e.g., patients living in remote areas and those for whom inflexible work hours, familial demands, comorbid conditions or cost make travel prohibitive) and in providing psychosocial support for both patients and their families. The specialist physician will be responsible for ordering PSA and other laboratory tests, but the practice nurses and health educators/navigators can follow the results as well. As part of the follow-up assessment, application of a specific QOL instrument such as the FACT-G (Functional Assessment of Cancer Therapy—General scale) questionnaire, the Quality of Life Index and the EORTC (European Organization for Research and Treatment of Cancer) Quality of Life questionnaire—all of which are appropriate with interviewer assistance in patients of low socioeconomic status—may be useful to provide insight into patient functioning and to help discriminate between stable and progressive disease at the point of care. aripiprazole depression

Posttreatment complications that may be particularly troublesome for patients include urinary incontinence, radiation-induced diarrhea/enteritis, erectile dysfunction and, in those treated with androgen ablative therapy, hot flashes. Patients should be comprehensively assessed for such problems and given the opportunity to discuss any difficulties they may be experiencing. Information on the many treatment options available to alleviate these complications should be provided (Table 4) and supportive management instituted whenever possible. Patients experiencing intractable symptoms should be assessed for their interest in a referral and encouraged to see a specialist physician about the problem. Lexapro depression
CONCLUSIONS

As a consequence of their lower educational levels and economic circumstances, the diagnosis and treatment of prostate cancer in men of low socioeconomic status are generally later than for men of higher socioeconomic status, and outcomes are consequently worse. In addition, low literacy often limits the ability of men of low socioeconomic status to comprehend information given to them about prostate cancer and its treatment, and this may adversely influence their ability to participate in shared decision-making regarding optimal treatment and, consequently, their satisfaction with the treatment they receive. canadian drugs

Barriers to delivering appropriate healthcare to men of low socioeconomic status include medical insurance and cost/copayment difficulties, language difficulties, homelessness, cultural attitudes and beliefs (e.g., healthcare may be perceived as a concern of females), concerns over sexuality, and reluctance to discuss or treat problems that involve the reproductive system. Improving the outcome for such men requires, initially, the implementation of educational programs tailored specifically to this population. The objective of such programs is to improve patient-physician communication; provide a better understanding of prostate cancer; and achieve higher levels of patient acceptance of the treatment(s) advocated on the basis of clinical variables such as age, stage, PSA level, Gleason score and comorbidities. The better informed patients are, the more assertive they are likely to be in seeking interventions that will provide the optimal result for their particular situation, i.e., the desired balance between the chance of a “cure” on the one hand and possible occurrence of unacceptable posttreatment complications on the other. Losartan hypertension

Improving outcomes also requires careful post-treatment follow-up to ensure that patients are following instructions on recovery activity levels, changes of dressings and fluid intake; are not experiencing a cancer recurrence; and are not unduly bothered by complications such as urinary incontinence, erectile dysfimction, postradiation diarrhea/enteritis, or hot flashes. Patients should be given the opportunity to discuss difficulties they are experiencing because self-image concerns and cultural barriers to effective dialogue may lead to problems being ignored and having an adverse influence on QOL. Active questioning of patients about likely posttreatment complications and the application of specific QOL instruments may be useful to gain insights into patient functioning and to effectively identify problems early. Generic Rosuvastatin

In summary, practice nurses and health educators/navigators can play an important role in implementing educational strategies designed to improve knowledge about prostate cancer and its treatment, monitoring patients posttreatment (particularly when their ability to attend specialist follow-up appointments is compromised), advising on management of posttreatment complications and providing psychoso cial support for patients and their families. In doing so, nurses need to be aware of the issues and controversies surrounding the screening for and early detection of prostate cancer, and the benefits and risks of the treatment options available. For patients of low socioeconomic status, education and well-informed advice have the potential to result in: 1) improved detection of prostate cancer such that it is diagnosed at an earlier stage and the incidence of metastatic disease is decreased, 2) improved dialogue with the physician such that patient participation in the treatment decision-making process is enhanced, and 3) improved detection and management of posttreatment complications such that QOL is maximized.