A Qualitative Exploration of Prostate Cancer Survivors Experiencing Psychological Distress: Loss of Self, Function, Connection, and Control

Abstract

Purpose: To explore the experiences of men with prostate cancer identified as having psychological distress and to identify factors influencing distress. Participants and setting: 28 men with prostate cancer diagnosed 18-42 months earlier, identified as having psychological distress on survey measures. Methodologic approach: Semi-structured telephone interviews were conducted. Thematic analysis using a Framework approach was used. Findings: Men with psychological distress had strong perceptions of 'loss' towards a) self (identity, sexuality/masculinity, self-confidence), b) function (physical, activities), c) connection (relational, social, community) and d) control (future, emotional). Psychological vulnerability appeared heightened in particular groups of men. Maladaptive strategies of emotional concealment, helpseeking avoidance and withdrawal appeared to contribute to distress. Implications for nursing: Distress in men with prostate cancer is multifaceted. Men with distress should be identified and offered support. Nursing and/or peer-led interventions are required. Knowledge Translation: 1. A significant minority of men with prostate cancer report distress 18-42 months following diagnosis. Screening tools for psychological difficulties may help identify men in need of further support. 2. The author's conceptual model highlights pre-existing and treatment related factors, as well as maladaptive coping strategies influencing distress. Greater support with restoring selfidentity and confidence is needed. 3. Nurse-led patient education and information on managing psychological and physical concerns, as well as sign-posting to peer support, community or online support groups is required.

Body image, self-esteem, and sense of masculinity in patients with prostate cancer: a qualitative meta-synthesis

“…Retaining sexual function was also so important to some men that they recounted choosing treatment depending on which offered the best potential for preservation of function [ 72 ], even if this reduced survival [ 35 , 65 , 75 ]. Multiple studies reported that men saw post-treatment erectile dysfunction as the most important factor they overcame [ 34 , 54 , 56 , 89 ], with the shame of erectile dysfunction further compounded by incontinence disrupting their sexual relationships [ 55 , 62 , 80 ]. Decline in sexual function made men feel ‘not worthy’, less of, or unable to be a man compared to pre-treatment [ 30 , 31 , 33 , 66 , 77 , 90 ].…”

“…Men described gaining ‘boobs’ [ 37 , 59 ], demonstrating how men immediately saw gynaecomastia as a signifier of their feminine transition. Many also attributed emotional changes to ADT—crying more often [ 53 , 80 ], becoming sentimental [ 59 ], and even wanting to bake more often [ 47 ].…”

“…Partner relationships were frequently mentioned by men. Studies predominantly included heterosexual men, with only eight studies including gay or bisexual men [ 48 , 55 , 57 , 62 , 63 , 73 , 75 , 80 ]. In men experiencing erectile dysfunction and loss of libido, the attitude of partners was a concern.…”

“…They helped men both deal with the consequences of cancer [ 47 ], and encouraged them to seek out healthcare in the form of ‘nagging’ or ‘worrying’ [ 35 , 37 , 39 , 42 ]. However, for single men, the effects of erectile dysfunction made them less likely to seek out new relationships [ 34 , 38 , 48 , 80 ], end current ones [ 44 ], or to hide their diagnosis from romantic interests [ 65 ].…”

Phenotypes of caregiver distress in military and veteran caregivers: Suicidal ideation associations

“…Loss of self has been studied in the context of the patient with some evidence of the impact in cancer survivors [38] and chronically ill patients [39] and highly associated to self-esteem, but loss of self has rarely been examined in caregiver research. Extant studies have found loss of self mostly among caregivers that are spouses, younger, and women [23].…”