Knowledge, attitudes and beliefs towards management of men with locally advanced prostate cancer following radical prostatectomy: an Australian survey of urologists

Abstract

ObjectiveTo investigate Australian urologists' knowledge, attitudes and beliefs, and the association of these with treatment preferences relating to guideline-recommended adjuvant radiotherapy for men with adverse pathologic features following radical prostatectomy. Subjects and methodsA nationwide mailed and web-based survey of Australian urologist members of the Urological Society of Australia and New Zealand (USANZ). Results157 surveys were included in the analysis (45% response rate). Just over half of respondents (54%) were aware of national clinical practice guidelines for the management of prostate cancer. Urologists' attitudes and beliefs towards the specific recommendation for post-operative adjuvant radiotherapy for men with locally advanced prostate cancer were mixed. Just over half agreed the recommendation is based on a valid interpretation of the underpinning evidence (54.1%, 95% CI [46%, 62.2%]) but less than one third agreed adjuvant radiotherapy will lead to improved patient outcomes (30.2%, 95% CI [22.8%, 37.6%]). Treatment preferences were varied, demonstrating clinical equipoise. A positive attitude towards the clinical practice recommendation was significantly associated with treatment preference for adjuvant radiotherapy (rho = 0.520, P < 0.0001). There was stronger preference for adjuvant radiotherapy in more recently trained urologists (registrars) while preference for watchful waiting was greater in more experienced urologists (consultants) (b = 0.156, P = 0.034; 95% CI [0.048, 1.24]). Urologists' attitudes towards clinical practice guidelines in general were positive. ConclusionThere remains clinical equipoise among Australian urologists in relation to adjuvant radiotherapy for men with adverse pathologic features following radical prostatectomy.

A clinician‐centred programme for behaviour change in the optimal use of staging investigations for newly diagnosed prostate cancer

“…Unintentional non‐adherence arises from lack of knowledge regarding the existence and content of clinical guidelines . Even when clinicians use guidelines in regular practice, the specific details of the recommendations within may not be well known , and many do not agree that recommendations are based on valid interpretations of the evidence . Our results would appear to show that unintentional non‐adherence has been a major contributor to guideline‐discordant imaging in our region.…”

An objective measurement of urinary continence recovery with pelvic floor physiotherapy following robotic assisted radical prostatectomy

“…A lack of consensus guidelines on management serves to remind us of the gaps in the literature to provide high-level evidence on the best pathways to follow (22). This study demonstrates that urinary leakage following RALP considerably improves in the short-term with the aid of pelvic floor physiotherapy.…”

Changing attitudes towards management of men with locally advanced prostate cancer following radical prostatectomy: A follow‐up survey of Australia‐based urologists

“…Full details of survey development have been previously published. 11 Briefly, the survey comprised six sections relating to: (i) clinical equipoise; (ii) use of, and attitudes and beliefs towards, clinical guidelines in practice; (iii) innovation and current clinical practice; (iv) barriers to adherence to a clinical practice recommendation; (iv) perceptions of organisational readiness for change; and (vi) demographic information. The survey predominantly used a 5-point Likert scale ('strongly disagree' to 'strongly agree') coded as consecutive integers for analysis (with an additional 'don't know' option coded as missing).…”

“…In 2012, two years after the release of the Australian Cancer Network Clinical Practice Guidelines for the Management of Locally Advanced and Metastatic Prostate Cancer, 6 we conducted a nationwide survey to investigate Australian urologists' knowledge, attitudes and beliefs, and the association of these with treatment preferences relating to guideline-recommended adjuvant radiotherapy for men with adverse pathologic features following radical prostatectomy. 11 The survey provided baseline data to inform the development of the 'Clinician-Led Improvement in Cancer Care (CLICC)' implementation trial. 12 Results from the 2012 survey indicated that urologists varied in their attitudes and beliefs regarding adjuvant radiotherapy after radical prostatectomy for men with adverse pathologic features.…”

“…12 Results from the 2012 survey indicated that urologists varied in their attitudes and beliefs regarding adjuvant radiotherapy after radical prostatectomy for men with adverse pathologic features. 11 Less than one-third agreed that adjuvant radiotherapy would lead to improved outcomes, while more than two-thirds agreed that it may result in unnecessary patient discomfort. Consequently there was clinical equipoise for a hypothetical clinical scenario that would indicate its use ( Fig.…”