Estudio mixto sobre la calidad de vida de pacientes sometidos a prostatectomía radical
- MARTÍNEZ BORDAJANDI, ÁLVARO
- Cayetano Fernández Sola Director
- José Manuel Hernández Padilla Co-director
Defence university: Universidad de Almería
Fecha de defensa: 30 March 2023
- Manuel Ferrer Márquez Chair
- José Granero Molina Secretary
- Susana Núñez Nagy Committee member
Type: Thesis
Abstract
Introduction: Prostate cancer is the most prevalent tumor lesion and the second cause of cancer mortality in men throughout the world. Its clinical prognosis is estimated using normograms based on statistical methods. However, accurately determining pathologic stage from clinical data remains a challenge in practice. Depending on the pre-surgical staging, radical prostatectomy is one of the available therapeutic options. This intervention entails long-term adverse effects that can affect the quality of life of patients. Aims: (1) Describe and analyze the relationship between sociodemographic factors, quality of life and clinical variables in patients undergoing radical prostatectomy. (2) To explore the experiences and perceptions of older adults about their quality of life after radical prostatectomy. (3) To know the experience and expectations of men in relation to social support after a radical prostatectomy. (4) Understand the sexuality experiences of patients who underwent non-nerve sparing radical prostatectomy. Method: Design: Mixed study consisting of a cross-sectional observational quantitative study with 51 participants and a qualitative part, based on the naturalistic paradigm, with a descriptive study and two phenomenological studies. Data collection: For the quantitative study, the data were obtained from patients who had undergone biopsy of a surgical piece after radical prostatectomy. Sociodemographic variables, tests related to quality of life, pre-surgical clinics and post-surgical clinics were collected. For the qualitative naturalistic study, 10 in-depth interviews and a focus group with 8 participants were conducted. In the qualitative phenomenological studies, 16 individual interviews were carried out. Analysis of the data: The quantitative study was based on descriptive statistics. Quantitative variables were analyzed with measures of central tendency and dispersion. For the qualitative variables, an analysis of frequencies and percentages was used. The normality of all variables was studied. A descriptive and association/correlation analysis of the most relevant variables of the study was performed. In addition, a multivariate analysis was performed to study the intergroup differences between variables with significant correlation. For this we use the software IBM SPSS Statistics v26. For the qualitative studies, the transcription and incorporation into a hermeneutical unit of the ATLAS.ti v8.0 software was carried out. For the qualitative descriptive study, the thematic analysis of Braun and Clarke was used and for the phenomenological ones the analytical procedure of Fleming, Gaidys and Rob. Results: Quantitative study: Age was related to a greater occurrence of erectile dysfunction (f=10.594; p=0.09) and a lower percentage of consultations for this reason (x2=6.996; p=0.012). Overweight/obese patients had a more aggressive result on the Gleason scale (w=151.5; p=0.019). Differences were found between the ultrasound and the prostate volume of the surgical specimen (f=10.324; p=0.004). There were differences between the Gleason score obtained from the biopsy and the surgical piece (f=23.330; p=0.00001). Naturalistic qualitative study: Two main themes emerged from the analysis: (1) Physical and psychological sequelae after prostatectomy. (2) Quality of life and environment of the prostatectomy patient. Phenomenological qualitative study (objective 3): Two main themes emanate from the analysis: (1) “The couple as a source of support and conflict after prostatectomy”. (2) "The importance of the social and professional circle in the structural support." Phenomenological qualitative study (objective 4): Two themes emerged from the analysis that reflect the experiences of the patients: (1) Sexuality as a key element of quality of life: crisis and change of priorities. (2) Prostatectomy: from a coitocentric sexuality to a holistic sexuality. Conclusions: Clinical data are not yet a perfect final staging tool and should be used with caution when establishing the prognosis and treatment of a patient with prostate cancer. The physical sequelae in the urinary and erectile function of prostatectomized patients imply a reduction in the quality of life. These changes cause problems in sexual and intimate relationships. Faced with this situation, some participants question their habitual sexual practices and try to adapt to a holistic sexuality that is not focused on intercourse, incorporating innovative forms of sexuality. These limitations in their sexual life cause additional psychological consequences, which is accentuated by the appearance of a lack of communication with their relatives. The empathic reconnection that occurs with the couple and the changes in sexual and coexistence patterns after radical prostatectomy puts the deficiencies of the health system to the test. This includes terms of information and sexual advice. All of this emphasizes the need to carry out interventions to train professionals in interpersonal communication and in forgotten areas of quality of life, such as sexuality. This should include both the patient and her environment.