abstract
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Defining the Advanced Practice Nursing (APN) Role in Advanced Prostate Cancer: Application of a Systematic Patient-Focused Approach Purpose To identify priorities for defining an APN role in advanced prostate cancer. The principles of participatory action research and knowledge of APN were used to adapt two role implementation frameworks to provide a patient-focused approach to role development. Two studies were conducted, the first to examine health related quality of life (HRQL) and health problems across a continuum of prostate cancer care; and the second to examine the prevalence and impact of mental health disorders on HRQL and health care costs. Patients and Methods Study one involved five groups of patients with prostate cancer receiving care at a comprehensive cancer centre including: Early Stage Newly Diagnosed (E-NEW), Early Stage On Treatment (E-RX), Early Stage Receiving Follow-Up (E-FLP), Advanced Hormone Sensitive (A-HS), and Advanced Hormone Refractory (A-HR). 631 patients attending clinic appointments were approached and 551 (87%) participated in the study. HRQL was examined using the Functional Assessment of Cancer Therapy-Prostate scale. Patients identified priority health needs using a checklist of possible health problems. Regression analysis was used to identify patient characteristics that predicted HRQL. A sample of 99 consecutive patients with advanced prostate cancer at the same centre participated in Study two. Participants completed a questionnaire assessing mental health disorders, HRQL, and health costs through a telephone interview. Results A-HS patients experienced HRQL and health problems similar to patients with early stage disease. A-HR patients had significantly poorer HRQL (p<0.001), more severe health problems, and different priority needs compared to other groups. In addition to urinary and sexual function, common health problems across patient groups related to comfort, coping, fatigue, and decreased physical ability. Disease status, prostatic specific antigen, and a history of mental health problems were modest predictors of poor HRQL. 19% of patients with advanced prostate cancer were found to have a mental health disorder. The presence of anxiety and/or drepression was associated with significant declines in HRQL. Higher health care costs were observed in patients with mental health disorders and those receiving palliative care. Conclusions In applying a patient-focused approach, new opportunities for defining the APN role and improving care delivery in advanced prostate cancer were identified. The supportive care role of the APN involving early intervention and health promotion across the continuum of prostate cancer care was envisioned for key foci related to prostate cancer health, mental health, and functional capacity. Recommendations for developing the clinical and non-clinical aspects of the APN role in advanced prostate cancer are provided along with recommendations for future research.