Radical Prostatectomy May often Defeat Men’s Unrealistic Hopes for Evading Surgical Side-Effects — Says a Small University of Michigan Study

07 September 2011

A high proportion of radical prostatectomy patients are apparently psychologically unprepared for the negative corollary effects of the surgery

The University of Michigan’s Comprehensive Cancer Center reported that:

The study showed that for the most part, [152] men’s expectations of hormonal and bowel function matched what happened one year after surgery.

But, when it came to urinary incontinence only 36 percent of the men’s expectations corresponded to what happened one year post-surgery.

In addition, only 40 percent of men found what they expected for sexual function to be true one year post-surgery.

Also, 46 percent of the men found worse than expected outcomes in urinary incontinence and 44 percent of men found worse than expected outcomes in sexual function one year after surgery.

Citation

Daniela Wittmann, Chang He, Michael Coelho, Brent Hollenbeck, James E. Montie, and David P. Wood Jr., Patient Preoperative Expectations of Urinary, Bowel, Hormonal and Sexual Functioning Do Not Match Actual Outcomes 1 Year After Radical Prostatectomy, Journal of Urology 186(2): 494-499 (August 2011)

Does this represent a problem with pre-operative counseling or overly optimistic patients?

The lead author concluded:

"When we provide preoperative education, we can only inform men in terms of overall statistics. We can't predict for the individual,” explains [Daniela] Wittmann.

“This may mean that, if in doubt, people tend toward being hopeful and optimistic, perhaps overly optimistic.”

The study findings may also mean that routine pre-operative counseling failed to give post-surgical side effects the emphasis they deserve.

For example, there is a big difference between quickly reading over an informed consent form (as often happens) and actually drawing the patient’s attention to each possible (and not so improbable) negative outcome.

Are we asking too much of surgeons in regard to informed consent?

Experience with surgeons indicates that many, perhaps most:

(a) have not themselves undergone the surgery they are proposing,

(b) exhibit a tendency to under-estimate the psychologically taxing components of even good outcomes,

and/or

These traits are completely understandable, given the demographics of surgeons and patients. Toss in surgeons’ frequent belief that optimism is healing, and we can easily explain incomplete or misunderstood communications about probable risks.

On the other hand, one can posit (and I often do) that financial self-interest sometimes motivates medical practitioners to act in ways that are not always in the patient’s full best interest.

The moral? — Patients should be prepared to ask pointed questions

When such a high proportion of this small study sample was not prepared for the negative consequences of surgery one year afterward, my suspicion is that pre-operative counseling dropped the ball more sharply than apprehensive or overly optimistic patients did.

Genuine informed consent requires that professionals recognize and overcome patients’ psychological barriers to attaining reasonable understanding.

It is certainly true that a minority of patients will never “hear” (no matter how skillful the surgeon’s communication). But, with properly obtained informed consent, most patients will probably understand enough not to be subsequently surprised by post-surgery unpleasantness.

PeteFree.com

Radical Prostatectomy May often Defeat Men’s Unrealistic Hopes for Evading Surgical Side-Effects — Says a Small University of Michigan Study