Meet NHS Lothian
NHS Lothian is a Health Board in Scotland covering Edinburgh and the surrounding area. This project was run by the urology team at the Western General Hospital in Edinburgh. The large team is led by two consultant urologists who perform prostatectomies. They are supported by two cancer nurse specialists, who provide a prostate biopsy service, and a specialist physiotherapist providing specialist therapy to men following treatment.
The big idea
Given the large population of the area, there is a high incidence of prostate cancer; NHS Lothian undertakes 1,200 biopsies per year, of which around 44% are positive. Of this, on average around 150 men per year undergo a prostatectomy. There is already a post operation clinic in place, but this programme was designed to provide pre-operation support as well.
Making it happen
The need for a pre-prostatectomy clinic was first outlined during a patient focus group which was attended by 35 recent or current patients. Many men expressed a need for pre-operative access to an erectile dysfunction specialist nurse and urology physiotherapist.
In addition, there is further anecdotal evidence that men find out lots about their treatment and recovery after their operation that they would like to know before. In response to this NHS Lothian set up a pre-prostatectomy clinic.
The clinic is run by a specialist senior physiotherapist. The funding from Prostate Cancer UK supported a Band 6 physiotherapist to support the senior physiotherapist with the clinics and provide an opportunity to develop more specialist skills in urology physiotherapy There are only a handful of physiotherapists providing this sort of specialist support to men being treated for prostate cancer in the UK; therefore bringing someone in at band 6 to train with the existing specialist physiotherapist will go some way to addressing the skills shortage. The clinic is now running on a weekly basis. The clinic teaches the importance of pelvic floor muscle strengthening and helps to ensure correct technique prior to the patients operation.
In addition lifestyle advice is provided and discussions regarding possible post operative bladder symptoms are discussed to help manage patient expectations.
Finding out what works
Establishing a new service within an existing pathway has been challenging. Availability of appropriately skilled physiotherapists was initially a problem and this is foreseen to continue to be an issue for the profession at large. There is a training need for physiotherapists with a traditional Women’s health training to be given exposure and mentoring to be able to transfer their skills to men’s health. This will help to upskill physiotherapists in treating men for incontinence Succession planning has also been challenging in a climate of financial constraints. With the increasing incident rate of prostate cancer, this requires action for both the CSP and NHS.
The clinics are now established and running weekly. A total of 192 men have been supported to date.
- Preliminary data show increased satisfaction from patients and increased confidence pre and post operation (demonstrated in satisfaction questionnaires).
- Preliminary data shows a possible reduction in duration of incontinence post operatively. A full evaluation to confirm this will be available in March 2016
- Band 6 physiotherapist is now upskilled in specialist skills in urology physiotherapy.
- 34 of the 38 men surveyed who attended the pre operative clinic felt the advice given was sufficient to help them cope with post operative of urinary incontinence.
The full evaluation is due in March 2016.