Support for patients and the role of eHealth in rehabilitation after radical prostatectomy

Abstract

Background: Patients undergoing radical prostatectomy for prostate cancer often experience urinary incontinence and sexual dysfunction posttreatment. Active self-care can reduce this burden. However, support maybe needed to maintain motivation during the long rehabilitation. eHealth has the potential to provide such support. Aim: To investigate the effects of eHealth support and describe patients'experiences of support in self-care during the rehabilitation after radical prostatectomy. Method: The Medical Research Council’s framework for complex interventions governed the overall design of this thesis. In Study I, patients’ experiences of the usability of a new eHealth support, the electronic Patient Activation in Treatment at Home (ePATH), was described using individual interviews and deductive content analysis. The effects of ePATH on symptoms and activation were evaluated through a multicenter longitudinal randomized controlled trial (II, III). Patients planned for radical prostatectomy at three sites were eligible for inclusion. The intervention group had access to ePATH during one year after surgery. Questionnaires at five timepoints were analyzed with linear mixed models and generalized estimation equations. Study IV described patients’ experiences of support for managing self-care through individual interviews and inductive content analysis. Results: Study I covered the usability of ePATH as to managing the technology, turning input into output, and how the eHealth support assisted in task performance. The randomized controlled trial showed no significant differences between groups regarding urinary incontinence, sexual function, physical activity, pelvic floor exercises (II), or patient activation (III). In the intervention group, 64% used ePATH. Initial patient activation and depression significantly influenced patient activation over the course of the rehabilitation year. In Study IV, patients described a progression in self-care management, where their abilities grew through interconnected phases. Conclusion: The needs for support differ during a patient's journey through prostate cancer rehabilitation. This places demands on the support and underscores the need for accessibility, individual adaptation, and continuity. Future research should focus on adjustable aids for patients in long-term rehabilitation, integrating multiple aspects, to enable tailoring of the support.