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Improvement in clinicians' perceptions of inpatient urinary continence care following an implementation study: a before and after study using a questionnaire aligned to the Theoretical Domains Framework with practical methods for analysing and presenting barrier and enabler data

Tue, 14 Oct 2025 00:00:00 GMT

Title: Improvement in clinicians' perceptions of inpatient urinary continence care following an implementation study: a before and after study using a questionnaire aligned to the Theoretical Domains Framework with practical methods for analysing and presenting barrier and enabler data Authors: Marsden, D. L.; Boyle, K.; Birnie, J.; Buzio, A.; Dunne, J.; Hill, K.; Lambkin, D.; Lever, S.; Minett, F.; Ormond, S.; Shipp, J.; Steel, J.; Styles, A.; Wiggers, J.; Cadilhac, D. A-M.; Duff, J.; I-SCAMP Project Team Abstract: Background: Although 10-50% of patients in hospital experience urinary continence issues many do not receive guideline-recommended care. We developed and tested a co-created practice-change package that improved then maintained the proportion of symptomatic inpatients receiving a urinary continence assessment, diagnosis, and management plan. In this present study we aimed to categorise clinicians' perceptions of urinary continence care as barriers or enablers, and determine any change after implementation of the package. Methods: Overall, fifteen adult wards (acute = 3, rehabilitation = 7, acute and rehabilitation = 5) in 12 Australian hospitals (large city = 4, regional = 8) participated. All wards were to receive the practice-change package during the study. The selected implementation strategies addressed barriers identified before implementation, and targeted inpatient clinicians. These clinicians were invited to complete a web-based questionnaire before and immediately after the 6-month implementation phase. The questionnaire was aligned to 13/14 domains of the Theoretical Domains Framework. It included 57 subitems covering assessment, diagnosis, management, or general continence care. A 5-point Likert scale was used (e.g. "strongly agree" to "strongly disagree"). To categorise responses, each subitem was dichotomised as positive (e.g. "agree", "strongly agree") or neutral/ negative ("unsure", "disagree", "strongly disagree"). Subitems were classified and colour coded as barriers (< 60% positive responses, red), neutral (60-69% positive, orange) or enablers (> 69% positive, green). Changes from before to after-implementation were assessed. Results: Clinicians from 12 hospitals participated before-implementation (n=291, 82% female, 88% nursing), and from 10/12 hospitals (n=195, 86% female, 94% nursing) after-implementation. Two hospitals withdrew as the start of their implementation phase coincided with the onset of COVID-19. After implementation substantial improvements in perceptions were observed in 7/13 TDF domains: "skills", "knowledge", "memory", "beliefs about capabilities", "emotion", "environmental context and resources", and "social and professional role". Three domains ("goals", "beliefs about consequences" and "reinforcement") were high scoring enablers at both timepoints. Three domains had limited or no change ("social influences", "intentions", "behaviour regulation"). Conclusion: Categorisation and colour-coding of perceptions can assist end-users to quickly understand the data, identify areas for improvement, and changes after-implementation. The results helped to identify and explain which implementation strategies appeared to be successful in changing practice, and which ones need refining.

Analysis of a volumetric-modulated arc therapy (VMAT) single phase prostate template as a class solution.

Thu, 01 Nov 2018 00:00:00 GMT

Title: Analysis of a volumetric-modulated arc therapy (VMAT) single phase prostate template as a class solution. Authors: Hoffmann, Matthew; Pacey, J.; Goodworth, J.; Laszcyzk, A.; Ford, R.; Chick, Brendan; Greenham, Stuart; Westhuyzen, Justin Abstract: AIM To assess a class solution template for volumetric-modulated arc therapy (VMAT) for prostate cancer using plan analysis software. BACKGROUND VMAT is a development of intensity-modulated radiotherapy (IMRT) with potential advantages for the delivery of radiotherapy (RT) in prostate cancer. Class solutions are increasingly used for facilitating RT planning. Plan analysis software provides an objective tool for evaluating class solutions. MATERIALS AND METHODS The class solution for VMAT was based on the current static field IMRT template. The plans of 77 prostate cancer patients were evaluated using a set of in-house plan quality metrics (scores) (PlanIQ™, Sun Nuclear Corporation). The metrics compared the class solution for VMAT planning with the IMRT template and the delivered clinical plan (CP). Eight metrics were associated with target coverage and ten with organs-at-risk (OAR). Individual metrics were summed and the combined scores were subjected to non-parametric analysis. The low-dose wash for both static IMRT and VMAT plans were evaluated using 40 Gy and 25 Gy isodose volumes. RESULTS VMAT plans were of equal or better quality than the IMRT template and CP for target coverage (combined score) and OAR combined score. The 40 Gy isodose volume was marginally higher with VMAT than IMRT (4.9%) but lower than CP (-6.6%)(P = 0.0074). The 25 Gy volume was significantly lower with VMAT than both IMRT (-32.7%) and CP (-34.4%)(P < 0.00001). CONCLUSIONS Automated VMAT planning for prostate cancer is feasible and the plans are equal to or better than the current IMRT class solution and the delivered clinical plan.

Overall survival of men with metachronous metastatic hormone-sensitive prostate cancer treated with enzalutamide and androgen deprivation therapy

Wed, 01 Sep 2021 00:00:00 GMT

Title: Overall survival of men with metachronous metastatic hormone-sensitive prostate cancer treated with enzalutamide and androgen deprivation therapy Authors: Sweeney, C. J.; Martin, A. J.; Stockler, M. R.; Begbie, S.; Chi, K. N.; Chowdhury, S.; Coskinas, X; Frydenberg, M.; Hague, W. E.; Horvath, L. G.; Joshua, A. M.; Lawrence, N. J.; Marx, G. M.; McCaffrey, J.; McDermott, R.; McJannett, M.; North, S. A.; Parnis, F.; Parulekar, W.; Pook, D. W.; Reaume, M. N.; Sandhu, S. K.; Tan, A.; Tan, T. H.; Thomson, A.; Tu, E.; Vera-Badillo, F.; Williams, S. G.; Yip, S.; Zhang, A. Y.; Zielinski, R. R.; Davis, I. D.; ENZAMET Trial Investigators and the Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP) Abstract: Men who initially present with localized prostate cancer and later develop metachronous metastases have a better prognosis than men with de novo metastatic disease and often have a low burden of disease on conventional imaging. Some have disease amenable to metastasis-directed therapy for lymph node or bone metastases, a strategy used by some because no documented overall survival (OS) benefit of combination systemic therapy in this setting. We report data for patients prospectively classified as "M0" at initial diagnosis from the interim analysis of the ENZAMET trial, with 34 mo of median follow-up for survivors. A total of 312 (28%) of the 1125 enrolled patients were classified as M0 at diagnosis, and 205 (66%) of the 312 patients had low-volume disease at study entry as per the CHAARTED criteria. The hazard ratio for OS, that is, HR(OS), was 0.56 (95% confidence interval [CI]: 0.29-1.06) with the addition of enzalutamide for all patients with metachronous metastatic hormone-sensitive prostate cancer, and for the low-volume subset the HR(OS) was 0.40 (95% CI: 0.16-0.97). The 3-yr OS was 83% without and 89% with enzalutamide for all patients with metachronous metastases, and 83% and 92%, respectively, for the low-volume subset. Intensification of hormonal therapy should strongly be considered for these men. PATIENT SUMMARY: Many men present with prostate cancer that has spread to distant sites beyond the prostate gland years after their initial diagnosis and treatment, while others have distant spread at the time the cancer is diagnosed. On average, men whose cancer comes back years after the initial diagnosis often survive much longer than men whose cancer has been found to spread to distant sites when it is first diagnosed. In this report, we demonstrate strong evidence for the first time that the survival of men whose cancer comes back years later is improved when drugs such as enzalutamide or apalutamide are added to testosterone suppression in this setting.

Testosterone suppression plus enzalutamide versus testosterone suppression plus standard antiandrogen therapy for metastatic hormone-sensitive prostate cancer (ENZAMET): an international, open-label, randomised, phase 3 trial

Sat, 01 Apr 2023 00:00:00 GMT

Title: Testosterone suppression plus enzalutamide versus testosterone suppression plus standard antiandrogen therapy for metastatic hormone-sensitive prostate cancer (ENZAMET): an international, open-label, randomised, phase 3 trial Authors: Sweeney, C. J.; Martin, A. J.; Stockler, M. R.; Begbie, S.; Cheung, L.; Chi, K. N.; Chowdhury, S.; Frydenberg, M.; Horvath, L. G.; Joshua, A. M.; Lawrence, N. J.; Marx, G.; McCaffrey, J.; McDermott, R.; McJannett, M.; North, S. A.; Parnis, F.; Parulekar, W.; Pook, D. W.; Reaume, M. N.; Sandhu, S. K.; Tan, A.; Tan, T. H.; Thomson, A.; Vera-Badillo, F.; Williams, S. G.; Winter, D.; Yip, S.; Zhang, A. Y.; Zielinski, R. R.; Davis, I. D.; ENZAMET trial investigators and Australian and New Zealand Urogenital and Prostate Cancer Trials Group Abstract: Background: The interim analysis of the ENZAMET trial of testosterone suppression plus either enzalutamide or standard nonsteroidal antiandrogen therapy showed an early overall survival benefit with enzalutamide. Here, we report the planned primary overall survival analysis, with the aim of defining the benefit of enzalutamide treatment in different prognostic subgroups (synchronous and metachronous high-volume or low-volume disease) and in those who received concurrent docetaxel. Methods: ENZAMET is an international, open-label, randomised, phase 3 trial conducted at 83 sites (including clinics, hospitals, and university centres) in Australia, Canada, Ireland, New Zealand, the UK, and the USA. Eligible participants were males aged 18 years or older with metastatic, hormone-sensitive prostate adenocarcinoma evident on CT or bone scanning with 99mTc and an Eastern Cooperative Oncology Group performance status score of 0-2. Participants were randomly assigned (1:1), using a centralised web-based system and stratified by volume of disease, planned use of concurrent docetaxel and bone antiresorptive therapy, comorbidities, and study site, to receive testosterone suppression plus oral enzalutamide (160 mg once per day) or a weaker standard oral non-steroidal antiandrogen (bicalutamide, nilutamide, or flutamide; control group) until clinical disease progression or prohibitive toxicity. Testosterone suppression was allowed up to 12 weeks before randomisation and for up to 24 months as adjuvant therapy. Concurrent docetaxel (75 mg/m2 intravenously) was allowed for up to six cycles once every 3 weeks, at the discretion of participants and physicians. The primary endpoint was overall survival in the intention-to-treat population. This planned analysis was triggered by reaching 470 deaths. This study is registered with ClinicalTrials.gov, NCT02446405, ANZCTR, ACTRN12614000110684, and EudraCT, 2014-003190-42. Findings: Between March 31, 2014, and March 24, 2017, 1125 participants were randomly assigned to receive non-steroidal antiandrogen (n=562; control group) or enzalutamide (n=563). The median age was 69 years (IQR 63-74). This analysis was triggered on Jan 19, 2022, and an updated survival status identified a total of 476 (42%) deaths. After a median follow-up of 68 months (IQR 67-69), the median overall survival was not reached (hazard ratio 0·70 [95% CI 0·58-0·84]; p<0·0001), with 5-year overall survival of 57% (0·53-0·61) in the control group and 67% (0·63-0·70) in the enzalutamide group. Overall survival benefits with enzalutamide were consistent across predefined prognostic subgroups and planned use of concurrent docetaxel. The most common grade 3-4 adverse events were febrile neutropenia associated with docetaxel use (33 [6%] of 558 in the control group vs 37 [6%] of 563 in the enzalutamide group), fatigue (four [1%] vs 33 [6%]), and hypertension (31 [6%] vs 59 [10%]). The incidence of grade 1-3 memory impairment was 25 (4%) versus 75 (13%). No deaths were attributed to study treatment. Interpretation: The addition of enzalutamide to standard of care showed sustained improvement in overall survival for patients with metastatic hormone-sensitive prostate cancer and should be considered as a treatment option for eligible patients.