Hypothesis / aims of study
The UriNary oBstruction relieved by Laser Or Conventional Surgery (UNBLOCS) trial is a national randomised controlled trial comparing thulium laser transurethral vaporesection of the prostate (ThuVARP) versus transurethral resection of the prostate (TURP) in the National Health Service (NHS), UK. Qualitative methods are increasingly used to develop a thorough understanding of the views and experiences of patients involved in randomised controlled trials1 This is vital as it is reported that successful clinical outcome may not necessarily equate to patient satisfaction2. A qualitative study nested within the UNBLOCS study provided a unique insight into the participants’ views of their symptom experience and outcomes from the interventions.
Study design, materials and methods
The specific aims of the qualitative study were to investigate the participants’ experiences of their initial symptoms, and their treatment intervention and recovery.
All participants in the main trial were invited to provide consent to participate in the qualitative study. Participants were purposively sampled from this group to represent TURP/ThuVARP intervention, different presentations for surgery (LUTS and urinary retention), and geographical location. Participants were interviewed at one time point between three and six months following surgery, either in person or on the telephone, using a structured interview schedule. Interviews were recorded, transcribed verbatim and underwent thematic analysis using NVivo 10 to identify emerging themes until data saturation was achieved3.
Thirty seven participants took part in the interviews (age range 61 – 83 years, median 70 years) between July 2015 and January 2017 across seven UK centres. The characteristics of the population are displayed in Table 1.
Four themes and fifteen sub-themes captured the patient journey as detailed in the conceptual framework (Figure 1).
Of note were the following comments that typified the headline findings:
Satisfaction with eventual outcome
It’s fantastic now. When we go out I don’t have the inconvenience. I can last for longer now than I’ve lasted for years I think. (66 years, LUTS presentation, ThuVARP)
I'm pretty pleased with what I've had done so I would recommend it to any one of my friends. (75 years, Urinary Retention presentation, TURP)
I was coping with it before, it's just I don't have to think about it now. I suppose that's the difference it's made. (64 years, LUTS presentation, ThuVARP)
My happiness is like I am a new person… I can smile again. (75 years, Urinary Retention presentation, TURP)
[The pain] was horrendous and I wasn't told that. Okay it would have been nice to have been told that that was pretty painful. (69 years, LUTS presentation, TURP)
I thought once I was discharged I was going to be fine you know but I was quite rough. (73 years, Urinary Retention presentation, ThuVARP)
I was hoping something might change because on a lot of the questionnaires there was questions about that [limitation to sexual matter] ….but I think you're the first person who has talked about it. (70 years LUTS presentation, ThuVARP)
Interpretation of results
Interviews confirmed that both procedures resulted in a fairly equal patient experience although a period of uncertainty that preceded satisfactory outcomes was also common. This is valuable for counselling future patients. Despite being in a trial setting, men described a lack of knowledge regarding specific effects and suggested that the level of information received played a large role in shaping their feelings of satisfaction. The opportunity to discuss sexual matters during the patient journey is important as men commented that this was the first time they had been asked and may provide an opportunity for signposting to enable men to seek treatment if desired.