EAU 2012 Report – Ideas to get men talking to GPs about BPH

25 Feb 2012 – EAU Paris – Men often finds it difficult to talk with primary health specialists and this is certainly true in the case of BPH. The symptoms surrounding BPH can be difficult to discuss and enquiries surrounding the condition may come out at the last minutes of a consultation, often referred to as the “door knob question”, they mention a problem they are having at the last minute.During the EAU in Paris, IMI had the chance to talk with two Irish urology nurses, Mary Cooney (pictured) from St. Michaels Hospital, Dun Laoghaire and Alice Madden from Cork University Hospital and they agree it is crucial that nurses learn a style of questioning a patient that will allow these issues to come out into the open for discussion.Mary said, “Nurses need to learn the language of how to ask the questions to the patient. It is important to normalise it first in a general way or perhaps use a brief vinette of a situation to bring up the subject of frequent urination at night or urinary incontinence…then say something like ‘is this a problem for you?’, you will be surprised how relieved the patient is that the door has been opened to talk about a subject they are afraid to discuss.”This fear has been generational. Many men in their 50’s today may have seen their father or their grandfather incontinent and in adult nappies. There is an acceptance of this as a fact of becoming older. Alice agrees that the lack of communication between men fosters this insecurity about their symptoms. “They wouldn’t even know if their brother, uncle or father had medical issues, that is how private and non-communicative they are”.What is the best way to engage in a dialogue between nurses and patients about BPH?

Alice: When I first started nursing, men didn’t know what a prostate was or that it was a male issue. I have been a nurse for 13 years and I see things changing. Due to all the media and press about prostate cancer, more men know about the prostate being a male health issue. Most men are willing to talk about it, but they need a one-to-one setting and a secure environment using simple language.

Mary: It is usually the “door knob question”, the thing that the patient mentions as he is walking out the door. I find that if I show him a model or a medical image and I explain about the prostate and the reason for their incontinence or urination problems, then they understand their symptoms and this knowledge “empowers” the patient. One of the hardest issues we have is that men don’t go to the GP’s surgery in the first place. Since men’s don’t go to the doctor, the information needs to go to them, most likely at places men frequent like the ploughing championships, the barber shop, pubs, etc. This communication should consist of general information about BPH, the treatable symptoms and to encourage the dialogue with their nurse or doctor.

Why do you think men don’t go to the doctor?

Alice: I think due to an increased fear that they have something serious, like prostate cancer. There is so much coverage of serious diseases in the press that they hear of the symptoms of urinary incontinence and they fear what they will find out. Also, since there are many TV commercials about OAB, some men think they have a “women’s problem” when they come into the surgery since they have problems urinating at night or lack of control during the day. When you are waiting in the GP surgery, most of the posters and information is for women, such as breast cancer, menopause, birth related issues, OAB, etc.  Most men don’t realise that urinary incontinence is a major indication of a treatable issue like BPH.

What do you think can be done in Ireland to increase nurses’ knowledge about BPH?

Alice: After doing a pharmacology course recently, I realised that there was only one lecture about issues such as UTIs, but there was very little information about urology in general.  BPH was not recognised in any nurses training.  I think it is essential to increase the nurses training and ease of access to information, not just about BPH, but about how to talk with men about their symptoms…and to get them talking. I think they should be more information at undergrad level about the awareness of BPH and how to use education in urology to improve patient care.

So how can we break this cycle and help more patients with BPH? Increase the education and awareness within the urology nurses arena. It would be ideal if there were hands-on training days, information desks or a workshop on BPH and communication with patients. Alice suggests that increasing the nurses’ training in this BPH area and providing them with easy access information, not just about BPH, but about how to talk with the men and get them talking will definitely help the situation.

Considering the demographics of the male BPH patients, what is the best platform to reach men and teach them about BPH?

Mary: We need to get the men talking, so word of mouth is needed. Usually it is the wife or partner that nags them to get them into the GP. Also use of traditional newspapers, radio and TV

Mary and Alice agree that a combined use of traditional media with digital media would help to reach men via various technologies and communication tools. They also agreed that doing a communication campaign using an “ordinary man” from sports like a GAA player or a rugby player would help to get the message out.

Women have an opportunity to see their GPs more often for their own issues or when brining the children, etc. so as nurses, we need to be more aware of how to ask the right questions when the men DO come into the surgery to get them talking.

What is the best way to get men talking when they are visiting the GP surgery?

Alice: Nurses need to learn the language of how to ask the questions…first we need to normalise the situation first, then ask them if this is a situation the patient has encountered or experienced. For example, “some of my patients tell me that they have to get up many times at night to go to the loo…is this a problem for you?” or “it is quite common for men that have BPH to feel like they are never really empty after they urinate, is this a problem for you?”

Mary: asking the right questions gives us the information we need to help them to improve their quality of life. All of this shame and secretiveness leads these men to have a low quality of life. They don’t feel confident going to GAA matches, the Cinema or on a long journey for fear they might have an accident. Their social life changes, and also the way they interact with their partners. It leads to a downward spiral with increased embarrassment and depression. All of this could be resolved with some dialogue with their GP or nurse. Mary confirms this, “Men with urinary incontinence or urge problems have a lower quality of life due to fear and lack of confidence about urination.”

What are some key messages and highlights from the EAU that you can share with colleagues?

Alice: I learned from one of the workshops about how people learn in different ways, this was very helpful and relevant to see how we need to repeat information and enforce ideas to help with patient understanding and compliance.

Alice also stated that there is a growing need to speak up more about patient cure in terms of incontinence. Mary concluded that patients present with mainly obstructive and irratative symptoms and that patients also present with issues that affect their own quality of life. What bothers them is where they start to discuss issues they find hard to deal with, such as night time urination or issues of “urge and urge incontinence”. It is important to take these comments as well as their IPSS score and come up with patient treatment options that will ultimately improve their quality of life. We can outline possible treatments that are available, such as behaviour modifications. These include: reduction of fluids, reduction of caffeine, pelvic floor muscle exercises, post techniques to help with micturition dribble (leak of urine) and medications that are available for BPH.

Mary: I think the networking opportunities are valuable. It is great to share knowledge and information with nurses from different countries and different cultural backgrounds. It is great forum for sharing ideas and best practice and to bring these ideas back to our own work environments.