Acceptance and commitment therapy to increase adherence to penile injection therapy-based rehabilitation after radical prostatectomy: Pilot randomized controlled trial Journal Article
| Authors: | Nelson, C. J.; Saracino, R. M.; Napolitano, S.; Pessin, H.; Narus, J. B.; Mulhall, J. P. |
| Article Title: | Acceptance and commitment therapy to increase adherence to penile injection therapy-based rehabilitation after radical prostatectomy: Pilot randomized controlled trial |
| Abstract: | Introduction: Despite the importance of using penile injections as part of a penile rehabilitation program, men have difficulty complying with these programs. Aim: To test a novel psychological intervention based on Acceptance and Commitment Therapy for erectile dysfunction (ACT-ED) to help men utilize penile injections. Methods: This pilot randomized controlled trial (RCT) recruited men who were beginning a standard care (SC) structured penile rehabilitation program following radical prostatectomy. The SC program instructed patients to use penile injections 2 to 3 times per week. Participants were randomized to SC+ACT-ED or SC+enhanced monitoring (EM). Over 4 months, patients in the SC+ACT-ED group received SC plus 4 ACT sessions and 3 ACT phone calls; those in the EM group received SC plus 7 phone calls from an experienced sexual medicine nurse practitioner. Participants were assessed at study entry and at 4 and 8 months. For this pilot study, the goal was to determine initial efficacy (ie, effect sizes, where d = 0.2 is small, d = 0.5 is medium, and d = 0.8 is large). Main Outcome Measure: Primary outcomes were feasibility and use of penile injections. Secondary outcomes were ED treatment satisfaction (ie, Erectile Dysfunction Inventory of Treatment Satisfaction, or EDITS), sexual Self-Esteem and Relationship (SEAR) quality, sexual bother (SB), and prostate cancer treatment regret. Results: The 53 participants were randomized (ACT, n = 26; EM, n = 27). The study acceptance rate was 61%. At 4 months, the ACT-ED group utilized more penile injections per week (1.7) compared to the EM group (0.9) (d = 1.25; P =.001) and was more adherent to penile rehabilitation compared to the EM group (ACT, 44%; EM, 10%; relative risk [RR], 4.4; P =.02). These gains were maintained at 8 months for injections per week (ACT, 1.2; EM, 0.7; d = 1.08; P =.03) and approached significance for adherence (ACT, 18%; EM, 0%; P =.10). At 4 months, ACT-ED, compared to EM, reported moderate effects for greater satisfaction with ED treatment (d = 0.41; P =.22), greater sexual self-esteem (d = 0.54; P =.07) and sexual confidence (d = 0.48; P =.07), lower sexual bother (d = 0.43; P =.17), and lower prostate cancer treatment regret (d = 0.74; P =.02). At 8 months, moderate effects in favor of ACT-ED were maintained for greater sexual self-esteem (d = 0.40; P =.19) and less treatment regret (d = 0.47; P =.16). Clinical Implications: ACT concepts may help men utilize penile injections and cope with the effects of ED. Strengths and Limitations: Strengths include use of an innovative intervention utilizing ACT concepts and pilot RCT. Limitations include the pilot nature of the study (eg, small samples size, lack of statistical power). Conclusion: ACT-ED is feasible and significantly increases the use of penile injections. ACT-ED also shows promise (moderate effects) for increasing satisfaction with penile injections and sexual self-esteem while decreasing sexual bother and prostate cancer treatment regret. Nelson CJ, Saracino RM, Napolitano S, et al. Acceptance and Commitment Therapy to Increase Adherence to Penile Injection Therapy-Based Rehabilitation After Radical Prostatectomy: Pilot Randomized Controlled Trial. J Sex Med 2019; 19:1398–1408. © 2019 International Society for Sexual Medicine |
| Keywords: | prostate cancer; erectile dysfunction; sexual function; erectile rehabilitation |
| Journal Title: | Journal of Sexual Medicine |
| Volume: | 16 |
| Issue: | 9 |
| ISSN: | 1743-6095 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2019-09-01 |
| Start Page: | 1398 |
| End Page: | 1408 |
| Language: | English |
| DOI: | 10.1016/j.jsxm.2019.05.013 |
| PUBMED: | 31277968 |
| PROVIDER: | scopus |
| PMCID: | PMC6943977 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 30 August 2019 -- Source: Scopus |
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