Bladder filling protocols for radical prostate radiotherapy: an exploration of patient experience

Introduction: Innovation in treatment planning and delivery, combined with evidence regarding the importance of dose escalation has driven fundamental changes in radical prostate radiotherapy. These changes have improved long term survival [1], but heightened the importance of protecting organs at risk through effective bladder immobilisation [2]. No consensus exists regarding the best way to achieve this, so each radiotherapy department utilises its own protocol. Within the local department the patients are requested to drink 500ml of water one hour before starting radiotherapy. Anecdotally, therapeutic radiographers report how patients can struggle with this, causing them to empty their bladders early, adding delays to treatment times. This work sought to explore patient perceptions of their experience of following the protocol when attending for radiotherapy. Method and Materials: Prostate cancer patients who received radiotherapy were invited via the local information and support centre to participate in a focus group. Thematic analysis was carried out on the transcriptions of these discussions to identify potential themes. Results: To promote attendance, two one-to-one interviews and one focus group were conducted. Across the data collection methods a total of six participants, four patients and two carers took part. Three themes emerged; information, services and holistic needs. The analysis demonstrated that within each theme, there were departmental procedures and therapeutic radiographer’s practices which directly influenced the patient’s quality of life whilst attending for radiotherapy. It was demonstrated that patients were making unnecessary modifications to their behaviours and lifestyles not required to adhere to the protocol. Levels of engagement and knowledge sharing affected whether the patient had a positive or negative experience of the drinking protocol. Conclusion and Discussion: This work has demonstrated prostate patients require information to support the drinking protocol wider than just instruction on how to follow it. Identifying these needs and the effects the omission of supportive information has on patients will enable the department to review the structure and information provided to patients. Implementation of changes aims to improve patient experience and reduce any negative impact on their quality of life.