title: Role of information in preparing men for transrectal ultrasound guided prostate biopsy: a qualitative study embedded in the ProtecT trial.
abstract: BACKGROUND
  The histological diagnosis of prostate cancer requires a prostate needle biopsy. Little is known about the relationship between information provided to prepare men for transrectal ultrasound guided biopsy (TRUS-Bx) and how men experience biopsy. The objectives were a) to understand men's experiences of biopsy as compared to their expectations; and b) to propose current evidence-based information for men undergoing TRUS-Bx.
  
  
  METHODS
  Between February 2006 and May 2008, 1,147 men undergoing a standardised 10-core transrectal ultrasound guided biopsy protocol under antibiotic cover following a PSA 3.0-19.9 ng/ml in the Prostate Testing for Cancer and Treatment (ProtecT) trial, completed questionnaires about biopsy symptoms. In this embedded qualitative study, in-depth interviews were undertaken with 85 men (mean age 63.6 yrs, mean PSA 4.5 ng/ml) to explore men's experiences of prostate biopsy and how the experience might be improved. Interview data were analysed thematically using qualitative research methods. Findings from the qualitative study were used to guide selection of key findings from the questionnaire study in developing a patient information leaflet preparing men for biopsy.
  
  
  RESULTS
  Although most men tolerated TRUS-Bx, a quarter reported problematic side-effects and anxiety. Side effects were perceived as problematic and anxiety arose most commonly when experiences deviated from information provided. Men who were unprepared for elements of TRUS-Bx procedure or its sequelae responded by contacting health professionals for reassurance and voiced frustration that pre-biopsy information had understated the possible severity or duration of pain/discomfort and bleeding. Findings from questionnaire and interview data were combined to propose a comprehensive, evidence-based patient information leaflet for TRUS-Bx.
  
  
  CONCLUSIONS
  Men reported anxiety associated with TRUS-Bx or its side-effects most commonly if they felt inadequately prepared for the procedure. Data from this qualitative study and the previous questionnaire study have been used to propose an updated, comprehensive evidence-based set of information for men undergoing TRUS-Bx.
authors.affiliation: School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Clifton, Bristol, BS8 2PS, UK. julia.wade@bristol.ac.uk.
authors.forename: Julia
authors.initials: J
authors.lastname: Wade
authors.affiliation: Academic Urology Unit, Royal Hallamshire Hospital, University of Sheffield, Sheffield, S10 2JF, UK. d.j.rosario@sheffield.ac.uk.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Rosario
authors.affiliation: Protect study Urology Research, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK. Joanne.Howson@sth.nhs.uk.
authors.forename: Joanne
authors.initials: J
authors.lastname: Howson
authors.affiliation: School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Clifton, Bristol, BS8 2PS, UK. kerry.avery@bristol.afc.uk.
authors.forename: Kerry N L
authors.initials: KN
authors.lastname: Avery
authors.affiliation: School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Clifton, Bristol, BS8 2PS, UK. liz.salter2@blueyonder.co.uk.
authors.forename: C Elizabeth
authors.initials: CE
authors.lastname: Salter
authors.affiliation: Academic Urology Unit, Royal Hallamshire Hospital, University of Sheffield, Sheffield, S10 2JF, UK. louise.goodwin@sheffield.ac.uk.
authors.forename: M Louise
authors.initials: ML
authors.lastname: Goodwin
authors.affiliation: School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Clifton, Bristol, BS8 2PS, UK. j.m.blazeby@bristol.ac.uk.
authors.forename: Jane M
authors.initials: JM
authors.lastname: Blazeby
authors.affiliation: School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Clifton, Bristol, BS8 2PS, UK. athene.lane@bristol.ac.uk.
authors.forename: J Athene
authors.initials: JA
authors.lastname: Lane
authors.affiliation: School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Clifton, Bristol, BS8 2PS, UK. chris.metcalfe@bristol.ac.uk.
authors.forename: Chris
authors.initials: C
authors.lastname: Metcalfe
authors.affiliation: Oncology Centre, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK. den22@medschl.cam.ac.uk.
authors.forename: David E
authors.initials: DE
authors.lastname: Neal
authors.affiliation: Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK. Freddie.Hamdy@nds.ox.ac.uk.
authors.forename: Freddie C
authors.initials: FC
authors.lastname: Hamdy
authors.affiliation: School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Clifton, Bristol, BS8 2PS, UK. jenny.donovan@bristol.ac.uk.
authors.forename: Jenny L
authors.initials: JL
authors.lastname: Donovan
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety; D001706:Biopsy / Q000379:methods*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D010353:Patient Education as Topic; D017430:Prostate-Specific Antigen; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D036761:Ultrasound, High-Intensity Focused, Transrectal
chemical_list: D017430:Prostate-Specific Antigen