4. Summary

Overall

The results of this survey are very important. We know that men with prostate cancer are lagging behind other cancer patients in their experience of cancer care. It is not clear why this is, although we have some clues. It could be the lack of specific NICE guidelines on care of these men. The development process for these has already started. It could be that the Palliative Care and Supportive Care Guidelines already extant are taking a while to bed in. The same applies to the NICE guidelines on Urological Cancers. These are only partial answers. There will also be some more complex influences at play. It will not just be the ‘system’. Men’s expectations, health professionals’ attitudes and also the valuing of older men in society will also influence how all these aspects relate in prostate cancer care.

Clearly some men are getting care they value. We have to concentrate on the areas where there are problems - to drive up standards. There seems to be a sizeable proportion of men who feel uninformed, unaware, with unacknowledged needs and so much uncertainty. This significant minority - about 1 in 4 of men with prostate cancer in this survey - are expressing a broad dissatisfaction with care. Much of what they are saying does not need a highly complex solution. So much of good cancer care is simply about taking the time. Why were so many men not given the time and opportunity to experience good care - or to put it another way, to feel taken care of?

Solutions

Some of the solutions are simple and practical. Good quality information available - at the right time. The Voluntary Sector could provide it. The NHS knows where the patients are, and can distribute the information. They know who is going to be given a cancer diagnosis. It may come as a shock to the patient, but the doctor is not usually in that position. Making the circumstances right for committed health professionals to deliver care in a timely fashion would remove much of the uncertainty.

We always come back to the communication skills of health professionals and linked to this, taking the time to care. Sometimes the problem is the health professional, but more commonly it is the circumstances within which health professionals find themselves.

Cancer care is not only the stories in the headlines, firing ever more people through the door of the hospital ever more quickly, with guaranteed access to the right drug. It is also about very much more low tech requirements - empathy, listening, imagining - and it is also about workforces - about the right nurses in the right place with the right facilities, training and attitudes. It is about getting the teams working well and those good relationships spilling over into the patient's lap. Seeing and understanding men as members of a wider society with responsibilities, attitudes, strengths and vulnerabilities could also make a difference.

Doing the right thing right is not hard, but we seem to have forgotten how to do it in relation to these men with prostate cancer. It is not rocket science but sometimes getting a man into orbit might be easier than helping him make a fully informed choice about treatment.

What can we achieve for men in the future? We can improve their expectations of medical care and older age. We can and will improve all men's experiences of health care choices. We will help them demand attention. We must change society's views so men's entitlement to tailored health care is as respected as women's is.

Sometimes the health professionals fail their patients. Rather more often the system within which they work fails them.

The last word should come from a man with prostate cancer:

The treatment and care I received was first class and have nothing but the highest praise for everyone concerned. But I could not help but notice the tremendous pressure the doctors and staff in all departments were under.

Chris Hiley

back: Men's Lives | next: Contents