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Medwave se preocupa por su privacidad y la seguridad de sus datos personales. Palabras clave: prostate cancer, questionnaire, beliefs, digital rectal examination, pain, discomfort. Percentages were used for the descriptive analysis. The results showed that It was observed that Digital rectal examination was deemed traumatic by A high number of patients responded they would repeat prostate exam the following year The main reasons for not assisting to the urologist was to avoid biopsy and the digital rectal examination.

Nonetheless, in most patients traumatic digital rectal examination was performed and responders said they would repeat it in the future. Prostate cancer is a world health problem as it is the second tumor diagnosed in men worldwide, with 1. The appearance of this type of tumor is increasing due to the growth and aging of the population. The variation in incidence rates is the reflection of the widespread use of prostate specific antigen PSA testing, its tumor marker par excellence [1].

The highest mortality rates were observed in the Caribbean and in South Africa [2]. In Cuba, according to the Health Statistical Yearbook , this type of tumor is the second in incidence and second in mortality. The clinical stages distribution of the cases studied shows an increase in diagnosis in advanced stages, with an incidence of 3, cases and an age-adjusted rate of The total number of cancer deaths in the Cuban population was 2, cases in , with Before the introduction of prostate specific antigen, prostate cancer was diagnosed in individuals with clinical symptoms indicative of advanced disease and older than 70 years.

The combined use of digital rectal examination DRE and prostate-specific antigen, is the method used in secondary prevention with periodic screening in men over 50 years with a more than 10 years life expectancy and after discussion with the doctor about the risks and benefits of their practice [5] , [6] , [7] , [8].

Yet, there are several controversies concerning to prostate cancer screening [9] , [10]. The factors that influence the adoption of healthy and preventive behaviors, such as screening, may be multiple because they not only depend on its implementation by the Ministry of Public Health of Cuba. People make decisions about preventive practices according to their perceptions and assessments, made individually or in groups, on the consequences of such practices.

Taking into account all these factors, the present study was developed in order to describe the beliefs, knowledge and opinions about the digital rectal exam in a group of urological patients who attended to the Institute of Oncology and Radiobiology of Cuba. A cross-sectional descriptive study was conducted based on self-perception interview about prostate cancer and its diagnostic methods.

It was carried out from May to February , at the Institute of Oncology and Radiobiology INOR , in patients who came to the urologist consultation for the first time. This research was performed according to the protocol approved by the Scientific Council and the Ethics Committee of the INOR, following the Helsinki Declaration of , with the current review of [11].

Universe and sample The universe consisted of all patients who attended the urologist consultation at the Institute of Oncology and Radiobiology, for a review or because of urinary obstructive symptoms. Participants were a convenience sample and the interview was conducted by pollsters trained in the clinical area. They invited to participate individually, men between 45 and 70 years old, to whom the aims of study were explained and presented and who were given a preliminary talk on what the study was for.

Data concerning socio-demographic variables were collected anonymously and it was verified that they had no physical or mental conditions preventing their participation. The latter, along with the age outside the range described above, were the exclusion criteria.

Informed consent was requested from each participant before he answered the questionnaire. The urologist and a resident in oncology were always present in each interview. After the completion of the questionnaire, a pamphlet with information about the disease was given to each participant, so they could be able to review and check their answers to pollsters, as required [12].

The principal investigator reviewed each questionnaire and verified its proper implementation. To avoid bias, each interview was coded and was analyzed by the principal investigator who did not apply the survey instrument. Questionnaire design In the absence of validated questionnaires on the subject at the Institute of Oncology and Radiobiology, the present one was built starting with 15 questions grouped into three blocks, with application time estimated to be 30 to 35 minutes.

The interview blocks 1 and 2 lasted 10 to 15 minutes, pollsters waited five minutes after digital rectal examination and then resumed for 10 minutes to perform questions of block 3. For each question data were organized, coded and categorized. The first block contained socio-demographic variables Table 1 : age, skin color, educational level, place of residence rural or urban and family history of prostate cancer or other locations.

Table 1: Socio-demographic and clinical variables of sample individuals at National Institute of Oncology and Radiobiology, Cuba. For age analysis purposes participants were split into three groups: 45 to 54, 55 to 64 and 65 to 70 years. Meanwhile, for schooling they were classified into four major ranges according to educational levels acquired by a person in Cuba: primary, secondary, skilled worker, technician, university.

The second questionnaire block Table 2 , focused on the type and way of getting information about prostate cancer and digital rectal examination. This block, was also linked to the reluctance to go to the urology consulting room and intend to practice rectal examination. The third block of the questionnaire Table 3 , directed the questions to nonconformity with digital rectal examination once it was practiced and to the possibility of a medical exam periodically.

In order to perform the digital rectal examination to each patient, the urologist took him to a contiguous and private room. Before executing the procedure, the urologist explained everything about the digital rectal exam. Table 2: Questionnaire results of individuals at National Institute of Oncology and Radiobiology, before digital rectal exam practice.

Table 3: Questionnaire results of sample individuals at INOR, applied after digital rectal exam practice. Statistical analysis Descriptive statistics to summarize categorical variables were absolute frequencies and percentages. We created a database in Access program and used the statistical program GraphPad Prism 5.

The beliefs held by individuals on testing for prostate biopsy, the degree of nonconformity with the digital rectal exam and the possibility of a periodic medical examination, were expressed as dichotomous variables yes or no. The major impediment to attend the urologist consultation undergo prostate-specific antigen testing, digital rectal examination, biopsy or ultrasound , and the level of painful examination absent or low versus moderate, severe or unbearable were categorical variables.

The results were presented in a workshop at the Institute of Oncology and Radiobiology, where the participants in the study and population were also invited. All of them received information and training on the topic in two scheduled sessions, taking into account the research findings.

Data from 95 questionnaires were processed, however, once quality control was performed before digitation; eleven were canceled seven for absence of some answers and four for inconsistencies , finally a total of 84 surveys were analyzed.

Median age was Patients with ages between 55 and 64 years old were more frequent Table 1. Individuals with white skin color and no family history of prostate cancer, predominated.

In addition, it was perceived that most patients attending the urology consulting room had an average or higher level education, and were mostly from urban and not rural areas Table 1.

However, The major impediments to attend to the urologist consulting room were not undergoing a biopsy The degree of discomfort associated with pain was summarized in Table 3 where This led to the However, there was a propensity to undergo the transrectal ultrasound Eighty eight percent of subjects responded that they would repeat the digital rectal exam next year and also would invite a friend to a similar medical exam.

However, since the publication of the multicenter study carried on by Catalona et al. Digital rectal exam is an important clinical tool used on individuals, with the aim of providing information about the morphology, size, consistency, mobility, shape, sensitivity and presence of nodules on the prostate gland, so it is of great clinical utility for diagnosis.

The combined effect of the digital rectal exam test with the values of prostate specific antigen, facilitates the early detection of prostate cancer [14] , [15] , even though the use of mass screening continues controversial [9] , [10] , [16]. In spite of a large number of prostate cancer deaths in Cuba, men are not familiar with the digital rectal exam practice. This has a negative influence on mortality, as there are a high number of patients diagnosed in advanced stages [3]. In addition, we did not count on validated questionnaires to assess knowledge about prostate cancer or about criteria, beliefs and factors that might influence the performance of the digital rectal examination, in Cuban individuals.

In order to eliminate barriers to access to this preventive and free service of the Ministry of Public Health of Cuba, the development of actions is necessary to ensure a higher quality induction demand on digital rectal examination practice, as the most appropriate and relevant information concerning the practice of this test as was described in this study, according to the points made by other authors [12] , [17].

To generalize this study, the potential offered by primary care in Cuba will be used. The Cuban family doctors systematically perform digital rectal examination to a high number of patients older than 50 years, who present symptoms of obstructive lower urinary tract and frequently, measures of prostate specific antigen are made. The present study found a large number of patients with affirmative answer about prostate cancer knowledge and prostate-specific antigen, these results were higher than those reported by other authors in Latin American countries who developed similar studies [18] , [19] , [21].

This fact suggests that the elevated educational standard and literacy existing in Cuba, could have had a positive impact on the information levels about prostate cancer and its diagnostic methods. Regarding this aspect, it has been raised in similar studies that psychosocial and demographic factors along with beliefs, were the biggest obstacles to perform the digital rectal exam and prostate cancer screening enrollment [22] , [23] , [24].

One of the biggest fears persisting in Latin American men is undergoing the prostate test, even though this can save their life.

This palpation produces a lot of insecurity for fear of losing masculinity. This concept, which has the man about himself and is related to a culture and custom rooted in most Latin American countries [18] , [19] , [20] , [21] , is not restricted only to Latinos, African Americans suffer from similar insecurities [24] , [25].

In consideration of the foregoing, it has been suggested that some socio-demographic factors such as beliefs, anxiety and attitude to a rectal examination [18] , [19] , [21] , [24] , may adversely affect the test. This generates a delay in the visit to the urology clinic, which could be related or not with the diagnosis delay of the disease.

The level of discomfort given by the degree of the referred pain to the digital rectal exam, was postulated as one of the main barriers to conducting screening in the population [27] , [28]. About this, it is known that the pain may be due to the contraction of the sphincter and palpation of the prostate, seminal vesicles and bladder trigone.

These structures are innervated by the visceral nervous system, which transmits pain sensation through the parasympathetic and sympathetic autonomous nervous system [27]. This high pain perception observed in the present study, was also reported by other authors [18] , [19] , [21]. Besides, the discomfort of the exam or preventive action here takes relevance shame and the possibility of a threat to their privacy during the prostate exam was also the subject of others studies [29] , [30] where results were similar to ours.

Rejection of the biopsy and the digital rectal examination, caused reluctance to go to the urologist consultation in most of the interviewed individuals. This type of behavior may affect early detection disease, as has been proposed by other authors [19].

In spite of the above, This indicates that, despite of taboos concerning the realization of digital rectal examination, this would not influence the performance of future research. These results were consistent with other investigations with similar purpose than the present study [21] , [22] , [27]. The limitations of this study have to do with its not probabilistic sample, which prevents inferences or causality conclusions.

An additional limitation was related to the fact that information about the practice of digital rectal exam was self-reported.

This is a bias found in the study results, given the tendency of individuals to give answers which might satisfy the pollster, especially if it is a female, as it was the case in this study. Taking this into account, the practice antecedent of digital rectal exam can be even lower than described. In addition, the design was structured and predetermined, which limited the collection of more comprehensive data. Despite limitations referred to, the study results are useful to guide actions in order to increase the coverage of the digital rectal exam practice.


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