Table 3 Quotations describing enablers to provision/receipt of preoperative PFMT

1. Social/Professional role & beliefs about capabilities

  (Regarding referring patients for PFMT) (it) routinely occurs for every patient, private and public, preoperatively. As soon as a decision is made for surgery, in some cases even before the decision for surgery has been made.

(Urological Cancer Surgeon 1)

  What we've found dealing with a few urologists, the ones that do refer the surgeons straight through will present to treatment. … I'm assuming here, but I think that anything that their urologist will tell them, they will do.

(Physiotherapist (Private Sector) 2)

  I suppose for our practice, it's a specific service that we offer. And I suppose the resources and the amount of work that's gone into developing the educational packages makes it, I suppose, a lot easier for us to provide the service.

(Physiotherapist (Private Sector) 4)

  … there is a reliance on us for certain surgeons to really focus on this (PFMT) and get it absolutely right, and also to make sure patients have had feedback about their knowledge of performance, about their ability to do these exercises specifically, and how well they're doing them.

(Physiotherapist (Private Sector) 5)

2. Knowledge/skills

  There's a good paper that is currently being reviewed … that shows that preoperative pelvic floor exercises make a significant difference to postoperative time of incontinence and also grade of incontinence. There's also a randomised study that shows that preoperative pelvic floor exercises make a difference to postoperative incontinence. And so those two studies are probably the main reasons why I do it (refer to PFMT).

(Urological Cancer Surgeon 1)

  … so just hearing men's stories, that come back month after month and year after year, and reporting back on where they were and where they are, there certainly is evidence that… that pelvic floor exercises really do work.

(Urological Cancer Nurse 2)

  Unless he (the surgeon) had said anything about it (PFMT), I wouldn't have even dreamt about it, having it. So what I would say to you, is that it comes back to your specialist.

(Patient 8)

3. Environmental context and resources

  … most of the patients that I've seen are reasonably close by, because the referrals we receive are from the urologists working out of (the same suburb).

(Physiotherapist (Private Sector) 3)

  I think it's relatively easy (to provide PFMT), because we've got all the services, we've got everything in place to do that. The provision of the real-time ultrasound, we've got specific allocation of time for those patients.

(Physiotherapist (Private Sector) 4)

4. Memory, attention and decision processes

  Every time the patient gets a request form for radical prostatectomy, … my secretary as a standing practice will actually refer to (a physiotherapist) in the private system. In the public system, they will go to a continence service. Or they also get given the option of going privately as well.

(Urological Cancer Surgeon 2)

  He (the surgeon) said to go and see his receptionist, and she'll give you all the details. So she gave me (the physiotherapist’s) name, the phone number, and where… she said they're just around the corner so I rang up and made an appointment.

(Patient 4)

  Well this (advice to undertake PFMT) was part of his (the surgeon’s) professional advice, that I (had) come to seek. So yes, I didn't think I had an option to say, 'No, I'm not going to do that,' it wasn't even part of my thinking.

(Patient 4)

5. Social Influences (Norms)

  … if you're going to put yourself in the hands of a medical professional, you're really a bit of a dill if you don't embrace, to all intents and purposes, everything that is being said and recommended to you.

(Patient 5)

  … a few other colleagues who I'd spoke to had said (to) make sure you do your pelvic floor exercises, so I thought, gee this is really important.

(Patient 11)

  I have two daughters who are science graduates from university, they took a great interest in it, and they were the first people to tell me about doing these exercises for the pelvic floor. And they said, 'You must practice before you go into hospital, Dad'. And I started doing it.

(Patient 12)

6. Beliefs about consequences

  The benefit (of PFMT) is it will reduce the impact of the surgery on their (patient's) symptoms, and the time course of their symptoms. But also, what you're also doing is it will reduce the impact of them not knowing what is likely to happen to them. And also, essentially what you're doing is reestablishing and improving the patient's locus of control.

(Physiotherapist (Private Sector) 5)

  I was scared shitless (of PPUI), that's the long and the short of why I took it (PFMT) up, because I wanted to make it as easy as possible for myself.

(Patient 10)

  It (cost) wasn't a consideration. I mean, I would have paid the earth provided I could get some guarantees that, you know, I'm going to come out as well as possible.

(Patient 10)