{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T14:55:35Z","timestamp":1791644135025,"version":"4.3.4"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2019,7,2]],"date-time":"2019-07-02T00:00:00Z","timestamp":1562025600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"},{"start":{"date-parts":[[2019,7,2]],"date-time":"2019-07-02T00:00:00Z","timestamp":1562025600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["R21 CA 149536"],"award-info":[{"award-number":["R21 CA 149536"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["T32CA009461"],"award-info":[{"award-number":["T32CA009461"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["P30CA008748"],"award-info":[{"award-number":["P30CA008748"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["R21 CA 149536"],"award-info":[{"award-number":["R21 CA 149536"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["T32CA009461"],"award-info":[{"award-number":["T32CA009461"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["P30CA008748"],"award-info":[{"award-number":["P30CA008748"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["jsm.jsexmed.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2019,9,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Despite the importance of using penile injections as part of a penile rehabilitation program, men have difficulty complying with these programs.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Aim<\/jats:title>\n                  <jats:p>To test a novel psychological intervention based on Acceptance and Commitment Therapy for erectile dysfunction (ACT-ED) to help men utilize penile injections.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This pilot randomized controlled trial (RCT) recruited men who were beginning a standard care (SC) structured penile rehabilitation program following radical prostatectomy. The SC program instructed patients to use penile injections 2 to 3 times per week. Participants were randomized to SC+ACT-ED or SC+enhanced monitoring (EM). Over 4 months, patients in the SC+ACT-ED group received SC plus 4 ACT sessions and 3 ACT phone calls; those in the EM group received SC plus 7 phone calls from an experienced sexual medicine nurse practitioner. Participants were assessed at study entry and at 4 and 8 months. For this pilot study, the goal was to determine initial efficacy (ie, effect sizes, where d = 0.2 is small, d = 0.5 is medium, and d = 0.8 is large).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Main Outcome Measure<\/jats:title>\n                  <jats:p>Primary outcomes were feasibility and use of penile injections. Secondary outcomes were ED treatment satisfaction (ie, Erectile Dysfunction Inventory of Treatment Satisfaction, or EDITS), sexual Self-Esteem and Relationship (SEAR) quality, sexual bother (SB), and prostate cancer treatment regret.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The 53 participants were randomized (ACT, n = 26; EM, n = 27). The study acceptance rate was 61%. At 4 months, the ACT-ED group utilized more penile injections per week (1.7) compared to the EM group (0.9) (d = 1.25; P = .001) and was more adherent to penile rehabilitation compared to the EM group (ACT, 44%; EM, 10%; relative risk [RR], 4.4; P = .02). These gains were maintained at 8 months for injections per week (ACT, 1.2; EM, 0.7; d = 1.08; P = .03) and approached significance for adherence (ACT, 18%; EM, 0%; P = .10). At 4 months, ACT-ED, compared to EM, reported moderate effects for greater satisfaction with ED treatment (d = 0.41; P = .22), greater sexual self-esteem (d = 0.54; P = .07) and sexual confidence (d = 0.48; P = .07), lower sexual bother (d = 0.43; P = .17), and lower prostate cancer treatment regret (d = 0.74; P = .02). At 8 months, moderate effects in favor of ACT-ED were maintained for greater sexual self-esteem (d = 0.40; P = .19) and less treatment regret (d = 0.47; P = .16).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Clinical Implications<\/jats:title>\n                  <jats:p>ACT concepts may help men utilize penile injections and cope with the effects of ED.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Strengths and Limitations<\/jats:title>\n                  <jats:p>Strengths include use of an innovative intervention utilizing ACT concepts and pilot RCT. Limitations include the pilot nature of the study (eg, small samples size, lack of statistical power).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>ACT-ED is feasible and significantly increases the use of penile injections. ACT-ED also shows promise (moderate effects) for increasing satisfaction with penile injections and sexual self-esteem while decreasing sexual bother and prostate cancer treatment regret.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1016\/j.jsxm.2019.05.013","type":"journal-article","created":{"date-parts":[[2019,7,2]],"date-time":"2019-07-02T21:11:43Z","timestamp":1562101903000},"page":"1398-1408","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":26,"title":["Acceptance and Commitment Therapy to Increase Adherence to Penile Injection Therapy-Based Rehabilitation After Radical Prostatectomy: Pilot Randomized Controlled Trial"],"prefix":"10.1093","volume":"16","author":[{"given":"Christian J.","family":"Nelson","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences , New York, NY , USA"},{"name":"Memorial Sloan-Kettering Cancer Center , New York, NY , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca M.","family":"Saracino","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences , New York, NY , USA"},{"name":"Memorial Sloan-Kettering Cancer Center , New York, NY , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Napolitano","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences , New York, NY , USA"},{"name":"Memorial Sloan-Kettering Cancer Center , New York, NY , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hayley","family":"Pessin","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences , New York, NY , USA"},{"name":"Memorial Sloan-Kettering Cancer Center , New York, NY , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph B.","family":"Narus","sequence":"additional","affiliation":[{"name":"Sexual and Reproductive Medicine Program , New York, NY , USA"},{"name":"Urology Service , New York, NY , USA"},{"name":"Department of Surgery , New York, NY , USA"},{"name":"Memorial Sloan-Kettering Cancer Center , New York, NY , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John P.","family":"Mulhall","sequence":"additional","affiliation":[{"name":"Sexual and Reproductive Medicine Program , New York, NY , USA"},{"name":"Urology Service , New York, NY , USA"},{"name":"Department of Surgery , New York, NY , USA"},{"name":"Memorial Sloan-Kettering Cancer Center , New York, NY , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,7,2]]},"reference":[{"key":"2023010721201923300_bib1","article-title":"Cancer facts and figures 2018","author":"ACS","year":"2018"},{"key":"2023010721201923300_bib2","doi-asserted-by":"crossref","first-page":"1636","DOI":"10.1111\/jsm.12135","article-title":"Back to baseline: erectile function recovery after radical prostatectomy from the patients\u2019 perspective","volume":"10","author":"Nelson","year":"2013","journal-title":"J Sex Med"},{"key":"2023010721201923300_bib3","doi-asserted-by":"crossref","first-page":"1425","DOI":"10.1056\/NEJMoa1606221","article-title":"Patient-reported outcomes after monitoring, surgery, or radiotherapy for prostate cancer","volume":"375","author":"Donovan","year":"2016","journal-title":"N Engl J Med"},{"key":"2023010721201923300_bib4","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1111\/j.1743-6109.2009.01546.x","article-title":"Sexual bother following radical prostatectomyjsm","volume":"7","author":"Nelson","year":"2010","journal-title":"J Sex Med"},{"key":"2023010721201923300_bib5","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.1016\/j.jsxm.2018.05.016","article-title":"Erectile dysfunction and depression: a systematic review and meta-analysis","volume":"15","author":"Liu","year":"2018","journal-title":"J Sex Med"},{"key":"2023010721201923300_bib6","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1080\/00926239008405253","article-title":"Evaluation of sexual satisfaction in partners of men experiencing erectile failure","volume":"16","author":"Carroll","year":"1990","journal-title":"J Sex Marital Ther"},{"key":"2023010721201923300_bib7","doi-asserted-by":"crossref","first-page":"1687","DOI":"10.1111\/j.1743-6109.2010.01804.x","article-title":"Erectile function rehabilitation in the radical prostatectomy patient","volume":"7","author":"Mulhall","year":"2010","journal-title":"J Sex Med"},{"key":"2023010721201923300_bib8","doi-asserted-by":"crossref","first-page":"1773","DOI":"10.1002\/cncr.10848","article-title":"Defining sexual outcomes after treatment for localized prostate carcinoma","volume":"95","author":"Schover","year":"2002","journal-title":"Cancer"},{"key":"2023010721201923300_bib9","doi-asserted-by":"crossref","first-page":"1941","DOI":"10.1111\/j.1743-6109.2008.00810.x","article-title":"Does educational status affect a patient's behavior toward erectile dysfunction?","volume":"5","author":"Salonia","year":"2008","journal-title":"J Sex Med"},{"key":"2023010721201923300_bib10","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1080\/00926238908403816","article-title":"Why do so many people drop out from auto-injection therapy for impotence?","volume":"15","author":"Althof","year":"1989","journal-title":"J Sex Marital Ther"},{"key":"2023010721201923300_bib11","first-page":"171","article-title":"Reasons for high drop-out rate with self-injection therapy for impotence","volume":"6","author":"Weiss","year":"1994","journal-title":"Int J Impot Res"},{"key":"2023010721201923300_bib12","doi-asserted-by":"crossref","first-page":"2559","DOI":"10.1111\/jsm.12271","article-title":"Injection anxiety and pain in men using intracavernosal injection therapy after radical pelvic surgery","volume":"10","author":"Nelson","year":"2013","journal-title":"J Sex Med"},{"key":"2023010721201923300_bib13","doi-asserted-by":"crossref","first-page":"1646","DOI":"10.1002\/pon.3771","article-title":"Men\u2019s experience with penile rehabilitation following radical prostatectomy: a qualitative study with the goal of informing a therapeutic intervention","volume":"24","author":"Nelson","year":"2015","journal-title":"Psychooncology"},{"key":"2023010721201923300_bib14","article-title":"Acceptance and commitment therapy: an experiential approach to behavioral changes","author":"Hayes","year":"1999"},{"key":"2023010721201923300_bib15","article-title":"Get out of your mind and into your life \u2026 the new acceptance and commitment therapy","author":"Hayes","year":"2005"},{"key":"2023010721201923300_bib16","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1002\/cncr.11894","article-title":"Cognitive-behavioral stress management improves stress-management skills and quality of life in men recovering from treatment of prostate carcinoma","volume":"100","author":"Penedo","year":"2004","journal-title":"Cancer"},{"key":"2023010721201923300_bib17","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1207\/s15324796abm3103_8","article-title":"A randomized clinical trial of group-based cognitive-behavioral stress management in localized prostate cancer: development of stress management skills improves quality of life and benefit finding","volume":"31","author":"Penedo","year":"2006","journal-title":"Ann Behav Med"},{"key":"2023010721201923300_bib18","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1002\/cncr.21231","article-title":"Improving the quality of life of patients with prostate carcinoma: a randomized trial testing the efficacy of a nurse-driven intervention","volume":"104","author":"Giesler","year":"2005","journal-title":"Cancer"},{"key":"2023010721201923300_bib19","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1037\/0278-6133.22.5.443","article-title":"Improving quality of life in men with prostate cancer: a randomized controlled trial of group education interventions","volume":"22","author":"Lepore","year":"2003","journal-title":"Health Psychol"},{"key":"2023010721201923300_bib20","doi-asserted-by":"crossref","first-page":"1854","DOI":"10.1002\/cncr.10390","article-title":"Helping patients with localized prostate carcinoma manage uncertainty and treatment side effects: nurse-delivered psychoeducational intervention over the telephone","volume":"94","author":"Mishel","year":"2002","journal-title":"Cancer"},{"key":"2023010721201923300_bib21","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1111\/j.1743-6109.2006.00219.x","article-title":"Sexual counseling improved erectile rehabilitation after non-nerve-sparing radical retropubic prostatectomy or cystectomy\u2014results of a randomized prospective study","volume":"3","author":"Titta","year":"2006","journal-title":"J Sex Med"},{"key":"2023010721201923300_bib22","doi-asserted-by":"crossref","first-page":"2689","DOI":"10.1002\/cncr.21537","article-title":"Pilot intervention to enhance sexual rehabilitation for couples after treatment for localized prostate carcinoma","volume":"104","author":"Canada","year":"2005","journal-title":"Cancer"},{"key":"2023010721201923300_bib23","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1037\/0033-2909.112.1.155","article-title":"A power primer","volume":"112","author":"Cohen","year":"1992","journal-title":"Psychol Bull"},{"key":"2023010721201923300_bib24","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1016\/S0090-4295(97)00238-0","article-title":"The International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction","volume":"49","author":"Rosen","year":"1997","journal-title":"Urology"},{"key":"2023010721201923300_bib25","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.1111\/j.1743-6109.2010.02163.x","article-title":"Intimacy-enhancing psychological intervention for men diagnosed with prostate cancer and their partners: a pilot study","volume":"8","author":"Manne","year":"2011","journal-title":"J Sex Med"},{"key":"2023010721201923300_bib26","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1002\/pon.1307","article-title":"A 3-factor model for the FACIT-Sp","volume":"17","author":"Canada","year":"2008","journal-title":"Psychooncology"},{"key":"2023010721201923300_bib27","doi-asserted-by":"crossref","first-page":"1218","DOI":"10.2337\/diacare.27.5.1218","article-title":"A systematic review of adherence with medications for diabetes","volume":"27","author":"Cramer","year":"2004","journal-title":"Diabetes Care"},{"key":"2023010721201923300_bib28","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1056\/NEJMra050100","article-title":"Adherence to medication","volume":"353","author":"Osterberg","year":"2005","journal-title":"N Engl J Med"},{"key":"2023010721201923300_bib29","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1016\/S0090-4295(98)00582-2","article-title":"EDITS: Development of questionnaires for evaluating satisfaction with treatments for erectile dysfunction","volume":"53","author":"Althof","year":"1999","journal-title":"Urology"},{"key":"2023010721201923300_bib30","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1038\/sj.ijir.3901095","article-title":"Development and validation of the Self-Esteem and Relationship (SEAR) questionnaire in erectile dysfunction [see comment]","volume":"16","author":"Cappelleri","year":"2004","journal-title":"Int J Impot Res"},{"key":"2023010721201923300_bib31","doi-asserted-by":"crossref","first-page":"100","DOI":"10.3816\/CGC.2005.n.017","article-title":"A measure of health-related quality of life among patients with localized prostate cancer: results from ongoing scale development","volume":"4","author":"Befort","year":"2005","journal-title":"Clin Prostate Cancer"},{"key":"2023010721201923300_bib32","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1023\/A:1016673003237","article-title":"The evaluation of the Center for Epidemiologic Studies Depression (CES-D) scale: depressed and positive affect in cancer patients and healthy reference subjects","volume":"9","author":"Schroevers","year":"2000","journal-title":"Qual Life Res"},{"key":"2023010721201923300_bib33","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1177\/0272989X03256005","article-title":"Validation of a decision regret scale","volume":"23","author":"Brehaut","year":"2003","journal-title":"Med Decis Making"},{"key":"2023010721201923300_bib34","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1111\/j.1743-6109.2005.00081_1.x","article-title":"The use of an erectogenic pharmacotherapy regimen following radical prostatectomy improves recovery of spontaneous erectile function","volume":"2","author":"Mulhall","year":"2005","journal-title":"J Sex Med"},{"key":"2023010721201923300_bib35","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1136\/thx.2009.133215","article-title":"A telemedicine intervention to improve adherence to continuous positive airway pressure: a randomised controlled trial","volume":"65","author":"Sparrow","year":"2010","journal-title":"Thorax"},{"key":"2023010721201923300_bib36","first-page":"CD000011","article-title":"Interventions for enhancing medication adherence","volume":"11","author":"Haynes","year":"2008","journal-title":"Cochrane Database Syst Rev"},{"key":"2023010721201923300_bib37","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1186\/1471-2407-8-226","article-title":"ProsCan for couples: randomised controlled trial of a couples-based sexuality intervention for men with localised prostate cancer who receive radical prostatectomy","volume":"8","author":"Chambers","year":"2008","journal-title":"BMC Cancer"}],"container-title":["The Journal of Sexual Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1743609519312226?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1743609519312226?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/16\/9\/1398\/48477179\/jsm_16_9_1398.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/16\/9\/1398\/48477179\/jsm_16_9_1398.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,7]],"date-time":"2023-01-07T21:21:17Z","timestamp":1673126477000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jsm\/article\/16\/9\/1398\/6966761"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,7,2]]},"references-count":37,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2019,7,2]]},"published-print":{"date-parts":[[2019,9,1]]}},"URL":"https:\/\/doi.org\/10.1016\/j.jsxm.2019.05.013","relation":{},"ISSN":["1743-6109","1743-6095"],"issn-type":[{"value":"1743-6109","type":"electronic"},{"value":"1743-6095","type":"print"}],"subject":[],"published-other":{"date-parts":[[2019,9]]},"published":{"date-parts":[[2019,7,2]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Acceptance and Commitment Therapy to Increase Adherence to Penile Injection Therapy-Based Rehabilitation After Radical Prostatectomy: Pilot Randomized Controlled Trial","name":"articletitle","label":"Article Title"},{"value":"The Journal of Sexual Medicine","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jsxm.2019.05.013","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2019 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.","name":"copyright","label":"Copyright"}]}}