Retal touch examination: the nurses professional role in prostate cancer prevention

__________________________________________________________________________ Abstract. This research aimed to broaden the knowledge of the academic community about the challenges of this neoplasm and to identify the scientific evidence on the role of nurses in strategies for adherence/educational actions to the preventive exam of prostate cancer. This is a qualitative, exploratory, literature review, based on the question: How can nurses contribute to adherence strategies in relation to rectal examination for prostate cancer diagnosis? The results showed that nurses have a significant role in preventive actions and adherence in relation to the rectal examination, and that there should be campaigns to deconstruct ideas linked to the myth that rectal touch hurts the masculinity of men. __________________________________________________________________________


Introduction
Prostate cancer occurs when there is disordered multiplication of prostate cells, giving rise to a tumor that can develop quickly, affecting other organs in the body and leading to death. In its early stage, prostate cancer has a silent evolution in which many patients have no symptoms or, when they do, are similar to those of benign prostate growth (difficulty urinating, need to urinate more often during the day or night), in its advanced phase, can cause bone pain, urinary symptoms or, when more severe, generalized infection or kidney failure. (RIBEIRO et al., 2015;INCA 2018).
In Brazil, mortality from prostate cancer is a major public health problem, and although it is the most common type of cancer among men, it is also the most difficult to discuss, limiting its possibilities for care (MOSCHETA & SANTOS 2011). Factors such as lack of information about the population, with beliefs and values that define what it is to be male, embarrassment, fear and prejudice in performing the rectal examination and specific prostate antigen (PSA) dosage are the negative interferences in the prevention of prostate cancer (VIEIRA et a., 2012).
These factors mean that men do not seek primary care services as women do, despite their greater vulnerability and high morbidity and mortality rates, being inserted in the health system by outpatient and inpatient care of medium and high complexity, as a result the aggravation of the disease due to delayed attention and higher cost to the health system (BARBOSA, 2015).
Among the tools for prostate cancer prevention, the role of nurses in the health team stands out, since the legislation on Nursing Care Systematization (NCS) and the implementation of the Nursing Process establishes as a private function of the nurse. the Nursing Consultation and resolves that the Nursing Process should be performed, deliberately and systematically, in all environments, public or private, where nursing professional care occurs. (COFEN, 2009). Thus, nurses should take advantage of the daily situations of nursing care, with a view to promoting men's health with the aim of early detection of diseases, in order to guide them on risk factors and cancer prevention measures of the prostate cancer (MEDEIROS et al., 2010). It is up to the professional nurse to disclose with greater emphasis the campaigns and give lectures, raising awareness about the care, prevention and consequences that may come if not diagnosed early prostate cancer.
In this context, it is expected that this study broaden the knowledge of the academic community about the challenges of coping with this neoplasm and identify the scientific evidence on the role of nurses in strategies for adherence / educational actions to preventive prostate cancer screening.

Methods
This is a qualitative, exploratory, literature review study based on the question: How can nurses contribute to adherence strategies in relation to rectal examination for prostate cancer diagnosis?
Inclusion criteria for the materials in the present research were texts published in the last five years (2013 to 2018), which answered the question and presented the full text for free consultation. For this, the Virtual Health Library database was consulted. (LILACS, MEDLINE, SCIELO), using unique and combined descriptors: Rectal Touch Examination (RTE), Role of the nurse in the prevention of prostate cancer and Men's Health. And as an exclusion criterion: texts that did not deal with the theme in question and did not present a good study design.

Results and discussion
The research resulted in 82 texts, which after being reviewed, were excluded those that did not meet the inclusion criteria, and nine texts were selected for the construction of this article, these texts were specialized works and articles published in scientific journals in the health area. as can be seen in Table 1. After reviewing the selected texts, it was observed that all of them addressed the prejudice against rectal examination and the importance of health professionals focusing on the nurse in promoting men's health to increase the active search for the preventive examination of rectal examination. As pointed out by Turri & Faro (2018), there are innumerable beliefs about the rectal exam in which the conception of masculinity acts as an element of prejudice, in which the beliefs that permeate this exam directly influence men's care behavior and prevention of the prostate cancer.
Rectal touch is one of the patient's greatest fears at the time of the urological consultation, given that the patient, during the examination, has the experience of being penetrated and may associate the examination as a violation, even if symbolic, of his masculinity. Associated with this masculinity culture barrier is still a lack of information and awareness campaigns (GOMES et al. 2008;AMTHAUER 2016).
Regarding awareness, the nurse has a primordial role, since he is the qualified professional within a multidisciplinary team to support and guide the patient and family during the disease, treatment and intervention, especially to prevent it of the disease to settle. Freitas et al. (2015) also considers that knowledge of the disease and access to preventive and diagnostic services are considered the key point in preventive practice and that the lack of information and/or incorrect information about prostate cancer reflects false beliefs, making adherence difficult, consistent with early detection tests.
In this process, nurses become fundamental in health education and preventive care, being able to plan and evaluate the care offered to the male population "aiming at achieving well-being and better conditions for health maintenance, as well as establishing strategies focused on male specificity (SILVA et al., 2013).
The nurse stands out as an educator among health professionals, as he has experience with the educational process since academic time, the nurse as a health educator can discuss with prostate cancer adult men whenever appropriate and emphasize its importance and naturalness to minimize feelings of discomfort, whether physical or mental, contributing to modification of the existing stigma related to prostate touch, improving the prioritization of health by men, regardless of how such tests will be performed (COSTA & MOURA 2013).
According to Czrony et al. (2017) the nurse plays a fundamental role in the prevention and health promotion in primary care, being the private function of this category the nursing consultation, which is the time to conduct guidelines, identifying the diseases early, with the aim of advising them on risk factors and preventive measures regarding prostate cancer and other diseases.
Among the strategies used by nurses as well as by the entire health team for the prevention and early detection of prostate cancer, the following actions can be performed: first, carry out a quantitative survey of men in the age group of priority for specific actions with the group, reorganize health actions through an inclusive proposal, adjusting the hours of operation of the basic health unit so that the unit can serve users who are working during normal hours of operation. Santos (2013) emphasizes that it is necessary to know its target audience for a better organization of preventive actions.
Thereafter it is necessary to hold biweekly meetings, with discussions of topics related to prostate cancer, as well as make available free testing of PSA dosages to patients and schedule medical appointments and campaigns on local radio. Soares (2014) points out that educational campaigns can raise awareness among the male population regarding the adoption of healthy lifestyle habits and also cancer prevention actions.
Another action that can sensitize the male population, is through direct action through home visits and calling, as well as conducting individualized educational actions in order to clarify on the proposed theme (prostate cancer) may have contributed significantly to higher than expected attendance (BARBOSA 2015).
Thus, it can be observed that nurses play a significant role in preventive actions and adherence in relation to the rectal examination, and that there should be campaigns to deconstruct ideas linked to the myth that rectal touch hurts the masculinity of men.

Conclusion
The results indicate that nurses play a fundamental role in promoting actions for adherence to the rectal exam. And this research also contributes to enrich the discussion on the subject, enabling health promotion and cancer prevention, as well as changes in the education of the population and a greater emphasis on the specific teaching of professional nurses, bearing in mind that this Professionals can develop targeted educational strategies that can provide greater adherence to health promotion and cancer prevention programs by individuals.