Neurogenic Bowel and Bladder Management After Spinal Cord Injury: Examining Factors Involved in Successful Decision-Making Processes
Abstract
Living with spinal cord injury requires the ability to make difficult health-related decisions on a daily basis. People with spinal cord injuries make decisions about their care that directly affect the management of their condition, especially for loss of bladder and bowel function. These decisions can often determine success in managing their bladder and bowel to avoid medical complications such as urinary tract infections, bladder and bowel leakage, constipation, and others. These complications can have negative effects on all parts of life including physical ability, pain, mental and emotional well-being, and sexual function and satisfaction, making successful management of bowel and bladder a top priority for persons with spinal cord injury. Even though it is very important, there are very few research studies on decision-making related to bladder and bowel management after spinal cord injury. Of those, almost none focus on the way patients make decisions. The process itself involves many related factors, such as preventing complications, modifying routines, caregiving, costs, etc. while also dealing with stress related to pain and discomfort and embarrassment. Making these decisions is especially hard for those living longer and aging with spinal cord injury, now dealing with new health problems (i.e., diabetes, obesity, pressure ulcers). Because of these problems, we need to better understand how people with spinal cord injuries make decisions regarding their bladder and bowel management. We need to better understand how these decisions affect their health, as well as to design new ways for physicians to better help patients manage their bladder and bowel. Making good decisions involves mutual respect, emotional support and information sharing among patients, providers and, in some cases, patients’ caregivers. The proposed study will look at how Veterans and civilians make decisions about their bladder and bowel management, and what happens as a result of these decisions, including how problems are solved, if new health problems are avoided, and if the participants are happy with their new management methods. We will interview 60 people with spinal cord injury about how they make decisions. We will also have a focus group to confirm things we learn from the interviews. Participants in our study will complete surveys to compare to their interview stories. Second, we will compare their decisions with guidelines doctors use to decide on how to treat spinal cord injury patients. Findings from our previous Department of Defense research study showed differences between Veterans and civilians in how each chose to manage their bladder and bowel issues. Veterans seemed to select more surgical solutions (i.e., colostomy, urostomy) compared to civilians, when matched by age. Our study will focus on how these decisions were made, what factors people used to make the decision, and what happened because of these decisions. The study aims are: (1) to identify the factors influencing the decision-making process and potential changes across time considering age and time since injury; (2) to assess participants’ abilities and coping styles in carrying out these management decisions; and (3) to assess the outcomes of these decisions on their health and well-being, overall satisfaction, and quality of life while comparing these decisions to clinical practice guidelines. The results of our research study will give us a better understanding of the factors people use to make decisions about bladder and bowel management after spinal cord injury and what happens as a result of these decisions. It will provide the patient’s point of view to what seems to work the best for him/her. We will look at medical issues, availability of resources, convenience, and personal satisfaction to see how these decisions affect quality of life, social life, and overall health. Implications for treatment will be drawn from this study.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Oct 29, 2018
- Source ID
- W81XWH1710494
Entities
People
- Denise G Tate
Organizations
- United States Army
- University of Michigan