Barriers affecting patient adherence to intermittent self-catheterisation
Intermittent self-catheterisation (ISC) is now considered the standard of care for most patients with neurological conditions and associated lower urinary tract disorders. Numerous societies, led by the International Continence Society, are in agreement on the effectiveness of ISC. Use of intermittent catheters is reported to reduce the risk of catheter-associated urinary tract infection compared with indwelling urinary catheters while improving patient comfort and quality of life. However, previous studies have shown that, despite the benefits of ISC, it will not guarantee behavior change and the integration of this procedure into the daily life of patients. Patients may encounter internal (related to the patient themselves) and external (related to their environment) difficulties. Identifying these obstacles early will help promoting ISC success. This review aims to identify internal and external barriers related to ISC and to propose adequate solutions to avoid them.
Intermittent self-catheterisation (ISC) is now considered the standard of care for most neurologic patients with lower urinary tract disorders (Groen et al, 2016). Self-catheterisation is usually a simple procedure. It involves the introduction of a catheter through the urethra to the bladder by the patient in order to ensure the complete evacuation of urine. Numerous societies, headed by the International Continence Society, are in agreement on the effectiveness of ISC (Tornic et al, 2018).
Guidance from the National Institute for Health and Care Excellence (NICE) 2012a; 2012b) recommends that, whenever possible, ISC should be considered for its benefits. Use of intermittent catheters is reported to reduce the risk of catheter-associated urinary tract infection (CAUTI) compared with indwelling urinary catheters while improving patient comfort and quality of life (Beauchemin et al, 2018). ISC is considered the first step towards independence, normalisation, control, dignity and self-esteem in relation to bladder management (Shaw and Logan, 2013).
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