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Factors influencing decisions about neurogenic bladder and bowel surgeries among veterans and civilians with spinal cord injury

The Journal of Spinal Cord Medicine, 2023 · DOI: 10.1080/10790268.2021.1970897 · Published: March 1, 2023

Spinal Cord InjuryUrologySurgery

Simple Explanation

This study explores what affects the choices veterans and civilians with spinal cord injuries make about surgeries for bladder and bowel issues. The research involved interviews and surveys to understand the factors influencing these surgical decisions and how satisfied people were with the outcomes. The study found that decisions are influenced by recurring symptoms, balancing risks and benefits, wanting independence, personal traits, support from others, and access to resources.

Study Duration
Not specified
Participants
18 participants with SCI (7 civilians and 11 veterans) who underwent surgeries
Evidence Level
Not specified

Key Findings

  • 1
    Surgery decisions were influenced by the perceived risk of more serious complications, the benefits of having a more effective or easier method of management, need for independence, physical and financial access to hospitals and experienced doctors, concerns about body image and sexuality, embarrassment due to accidents, and past experiences with surgeries.
  • 2
    Most participants were satisfied with their surgeries, particularly those who had suprapubic catheter surgery, Mitrofanoff, or Modified Indiana pouch procedures.
  • 3
    Shared DM (SDM) is a process of matching choices to patients’ values and preferences with the goal of promoting individual autonomy.

Research Summary

The study investigated factors influencing surgical decision-making for neurogenic bladder and bowel (NBB) dysfunction in veterans and civilians with spinal cord injury (SCI). Semi-structured interviews and survey measures were used to identify themes related to factors, decision-making enactment, and outcomes, including surgery satisfaction and quality of life (QOL). The study concluded that attending to the complexity of the decision-making process through careful listening and clear communication will allow clinicians to better assist patients in making surgical decisions about NBB management.

Practical Implications

Improved Patient-Provider Communication

Clinicians should carefully listen to and communicate clearly with patients to assist them in making informed surgical decisions.

Emphasis on Patient Autonomy

Interventions should be implemented to increase patient engagement in decision-making, promoting autonomy and self-confidence.

Development of Clinical Practice Guidelines

Clinical practice guidelines should highlight the importance of a patient-provider alliance in treatment decision-making, discussing risks and consequences of each option.

Study Limitations

  • 1
    Small sample size and geographic limitations may not represent all veterans and civilians with SCI.
  • 2
    Potential bias in quote selection and categorization of decision-making enactment styles.
  • 3
    Findings are based only on participants who decided to have surgery, not those who chose non-surgical options.

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