title: Perspectives From Patients and Care Providers on the Management of Fecal Incontinence: A Needs Assessment.
abstract: BACKGROUND
  A large proportion of Canadians experience fecal incontinence, with no avenue for effective treatments. The Ottawa Hospital has recently started a percutaneous tibial nerve stimulation program for patients who have not improved with conservative efforts.
  
  
  OBJECTIVE
  As part of this program implementation, a qualitative needs assessment was undertaken to better define successful outcomes and to identify barriers for program sustainability.
  
  
  METHODS
  This was a cross-sectional, qualitative study involving standardized, semistructured interviews.
  
  
  METHODS
  The study was conducted at a single tertiary care center.
  
  
  METHODS
  Patients experiencing fecal incontinence, as well as nurses, physical therapists, and physicians, were enrolled in the study.
  
  
  METHODS
  Interview questions revolved around success definitions, barriers, and promoters of fecal incontinence care. Transcripts were analyzed to develop themes surrounding fecal incontinence care.
  
  
  RESULTS
  Twelve interviews were undertaken raising a total of 17 different themes. Barriers to fecal incontinence care included education for both the care provider and patients. Access issues for treatments were also highlighted. Promoters of fecal incontinence care were reflected by the impact that it has on quality of life, personal hygiene, psychological burden, and activity and productivity. The definition of fecal incontinence success was focused on improvements in quality of life rather than a numerical reduction of incontinence episodes.
  
  
  CONCLUSIONS
  This study was limited in its small number of interviews conducted. We were unable to identify patients who were unable to seek out care for fecal incontinence.
  
  
  CONCLUSIONS
  Patient and care provider education surrounding fecal incontinence is lacking. Furthermore, access for effective treatments is a real barrier for Canadians experiencing fecal incontinence. Programs should focus on improvement of overall quality of life rather than a reduction of incontinence episodes.
authors.affiliation: 1 Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada 2 The Ottawa Hospital, Ottawa, Ontario, Canada 3 Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Ramzi M
authors.initials: RM
authors.lastname: Helewa
authors.forename: Husein
authors.initials: H
authors.lastname: Moloo
authors.forename: Lara
authors.initials: L
authors.lastname: Williams
authors.forename: Kristine M
authors.initials: KM
authors.lastname: Foss
authors.forename: Waheeda
authors.initials: W
authors.lastname: Baksh-Thomas
authors.forename: Isabelle
authors.initials: I
authors.lastname: Raiche
mesh_terms: D001291:Attitude of Health Personnel; D002170:Canada; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D004526:Efficiency; D004599:Electric Stimulation Therapy; D005242:Fecal Incontinence / Q000523:psychology / Q000628:therapy*; D017048:Health Care Costs; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D020380:Needs Assessment; D009726:Nurses; D010349:Patient Compliance; D059825:Physical Therapists; D010820:Physicians; D015397:Program Evaluation; D036301:Qualitative Research; D011788:Quality of Life; D013979:Tibial Nerve