Goals of Fecal Incontinence Management in Community Patients

Clinicians and patients rarely discuss fecal incontinence (FI) at health visits, and little is known about the goals of FI management that are most important to patients. The purpose of this study was to identify FI management goals of community adults if complete continence may not be possible and the importance of these goals to them. 189 participants (77% female, 92% White, age=58(14) mean(sd) years) in a study about managing FI with dietary fiber completed a semi-structured interview about goals of FI management at study start. Patients identified their own goals via open-ended questions and selected others from 12 investigator-identified goals. They rated the importance of the goals using a scale (5=very, 1=not at all important) and allocating 30 points among three top goals.  Five goal categories emerged from content analysis: FI/Bowel Pattern, Emotional Responses, Self-Care, Lifestyle, and Adverse FI Effects. Most patient-identified goals (45%, 52/114) were about FI/Bowel Pattern; only 3% focused on Self-Care. Subjects selected a median of 7 (range=2-12) investigator-identified goals. Goals selected by the most subjects were “Decreasing the number of accidental leaks” and “Being more confident that they can control FI better”. All patient-identified goals were considered very important (median(range)=4(2-4)). Selected investigator-identified goals were also considered very important (median(range)=4(1-4)) except for two of three goals in the category “Self Care Practices for FI” that were considered moderately important (median(range)=3(1-4)). Goals awarded the most importance points were “Decreasing number of accidental leaks” (8.74(7.6)) (mean(SD) points), “Decreasing leakage of loose or liquid stool” (5.66(6.7)), and “Being more confident that they can control FI better” (3.6(5.9)). The variety of goals selected suggests a possible benefit of an individualized approach to FI management. Understanding a patient’s goals will guide nurses in recommending management options, setting realistic improvement levels, and improving satisfaction.