Thursday, July 12, 2007
This presentation is part of : Chronic Illness Initiatives
Patient Adherence to Clean Intermittent Self-Catheterization Procedures
Theo Van Achterberg, PhD, RN1, Gerda Holleman, MSc, RN1, Hanny Cobussen-Boekhorst, MA2, Rita Arts, BA3, and John Heesakkers, PhD, MD2. (1) Centre for Quality of Care Research, Nursing Science Section, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands, (2) Urology Dept, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands, (3) Surgical Units Coordination, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
Learning Objective #1: describe adherence in patients who are advised to perform Clean Intermittant Self-Catheterization.
Learning Objective #2: describe factors that hinder or promote adherence in these patients.

Background - Clean intermittent self-catheterization is associated with favorable patient outcomes, but adherence to the procedure is not addressed in the international literature. 
Aims & objectives – The aim of the current study was to explore factors that hinder or promote adherence to Clean Intermittent Self-Catheterization (CISC) procedures in adults.
Methods – Relevant factors were explored in two studies. A first study (n=10) addressed mastery and short term adherence, whereas a second study (n=20) addressed long term adherence in these patients. Determinants of patient adherence were derived from pre-structured interviews with patients, using a content-analysis procedure.
Results – A list of sixteen determinants of mastery and short-term adherence and a list of twelve determinants of long-term adherence was found. Most of these determinants were found in both older (³65 years of age) and younger patients. However, five determinants of mastery and short term adherence and six determinants of long-term adherence were specific to patients under the age of 65.
Conclusion – Our findings give a first insight into CISC adherence. General determinants of adherence relate to knowledge, complexity of the procedure, misconceptions, fears, shame, motivation and quality and continuity of professional care. Furthermore integrating CISC in everyday life can be difficult. In younger patients, availability of materials, physical impairments and resistance to a sickness role can further compromise adherence.
Relevance to clinical practice – Issues of knowledge, fears, motivation and potential psychological impact of performing CISC should be addressed prior to deciding on CISC and instructing patients. Follow-up care should be improved to include re-evaluations of skills, discussing adherence, integrating CISC in daily activities and general coping issues.