Reaching Global Consensus on Clinical Practice Guidance
According to the World Health Organization between 250,000 and 500,000 people suffer a spinal cord injury (SCI) every year. Global estimates of people living with spinal cord injuries run as high as 1.3 million. The quality of life for these individuals depends on their overall health, wellbeing, personal mobility and independence. One of the challenges faced by many people with an SCI is the development of Neurogenic Bowel Dysfunction (NBD), in the forms of constipation and/or fecal incontinence. NBD has a clinically relevant negative impact on the persons health, well-being, self-esteem and personal life.
Despite different treatments and coping strategies being available for clinicians managing patients with NBD, this is done largely empirically. It is not easy for clinicians and other healthcare professionals to know when a patient’s bowel management regime is not sufficiently effective, and when an escalation or change of the treatment could be indicated.
The clinical guidance and specific tool developed through this project will help clinicians and patients employ proactive, best-practice based treatment recommendations with the objective of maximising independence on bowel care while supporting long-term optimal health and well-being. The potential global impact is huge, with approximately 200,000 patients potentially benefiting from the tool annually and enjoying a higher quality of life as a result of improved standard of care.
IAF Hall of Fame members Ann Epps, CPF and Malin Moren, CPF with Bruno Gallo Santacruz and Kimberly Bain, CPF at the 2017 Facilitation Impact Awards ceremony in Paris.
Context and challenges
Coloplast develops products and services that make life easier for people with very personal and private medical conditions. Working closely with the people who use our products, we create solutions that are sensitive to their special needs. We call this intimate healthcare. Our business includes Ostomy Care, Continence Care, Wound & Skin Care and Urology Care. We operate globally and our organisation is more than 10,000 people strong.
Bowel Management for patients with spinal cord injuries is critical to quality of life and general health and well-being. However, there was no global consensus on standardised evidence-based practice guidelines to assist physicians determine what treatment to recommend and when to change treatment regimens for individual cases. This meant that patient care could vary greatly between physicians due to lack of evidence-informed decision-making guidance. Coloplast wanted to change that.
The challenge was how to design a process that was robust, consensus-based, relied on scientific techniques, that was itself medically evidence-based and that was timely. Often developing globally accepted clinical practice guidelines takes years, however the urgency to help the ever-increasing number of spinal cord injury patients world-wide required immediate action and immediate results.
The objective was to develop globally accepted, evidence-based clinical practice guidance for Bowel Management for neurogenic patients
This project was in direct support of Coloplast’s mission:
- Our mission is making life easier for people with intimate healthcare needs.
- Our vision is setting the global standard for listening and responding.
- Our values are closeness to our customers, passion for what we do, respect and responsibility for each other and the world around us.
The purpose of bowel management for people with spinal cord injuries is to ensure the highest quality of life possible by providing treatment options that support physical health and maintains the highest levels of independence and mobility possible for that patient.
An IAF Certified™ Professional Facilitator was hired at the outset of the project to help design a robust consensus-building process using a Modified Delphi Technique combined with more traditional consensus-building workshop methods in face-to-face meetings and through facilitated on-line sessions.
Facilitation was used consistently until the final consensus was reached. Coloplast then worked with internal and external clinical experts to develop a new tool and to conduct double-blind validation studies of the tool and the guidance contained in it.