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By Nicki Sutton
Urinary catheterisation - particularly the high incidence of catheter-associated urinary tract infection - has been a recent subject of interest in the mainstream media1,2. Research by Prof Mandy Fader, Professor of Continence Technology at the University of Southampton, highlights the over-zealous use of catheters within hospitals, combined with the lack of innovation, research and development targeted at urinary catheters and the materials used to manufacture them. Indeed, Fader suggests that ‘the lowly catheter has actually changed very little in the last 80 years’.
Drawing on my own research experience with long-term catheter users, I can see an even wider innovation gap: that of meeting patients’ emotional needs – both important and diverse, yet remaining substantially under-served in today’s urinary catheter market.
If there is to be genuine progress in the world of continence care, then innovators must look beyond simply finding solutions that address cold, hard clinical and functional needs and the practical requirements of the healthcare professional. They must also address and solve the emotional challenges faced by a diverse range of users. We naturally dismiss the concept that ‘one size fits all’ in a physical sense. We must dismiss it in an emotional sense too.
With an aging population, and little in the way of solutions for age-related degeneration of the urological system, this is likely to become an issue that more and more of us will be affected by, as potential carers or even as users, in the years to come. The continence care market has reach far beyond the realms of the hospitalised and the elderly, however. Incontinence can strike any of us at any time. This was bought home to me a few years ago when, in my role as an innovation consultant, I undertook primary research for a leading provider of continence management products.
Long-term catheter users were selected from groups of people who had incontinence as a result of multiple sclerosis, spinal cord injury, or spina bifida, or were men who had undergone surgical intervention for prostate cancer. I interviewed men, women, teenagers and the elderly. Of course, the issue of urinary tract infection was raised, and this was an almost universal concern. Most revealing was the different emotional challenges that these user groups faced. Whilst by no means representing a one-to-one mapping (rarely can market segments be defined by such convenient means), the different user groups had a range of needs driven by underlying emotional challenges and outlooks.
People with multiple sclerosis represented an emotionally complex group; having to deal with a degenerative disease, knowing that without pharmaceutical interventions symptoms would get worse over time. Incontinence was just one aspect of a multi-faceted, burdensome disease that required use of scarce physical and mental energy to face it head on.
Given the nature of the condition, spina bifida users represented a group comprising teenagers and young adults. Naturally, their parents had played an active role in their care and the goal of those with spina bifida was to obtain or maintain their independence – to socialise with and be like their friends.
The spinal cord injured group was most demographically diverse. In many cases their injury was a result of an accident during outdoor activity. This group contained, by nature, outgoing, adventurous, positive ‘can-do’ thinkers. They were pragmatic and determined not to let incontinence alter their outlook on life. Incontinence as a result of a catastrophic event seemed to be a more manageable prospect than when part of a degenerative disease.
Finally, men whose incontinence was a result of prostate cancer surgery fell into two groups; those who felt that they had beaten cancer and who would not let incontinence get the better of them, and those who struggled because they felt isolated; unable to share their concerns and worries with their family and particularly not within their circle of friends. Absolute dread of an incontinence episode when out in public was fear above all.
Within these groups, I spoke with people who valued discretion most highly, those who most wanted independence, those who needed reassurance and support, others who wished to avoid being stigmatised, and those who wanted their fears abated. In short; people who had a range of different, important emotional needs that weren’t being addressed with existing continence care solutions.
Whilst new developments in materials and better understanding of biofilm behaviour will get us far in combating catheter-associated urinary tract infection, we must go beyond science and technology if we really want to develop life-changing products that consider more than just clinical and functional needs to improve the entire continence management experience of those who have to deal with incontinence in their daily lives.
A great example of emotional innovation was provided by GE Healthcare when they devised their CT Pirate Island Adventure; a CT scanner that looks like a pirate ship. GE looked beyond the quality of the images and the design of control interface and, instead, ‘put the child in the driver’s seat’. They understood the emotional distress and fears of children when being scanned and turned a CT scan into a whole new pleasurable experience. They innovated on an emotional level and changed the game. It is a model that all medical device innovators would do well to follow.
For me, the most personally significant moment of the continence care research occurred as I thanked one particular man for inviting me into his home to discuss such a truly personal matter. He replied “No, thank you. You are the first person who has ever asked what’s important to me”. I left humbled and moved, but with a strong drive to ensure that I would always push to involve users in the innovation process.
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