Patient and health care professionals’ perception of weekly prophylactic catheter washout in adults living with long-term catheters: Qualitative Study of the CATHETER II Trial

Tripathee S1, Abdel-fattah M1, Johnson D1, Constable L1, Cotton S1, Maclennan G1, Norrie J2, Omar M1, Maclennan S1, CATHETER II T1

Research Type

Pure and Applied Science / Translational

Abstract Category

Continence Care Products / Devices / Technologies

Abstract 320
Products, Health Services Delivery and Postpartum Haemorrhage
Scientific Podium Short Oral Session 30
Friday 25th October 2024
16:22 - 16:30
Hall N106
Infection, Urinary Tract Clinical Trial Stress Urinary Incontinence Quality of Life (QoL) Conservative Treatment
1. University of Aberdeen, 2. Queens University Belfast
Presenter
Links

Abstract

Hypothesis / aims of study
The CATHETER II qualitative study aimed to explore participants’ experience of long-term catheters (LTC), the acceptability of washout policies, and self-management, their experience of the CATHETER II trial and their satisfaction with outcomes. The objectives for the healthcare professionals (HCPs) were to explore their attitudes towards weekly prophylactic catheter washout and their views on the provision of training, and participants’ ability to enact wash-out behaviours.
Study design, materials and methods
This was a longitudinal qualitative study embedded within the CATHETER II, a community-based randomised controlled trial (RCT) in the United Kingdom (UK). Participants were recruited from the CATHETER II RCT. All participants received standard LTC care and were randomly allocated (1:1:1) to receive standard LTC care with either 1) weekly saline washouts, 2) weekly citric acid washouts or 3) no prophylactic washouts for up to 24 months. The trial methodology was in accordance with CONSORT (Consolidated Standards of Reporting Trials) guidelines and the protocol of the trial, and this embedded qualitative study have been published (1, 2).
Semi-structured interviews with trial participants were conducted at two time points; once prior to the trial and 6-8 month after their participation in the trial. Semi-structured interview and focus group with Heath care professional were conducted at least 6 months after the RCT had been running in their sites. Data were analysed using the Theoretical Framework of Acceptability and Theoretical Domains Framework.
Results
50 (24 female, 26 male) CATHETER II trial participants took part in the study. Participants, aged between 23 and 100 years. All participants were living with LTC and deemed able to self-manage the washout and study documentation independently, or supported by the help of a carer. Seven health care professionals (5 female, 2 male) also participated in the qualitative study. HCPs included one urogynecologist and six research nurses with various nursing backgrounds (community, district, primary care, continence).

The participants had positive attitudes towards weekly prophylactic saline or acidic catheter washouts and other trial elements, such as washout training, catheter calendar and monthly phone calls. Their perceived effectiveness of, and optimism towards washouts, and their altruistic desire to contribute to research motivated them to take part in the RCT. HCPs highlighted the need for the RCT due to the current lack of robust evidence on best washout policies to guide clinical practice.
Participants and HCPs found the ‘ask’ of the CATHETER II trial and the weekly self-administered prophylactic washout policies to be feasible. Participants engaged in and adhered to all elements of the trial. 

The participants found the catheter washout training provided during the RCT enhanced their self-efficacy, skills, and self-reported capability to carry out the washout procedures. Participants and HCPs agreed that self-management for prophylactic catheter washouts is both feasible and, following training, achievable without any need for additional support e.g. assistance from a HCP. This was the case for both in-person or virtual training. The catheter washout training package within the trial was praised as a key element in enabling participants to self-manage their LTC and washout. HCPs had a positive attitude regarding washouts and confirmed the participants’ willingness and ability to self-manage their catheter washout after the training provided. 

Participants in the washout groups reported having positive outcomes from the weekly washout. These included reduced blockage, pain or infection, reduced need for HCP support, and greater psychological reassurance because of their newfound ability to self-manage potential complications. There were no notable differences in participants’ descriptions of their experience of the training, self-management of washout, and outcomes between saline and citric acid washout groups. HCPs attested to the participants understanding of and adherence to the weekly washouts and other elements of the trial.
Interpretation of results
This study shows acceptability, feasibility, and self-reported fidelity (e.g. demonstration of conducting the wash-out behaviour as per protocol) of the CATHETER II trial on a behavioural level for both patients and Health care professionals. 
Self-management for prophylactic catheter washouts is both feasible and achievable without any need for additional support when appropriate training is provided. Washout training could be crucial in enhancing patients self-efficacy and skills and empowering them in self-management of their catheter care. Weekly prophylactic catheter washout could reduce the long-term catheter related complications.
Concluding message
To our knowledge, this is the first qualitative study embedded within a RCT to report on patient and health care professionals’ perceptions of prophylactic washout. The study shows that weekly prophylactic washout could be beneficial in reducing LTC related complications. Self-management of prophylactic catheter washouts was found to be feasible and acceptable to patients following in-person or distant video training. The specific catheter washout training used within this trial was found be essential, acceptable, and effective in empowering patients to self-manage their catheter washout. These results have the potential to influence NICE and other relevant guidance for long-term catheter maintenance.
References
  1. Abdel-fattah M, Johnson D, Constable L, Thomas R, Cotton S, Tripathee S, et al. Randomised controlled trial comparing the clinical and cost-effectiveness of various washout policies versus no washout policy in preventing catheter associated complications in adults living with long-term catheters: study protocol for the CATHETER II study. Trials 2022 Aug 4;23(1):630
  2. Tripathee S, Omar MI, Abdel-Fattah M, MacLennan SJ. Patients' and Health Care Professionals' Expectations, Experience, and Perception of the Outcomes of Various Washout Policies in Preventing Catheter-associated Complications: Qualitative Study of the CATHETER II Trial. Eur Urol Focus. 2022;8(1):235-8.
Disclosures
Funding National Institute for Health Research Health Technology Assessment Programme (17/30/02) funded this study. The supply of washout solutions for use in the CATHETER II study were donated by B. Braun Medical AG. Clinical Trial Yes Registration Number ISRCTN registry, ISRCTN17116445 RCT Yes Subjects Human Ethics Committee Wales Research Ethics Committee 6 (19/WA/0015). Helsinki Yes Informed Consent Yes
Citation

Continence 12S (2024) 101662
DOI: 10.1016/j.cont.2024.101662

14/11/2024 03:23:32