Important role of physicians in addressing psychological aspects of interstitial cystitis/bladder pain syndrome (IC/BPS): a qualitative analysis

Abstract

Introduction: Interstitial cystitis/bladder pain syndrome (IC/BPS) is a poorly understood source of chronic pain causing significant morbidity, with variable treatment success. Despite the need to understand patient perspectives in chronic pain, there is a paucity of qualitative data for IC/BPS. We aimed to acquire information regarding patient experience with IC/BPS symptoms and with their medical care to elicit suggestions to improve patient satisfaction with that care.

Methods: Fifteen women with IC/PBS participated in a total of four focus groups. Sessions were recorded and transcribed and information deidentified. Focus groups were conducted until thematic saturation was reached. All transcripts were coded and analyzed by a minimum of three independent physician reviewers. Investigators identified emergent themes and concepts using grounded-theory methodology.

Results: Participant's mean age was 52.6 years, with an average IC/BPS duration of 6.3 years. Thematic saturation was reached after four focus groups. We identified three emergent patient experience concepts: IC/PBS is debilitating, the disease course is unpredictable and unrelenting, and patients experience significant isolation. Importantly, suicidal ideation was expressed in each group. Patients voiced strong preference for physicians who provided education regarding the condition, an array of treatment options, organized treatment plans, and optimism and hope regarding treatment outcomes.

Conclusions: Our study presents novel findings of the importance of patient-physician interaction in IC/BPS and reinforces the tremendous disability and burden of this disease, which frequently manifests in suicidal ideation. Patients preferred organized treatment plans with diverse choices and providers who offered hope in dealing with their condition.

Keywords: Chronic pain; Complementary therapies; Cystitis; Emotional stress; Interstitial; Qualitative research.

Conflict of interest statement

Financial Disclosures/Conflicts of Interest: KA Volpe-None SB Cichowski-None PC Jeppson-None Y Komesu-None

Figures

Figure 1

Schematic of interaction between disease factors, psychological effects of IC/BPS, and how physicians can impact the condition. Options allow patients to better manage flares when they come. Hope from providers is important to patients when facing a debilitating condition. Providers listening and validation is important as patients may not be receiving this from usual support systems given the public’s lack of understanding about the condition. All of these interventions may ultimately effect the disease process and associated depression.