Continence Coach: Proliferating Hope

     A stirring editorial¹ by Catherine D. DeAngelis, Editor-in-Chief of the Journal of the American Medical Association, and her pediatrician husband, James C. Harris, reminds all healthcare professionals that personal care begins with establishing a sense of hope for and with the patient. Although the editorial, “The Power of Hope,” which also was discussed on National Public Radio, speaks specifically about the physician’s role, the message applies to all clinicians.

     Hope is defined as the expectation of something desired; a more archaic meaning is “to trust or rely”. Much of what appears in the medical literature with a keyword search of the word “hopefulness” addresses end-of-life care. Yet, hopefulness actually is established not when life is ending but rather when the patient-provider relationship is just beginning. Hope comes when the sense of trust is being developed, when mutual respect is being established between the two parties, just as the early sense of the word implies. Hopefulness is not a projection but a feeling, a bonding — never a false or misleading communication. The richness and value of hope reside in how communication takes place between patient and provider.

     The clinician, whether a specialist or a primary care practitioner, has a unique opportunity to serve as a bridge and as such a translator for others who serve the patient’s needs, including the sharing of hope. Today, half of all Americans are living with one or more chronic conditions and illnesses such as heart disease, chronic pulmonary conditions, neurological illnesses, and spinal cord injuries. Managing these conditions requires an interdisciplinary approach among experts. But with the advent of computerized medical records, diagnostics, and messaging, we must remain mindful of signs and symptoms that defy inclusion in software — human feelings that deserve the touch of a hand, direct eye contact, and an attentive ear. Clinicians can and must use their senses —sight, touch, hearing, smell — in responding to and linking with others on the care team to bring their interpretations and recommendations back to the patient.

     Many chronic conditions present with symptoms and concerns about bladder and bowel control. To impart hopefulness in response to a patient’s anxiety and decreased quality of life requires that a clinician stay abreast of new research and technology in continence care. This includes awareness of clinical successes with injectables such as Botox® (Allergan, Irvine, CA) for addressing bladder spasticity, information about clinical trials on a new generation of medications for overactive bladder with fewer negative side effects, and knowledge of the evolution of minimally invasive device development, such as sacral nerve stimulation for patients not responsive to more conservative measures to reduce frequency of urination. Patients are eager to hear about the world of inquiry, research, and advancement — ie, the world of hope. Keeping up with the latest developments is why you read journals like this one. Sharing encouraging news is how healthcare professionals kindle patient trust.

     The National Association For Continence (NAFC) just published the third edition of Continence Care for People Living with Multiple Sclerosis. In the preface, we write about a gentleman caring for his wife — his comments 5 years ago initiated an entire family of related NAFC publications. He told us, “The most important service the NAFC provides to people in our situation is to give us hope.” His remark serves as a constant reminder of what sustains us in the journey of caring and what connects us to each other. More than anything else in the field of healthcare, it is the sense of hope we seek to instill in those searching for answers, healing, and comfort ... and trust lies at the heart of where hopefulness thrives. Hopefulness. Give it freely, but give it knowingly.

The National Association For Continence is a national, private, non-profit organization dedicated to improving the quality of life of people with incontinence. The NAFC’s purpose is to be the leading source for public education and advocacy about the causes, prevention, diagnosis, treatments, and management alternatives for incontinence.

This article was not subject to peer review.

1.     Harris JC, DeAngelis CD. The power of hope. JAMA. 2008;300(24):2919–2920.