NURSING MANAGEMENT OF IBS--IMPROVING OUTCOMES

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DESCRIPTION (Adapted from the Applicant's Abstract): In the United States, it is estimated that 17-30% of the population experience symptoms compatible with Irritable Bowel Syndrome (IBS). IBS is a functional condition characterized by change in bowel patterns, (e.g., constipation, diarrhea), abdominal pain and bloating. It affects more women than men, causing significant symptom distress, interfering with functional activities and increasing health care utilization. Current recommended therapies include diet manipulation (increased fiber, exclusion diets), self-management, psychotherapy, and motility modulation via pharmacological therapy. The effectiveness of these therapies either singly or in combination warrant additional investigation because of the 1) use of a heterogeneous sample with respect to predominant bowel symptoms, psychological profile, and duration/chronicity of IBS, 2) use of retrospective measures to document the symptom profile prior to and following the intervention, and 3) failure to control for menstrual cycle variations in symptom profiles in predominantly female samples. Also rarely is comprehensive follow-up data including descriptions of symptom trajectory and utilization of health care services by patients occur in the intervention literature. The purpose of the present study is to compare the effectiveness of a brief, 1 session, self-management intervention to a comprehensive, 8 week, self-management intervention in reducing symptoms in women with medically diagnosed IBS. A third group of women with IBS will receive no treatment and serve as the control group. In addition to measuring changes in symptoms, indicators of functional ability and health care utilization will be measured for 12 months following the intervention. The third aim is to explore the contribution of psychological and physiological indicators to a change in IBS symptoms. A further understanding of the contribution of each of these potentially causal mechanisms will provide useful information for developing treatment recommendations. Women who are between 20 and 45 years of age and diagnosed with IBS by a health care provider will be recruited from a medical center clinic as well as gastroenterology and primary care clinics of a large HMO (Group Health Cooperative). Subjects will be followed for one menstrual cycle using daily symptom diaries then randomized to one of the 3 groups (minimal or comprehensive self-management or control group). Following the 8 sessions (or equivalent time) and at 6 and 12 months, a post intervention assessment will occur across one menstrual cycle.