Title: Managing Faecal Incontinence in people with advanced dementia resident in Care Homes a realist synthesis of the evidence (FINCH study)
Funder: Department of Health (England)

Abstract: Faecal incontinence (FI) is the involuntary loss of liquid or solid stool that is a social or hygienic problem. The prevalence of FI in residents of care homes is high but it is not an inevitable consequence of old age or dementia. There is good evidence on risk factors but very few studies providing evidence about effective interventions. There is a need to draw on a range of evidence to understand how why and in what circumstances particular programmes to reduce FI work (or not) for people with advanced dementia in care homes. The objectives of the realist synthesis are:1.Identify which (elements of the) interventions could potentially be effective how do they work on what range of outcomes 2.Identify the barriers and facilitators to the acceptability uptake and implementation of interventions designed to address FI in people with advanced dementia resident in care homes 3.Establish what evidence there is on the relative feasibility and (where appropriate) cost of interventions to manage FI Method: Realist synthesis aims to identify the mechanisms by which programmes to reduce FI work. By explaining the interaction between context mechanism and outcome it will establish which interventions or elements of interventions work for whom and in what circumstances. An iterative four stage approach is proposed. Phase One Establishing candidate theories and interventions: will focus on the contextual conditions and mechanisms that influence how FI is effectively managed in care homes for people with dementia to develop an initial programme theory or theories that will be tested through the review process. Consultation with five key stakeholder groups and a first mapping of the literature will identify why certain approaches to addressing FI with people with advanced dementia are thought to work (or not) and in what circumstances. In a one day workshop emerging issues and concepts will be reviewed and an explanatory model and candidate programme theories of how FI interventions work for this population and setting will be developed. Phase Two:will systematically search the published and unpublished evidence to test and develop the programme theories identified in Phase 1. An iterative approach to targeting evidence will be used across different databases and other information sources. Bespoke data extraction forms based on the programme theories will be populated according to what the evidence reveals about the links between Context Mechanism and Outcomes configurations (i.e. theories) of different programmes. Data synthesis will identify the patterns that cut across the evidence to either support or negate certain context–mechanism-outcome configurations. A second one day workshop will review findings and resultant configurations and the characteristics of the evidence underpinning them. Phase 3: Test and refine programme theory/ies (validation): We will validate our findings and final narrative from Phase 2 by testing them and then iteratively refining them through interviews with a purposive sample of participants from phase 1 as to their potential significance and feasibility of implementation and embedding them for people with advanced dementia in the care home setting. Phase 4: Recommendations will be developed for practice and research of what works for whom and in what context in relation to programmes to manage faecal incontinence for people with advanced dementia in care homes.


Research activity codes: 7.3 MANAGEMENT AND DECISION MAKING
Health categories: NEUROLOGICAL;ORAL AND GASTROINTESTINAL