Gender, Age, Society, Culture, and the Patient’s Perspective in the Functional Gastrointestinal Disorders
This review has been developed to discuss important variables that have been largely overlooked in the study of functional gastrointestinal disorders (FGID), namely gender, age, society, culture, and the patient’s perspective. These variables should be included in the design of research protocols to provide a more comprehensive understanding of these disorders from both a theoretical and a methodological perspective. Failure to consider these variables may result in an overly simplistic and incomplete interpretation of research data. The majority of studies that are discussed focus on irritable bowel syndrome (IBS) because it is the most studied of the FGID. We also recognize that knowledge generation and transfer has been traditionally given to the “expert,” who is usually a scientist or clinician rather than the individual who has the specific condition under study. For these reasons, this review starts with the patient’s perspective.
To advance the field of FGID, the following are sug- gested.
From a Research Perspective
1. Studies to identify positive aspects of patient–provider interactions that improve outcome should be performed and include recognition of the patient’s perspective, cultural and gender sensitivity, and implementation into patient care programs.
2. Studies using quantitative and qualitative methods are needed to better understand the patient’s illness experience and his or her views of the health care system.
3. Studies of varied populations around the world should be performed with appropriate tools to measure cul- tural and societal influences.
4. Studies evaluating sufficient numbers of men with IBS, and also making comparisons between healthy men and women, are needed to determine if gender differences in FGID are disease specific.
From a Clinical Practice Perspective
1. Recognize that FGID patients view their conditions as illnesses associated with uncertainty, stigma, and social isolation. Physicians can help patients to manage their condition by eliciting and addressing patient concerns; offering a positive diagnosis; providing clear, understandable, and legitimizing explanations of the disorder; and helping identify factors within the context of the patient’s own illness that he or she can influence and control.
There are a number of sex- and gender-related factors that may impact the clinical symptoms and response to treatment of IBS and should be considered, for example, gender role, sociocultural differences, hormonal effects such as menstrual cycle variation, and biological differences influencing gut function and treatment response.
Both men and women in clinical settings have psy- chological issues that may need to be addressed and there is a possibility that men may not do as well with psychological treatment as women.
Recognition and understanding of the association be- tween culture and health are also important for pa- tient care. It may be helpful to discuss with patients any cultural issues that may impact their clinical presentation or management of their condition. In addition, medical training and continuing medical education should include and emphasize cross-cultural competencies.