While the indication for long-term indwelling catheterization is typically established by the treating physician, shared decision-making (SDM) emphasizes that patient-reported functional goals should guide treatment selection [1]. However, the functional purpose patients attribute to their catheter use has not previously been investigated on a large scale. The Jobs-to-be-Done (JTBD) framework, originating from management and innovation science, conceptualizes products and services as tools that individuals ‘hire’ to accomplish specific functional goals in their lives [2]. Applied to catheter care, this framework suggests that patients across diagnostic groups may use catheters for fundamentally different purposes. This study aimed to identify the primary functional purposes patients attribute to their catheter use, and how these are distributed across patient-reported diagnostic groups

A cross-sectional survey was conducted among Dutch adults using an indwelling urethral or suprapubic catheter for ≥3 months, recruited via email through their catheter supplier. Participants answered two questions: 1) primary self-reported reason for catheter use (the ‘job to be done’: nine predefined options, including bladder emptying problems, incontinence management, impaired toilet access, nocturia reduction, pain reduction, and medical necessity according to doctor or nurse), and 2) the diagnosis their physician identified as the cause of their lower urinary tract dysfunction (eight predefined categories, including benign prostate enlargement (BPE), neurogenic bladder, underactive bladder, and overactive bladder). Data were summarized as frequencies, describing the distribution of diagnoses within each ‘job group’ and the distribution of ‘jobs to be done’ across diagnostic groups. A subgroup analysis comparing suprapubic and transurethral catheter users was performed using chi-square testing.

A total of 4,882 catheter users were approached, of whom 594 completed the questions (mean age 75 years; 79% male; 49% suprapubic catheter). Voiding-related jobs predominated across the cohort: ‘cannot pass urine at all’ was most frequently reported (37.7%), followed by ‘cannot empty bladder properly’ (22.1%), together accounting for nearly 60% of responses. A total of 11.8% of patients (n=70) identified medical necessity as determined by their clinician as their primary reason for catheter use, without citing a personal functional goal. Continence management was cited by 10.8% (n=64), impaired toilet access by 7.4% (n=44), nocturia reduction by 2.4% (n=14), and pain by only 0.8% (n=5). No significant difference in reported jobs was observed between suprapubic and transurethral catheter users (p=0.476).
Voiding-related jobs were primarily reported by patients with self-reported BPE, underactive detrusor, or urethral obstruction. Within the group reporting incontinence management as primary reason, neurogenic bladder dysfunction (31.2%) and overactive bladder (28.1%) represented the largest diagnostic subgroups (Figure 1). Conversely, in the overactive bladder group (n=51), continence management (35.3%) and impaired toilet access (19.6%) were the dominant jobs, while only 7.8% reported inability to void (Figure 2).

The majority of long-term catheter users report a clear voiding-related functional goal. However, two findings warrant attention. First, a substantial proportion of patients reported catheter use for incontinence management, impaired toilet access, nocturia reduction, or pain relief rather than voiding dysfunction (total 21.6%). As indwelling catheterization is not a first-line treatment for these conditions, this may suggest opportunities for more targeted alternatives such as containment products, behavioral therapy, or pharmacotherapy [3]. Second, nearly one in eight patients reported no personal functional goal, attributing catheter use solely to medical authority. From a JTBD perspective, this may reflect genuine absence of a patient-perceived functional purpose, potentially indicating a missed opportunity for SDM, or patients' limited ability to engage with treatment decisions.

Long-term catheter users report a diverse range of functional purposes, with voiding dysfunction predominating but a clinically relevant minority reporting alternative or no personal functional goals. Exploring this purpose may support SDM and identify opportunities for more targeted management.

Ossin DA, Carter EC, Cartwright R, et al. Shared decision-making in urology and female pelvic floor medicine and reconstructive surgery. Nat Rev Urol. 2022;19(3):161–170.
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Cameron AP, et al. The AUA/SUFU Guideline on the Diagnosis and Treatment of Idiopathic Overactive Bladder. J Urol. 2024.