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Brissette V, Monton O, Demian M, Al Busaidi N, Moon J, Sabboobeh S, Vasilevsky CA, Rajabiyazdi F, Boutros M. Exploring patients' needs and expectations for information on sexual dysfunction after rectal cancer treatment: A qualitative study. Colorectal Dis 2024. [PMID: 38890007 DOI: 10.1111/codi.17048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/25/2024] [Accepted: 05/15/2024] [Indexed: 06/20/2024]
Abstract
AIM Sexual dysfunction is an important, and often overlooked, sequela of rectal cancer treatment with significant implications for patients' quality of life. The aim of this study was to explore patients' information needs regarding sexual health after rectal cancer treatment and their experiences accessing information on sexual dysfunction throughout the cancer care continuum. The secondary aim was to explore surgeons' perspectives on patients' information needs and gain insight into their experiences providing information on sexual health following rectal cancer surgery. METHOD A qualitative study was conducted using semistructured interviews with 10 rectal cancer survivors and six colorectal surgeons from a Canadian tertiary care institution. Transcribed interviews were coded independently by two researchers and thematic analysis was performed. RESULTS Analysis of patient interviews revealed that patients had limited knowledge of sexual dysfunction symptoms following rectal cancer treatment and received inadequate information on sexual dysfunction from their treating medical team. Patients expressed the desire to receive information on sexual dysfunction in different formats, especially before the start of treatment. The surgeon interviews revealed that colorectal surgeons faced challenges when informing patients about sexual dysfunction. Surgeons did not routinely provide information on sexual dysfunction to all patients; however, they felt that patients should receive high-quality information on sexual dysfunction, both before and after treatment. CONCLUSION Patients' information needs related to sexual dysfunction after rectal cancer treatment were inadequately met. High-quality informational resources are needed to facilitate communication between patients and physicians and improve patients' understanding of sexual dysfunction.
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Affiliation(s)
- Vincent Brissette
- Department of Medicine (Neurology), University of Ottawa, Ottawa, Ontario, Canada
| | - Olivia Monton
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Marie Demian
- Division of Colon and Rectal Surgery, Department of Surgery, Jewish General Hospital, Montreal, Quebec, Canada
| | - Nasra Al Busaidi
- Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Jeongyoon Moon
- Department of Surgery, Division of General Surgery, McGill University, Montreal, Quebec, Canada
| | - Sarah Sabboobeh
- Division of Colon and Rectal Surgery, Department of Surgery, Jewish General Hospital, Montreal, Quebec, Canada
| | | | - Fateme Rajabiyazdi
- Department of Systems and Computer Engineering, Carleton University, Ottawa, Ontario, Canada
| | - Marylise Boutros
- Department of Surgery, McGill University, Montreal, Quebec, Canada
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA
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Ambe PC, Breuing J, Grohnmann E, Engel N, Pieper D, Zirngibl H, Kugler C. [Quality of life of ostomates in Germany]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2024; 62:473-478. [PMID: 37751772 DOI: 10.1055/a-2163-5299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
BACKGROUND The presence of an ostomy may have a serious impact on the quality of life (QoL). The aim of this study was to evaluate the QoL of ostomates in Germany. METHOD An online survey was performed using the validated Gastrointestinal Quality of Life Index (GIQLI) by Eypasch et al. Ostomates ≥ 18 yrs. with an ostomy duration ≥ 3 months were eligible to participate. RESULTS Completed questionnaires from 519 participants (79.3 % female) with a median age of 50 yrs. (range 19-83 yrs.) and a median ostomy duration of 3 yrs. (range 3 months-58 yrs.) were analyzed. The most common indications for an ostomy were Crohn's disease (36.5 %), colorectal cancer (19.8 %) and ulcerative colitis (18.2 %). The mean GIQLI-Score in the study population was 94.8 ± 24.6, with higher scores corresponding with better QoL and healthy individuals reach 125.8. Limitations were recorded with regard to sleep, tiredness, energy level, endurance, fitness and sexuality. Individuals with a stoma due to Colitis (103,0 ± 24,5), colorectal cancer (99,2 ± 21,7) and Crohn's (95,0 ± 22,8) had the highest mean GIQLI-scores amongst all ostomates. DISCUSSION The findings of this study confirm that ostomates have a reduced QoL compared to the healthy population. Amongst all ostomates, those with colitis, colorectal cancer and Crohn's have a better QoL compared to ostomy carriers with other diagnoses.
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Affiliation(s)
- Peter C Ambe
- Chair of Surgery II, Witten/Herdecke University, Witten, Germany
- Klinik für Allgemein-, Viszeralchirurgie und Koloproktologie, GFO Kliniken Rhein Berg, Vinzenz Pallotti Hospital Bensberg, Bergisch Gladbach, Germany
| | - Jessica Breuing
- Institut für Forschung in der Operativen Medizin, Universität Witten/Herdecke, Witten, Germany
| | | | | | - Dawid Pieper
- Institut für Forschung in der Operativen Medizin, Universität Witten/Herdecke, Witten, Germany
| | - Hubert Zirngibl
- Chair of Surgery II, Witten/Herdecke University, Witten, Germany
| | - Charlotte Kugler
- Institut für Forschung in der Operativen Medizin, Universität Witten/Herdecke, Witten, Germany
- Institut für Versorgungs- und Gesundheitssystemforschung, Fakultät für Gesundheitswissenschaften Brandenburg, Medizinische Hochschule Brandenburg, Brandenburg, Germany
- Zentrum für Versorgungsforschung Brandenburg, Medizinische Hochschule Brandenburg CAMPUS GmbH, Neuruppin, Germany
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García-Cabrera AM, de la Portilla de Juan F, Navarro-Morales L, Ribera García S, Durán Ventura MDC, Fernández Luque I, Padillo-Ruiz FJ. Influence of Preoperative Educational Intervention for Patients Undergoing Fecal Ostomy Surgery: A Comparison Cohort Study. J Wound Ostomy Continence Nurs 2023; 50:484-488. [PMID: 37966076 DOI: 10.1097/won.0000000000001020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
PURPOSE This aim of this study was to compare the impact on hospital stay and short-term overall complications prior to and following the introduction of an outpatient preoperative ostomy education program to an existing inpatient ostomy education program. DESIGN A comparison cohort study. SUBJECTS AND SETTING One hundred thirty-eight consecutive patients undergoing ostomy surgery were included. One group (n = 65, 47%) was given an experimental preoperative ostomy education intervention, along with standard care including a postoperative educational intervention during the initial hospital course. A second group (n = 73, 53%) received the same standardized education in the postoperative period. Data were collected from a single tertiary center located in Seville, Spain, during a 12-month period between July 2014 and June 2015. METHODS Data were collected in 2 phases. Data from participants undergoing postoperative (standard) education were collected retrospectively. Data for the group receiving preoperative education were collective prospectively. Outcome variables were postoperative length of stay, surgical complications (severity was assessed by the Clavien-Dindo grading system), subsequent interventions, and readmission rates. RESULTS Analysis indicated no differences between the average length of postoperative hospital stay (12.32 days in the preoperative education group vs 12.76 days in the postoperative education group, P = .401). In contrast, overall complications, mortality, and readmission rates were significantly higher in the preoperative education program group (P = .027, P = .047, and P = .046, respectively). CONCLUSIONS Delivering a standardized educational intervention during the preoperative period versus postoperative education delivery during the ostomy surgery hospital course did not reduce length of stay. Analysis indicated that overall complications, mortality, and readmission rates were significantly higher in the preoperative education program group but we hypothesize that intervening factors may have influenced these outcomes.
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Affiliation(s)
- Ana María García-Cabrera
- Ana María García-Cabrera, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
- Fernando de la Portilla de Juan, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
- Laura Navarro-Morales, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
- Sebastián Ribera García, CNS, Virgen del Rocío University Hospital, Seville, Spain
- María del Carmen Durán Ventura, CNS, Virgen del Rocío University Hospital, Seville, Spain
- Inés Fernández Luque, CNS, Virgen del Rocío University Hospital, Seville, Spain
- Francisco Javier Padillo-Ruiz, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
| | - Fernando de la Portilla de Juan
- Ana María García-Cabrera, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
- Fernando de la Portilla de Juan, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
- Laura Navarro-Morales, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
- Sebastián Ribera García, CNS, Virgen del Rocío University Hospital, Seville, Spain
- María del Carmen Durán Ventura, CNS, Virgen del Rocío University Hospital, Seville, Spain
- Inés Fernández Luque, CNS, Virgen del Rocío University Hospital, Seville, Spain
- Francisco Javier Padillo-Ruiz, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
| | - Laura Navarro-Morales
- Ana María García-Cabrera, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
- Fernando de la Portilla de Juan, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
- Laura Navarro-Morales, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
- Sebastián Ribera García, CNS, Virgen del Rocío University Hospital, Seville, Spain
- María del Carmen Durán Ventura, CNS, Virgen del Rocío University Hospital, Seville, Spain
- Inés Fernández Luque, CNS, Virgen del Rocío University Hospital, Seville, Spain
- Francisco Javier Padillo-Ruiz, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
| | - Sebastián Ribera García
- Ana María García-Cabrera, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
- Fernando de la Portilla de Juan, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
- Laura Navarro-Morales, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
- Sebastián Ribera García, CNS, Virgen del Rocío University Hospital, Seville, Spain
- María del Carmen Durán Ventura, CNS, Virgen del Rocío University Hospital, Seville, Spain
- Inés Fernández Luque, CNS, Virgen del Rocío University Hospital, Seville, Spain
- Francisco Javier Padillo-Ruiz, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
| | - María Del Carmen Durán Ventura
- Ana María García-Cabrera, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
- Fernando de la Portilla de Juan, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
- Laura Navarro-Morales, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
- Sebastián Ribera García, CNS, Virgen del Rocío University Hospital, Seville, Spain
- María del Carmen Durán Ventura, CNS, Virgen del Rocío University Hospital, Seville, Spain
- Inés Fernández Luque, CNS, Virgen del Rocío University Hospital, Seville, Spain
- Francisco Javier Padillo-Ruiz, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
| | - Inés Fernández Luque
- Ana María García-Cabrera, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
- Fernando de la Portilla de Juan, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
- Laura Navarro-Morales, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
- Sebastián Ribera García, CNS, Virgen del Rocío University Hospital, Seville, Spain
- María del Carmen Durán Ventura, CNS, Virgen del Rocío University Hospital, Seville, Spain
- Inés Fernández Luque, CNS, Virgen del Rocío University Hospital, Seville, Spain
- Francisco Javier Padillo-Ruiz, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
| | - Francisco Javier Padillo-Ruiz
- Ana María García-Cabrera, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
- Fernando de la Portilla de Juan, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
- Laura Navarro-Morales, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
- Sebastián Ribera García, CNS, Virgen del Rocío University Hospital, Seville, Spain
- María del Carmen Durán Ventura, CNS, Virgen del Rocío University Hospital, Seville, Spain
- Inés Fernández Luque, CNS, Virgen del Rocío University Hospital, Seville, Spain
- Francisco Javier Padillo-Ruiz, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
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Banasiewicz T, Kobiela J, Cwaliński J, Spychalski P, Przybylska P, Kornacka K, Bogdanowska-Charkiewicz D, Leyk-Kolańczak M, Borejsza-Wysocki M, Batycka-Stachnik D, Drwiła R. Recommendations on the use of prehabilitation, i.e. comprehensive preparation of the patient for surgery. POLISH JOURNAL OF SURGERY 2023; 95:62-91. [PMID: 38348849 DOI: 10.5604/01.3001.0053.8854] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Prehabilitation is a comprehensive preparation of a patient for primarily surgical treatments. Its aim is to improve the patient'sgeneral condition so as to reduce the risk of complications and ensure the fastest possible recovery to full health. Thebasic components of prehabilitation include: improvement of nutritional status, appropriate exercises to improve functioning,psychological support, and help in eliminating addictions. Other important aspects of prehabilitation are: increasinghemoglobin levels in patients with anemia, achieving good glycemic control in patients with diabetes, treatment or stabilizationof any concurrent disorders, or specialist treatment associated with a specific procedure (endoprostheses, ostomyprocedure). This article organizes and outlines the indications for prehabilitation, its scope, duration, and the method to conductit. Experts of various specialties related to prehabilitation agree that it should be an element of surgery preparationwhenever possible, especially in patients with co-existing medical conditions who have been qualified for major procedures.Prehabilitation should be carried out by interdisciplinary teams, including family physicians and various specialists in thetreatment of comorbidities. Prehabilitation requires urgent systemic and reimbursement solutions.
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Affiliation(s)
- Tomasz Banasiewicz
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Jarosław Kobiela
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Transplantacyjnej, Gdański Uniwersytet Medyczny
| | - Jarosław Cwaliński
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Piotr Spychalski
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Transplantacyjnej, Gdański Uniwersytet Medyczny
| | - Patrycja Przybylska
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Karolina Kornacka
- Oddział Chirurgii Ogólnej, Onkologicznej i Kolorektalnej, Wielospecjalistyczny Szpital Miejski im. J. Strusia, Poznań
| | | | - Magdalena Leyk-Kolańczak
- Zakład Pielęgniarstwa Chirurgicznego, Klinika Chirurgii Ogólnej, Endokrynologicznej i Transplantacyjnej, Gdański Uniwersytet Medyczny
| | - Maciej Borejsza-Wysocki
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Dominika Batycka-Stachnik
- Oddział Kliniczny Chirurgii Serca, Naczyń i Transplantologii, Krakowski Szpital Specjalistyczny im. Św. Jana Pawła II, Kraków
| | - Rafał Drwiła
- Katedra i Zakład Anestezjologii i Intensywnej Terapii, Collegium Medicum Uniwersytet Jagielloński, Kraków
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Olivia M, Allister S, Jeongyoon M, Marie D, Richard G, Carol-Ann V, Fateme R, Marylise B. An online educational and supportive care application for rectal cancer survivors with low anterior resection syndrome: A mixed methods pilot study. Colorectal Dis 2023; 25:1812-1820. [PMID: 37501348 DOI: 10.1111/codi.16665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/19/2023] [Accepted: 04/30/2023] [Indexed: 07/29/2023]
Abstract
AIM Restorative proctectomy is commonly associated with significant bowel dysfunction, known as low anterior resection syndrome (LARS), which has a negative impact on patients' quality of life. We developed an online patient-centred application on LARS (eLARS) for rectal cancer survivors. The primary objective of this study was to assess the feasibility of eLARS for rectal cancer survivors with LARS following restorative proctectomy. The secondary objective was to explore participants' experiences with LARS and the eLARS application. METHODS This was a mixed methods study, which included a feasibility and qualitative analysis. Participants were rectal cancer survivors who underwent restorative proctectomy for rectal cancer within 3 years, completed all adjuvant treatment, and suffered from bowel dysfunction postoperatively. Participants were given access to the application over a 2-month study period. Feasibility was defined as 75% of study participants using the application ≥4 times per month. Semi-structured interviews were conducted with participants after the study period and were analysed using thematic analysis. RESULTS Our sample included eight rectal cancer survivors, five women and three men. The median age was 58.5 years (56.5-64.5). Most participants (75%) were >1-year post-restorative proctectomy. 75% of study participants used the application ≥4 times per month for 2 months. Our thematic analysis revealed that participants felt that they lacked access to credible information and emotional support around the time of ileostomy closure, and found that eLARS addressed these challenges. CONCLUSION eLARS is a feasible educational and supportive care intervention for patients with LARS and has the potential to improve patients' quality of life.
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Affiliation(s)
- Monton Olivia
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Smith Allister
- Department of Emergency Medicine, Western University, London, Ontario, Canada
| | - Moon Jeongyoon
- Department of Surgery, Division of General Surgery, McGill University, Montreal, Quebec, Canada
| | - Demian Marie
- Department of Surgery, Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, Quebec, Canada
| | - Garfinkle Richard
- Department of Surgery, Division of General Surgery, McGill University, Montreal, Quebec, Canada
| | - Vasilevsky Carol-Ann
- Department of Surgery, Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, Quebec, Canada
| | - Rajabiyazdi Fateme
- Department of Systems and Computer Engineering, Carleton University, Ottawa, Ontario, Canada
| | - Boutros Marylise
- Department of Surgery, Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, Quebec, Canada
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Duque PA, Valencia Rico CL, Campiño Valderrama SM, López González LA. Effects of Socio-educational Interventions on the Quality of Life of People with a Digestive Ostomy. SAGE Open Nurs 2023; 9:23779608231177542. [PMID: 37255580 PMCID: PMC10226308 DOI: 10.1177/23779608231177542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 05/01/2023] [Accepted: 05/06/2023] [Indexed: 06/01/2023] Open
Abstract
Introduction The creation of digestive stomata is associated with a change in people's lives. Causing a strong impact that influences all dimensions of life. This paper reports on the effects of socio-educational interventions on the quality of life (QOL) of people with a digestive ostomy. Objective To describe the effect of a nursing intervention on the QOL of people with a digestive ostomy. Methods A quasiexperimental study was conducted whose sample consisted of 12 people who were ostomized in a public hospital in Colombia. Participants were selected through convenience sampling and randomly assigned to the intervention group and the control group. For the control group, an educational process was carried out through a theoretical session with virtual mediation (educational video). The QOL was evaluated before and after the interventions through the Montreux questionnaire. Results The average age was 57(+7) years. No statistical differences were found between the groups in the QOL index or for any of the dimensions that make up QOL. Pretest and post-test analysis for each intervention separately showed improvement in two dimensions of QOL for each group; in the intervention group body image dimension (p = .017) and the positive coping dimension (p = .027). In the control group, the physical well-being dimension (p = .037) and social concerns dimension (p = .034). Conclusions The personalized educational intervention or carried out through virtual pedagogical mediation, generated a clinically significant increase in the dimensions of QOL, without statistical differences. The study adds knowledge about the impact that digestive stomata have on the QOL, which is why it is necessary to establish specialized interdisciplinary teams to care for the person's new condition at home during the following months.
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Affiliation(s)
- Paula A. Duque
- Catholic University of Manizales,
Nursing Program, Manizales, Colombia
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Nizum N, Jacob G. Systematic Review of Ostomy Care Pathways. Adv Skin Wound Care 2022; 35:290-295. [PMID: 35442921 DOI: 10.1097/01.asw.0000823976.96962.b6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate if ostomy care pathways improve outcomes for adults anticipating or living with an ostomy. DATA SOURCES In this systematic review, the authors searched the MEDLINE, CINAHL, Cochrane Central, and EMBASE databases. STUDY SELECTION Studies were included if they met the following criteria: written in English, targeted adults anticipating or currently living with an ostomy, evaluated the impact of two or more components of an ostomy care pathway, and included one or more of the pertinent outcomes (patient satisfaction, hospital length of stay, hospital readmission rates, and staff satisfaction). DATA EXTRACTION Details recorded included design, setting, descriptions of intervention and control groups, patient characteristics, outcomes, data collection tools, effect size, and potential harms. DATA SYNTHESIS Of 5,298 total records, 11 met the inclusion criteria: 2 randomized controlled trials and 9 nonrandomized studies. The overall quality of the studies was low. Of the four studies that examined patient satisfaction, all studies reported improvement or positive satisfaction rates. Of the six studies that evaluated hospital length of stay, five noted a decrease in length of stay. Of the eight studies that evaluated hospital readmission rates, five found a reduction in hospital readmission rates. No studies reported on staff satisfaction. CONCLUSIONS Ostomy care pathways included preoperative education and counseling, postoperative education and discharge planning, and outpatient home visits and telephone follow-ups. Ostomy care pathways may contribute to patient satisfaction and decrease both hospital length of stay and hospital readmission rates. However, higher-quality literature is needed to be confident in the effectiveness of ostomy care pathways.
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Affiliation(s)
- Nafsin Nizum
- At the Registered Nurses' Association of Ontario in Toronto, Ontario, Canada, Nafsin Nizum, MN, RN, is Senior Manager, Research and Guideline Development, and Greeshma Jacob, MScN, RN, is Guideline Development Methodologist, Best Practice Guideline Development & Research Team
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Martinez-Cannon BA, Perez ACT, Hincapie-Echeverri J, Roy M, Marinho J, Buerba GA, Akagunduz B, Li D, Soto-Perez-de-Celis E. Anal cancer in older adults: A Young International Society of Geriatric Oncology review paper. J Geriatr Oncol 2022; 13:914-923. [DOI: 10.1016/j.jgo.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/06/2022] [Accepted: 04/06/2022] [Indexed: 02/07/2023]
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Pinto Pinto IS, Queirós S, Alves P, Sousa Carvalho TM, Santos C, Brito A. Nursing Interventions to Promote Self-Care in a Candidate for a Bowel Elimination Ostomy: Scoping Review. AQUICHAN 2022. [DOI: 10.5294/aqui.2022.22.1.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives: To identify nursing interventions, their characteristics, and outcomes for promoting self-care in candidates for a bowel elimination ostomy.
Materials and methods: A scoping review was carried out based on the Joanna Briggs Institute’s recommendations. For this, studies published in Portuguese, English, and Spanish on the Web of Science, CINAHL, and Scopus databases and without a time limit were selected on November 9, 2020.
Results: Of 2248 articles identified, 41 were included in this review. We identified 20 nursing interventions associated with the self-care of patients with an ostomy; most of them have gaps in their content, method, and frequency or dosing. More than 30 indicators were identified to assess the impact of nursing interventions; however, most of them were indirect assessments.
Conclusion: There is scarce evidence regarding the different aspects that must be involved in nursing interventions for patients with a stoma. Moreover, there is no standardization in methods, frequency, or dosing of intervention. It is urgent to define the content, method, and frequency of nursing interventions necessary to promote self-care in patients with a bowel elimination ostomy and to use assessment tools that directly measure stoma self-care competence.
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Goodman W, Allsop M, Downing A, Munro J, Taylor C, Hubbard G, Beeken RJ. A systematic review and meta-analysis of the effectiveness of self-management interventions in people with a stoma. J Adv Nurs 2021; 78:722-738. [PMID: 34708416 DOI: 10.1111/jan.15085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/20/2021] [Accepted: 10/16/2021] [Indexed: 11/28/2022]
Abstract
AIMS Explore the evidence from randomized controlled trials for the effect of self-management interventions on quality of life, self-management skills and self-efficacy, and to explore which intervention characteristics are associated with effectiveness. DESIGN Systematic review. DATA SOURCES A search of the literature was conducted in these databases: MEDLINE (OVID), EMBASE (OVID) and PsychINFO (OVID) from January 2000 to February 2020. REVIEW METHODS Studies were included if participants had a bowel stoma, were over the age of 18 and the design was a randomized controlled trial of a self-management programme. The outcome measures for this review were quality of life, self-management skills and self-efficacy. The Behaviour Change Technique Taxonomy was used to code interventions for underlying components and alongside other intervention characteristics, associations with improvements in outcomes were explored. RESULTS The search identified 3141 articles, 16 of which were eligible. A meta-analysis of self-efficacy scores from five studies (N = 536) found an improvement in those that received the self-management intervention at follow-up with a 12-point mean difference compared with the usual care group. Effects on quality of life and self-management skills were mixed, and meta-analyses of these data were not possible. Across 13 studies an average of 10 behaviour change techniques were used with, credible source (e.g. nurse, doctor, therapist) (n = 13), instruction on how to perform the behaviour (n = 13), demonstration of the behaviour (n = 12) used most often. The behaviour change technique of self-monitoring was associated with an improvement in quality of life. The involvement of a nurse was associated with higher self-efficacy and self-management skills. CONCLUSION This review suggests that self-management interventions can increase peoples' self-efficacy for managing their stoma. IMPACT A standardized approach to the reporting of interventions and the measures used is needed in future studies to better understand the effect on quality of life and self-management skills.
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Affiliation(s)
| | | | - Amy Downing
- School of Medicine, University of Leeds, Leeds, UK
| | - Julie Munro
- Department of Nursing, University of the Highlands and Islands, Inverness, UK
| | | | - Gill Hubbard
- Department of Nursing, University of the Highlands and Islands, Inverness, UK
| | - Rebecca J Beeken
- School of Medicine, University of Leeds, Leeds, UK.,Research Department of Behavioural Science and Health, University College London, London, UK
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Booth AT, Curran T. Preoperative optimization and enhanced recovery for colorectal surgery. SEMINARS IN COLON AND RECTAL SURGERY 2021. [DOI: 10.1016/j.scrs.2021.100827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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12
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Tejedor P, González Ayora S, Ortega López M, León Arellano M, Guadalajara H, García-Olmo D, Pastor C. Implementation barriers for Enhanced Recovery After Surgery (ERAS) in rectal cancer surgery: a comparative analysis of compliance with colon cancer surgeries. Updates Surg 2021; 73:2161-2168. [PMID: 34143398 DOI: 10.1007/s13304-021-01115-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/11/2021] [Indexed: 02/06/2023]
Abstract
We aim to analyze differences in compliance between colon and rectal cancer surgeries under Enhanced Recovery After Surgery (ERAS) for colorectal procedures, and to detect implementation barriers for rectal cancer surgeries. Patients who underwent elective rectal cancer surgeries under ERAS were case-matched based on gender, age, and P-POSSUM with an equal number of patients who underwent colonic surgeries. Achievements of ≥ 70% of ERAS items were considered an acceptable level of compliance. A multivariate analysis was carried out to identify independent risk factors for lower compliance. A total of 434 patients were included over a 5-year period. After matching, there were 111 patients in each group. Overall compliance was significantly lower in the rectal surgery group (73% vs 82%, p = 0.001). A good compliance rate differed from 55% in rectal vs 77.5% in colonic procedures (p = 0.000). We identified three independent risk factors for lower compliance rates: open surgical approach, the use of epidural catheter, and the presence of postoperative ileus. Our data showed that rectal cancer surgeries are more exigent to success on ERAS interventions when compared to colonic resections. There is a need to introduce specific modifications on the protocols for colorectal surgeries when applied to these particular procedures.
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Affiliation(s)
- Patricia Tejedor
- Colorectal Surgery Department, University Hospital Gregorio Marañón, Calle del Dr. Esquerdo, 46, Madrid, Spain. .,Colorectal Surgery Department, University Hospital Fundación Jiménez Díaz, Madrid, Spain.
| | | | - Mario Ortega López
- Colorectal Surgery Department, University Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Miguel León Arellano
- Colorectal Surgery Department, University Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Hector Guadalajara
- Colorectal Surgery Department, University Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Damián García-Olmo
- Colorectal Surgery Department, University Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Carlos Pastor
- Colorectal Surgery Department, University Hospital Fundación Jiménez Díaz, Madrid, Spain.,Colorectal Surgery Department, University Clinic of Navarre, Madrid, Spain
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Garfinkle R, Loiselle CG, Park J, Fiore JF, Bordeianou LG, Liberman AS, Morin N, Faria J, Ghitulescu G, Vasilevsky CA, Bhatnagar SR, Boutros M. Development and evaluation of a patient-centred program for low anterior resection syndrome: protocol for a randomized controlled trial. BMJ Open 2020; 10:e035587. [PMID: 32474427 PMCID: PMC7264642 DOI: 10.1136/bmjopen-2019-035587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Low anterior resection syndrome (LARS) is described as disordered bowel function after rectal resection that leads to a detriment in quality of life, and affects the majority of individuals following restorative proctectomy for rectal cancer. The management of LARS includes personalised troubleshooting and effective self-management behaviours. Thus, affected individuals need to be well informed and appropriately engaged in their own LARS management. This manuscript describes the development of a LARS patient-centred programme (LPCP) and the study protocol for its evaluation in a randomised controlled trial. METHODS AND ANALYSIS This will be a multicentre, randomised, assessor-blind, parallel-groups, pragmatic trial evaluating the impact of an LPCP, consisting of an informational booklet, patient diaries and nurse support, on patient-reported outcomes after restorative proctectomy for rectal cancer. The informational booklet was developed by a multidisciplinary LARS team, and was vetted in a focus group and semistructured interviews involving patients, caregivers, and healthcare professionals. The primary outcome will be global quality of life (QoL), as measured by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (QLQ-C30), at 6 months after surgery. The treatment effect on global QoL will be modelled using generalised estimating equations. Secondary outcomes include symptom change, patient activation, bowel function measures, emotional distress, knowledge about LARS and satisfaction with the LPCP. ETHICS AND DISSEMINATION The Research Ethics Committee (REC) at the Integrated Health and Social Services Network for West-Central Montreal (health network responsible for the Jewish General Hospital) is the overseeing REC for all Quebec sites. They have granted ethical approval (MP-05-2019-1628) for all Quebec hospitals (Jewish General Hospital, McGill University Health Center, CHU de Quebec) and have granted full authorisation to begin research at the Jewish General Hospital. Patient recruitment will not begin at the other Quebec sites until inter-institutional contracts are finalised and feasibility/authorisation for research is granted by their respective REC. The results of this study will be presented at national and international conferences, and a manuscript with results will be submitted for publication in a high-impact peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT03828318; Pre-results.
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Affiliation(s)
- Richard Garfinkle
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, Quebec, Canada
| | - Carmen G Loiselle
- Department of Oncology, McGill University, Montreal, Quebec, Canada
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Jason Park
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Julio F Fiore
- Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Liliana G Bordeianou
- Section of Colon and Rectal Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - A Sender Liberman
- Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nancy Morin
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, Quebec, Canada
| | - Julio Faria
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, Quebec, Canada
| | - Gabriela Ghitulescu
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, Quebec, Canada
| | - Carol-Ann Vasilevsky
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, Quebec, Canada
| | - Sahir R Bhatnagar
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Marylise Boutros
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, Quebec, Canada
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Dellafiore F, Pittella F, Arrigoni C, Baroni I, Conte G, Di Pasquale C, Casole L, Villa G, Caruso R. A multi‐phase study for the development of a self‐efficacy measuring scale for ostomy care nursing management. J Adv Nurs 2019; 76:409-419. [DOI: 10.1111/jan.14242] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/14/2019] [Accepted: 10/15/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Federica Dellafiore
- Health Professions Research and Development Unit IRCCS Policlinico San Donato San Donato Milanese Italy
| | - Francesco Pittella
- Health Professions Research and Development Unit IRCCS Policlinico San Donato San Donato Milanese Italy
| | - Cristina Arrigoni
- Department of Public Health, Experimental and Forensic Medicine Section of Hygiene University of Pavia Pavia Italy
| | - Irene Baroni
- Health Professions Research and Development Unit IRCCS Policlinico San Donato San Donato Milanese Italy
| | - Gianluca Conte
- Paediatric Intensive Care Unit IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation Milan Italy
| | | | - Lorenzo Casole
- Health Professions Research and Development Unit IRCCS Policlinico San Donato San Donato Milanese Italy
| | - Giulia Villa
- Unit of Urology IRCCS San Raffaele Scientific Institute Milan Italy
| | - Rosario Caruso
- Health Professions Research and Development Unit IRCCS Policlinico San Donato San Donato Milanese Italy
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15
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Scientific and Clinical Abstracts From WOCNext 2019. J Wound Ostomy Continence Nurs 2019. [DOI: 10.1097/won.0000000000000530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Cavallaro P, Bordeianou L. Implementation of an ERAS Pathway in Colorectal Surgery. Clin Colon Rectal Surg 2019; 32:102-108. [PMID: 30833858 DOI: 10.1055/s-0038-1676474] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Enhanced Recovery after Surgery (ERAS) protocols have been demonstrated to improve hospital length of stay and outcomes in patients undergoing colorectal surgery. This article presents the specific components of an ERAS protocol implemented at the authors' institution. In particular, details of both surgical and anesthetic ERAS pathways are provided with explanation of all aspects of preoperative, perioperative, and postoperative care. Evidence supporting inclusion of various aspects within the ERAS protocol is briefly reviewed. The ERAS protocol described has significantly benefitted postoperative outcomes in colorectal patients and can be employed at other institutions wishing to develop an ERAS pathway for colorectal patients. A checklist is provided for clinicians to easily reference and facilitate implementation of a standardized protocol.
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Affiliation(s)
- Paul Cavallaro
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Liliana Bordeianou
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
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17
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The Effects of Patient Care Results of Applied Nursing Intervention to Individuals With Stoma According to the Health Belief Model. Cancer Nurs 2018; 43:E87-E96. [PMID: 30543570 DOI: 10.1097/ncc.0000000000000678] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Individuals who have undergone stoma surgery take time to adjust to the stoma, and their quality of life is decreasing. OBJECTIVE The aim of this study was to examine the effects of home-based nursing interventions informed by the Health Belief Model on patient care outcomes for individuals having a stoma. METHODS This pretest, posttest, and semiexperimental design with a control group included adults who underwent a stoma operation in the previous 3 months. In total, 30 were assigned to the experimental group and 31 to the control group. Study forms included a sociodemographic questionnaire, the Stoma Quality of Life Scale, the Ostomy Adjustment Inventory, and the Pittman Complication Severity Index. RESULTS After home nursing interventions, there was a significant difference between the compliance rates of the individuals in the experimental group and the complication rates and cost averages (P < .05) with individuals in the control group; no significant difference in quality-of-life scores was found between the 2 groups. CONCLUSION In order to effectively support postoperative individuals following stoma surgery when they are released from the hospital, postdischarge follow-up care informed by the Health Belief Model components should be offered. IMPLICATIONS FOR PRACTICE We recommend creating hospital-based, home care teams that follow individuals with a stoma for at least 6 months after discharge.
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18
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Kandagatla P, Nikolian VC, Matusko N, Mason S, Regenbogen SE, Hardiman KM. Patient-Reported Outcomes and Readmission after Ileostomy Creation in Older Adults. Am Surg 2018. [DOI: 10.1177/000313481808401141] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Because of the concern about risk of poor outcome, ileostomy creation is sometimes avoided in older adults. We sought to evaluate the effect of a rigorous postoperative pathway and checklist on readmission and self-efficiacy in older surgical patients. After implementing a self-care checklist and standardized care pathway at our institution, we performed a retrospective review of patients between June 2013 and June 2016 and compared characteristics and outcomes for patients aged <65 and ≥65 years. Using logistic regression, we identified independent predictors of readmission. We also conducted a survey of patient self-efficacy after discharge to assess independence. There were 288 younger patients and 72 older patients. The older group had more patients with an American Society of Anesthesiologists >2 (53.0% vs 81.4%, P < 0.01) and were more likely to have had surgery for cancer (22.9% vs 48.5%, P < 0.01). In the multivariable analyses, age was not a predictor of readmission but American Society of Anesthesiologist and length of stay were. In the 57 patients surveyed after discharge, we found that older and younger patients reported similar self-efficacy scores. In our study, older and younger patients have similar rates of readmission and similar ability to independently care for their themselves after ileostomy creation.
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Affiliation(s)
- Pridvi Kandagatla
- Department of Surgery, Henry Ford Health System/Wayne State University, Detroit, Michigan and
| | - Vahagn C. Nikolian
- Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Niki Matusko
- Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Shayna Mason
- Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Scott E. Regenbogen
- Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Karin M. Hardiman
- Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
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David JG, Jofriet A, Seid M, Margolis PA. "A Guide to Gutsy Living": Patient-Driven Development of a Pediatric Ostomy Toolkit. Pediatrics 2018; 141:peds.2017-2789. [PMID: 29610402 PMCID: PMC5914495 DOI: 10.1542/peds.2017-2789] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2017] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jennie G. David
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania
| | | | - Michael Seid
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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Institution of a Preoperative Stoma Education Group Class Decreases Rate of Peristomal Complications in New Stoma Patients. J Wound Ostomy Continence Nurs 2017; 44:363-367. [PMID: 28549049 DOI: 10.1097/won.0000000000000338] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE The purpose of this study was to compare selected postoperative complications (including stomal and peristomal complications), hospital length of stay, and readmission rates in a group of patients who attended a preoperative educational intervention to a retrospective group of patients who did not receive the intervention. DESIGN Retrospective, comparison cohort study. SUBJECTS AND SETTING The intervention group comprised 124 patients who attended an educational session for persons with fecal ostomies at a single tertiary care center in the Northeastern United States. They were compared to findings from a group of 94 individuals who underwent ostomy surgery during a 1-year period before initiation of the class. Patients undergoing emergent procedures or who had previous stomas were excluded. We found no significant differences between the 2 cohorts with respect to age, gender, comorbidities, open versus minimally invasive procedures, or colorectal diagnoses. METHODS A preoperative 2-hour stoma education class was led by certified WOC nurses for all patients undergoing colorectal surgeries in which the creation of a stoma was anticipated. This session included a didactic portion outlining postoperative expectations in the management of new ostomies (including dietary changes, prevention of dehydration, and an overview of ostomy supplies), as well as a hands-on portion to practice stoma care skills. We compared postoperative complications within 30 days (particularly stoma-related complications, including pouch leakage due to loss of seal, and peristomal skin irritation) between the group attending the education session and the control group. We also compared length of stay and 30-day readmission rates. RESULTS Patients who participated in the educational intervention experienced significantly fewer peristomal complications than did patients in the historic control group (44.7% vs 20.2%, P = .002). Logistic regression analysis revealed that participation in the group was associated with a lower likelihood of peristomal skin complications (odds ratio = 0.35; 95% confidence interval, 0.18-0.67). Their length of stay (median 6 days vs 5 days, P = NS), and the proportion who experienced 30-day readmission (20.2% vs 15.3%, P = NS), did not significantly differ. CONCLUSIONS A preoperative stoma education group class significantly reduced the likelihood of frequent leakage from the ostomy pouching system and peristomal skin irritation.
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21
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Faury S, Koleck M, Foucaud J, M'Bailara K, Quintard B. Patient education interventions for colorectal cancer patients with stoma: A systematic review. PATIENT EDUCATION AND COUNSELING 2017; 100:1807-1819. [PMID: 28602564 DOI: 10.1016/j.pec.2017.05.034] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/15/2017] [Accepted: 05/25/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To describe the various types of patient education interventions for colorectal cancer patients with stoma and to examine their effects on quality of life, psychosocial skills and self-management skills. METHODS A systematic review was performed. Six electronic databases were searched. Inclusion criteria were: studies about patient education applying quantitative methods including digestive stoma adults with colorectal cancer. The primary outcome was quality of life. Secondary outcomes were psychosocial and self-management skills. RESULTS Thirteen studies were identified and included. Five studies examined quality of life and three reported improvements. Patient education improved some psychosocial and self-management skills. Contrasting findings were reported for specific-disease quality of life, emotional distress, length of hospital stay, stoma complications and readmission rate. CONCLUSIONS Patient education has a positive impact on some psychosocial and self-management skills, indicating that this area should be developed. Contrasting findings were reported for quality of life. Methodologies are heterogeneous making it difficult to produce evidence-based guidelines. This article proposes tools to carry out further studies on this subject and to improve understanding. PRACTICE IMPLICATION Further education intervention for stoma patients with colorectal cancer should be standardized in terms of intervention, duration and outcome measures to compare intervention and determine best practice.
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Affiliation(s)
- Stéphane Faury
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, F-33000 Bordeaux, France.
| | - Michèle Koleck
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, F-33000 Bordeaux, France
| | - Jérôme Foucaud
- "Laboratoire Educations et Pratiques de Santé", EA 3412, Univ. Paris-13 Sorbonne, Paris Cité, 93017 Bobigny, France
| | - Katia M'Bailara
- "Laboratoire de Psychologie", EA 4139, Univ. Bordeaux, Bordeaux, F-33076, France
| | - Bruno Quintard
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, F-33000 Bordeaux, France
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Sier MF, Oostenbroek RJ, Dijkgraaf MGW, Veldink GJ, Bemelman WA, Pronk A, Spillenaar-Bilgen EJ, Kelder W, Hoff C, Ubbink DT. Home visits as part of a new care pathway (iAID) to improve quality of care and quality of life in ostomy patients: a cluster-randomized stepped-wedge trial. Colorectal Dis 2017; 19:739-749. [PMID: 28192627 DOI: 10.1111/codi.13630] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 12/12/2016] [Indexed: 12/13/2022]
Abstract
AIM Morbidity in patients with an ostomy is high. A new care pathway, including perioperative home visits by enterostomal therapists, was studied to assess whether more elaborate education and closer guidance could reduce stoma-related complications and improve quality of life (QoL), at acceptable cost. METHOD Patients requiring an ileostomy or colostomy, for any inflammatory or malignant bowel disease, were included in a 15-centre cluster-randomized 'stepped-wedge' study. Primary outcomes were stoma-related complications and QoL, measured using the Stoma-QOL, 3 months after surgery. Secondary outcomes included costs of care. RESULTS The standard pathway (SP) was followed by 113 patients and the new pathway (NP) by 105 patients. Although the overall number of stoma-related complications was similar in both groups (SP 156, NP 150), the proportion of patients experiencing one or more stoma-related complications was significantly higher in the NP (72% vs 84%, risk difference 12%; 95% CI: 0.3-23.3%). Although in the NP more patients had stoma-related complications, QoL scores were significantly better (P < 0.001). In the SP more patients required extra care at home for their ostomy than in the NP (60.6% vs 33.7%, respectively; risk difference 26.9%, 95% CI: 13.5-40.4%). Stoma revision was done more often in the SP (n = 11) than in the NP (n = 2). Total costs in the SP did not differ significantly from the NP. CONCLUSION The NP did not reduce the number of stoma-related complications but did lead to improved quality of care and life, against similar costs. Based on these results the NP, including perioperative home visits by an enterostomal therapist, can be recommended.
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Affiliation(s)
- M F Sier
- Department of Surgery, University Medical Centre Leiden, Leiden, The Netherlands
| | - R J Oostenbroek
- Department of Surgery, Albert Schweitzer Hospital Dordrecht, Dordrecht, The Netherlands
| | - M G W Dijkgraaf
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - G J Veldink
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - W A Bemelman
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - A Pronk
- Department of Surgery, Diakonessen Hospital Utrecht, Utrecht, The Netherlands
| | | | - W Kelder
- Department of Surgery, Martini Hospital Groningen, Groningen, The Netherlands
| | - C Hoff
- Department of Surgery, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - D T Ubbink
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
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Forsmo HM, Pfeffer F, Rasdal A, Sintonen H, Körner H, Erichsen C. Pre- and postoperative stoma education and guidance within an enhanced recovery after surgery (ERAS) programme reduces length of hospital stay in colorectal surgery. Int J Surg 2016; 36:121-126. [PMID: 27780772 DOI: 10.1016/j.ijsu.2016.10.031] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 10/21/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Stoma formation delays discharge after colorectal surgery. Stoma education is widely recommended, but little data are available regarding whether educational interventions are effective. The aim of this prospective study was to investigate whether an enhanced recovery after surgery (ERAS) programme with dedicated ERAS and stoma nurse specialists focusing on counselling and stoma education can reduce the length of hospital stay, re-admission, and stoma-related complications and improve health-related quality of life (HRQoL) compared to current stoma education in a traditional standard care pathway. METHODS In a single-center study 122 adult patients eligible for laparoscopic or open colorectal resection who received a planned stoma were treated in either the ERAS program with extended stoma education (n = 61) or standard care with current stoma education (n = 61). The primary endpoint was total postoperative hospital stay. Secondary endpoints were postoperative hospital stay, major or minor morbidity, early stoma-related complications, health-related quality of life, re-admission rate, and mortality. HRQoL was measured by the generic 15D instrument. RESULTS Total hospital stay was significantly shorter in the ERAS group with education than the standard care group (median [range], 6 days [2-21 days] vs. 9 days [5-45 days]; p < 0.001). Regarding overall major and minor morbidity, re-admission rate, HRQoL, stoma-related complications and 30-day mortality, the two treatment groups exhibited similar outcomes. CONCLUSION Patients receiving a planned stoma can be included in an ERAS program. Pre-operative and postoperative stoma education in an enhanced recovery programme is associated with a significantly shorter hospital stay without any difference in re-admission rate or early stoma-related complications.
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Affiliation(s)
- H M Forsmo
- Department of Gastrointestinal and Emergency Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Norway.
| | - F Pfeffer
- Department of Gastrointestinal and Emergency Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Norway
| | - A Rasdal
- Department of Gastrointestinal and Emergency Surgery, Haukeland University Hospital, Bergen, Norway
| | - H Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - H Körner
- Department of Clinical Medicine, University of Bergen, Norway; Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - C Erichsen
- Department of Gastrointestinal and Emergency Surgery, Haukeland University Hospital, Bergen, Norway
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Tseng JH, Suidan RS, Zivanovic O, Gardner GJ, Sonoda Y, Levine DA, Abu-Rustum NR, Tew WP, Chi DS, Long Roche K. Diverting ileostomy during primary debulking surgery for ovarian cancer: Associated factors and postoperative outcomes. Gynecol Oncol 2016; 142:217-24. [PMID: 27261325 DOI: 10.1016/j.ygyno.2016.05.035] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 05/27/2016] [Accepted: 05/28/2016] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To examine the use, as well as postoperative and long-term oncologic outcomes of diverting loop ileostomy (DI) during primary debulking surgery (PDS) for ovarian cancer. METHODS Patients with stage II-IV ovarian, fallopian tube, or primary peritoneal carcinoma who underwent colon resection during PDS from 1/2005-1/2014 were identified. Demographic and clinical data were analyzed. RESULTS Of 331 patients, 320 (97%) had stage III/IV disease and 278 (84%) had disease of high-grade serous histology. Forty-four (13%) underwent a DI. There were no significant differences in age, comorbidity index, smoking status, serum albumin, or attending surgeon between the DI and non-DI groups. Operative time (OR=1.21; 95% CI, 1.03-1.42; p=0.02) and length of rectosigmoid resection (OR=1.04; 95% CI, 1.01-1.08; p=0.02) were predictors of DI on multivariable analysis. The overall anastomotic leak rate was 6%. A comparison of groups (DI vs non-DI) showed no significant differences in major complications (30% vs 23%; p=0.41), anastomotic leak rate (5% vs 7%; p=0.60), hospital length of stay (10 vs 9days; p=0.25), readmission rate (23% vs 17%; p=0.33), or interval to postoperative chemotherapy (41 vs 40days; p=0.20), respectively. Ileostomy reversal was successful in 89% of patients. Median follow-up was 52.6months. There were no differences in median progression-free (17.9 vs 18.6months; p=0.88) and overall survival (48.7 vs 63.8months; p=0.25) between the groups. CONCLUSIONS In patients undergoing PDS, those with longer operative time and greater length of rectosigmoid resection more commonly underwent DI. DI does not appear to compromise postoperative outcomes or long-term survival.
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Affiliation(s)
- Jill H Tseng
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rudy S Suidan
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Oliver Zivanovic
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Ginger J Gardner
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Yukio Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Douglas A Levine
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - William P Tew
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Dennis S Chi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Kara Long Roche
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA.
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