Multimedia education programme for patients with a stoma: effectiveness evaluation

Nursing interventions for the self-efficacy of ostomy patients: A systematic review

BACKGROUND

Self-efficacy interventions, which include the acquisition of skills that enable patients to manage their health on a daily basis, play a key role in ostomy patients, which leads to significant changes in the quality of life of patients. In this context, nursing interventions to increase self-efficacy of ostomy patients are very important. In this context, nursing interventions are crucial to increase the self-efficacy of ostomy patients.

OBJECTIVES

The aim of this systematic review is to describe nursing interventions for ostomy patients' self-efficacy (primary outcome) and the impact of these interventions on patient outcomes (complications, quality of life, satisfaction, psychological resilience, stoma adaptation) (secondary outcomes).

METHOD

As a systematic review, this study included articles published in PUBMED, Web of Science, Science-Direct, TUBITAK-ULAKBIM, and TRDizin databases between January 2013 and January 2023 that included nursing interventions for self-efficacy ostomy patients. This systematic review was developed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. The risk of bias was assessed using the RoB2 tool developed by Cochrane.

RESULTS

A total of 1211 articles were retrieved from the databases using Turkish and English keywords. Fifteen studies met the study criteria. These studies found that various interventions, such as training, telephone follow-up, psychosocial support groups, or mobile applications provided to intervention groups, increased self-efficacy, decreased stoma-related complications, improved stoma adaptation, and improved quality of life by increasing patients' knowledge and awareness of stoma.

CONCLUSION

Nursing interventions to improve the self-efficacy and adaptation of ostomy patients are critical. This improvement leads to a reduction in adverse patient outcomes and ostomy complications, shorter hospital stays, and increased patient and nurse satisfaction.

Management of adult intestinal stomas: The 2023 French guidelines

AIM

Digestive stoma are frequently performed. The last French guidelines have been published twenty years ago. Our aim was to update French clinical practice guidelines for the perioperative management of digestive stoma and stoma-related complications.

METHODS

A systematic literature review of French and English articles published between January 2000 and May 2022 was performed. Only digestive stoma for fecal evacuation in adults were considered. Stoma in children, urinary stoma, digestive stoma for enteral nutrition, and rare stoma (Koch, perineal) were not included.

RESULTS

Guidelines include the surgical landmarks to create digestive stoma (ideal location, mucocutaneous anastomosis, utility of support rods, use of prophylactic mesh), the perioperative clinical practice guidelines (patient education, preoperative ostomy site marking, postoperative equipment, prescriptions, and follow-up), the management of early stoma-related complications (difficulties for nursing, high output, stoma necrosis, retraction, abscess and peristomal skin complications), and the management of late stoma-related complications (stoma prolapse, parastomal hernia, stoma stenosis, late stoma retraction). A level of evidence was assigned to each statement.

CONCLUSION

These guidelines will be very useful in clinical practice, and allow to delete some outdated dogma.

Post-discharge health education for patients with enterostomy: A nationwide interventional study

Background

After discharge, patients with enterostomy face problems with poor self-nursing ability and low levels of psychological and social adjustment, which, without timely intervention, seriously affect their quality of life. We delivered health education to discharged enterostomy patients based on a WeChat health management program and evaluated its impact on their ostomy self-care ability and psychosocial adaptation level.

Methods

Based on the WeChat health management program, we conducted continuous health education in the first, third, seventh, 11th, and 23rd weeks after discharge of enterostomy patients/before temporary enterostomy restoration to observe its impact on their self-care ability and psychosocial adaptation levels, as evaluated by an ostomy self-care ability questionnaire and ostomy adjustment inventory-20 checklist.

Results

We included 4201 patients with enterostomy. Our findings showed that the self-care score of patients with enterostomy at discharge (baseline) (mean = 15.23, standard deviation (SD) = 5.22) was lower than that after intervention (mean = 17.71, SD = 1.28) (P < 0.05). The enterostomy psychosocial adaptation score of the enterostomy patients at discharge (baseline) (mean = 44.59, SD = 9.82) was lower than that after intervention (mean = 50.25, SD = 12.97) (P < 0.05).

Conclusions

Health education for enterostomy patients after discharge can improve their self-care ability and psychological adaptation. Future studies could further explore the views and attitudes of this population toward health education based on the WeChat health management program.

A randomized control study: The effectiveness of multimedia education on self-care and quality of life in patients with enterostomy

Colorectal cancer is typically treated through surgery, and self-care skills play a crucial role in disease adaptation and quality of life improvement. Therefore, this study aimed to investigate the effectiveness of a multimedia patient education intervention on enhancing the self-care and quality of life among patients with a postoperative stoma as well as on establishing an easy-to-use ostomy self-care skills assessment. The sample comprised 108 patients with new ostomies who were randomly assigned to two groups. Data were collected from June 2018 to March 2019. The conventional education service program group received individual education in the hospital environment, consisting of four 3-h sessions delivered over 4 consecutive days. The multimedia group viewed a multimedia educational program using a laptop. Data were collected at baseline and 3 months after the intervention using a demographic questionnaire, an ostomy self-care ability scale and the Stoma Quality of Life Scale. Before the intervention, there were no significant differences in self-care ability and quality of life scores between the two groups (p = 0.764 and p = 0.466, respectively). However, 3 months after the intervention, the group that received the multimedia software intervention showed significantly higher self-care ability and quality of life scores compared to the group that received conventional education services (p < 0.001). When a set threshold is reached, self-care ability and a good quality of life can be met. The threshold value of the ostomy self-care skill scale was determined to be 20 points, resulting in a sensitivity of 77.8% and a specificity of 75.5%. The results indicate that the multimedia education program enhanced home self-care ability and quality of life among patients with enterostomy.

The Impact of Health Technologies on Ostomy Care: A Systematic Review of Health Technologies Impact on Ostomy Care

PURPOSE

The purpose of this systematic review was to evaluate studies in which health information technology was used to improve ostomy care and management.

METHODS

Systematic literature review.

SEARCH STRATEGIES

The review was performed according to PRISMA Guidelines. Three scientific databases, Scopus, PubMed, and Web of Science, were searched with no time limitation using key words related to information technology and ostomy. The selection of articles and data collection were carried out by 2 reviewers and disagreements were resolved via discussion with a third, independent reviewer.

FINDINGS

The initial search of electronic databases retrieved 1679 elements; following removal of duplicate records, title and abstract review, and articles read in full for inclusion/exclusion criteria, 10 articles were included in the review. Analysis of findings from studies included in our review addresses technologies used to care for persons living with an ostomy. Elements were divided into 2 categories: (1) sensor-based wearable technologies, which were mostly used to assess the fecal output and fullness of ostomy pouching system, and (2) computer-based, tablet based, and smartphones platforms, which were used for teaching and learning. The most significant outcomes were increasing patients' knowledge and awareness of ostomy, enhancing patient's participation in self-care processes, and improving self-efficacy levels.

IMPLICATIONS FOR PRACTICE

We found limited research regarding the effectiveness of technology-based interventions on the management of ostomy patients. Findings of this systematic review suggest that the application of technologies has created a positive effect on the management of an ostomy, provided opportunities for enhancing self-efficacy, self-care, and self-management. The results of this study can be a basis for designing efficient technology-based systems for the management of ostomy.

Benefits of a Single-Session, In-Hospital Preoperative Education Program for Patients Undergoing Ostomy Surgery: A Randomized Controlled Trial

PURPOSE

The purpose of this study was to compare the effects of a 45-minute session of video-based preoperative ostomy education on self-care knowledge, self-care proficiency, anxiety, depression, length of hospital stay, and ostomy-related complications to a control group who received 3 postoperative educational sessions.

DESIGN

This was a randomized controlled trial.

SAMPLE AND SETTING

The sample comprised 47 patients scheduled to undergo ostomy surgery for colon or rectal cancer surgery at a tertiary referral hospital in Seoul, South Korea, from November 2018 to May 2019. However, 2 participants in the intervention group and 4 in the control group withdrew from the study and data analysis is based on 41 participants who completed study procedures.

METHODS

Participants were randomly allocated to an intervention group (n = 21) or a control group (n = 20). The intervention group received a single 45-minute session of video-based preoperative ostomy education along with stoma site marking and postoperative education. The control group underwent stoma site marking and 3 postoperative education sessions Self-care knowledge, anxiety, and depression were assessed by validated instruments. Self-care proficiency was assessed via direct observation using a checklist. Ostomy-related complications were evaluated by a WOC nurse. Length of hospital stay and disease-related characteristics were collected from medical records.

RESULTS

Compared with the control group, the intervention group showed significant improvements in self-care knowledge (P = .001) and self-care proficiency scores (P = .001). Intervention group participants also had lower anxiety scores (P = .025), depression scores (P = .014), shorter hospital stays (P = .008), and fewer ostomy-related complications (P = .001).

CONCLUSIONS

In patients undergoing ostomy surgery, a single 45-minute session of preoperative video-based ostomy education improved self-care knowledge and proficiency. This intervention also reduced depression, anxiety, and ostomy-related complications.

Nurse's Roles in Colorectal Cancer Prevention: A Narrative Review

The objective of this paper is to investigate the different roles of nurses as members of healthcare teams at the primary, secondary, and tertiary levels of colorectal cancer prevention. The research team conducted a narrative review of studies involving the role of nurses at different levels of colorectal cancer prevention, which included a variety of quantitative, qualitative, and mixed-method studies. We searched PubMed, Scopus, Web of Science, Cochrane Reviews, Magiran, the Scientific Information Database (SID), Noormags, and the Islamic Science Citation (ISC) databases from ab initio until 2021. A total of 117 studies were reviewed. Nurses' roles were classified into three levels of prevention. At the primary level, the most important role related to educating people to prevent cancer and reduce risk factors. At the secondary level, the roles consisted of genetic counseling, stool testing, sigmoidoscopy and colonoscopy, biopsy and screening test follow-ups, and chemotherapy intervention, while at the tertiary level, their roles were made up of pre-and post-operative care to prevent further complications, rehabilitation, and palliative care. Nurses at various levels of prevention care also act as educators, coordinators, performers of screening tests, follow-up, and provision of palliative and end-of-life care. If these roles are not fulfilled at some levels of colorectal cancer, it is generally due to the lack of knowledge and competence of nurses or the lack of instruction and legal support for them. Nurses need sufficient clinical knowledge and experience to perform these roles at all levels.

Feasibility of multimedia animations as preoperative guides for urgent abdominal surgeries in a public hospital in Brazil

Health literacy, culture and language play vital roles in patients' understanding of health issues. Obstacles are more evident in low- and middle-income countries (LMICs), where inadequate patient education levels are higher and hospital resources are lower. This is a prospective pilot study assessing the feasibility of digital preoperative animations as guides for surgical patients. Patients admitted to a public hospital in Brazil for acute cholecystitis or appendicitis were included. Feasibility was represented by acceptability rate and ease of integration with department protocols. Thirty-four patients were included, and 26 patients concluded the intervention (76.5% acceptability rate). Demographic factors seemed to affect the results, indicated by higher acceptability from those with lower education levels, from younger patients and from women. Few studies have evaluated the use of multimedia resources for surgical patients, and no studies assessed the use of animations as digital patient education resources in an LMIC. This study demonstrated that the use of animations for patient education in LMICs is feasible. A step-based approach is proposed to aid the implementation of patient education digital interventions. The use of digital multimedia animations as preoperative guides in LMICs is feasible. It may help improve patient education and promote clinical benefits.

Nursing Interventions to Promote Self-Care in a Candidate for a Bowel Elimination Ostomy: Scoping Review

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.

A systematic review and meta-analysis of the effectiveness of self-management interventions in people with a stoma

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.

Self-care of elderly people with ostomy by colorectal cancer

Objective To identify in literature the scientific production about self-care in elderly people with ostomies by colorectal cancer.

Method Integrative review, performed with the descriptors “self-care”, “ostomy” and “elderly/aged” with the Boolean operator AND in the following databases: SCOPUS, CINAHL, MEDLINE, LILACS and COCHRANE. For the theoretical basis, Orem's Self-Care Deficit Theory was used.

Results A total of 533 papers were found, however, after applying the eligibility criteria, 16 studies composed the final sample of the review.

Conclusion The nurse is one of the professionals closest to the person with the stoma and his family, and should act as a link between the elderly person, the family and the multi-professional health team. In this sense, health professionals, especially nurses, should be trained and competent in assisting the diverse demands of care of this specific population, so that it is effective, resolutive, integral and, above all, humanized, aiming at the improvement of quality of life.

Effectiveness of a Multimedia Patient Education Intervention on Improving Self-care Knowledge and Skills in Patients with Colorectal Cancer after Enterostomy Surgery: A Pilot Study

OBJECTIVE

Colorectal cancer is most commonly treated through surgery. Self-care knowledge and skills are instrumental for disease adaptation once the patient returns home. Therefore, this study examined the effects of a multimedia patient education intervention on improving self-care knowledge and skills in patients with colorectal cancer who underwent colostomy surgery.

METHODS

A quasi-experimental design was adopted to measure the self-care knowledge and skills of patients with colorectal cancer before and after surgery. The experimental group (n = 33) received a multimedia patient education intervention, whereas the control group (n = 30) was provided conventional instructions. Results were evaluated using analysis of covariance.

RESULTS

On the day prior to discharge from hospital, the experimental group exhibited significantly greater improvement in self-care knowledge than did the control group. The experimental group also exhibited significantly greater improvement in self-care skills than did the control group on the day of gas passage, the day prior to discharge from hospital, and during the first clinic visit after discharge from the hospital.

CONCLUSIONS

Multimedia patient education intervention yielded greater improvement in self-care knowledge and skills than did conventional instruction. Therefore, multimedia patient education is an adequate educational tool for patients with colorectal cancer who have undergone colostomy surgery.

Efficacy of education delivery through multimedia and text messaging on the psychological parameters of patients scheduled for coronary angiography: a single-blind randomized controlled clinical trial

Background

Angiography is a highly effective invasive method for diagnosing coronary artery diseases but can lead to certain psychological problems such as stress, anxiety, and depression. This study aimed to compare the effects of education delivery through multimedia DVD content or text messaging in comparison with conventional printed pamphlets on the psychological parameters of patients scheduled for angiography.

Methods

This study was a randomized controlled clinical trial. We used the convenience sampling method to select 120 patients who met the inclusion criteria among individuals who were scheduled for elective coronary angiography. The patients were randomly divided into three groups through the block randomization method. The necessary educational tips for before, during, and after the angiography procedure were delivered to the patients in interventional group 1 (n = 40) and interventional group 2 (n = 40) through text messages and a multimedia DVD, respectively. The control group received routine hospital education through pamphlets besides the opportunity for verbal discussions with nurses. All educational content was delivered to the patients four days before the scheduled day of angiography. The DASS-21 questionnaire, consisting of the three domains of stress, anxiety, and depression, was used to collect the data. The questionnaire was administered at the time of delivering the educational content as the pretest evaluation and 30 min after the angiography procedure as the posttest evaluation. SPSS software, version 18, was used for statistical analysis.

Results

There was no significant difference among the three groups of patients in terms of pretest DASS-21 scores. Conversely, the mean posttest scores in all DASS-21 domains were significantly lower among the patients receiving education via the multimedia DVD or text messaging in comparison with the control group (P < 0.001). However, there were no statistically significant differences between the mean scores in all domains between the participants in the DVD and text messaging groups.

Conclusion

It seems that both DVDs and text messaging are more effective than conventional pamphlets in controlling the anxiety, stress, and stress of patients scheduled for elective coronary artery angiography.

Iranian Registry of Clinical Trials: IRCT registration number: IRCT2015030121283N1, Registration date: 2015-10-05, 1394/07/13

Experiences of Living with Intestinal Ostomy: A Qualitative Meta-Synthesis

Aims and Objectives:

The aim and objective of the study was to identify, compare, and synthesize published qualitative evidence to have in-depth understanding of experiences of patients living with intestinal ostomy.

Background:

Over the past two decades, there have been numerous qualitative studies published depicting intense experiences of stoma patients brought about by the need to adapt with changing conditions following stoma creation. Synthesizing the findings of these studies can improve the understanding among health-care providers of needed support and care for ostomates.

Design:

This was a qualitative meta-synthesis.

Methods:

Published articles were identified from the Medline, CINAHL, SciELO, PsycINFO, PubMed, WOS, Google Scholar and a hand search through selected journals published since 2000, and from references lists. Thirteen articles were selected using the predefined criteria.

Results:

A total of 222 patients, aged between 14 and 83 years from 13 studies, were identified for data collection. Ninety-seven were male and the rest of them were female. The themes identified were physical problems, psychological issues, social relations, environmental impact, and coping and adaptation to stoma.

Conclusions:

The findings of the study identified numerous challenges and limitations in the life of patients with stoma. However, improving their skills of using problem-solving coping strategies and their interactions with other ostomates can help them to live a better and well-adjusted life.

Opportunities for patients to engage in postoperative recovery following cardiac surgery: A systematic narrative review

OBJECTIVE

To compare patient booklets with clinical guidelines and care pathways to assess: gaps in content and depth of information delivered, opportunities for patients participation and to review the trajectory of care to inform recovery.

METHODS

A systematic review of the grey literature was conducted using Google search engine and a variety of terms related to cardiac surgery, patient outcomes and recovery pathways. Patient books and care pathways were obtained from major hospitals in Melbourne. Resources were included if they were published between January 2013-August 2018 and written in English.

RESULTS

A total of 31 resources were included in the review, (n = 14 patient booklets, n = 17 clinician guides). Twenty-one topics of recovery were identified. Patient booklets provided information on more topics of recovery than clinician guides (50 % and 24 % respectively). Clinician guides provided more depth on information on topics of recovery than patient booklets (85 % and 73 % respectively). The majority of patient booklets outlined patient participation was in five topics of recovery.

CONCLUSIONS

Gaps in the type and depth of information exist between patient and clinician guidelines. Clearer guidelines on how patients can participate in care are needed.

PRACTICE IMPLICATIONS

Nurses are key drivers in facilitating patient participation in postoperative recovery.

Effectiveness of avatar-based technology in patient education for improving chronic disease knowledge and self-care behavior: a systematic review

OBJECTIVE

The objective of the review was to examine the effectiveness of patient education using avatar-based technology on knowledge and self-care behaviors in patients with chronic disease.

INTRODUCTION

Chronic disease is a major global problem. Patients with chronic disease who engage in self-care and self-management of their illnesses have better health outcomes and fewer hospitalizations and complications. Currently, information and communication technologies are used to support self-care and improve health outcomes. Within the body of literature, research into avatar-based technology for patient education is growing rapidly. To date, the evidence has not been systematically reviewed to determine the effectiveness of patient education using avatar-based technology on patients' knowledge and self-care behaviors in chronic disease.

INCLUSION CRITERIA

This review included studies of children and adults who have received avatar-based patient education interventions. The comparator was usual care or other forms of educational programs. The outcomes were knowledge, self-care behavior, self-efficacy, health-related quality of life, readmission and medication adherence. Experimental designs were eligible, including non-randomized controlled trials, and quasi-experimental, prospective and retrospective before and after studies.

METHODS

Seven databases, including MEDLINE, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials, ProQuest, Web of Science, Scopus and three other trial registries, including the World Health Organization (WHO), ClinicalTrials.gov and Australian New Zealand Clinical Trials Registry, were systematically searched for studies published between January 2005 and March 2017. Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using the standardized critical appraisal instrument from the Joanna Briggs Institute System for the Unified Management Assessment and Review of Information (JBI SUMARI). Data extracted from papers included specific details about the interventions, populations, study methods and outcomes significant to the review question and specific objectives using the standardized data extraction tool from JBI SUMARI. Due to heterogeneity among the included studies, statistical pooling and meta-analysis were not possible. The results were tabulated, and the data narratively synthesized.

RESULTS

Nine publications from eight studies were included in this review (n = 752). Three out of the eight studies were randomized controlled trials and five were non-randomized experimental studies. The overall quality of the included studies was moderate. There was a low risk of bias for the randomized controlled trial studies and moderate risk of bias for the quasi-experimental studies. Four of the eight studies showed that patients who participated in avatar-based education had a statistically significant improvement in knowledge (p < 0.05). Three studies showed improvement in behaviors and self-efficacy. Only three of eight studies examined health-related quality of life and adherence to medication, but the results were not statistically significant (p > 0.05). No studies identified the effectiveness of avatar-based patient education on readmission.

CONCLUSIONS

Avatar-based technology in patient education can have a positive effect on a wide range of healthcare outcomes. The intervention can improve knowledge, self-care behaviors and self-efficacy in patients with chronic diseases. However, there is limited evidence of improvement in health-related quality of life and adherence to medication, and no available research on readmission.

Effectiveness of Knowledge Translation Strategies in Audiovisual Language Compared With Other Languages to Improve Health Outcomes in Individuals and the General Population: Systematic Review

BACKGROUND

Knowledge translation (KT) not only encompasses a series of final actions in areas of dissemination, but also the identification of strategies for the implementation of this process.

OBJECTIVE

To evaluate the effectiveness of KT strategies in audiovisual language compared with other languages to improve health outcomes in the general population.

METHODS

We performed a search in MEDLINE, CENTRAL, PsycARTICLES, the WHO International Clinical Trials Registry Platform, EMBASE and LILACS.

RESULTS

We included 63 studies encompassing a broad range of study populations, languages that were compared to audiovisual language and measurement scales for outcomes. These studies presented a high risk of bias and the quality of evidence was not sufficient to draw conclusions about the effectiveness of the evaluated languages for knowledge translation.

CONCLUSIONS

We identified different languages that could be used in knowledge translation. The knowledge and the effects produced as a result of the strategy diminish as time progresses, regardless of the type of language used. This is an important point to consider when implementing this type of strategy.

What are the contents of patient engagement interventions for older adults? A systematic review of randomized controlled trials

OBJECTIVE

To describe the contents of interventions reported in RCTs focusing on patient engagement of older adults.

METHODS

A systematic literature review based on a search for "patient engagement/activation/empowerment/involvement/participation". Interventions were classified according to: (i) specific components (micro level), (ii) single/multiple dimensions (educational, behavioral, affective) (meso level), and (iii) the studies' main educational, behavioral or affective dimension (macro level).

RESULTS

After screening 2749 articles, 35 were included. 20 unique components were identified, mostly behavioral or educational (45.5% each) (e.g., goal setting or written informational materials). Most interventions with a single-focus were classified as educational (31%), one was solely affective (3%). Half of the interventions covered more than one dimension, with four (11%) combining all three dimensions. Studies mainly focusing on the affective dimension included older participants (72 vs. 67 years), had a higher proportion of females (71% vs. 44%), and included other dimensions more frequently (67% vs. 31%) than did studies with a main focus on the educational dimension.

CONCLUSION

The contents of the interventions that focused on patient engagement of older adults tend to focus more on behavioral and educational dimensions than the affective dimension.

PRACTICE IMPLICATIONS

The possibility of adding the affective dimension into behavioral and/or educational interventions should be explored.

Video-based patient decision aids: A scoping review

OBJECTIVE

This study reviews the published literature on the use of video-based decision aids (DA) for patients. The authors describe the areas of medicine in which video-based patient DA have been evaluated, the medical decisions targeted, their reported impact, in which countries studies are being conducted, and publication trends.

METHOD

The literature review was conducted systematically using Medline, Embase, CINAHL, PsychInfo, and Pubmed databases from inception to 2016. References of identified studies were reviewed, and hand-searches of relevant journals were conducted.

RESULTS

488 studies were included and organized based on predefined study characteristics. The most common decisions addressed were cancer screening, risk reduction, advance care planning, and adherence to provider recommendations. Most studies had sample sizes of fewer than 300, and most were performed in the United States. Outcomes were generally reported as positive. This field of study was relatively unknown before 1990s but the number of studies published annually continues to increase.

CONCLUSION

Videos are largely positive interventions but there are significant remaining knowledge gaps including generalizability across populations.

PRACTICE IMPLICATIONS

Clinicians should consider incorporating video-based DA in their patient interactions. Future research should focus on less studied areas and the mechanisms underlying effective patient decision aids.

Institution of a Preoperative Stoma Education Group Class Decreases Rate of Peristomal Complications in New Stoma Patients

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.

Patient education interventions for colorectal cancer patients with stoma: A systematic review

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.

A mixed-method study on the generic and ostomy-specific quality of life of cancer and non-cancer ostomy patients

PURPOSE

The aim of this study is to compare the generic and ostomy-specific quality of life (QoL) between cancer and non-cancer ostomy patients using a mixed-method design.

METHODS

All patients with an ostomy participating in the Stomapanel of the Dutch Ostomy Association were asked to complete a generic (RAND-36) and ostomy-specific (Stoma-QoL) QoL questionnaire. In addition, open-ended questions on symptoms, restrictions or adaptations influencing daily life were included. The generic and ostomy-specific QoL between cancer and non-cancer ostomy patients were compared using linear regression analyses. Qualitative responses were analysed using content analysis.

RESULTS

In total, 668 patients were included: 379 cancer patients (80 % colorectal, 17 % bladder and 3 % other) and 289 non-cancer patients (38 % colitis ulcerosa, 22 % Crohn's disease and 40 % other) with a colostomy (55 %), ileostomy (31 %) and/or urostomy (16 %). Adjusted for gender, age, type of ostomy and time elapsed since ostomy surgery, cancer ostomy patients scored higher (better) on Stoma-QoL (β = 2.1) and all RAND-36 domains (9.1 < β ≤ 19.5) except on mental health compared to non-cancer ostomy patients. Of the 33 themes coded for in the content analysis, fatigue or sleeplessness, leakages, pain, bladder or bowel complaints, physical functioning or activity, travelling or being away from home, other daily activities (including work), clothing and diet were among the 10 most frequently reported themes, although ranking differed between both patient groups. Besides, cancer ostomy patients frequently reported on the impact on (engaging in a) relationship or sexual intimacy and non-cancer ostomy patients frequently reported to be relieved of symptoms and restrictions in daily life.

CONCLUSIONS

Cancer patients reported better generic and ostomy-specific QoL than non-cancer ostomy patients. In both cancer and non-cancer ostomy patients, fatigue or sleeplessness, leakages, pain, bladder or bowel complaints, physical functioning or activity, travelling or being away from home, other daily activities (including work), clothing and diet were among the 10 most common reported themes influencing daily life. However, the ranking of these 10 most common themes was different in both patient groups.

Health related quality of life may increase when patients with a stoma attend patient education--a case-control study

Introduction

Adaptation to living with a stoma is complex, and studies have shown that stoma creation has a great impact on patients' health related quality of life. The objective was to explore the effect of a structured patient education program on health related quality of life. Therefore, we implemented interventions aimed at increasing health related quality of life during and after hospital admission.

Materials and Methods

We designed a case/control study aimed at adult patients admitted to the surgical ward for stoma creation, irrespective of type of stoma or reason for creation of stoma. We included 50 patients in the study. Health related quality of life was measured before hospital discharge, three months and six months after stoma creation. The program included educational interventions involving lay-teachers, alongside health professional teachers.

Results

We found a significant rise in health related quality of life in the intervention group (P<0.001) and no significant change in the control group (P = 0.144). However, we found no significant differences when comparing between groups at 3 and 6 months (p = 0.12 and p =  0.63, respective). Additionally, there were differences in scores in health related quality of life baseline (p = 0.045) with lower scores in the intervention group compared with the intervention group. However, there were no significant differences in the demographic variables at baseline

Conclusions

Educational activities aimed at increase in knowledge and focusing on patients' psychosocial needs may lead to a rise in patients' health related quality of life. When patients with a stoma attend a structured patient education program it is possible to improve their health related quality of life compared with patients with a stoma, who do not attend the program.

Trial Registration

ClinicalTrials.gov NCT01154725

Role of 3D animation in periodontal patient education: a randomized controlled trial

AIM

This randomized controlled parallel trial investigates the effect of 3D animation on the increase and recall of knowledge on periodontitis by patients with periodontitis. The effects of a 3D animation (3D animation group) were compared with narration and drawing (control group) for periodontal patient education.

MATERIAL AND METHODS

A total of 68 periodontitis patients were stratified according to educational level and then randomly allocated to control or 3D animation groups. All patients received: (1) a pre-test (baseline knowledge), (2) a patient education video (3D animation or control video), (3) a post-test (knowledge immediately after looking at the video), and (4) a follow-up test (knowledge recall after 2 weeks). Each test contained 10 multiple-choice questions.

RESULTS

There was no significant difference in baseline knowledge. Patients receiving the 3D animations had significantly higher scores for both the post-test and the follow-up test, when compared with patients receiving sketch animations.

CONCLUSION

3D animations are more effective than real-time drawings for periodontal patient education in terms of knowledge recall. 3D animations may be a powerful tool for assisting in the information process.

Patient education has a positive effect in patients with a stoma: a systematic review

AIM

A systematic review was performed to assess whether education of patients having stoma formation improves quality of life and whether it is cost effective.

METHOD

A literature search was performed to identify studies on the structured education of ostomates and outcome using the following databases: MEDLINE, Cinahl, Embase, Cochrane and PsycInfo. Inclusion criteria were: clinical studies reporting effects of educational interventions in relation to patients with a stoma. Commentaries or studies not testing an intervention were excluded.

RESULTS

Seven articles met the inclusion criteria of having rigorously evaluated an educational programme related to living with a stoma. The programmes were organized in different ways and had explored various interventions. The results showed an increase in health-related quality of life, as measured using a stoma quality of life instrument (P = 0.00001) and with the Short Form 36 (SF-36) (P = 0.000-0.006), an increase in proficiency in management of the stoma (P = 0.0005), two studies pointed to a reduction in postoperative hospital stay (8 days vs 10 days, P = 0.029; and 8 days vs 14 days, P = 0.17), a significant reduction in cost in the intervention group ($US 8570.54) compared with the control group ($US 7396.90) as well as higher effectiveness scores in the intervention group (166.89) compared with the control group (110.98), a significant rise in stoma-related knowledge (P = 0.0000) and an increase in psychosocial adjustment (P = 0.000).

CONCLUSION

Structured patient education aimed at patients' psychosocial needs seems to have a positive effect on quality of life as well as on cost. The interventions may be performed before, during or after hospital stay. However, the available data come from few studies with differences in interventions and in study design, and further studies are therefore needed before a final conclusion can be drawn.

On-line bariatric surgery information session as effective as in-person information session

BACKGROUND

All patients at our academic medical center complete a mandatory bariatric surgery information session before scheduling their first clinic visit. The patients could attend an in-person information session or view a prerecorded information session through our Web site. The study aimed to compare the information retention after both delivery methods using an institutional review board-approved test in an academic medical center in the United States.

METHODS

From February 2010 through March 2011, 338 tests were voluntarily completed by new preoperative bariatric patients at their clinic visit. The patients provided basic demographic information, co-morbid medical conditions, and identified which bariatric procedures they were interested in. The test assessed the retention of information delivered during the information session, including knowledge of the risks and benefits of bariatric surgery, the surgical options available at our center, and the steps commonly required for insurance approval. The patients and surgeons were kept unaware of the results.

RESULTS

Of the patients, 54% attended the on-line information session; 80% of these participants were women, and their mean body mass index was 48.09 kg/m(2). The remaining 46% attended the in-person information session, and 83% of these participants were women and their mean body mass index was 49.08 kg/m(2). The average test score was 85.69% for the on-line group and 80.32% for the in-person group. The difference in test scores for the on-line and in-person groups was statistically significant (P = .003).

CONCLUSION

Internet-based training is rapidly becoming a key educational tool. Our results suggest that on-line training has the potential to be as effective as traditional in-person training in educating patients about bariatric surgery. Bariatric surgery centers might consider incorporating on-line training into their educational programs as a convenient and potentially effective way to educate patients.