Experiences of wearing support garments by people living with a urostomy

Optimal Delivery of Follow-Up Care After Radical Cystectomy for Bladder Cancer

Purpose of Review

To identify components representing optimal delivery of follow-up care after radical cystectomy because of bladder cancer and report the current level of evidence.

Methods

We conducted a systematic literature search of the following databases: Cochrane, MEDLINE, Embase, CINAHL, Web of Science, Physiotherapy Evidence Database and ClinicalTrials.gov. The search results were managed in Covidence Reference Manager and abstracts were screened by title. Articles relevant to the subject of interest were included and the results are reported narratively.

Results

Several studies have evaluated the positive impact of enhanced recovery after surgery (ERAS) on length of stay, albeit not on the further impact on 90-day postoperative complication rate, functional recovery, or mortality. Minimally invasive surgery may result in a slighter shorter length of stay compared to open surgery. Physical training combined with nutritional intervention can improve functional recovery up to one year after surgery. Nutritional supplements can preserve muscle and bone mass, and potentially improve recovery. Patient education in stoma care and prevention of infection can significantly improve self-efficacy and avoid symptoms of infection postoperatively. Moreover, specific devices like applications (apps) can support these efforts. Continued smoking increases the risk of developing postoperative complications while no evidence was found on the impact of continued alcohol drinking. Currently, there is no evidence on psychological well-being, sexual health, or shared decision making interventions with an impact on rehabilitation after radical cystectomy.

Conclusion

Data are scarce but indicate that peri- and postoperative multi-professional interventions can reduce prevalence of sarcopenia, and improve functional recovery, physical capacity, nutritional status, and self-efficacy in stoma care (level 1 evidence). Continued smoking increases the risk of complications, but the effects of a smoking and alcohol intervention remain unclear (level 3 evidence). The results of this review provide guidance for future directions in research and further attempts to develop and test an evidence-based program for follow-up care after radical cystectomy.

Stoma support garments: a survey on patient information needs, product selection and equity of provision

Many people with a stoma wear support garments, often a belt or underwear, to support the abdominal muscles, secure the stoma and conceal the appliance. There is some evidence that they reduce the risk of a parastomal hernia developing or getting worse. To investigate the experiences of UK adults living with a stoma regarding the use of support garments, a cross-sectional online survey was designed and distributed on social media and via a mailing list. The questionnaire was completed by 1528 people, 598 of whom answered a free-text question. These responses underwent thematic analysis. This article discusses the responses related to information provision, product selection and equity of provision, while separate articles discuss those related to the rationale for wearing stoma support garments. A third of respondents had not received any expert information on support garments and had to rely on their own research to make their selection. Of the 1004 who had received information, the main sources were stoma care nurses (73.4%), commercial suppliers (49.7%), peers (20.9%) and support groups (19.2%). Free-text comments indicated that respondents did not always feel they had been adequately counselled about support garments or shown the range available. Many respondents described restrictions being imposed on the number or range of products they could order. This study highlights the important role stoma care nursing specialists can play in assessment and review of support garments to ensure ostomates select the right product for their prescription.