Effects of continuous care on health outcomes in patients with stoma: A systematic review and meta-analysis

Objective

Continuing care, which is an extension of post-discharge care, is recognized as a crucial element of high-quality health services and is essential to patients. This systematic review aims to identify the effectiveness of continuing care for patients with stomas.

Methods

PubMed, EMBASE, Cochrane Trial Register and Web of Science databases were searched. Study selection and quality appraisal were performed independently by two reviewers. We calculated the mean differences (MD) or the relative risk (RR) with 95% confidence intervals and assessed heterogeneity.

Results

Nine studies (1134 participants) met the inclusion criteria. This meta-analysis revealed that, in the continuous care group, the stoma self-efficacy (MD ​= ​6.46; 95% CI ​= ​3.81–9.11; P ​< ​0.001; I² ​= ​0%), and the quality of life (MD ​= ​7.48; 95% CI ​= ​5.13–9.82; P ​< ​0.001; I² ​= ​0%) increased significantly 1 month after discharge; stoma adjustment and care satisfaction also showed a trend toward improvement while stoma complications (RR ​= ​0.71; 95% CI ​= ​0.58–0.87; P ​= ​0.001; I² ​= ​25%) decreased significantly. Continuing care did not decrease hospital readmission rates or medical costs.

Conclusions

Continuing care showed beneficial effects in improving health outcomes and care satisfaction for patients with stomas compared with routine care. We proposed an integrated continuing care program with different elements and recommendations for its implementation.

Spatial Experiences of Female Cancer Survivors

A phenomenological approach of the home can inspire research of the ways in which female cancer survivors experience the transition from the oncology care setting to home. Ten gynecological cancer survivors were interviewed. The analysis was inspired by the hermeneutic approach described by Ricoeur, and followed an interpretive structure that consisted of naïve reading, structural analysis, and comprehensive understanding. Based on the women’s stories, we argue that we are beings for whom home is a developed extension of ourselves, and one that is particularly significant insofar as it provides us with a basis from which we find ourselves able to expand into a larger “space”—a world. Information from this study could provide guidelines for health care staff members.

Information needs across the colorectal cancer care continuum: scoping the literature

Because cancer care requires a multifaceted approach, providing useful and timely information to people with colorectal cancer may be fragmented and inconsistent. Our interest was in examining what has and has not captured the attention of researchers speaking to the information needs of people with colorectal cancer. We followed Arksey and O'Malley's framework for the methodology of scoping review. Focusing solely on colorectal cancer, we analysed 239 articles to get a picture of which information needs and sources of information, as well as the timing of providing information, were attended to. Treatment-related information received the most mentions (26%). Healthcare professionals (49%) were mentioned as the most likely source of information. Among articles focused on one stage of the care continuum, post-treatment (survivorship) received the most attention (16%). Only 27% of the articles consulted people with colorectal cancer and few attended to diet/nutrition and bowel management. This study examined the numerical representation of issues to which researchers attend, not the quality of the mentions. We ponder, however, on the relationship between the in/frequency of mentions and the actual information needs of people with colorectal cancer as well as the availability, sources and timing of information.

Patient satisfaction with colorectal cancer follow-up system: an audit

Although there have been studies into intensive follow-up versus non-intensive follow-up of patients following colorectal surgery, the evidence has not demonstrated sufficient benefit in the intensive follow-up regimen to warrant change in practice nationally, and there are no national guidelines for this. Currently at the authors' hospital the follow-up is non-intensive, and consists of an initial nurse-led surgical follow-up, dedicated patient hotline telephone number, surveillance, symptom list and open access to the nurse-led clinic as required. An audit was carried out to determine patient satisfaction with the current method of follow-up and to identify areas for improvement. The majority of patients (95%) were 'very or fairly' happy with the current service. Areas for improvement were identified. The key point from the survey was that patients would like a follow-up phone call post-diagnosis and 48 hours post-discharge from hospital. This has been implemented since the audit.