Psychometric Properties of New Subscales of the Ostomy Adjustment Scale: A Cross-Sectional Study

Experiences and results from using a novel clinical feedback system in routine stoma care nurse follow-up of patients with an ostomy: a longitudinal study

BACKGROUND

A faecal or urinary ostomy may be lifesaving. However, it involves significant bodily change, and the adjustment process to life with an ostomy includes a broad spectre of physical and psychosocial challenges. Thus, new interventions are needed to improve adaptation to living with an ostomy. This study aimed to examine experiences and outcomes using a new clinical feedback system with patient-reported outcome measures in ostomy care.

METHODS

In this longitudinal explorative study, 69 ostomy patients were followed by a stoma care nurse in an outpatient clinic, using a clinical feedback system postoperatively at 3, 6 and 12 months. The patients responded electronically to the questionnaires before each consultation. The Generic Short Patient Experiences Questionnaire was used to measure patient experiences and satisfaction with follow-up. The Ostomy Adjustment Scale (OAS) measured adjustment to life with an ostomy, and the Short Form-36 (SF-36) assessed the patient's health-related quality of life. Longitudinal regression models with time as an explanatory (categorical) variable were used to analyse changes. The STROBE guideline was applied.

RESULTS

The patients were satisfied with their follow-up (96%). Especially, they felt they received sufficient and individualised information, were involved in treatment decisions, and benefited from the consultations. The OAS subscale scores for 'daily activities', 'knowledge and skills' and 'health' improved over time (all p < 0.05), as did the physical and mental component summary scores of the SF-36 (all p < 0.05). Effect sizes of changes were small (0.20-0.40). Sexuality was the most challenging factor reported.

CONCLUSIONS

The clinical feedback system could be helpful because outpatient follow-ups for ostomy patients may be more tailored when clinicians use clinical feedback systems. However, further development and testing are needed.

Factors associated with leakage in patients with an ostomy: A cross-sectional study

AIMS

To explore the associations between sociodemographic and clinical data, the patient's knowledge and skills, and relationship to healthcare professionals with leakage from an ostomy.

DESIGN

Cross-sectional.

METHODS

This study included 160 patients with a colostomy, ileostomy, or urostomy. Leakage was the dependent variable and was assessed by self-report. Sociodemographic and clinical data and the Ostomy Adjustment Scale subscores, 'knowledge and skills' and 'health care professionals' were independent variables. Spearman's rho and multivariate partial least squares regression analysis were used to estimate possible factors associated with leakage.

RESULTS

Of the participants, 13.8% had leakage weekly or more often, 16.3% more often than once a month and 37, 5% had leakage more seldom than once a month. The most important risk factors for leakage were (1) having an ostomy placement that does not meet international guidelines, (2) not having an optimal relationship with health professionals, (3) having a diagnosis other than cancer, (4) not having proper knowledge and skills in ostomy care, (5) not having a colostomy, (6) having a convex baseplate, (7) having an oval ostomy, and (8) being dependent on others for ostomy care. The independent variables in the PLS- model explained 31% of the variance in leakage.

PATIENT OR PUBLIC CONTRIBUTION

We thank the patients in the user panel for their help during the study.

Patient reported outcome measures assessing quality of life in patients with an intestinal stoma: A systematic review

AIM

Living with a stoma can greatly influence quality of life. The purpose of this systematic review was to identify all patient reported outcome measures (PROMs) assessing health related quality of life (HRQoL) or similar constructs related to an intestinal stoma and to evaluate their level of validation.

METHODS

The study was reported in line with PRISMA guidelines. The protocol was registered in PROSPERO prior to the study. Eligible studies were any study investigating psychometric properties of a stoma-specific PROM. The databases MedLine, Embase, CINAHL and Cochrane Libraries were searched for eligible studies. Studies were screened on title and abstract, then full-text for eligibility. Data extraction on the study populations, PROM characteristics, psychometric properties as well as quality assessment using the COSMIN Risk of Bias checklist was performed.

RESULTS

In total, 40 studies were included concerning the development and/or validation of 21 PROMs. For most PROMs, few psychometric properties were assessed. In general, quality of content validity was poor, quality of construct validity and reliability was good. Assessment of responsiveness was lacking.

CONCLUSION

This systematic review offers an overview of existing PROMs measuring stoma-related HRQoL and their psychometric properties. A large number of PROMs exist and their measures overlap considerably. The PROMs generally have a low level of validation, emphasizing the need for future studies to further validate existing PROMs, rather than developing new ones.