Cancer survivors’ challenges with ostomy appliances and self-management: a qualitative analysis

Defining Opportunities to Improve Perioperative Ostomy Care and Education

Objective

We sought to qualitatively identify opportunities to improve perioperative ostomy care and education.

Background

Patients with a new ostomy utilize ostomy care-related resources to manage their ostomy. Many patients experience ostomy-related issues after surgery.

Methods

In this qualitative study, patients who underwent the construction of a new ostomy, their caregivers, and healthcare professionals were purposively recruited for semistructured phone interviews. Interviews included questions about ostomy-related experiences, education, and resources in the perioperative phases of care. Interviews were transcribed and thematically coded using inductive content analysis with NVivo 12 Software. Focus groups of patients, caregivers, and healthcare professionals were conducted to validate themes.

Results

Overall, 53 interviews including 20 patients, 16 caregivers, and 17 healthcare professionals were conducted. The average age of patients and caregivers was 59 years, 69% were non-Hispanic White, 72% were female, and 39% had limited health literacy. Themes in the preoperative phase included "not knowing what to expect regarding an ostomy," "patient difficulty understanding their health condition," and "overwhelming amount of information regarding an ostomy." Inpatient phase themes included "not knowing the best ostomy supplies to use," "challenges with ostomy appliance application," and "lack of patient acceptance and maladjustment." Postdischarge themes included "difficulty obtaining supplies," "challenges caring for inflamed skin," "variability in the utility of home healthcare," "missing outpatient resources," and "limited information on hydration and diet management." Themes were subsequently validated in focus groups.

Conclusions

Patients, caregivers, and healthcare professionals reported key perioperative barriers to obtaining, understanding, and utilizing ostomy care-related resources and education. These findings inform the development of interventions to improve ostomy care and education.

Self-care concept for people with elimination ostomy: a scoping review

OBJECTIVE

To analyze the literature for terminology, classifications, and factors influencing the adoption of self-care in people with an elimination ostomy.

METHOD

Scoping review, according to JBI methodology and, for structuring the article, the extension of the PRISMA checklist. The search included studies from 2018 to 2023, in four databases, with specific descriptors and alternative terms. Two reviewers selected the sample based on inclusion/exclusion criteria, using the software Rayyan®. The protocol was registered in the Open Science Framework.

RESULTS

Eight studies were included, which presented differences in the scope of the concept and classification of self-care. Names such as capacity, index, and level were used. Four tools were identified for assessing self-care. The factors that positively influenced self-care were female sex, being young, married, higher education level, pasty effluent, demarcation, social support, and education. Those influencing negatively were stress, complications, and inadequate care.

CONCLUSION

The concept of self-care for people with elimination ostomies is not standardized and is most often reduced to procedural self-care.

Impact of Ahmadi Continuing Nursing Model on self-care ability, stoma complications and quality of life of colostomy patients

OBJECTIVE

To analyze the effects of Ahmadi Continuing Nursing Model (ACNM) on the self-care ability, stoma complications and life quality in colostomy patients.

METHODS

The clinical data of 120 patients who underwent postoperative colostomy in our hospital from June 2020 to June 2023 were retrospectively analyzed. The patients were divided into control group (n = 60, treated with routine nursing) and observation group (n = 60, treated with the ACNM on the basis of routine nursing) according to different nursing methods. Postoperative recovery of gastrointestinal function, ostomy adaptability, self-care ability, and life quality before and after nursing were compared. The probability of complications before and after nursing was recorded between the two groups.

RESULTS

The time of first exhaust was 3.65 ± 0.82 d, the time of first meal was 1.83 ± 0.65 d, and the first bowel sound recovery was 1.47 ± 0.53 d in the observation group, which were shorter than those in the control group (4.38 ± 1.20 d, 3.12 ± 1.15 d, 2.39 ± 1.06 d, P < 0.001). After intervention, the positive emotions in the ostomy adaptation score were 32.09 ± 5.03 points, negative emotions were 31.41 ± 5.70 points, social life adaptation were 27.12 ± 4.98 points, and the total score was 90.78 ± 5.98 points in the observation group, which were significantly higher than those in the control group (26.32 ± 4.52 points, 24.25 ± 6.02 points, 20.25 ± 4.02 points, 67.25 ± 6.09 points, P < 0.001). The self-willingness was 34.18 ± 4.02 points, self-care skill was 10.57 ± 2.23 points, self-care knowledge was 18.59 ± 3.10 points, and the total score was 63.18 ± 4.98 points in the observation group, which were significantly higher than those in the control group (25.25 ± 3.08 points, 8.72 ± 2.13 points, 15.26 ± 2.70 points, 45.69 ± 4.09 points, P < 0.001). The physical function was 79.74 ± 2.81 points, psychological function was 76.71 ± 3.05 points, social function was 78.11 ± 3.50 points, and material life status was 60.06 ± 2.98 points in the quality of life in the observation group, which were significantly higher than those in the control group (75.36 ± 2.68 points, 69.72 ± 2.93 points, 72.33 ± 3.42 points, 51.23 ± 3.08 points, P < 0.001).

CONCLUSION

ACNM effectively promoted the recovery of gastrointestinal function after surgery in colostomy patients by improving patients' stoma adaptability, self-care ability and life quality and reducing the occurrence of complications, which was worthy of promotion.

Stoma Perceptions of Adults with an Ostomy: A Metaphor Analysis in a Single Center

OBJECTIVE

To use metaphor to evaluate stoma perceptions among adults with ostomies to conceptualize and portray their lived experiences using a figurative approach.

METHODS

A qualitative research design was used. Participants were 27 adults with an ostomy who were followed up in the stoma therapy unit. Individuals were included in the study if they had had a temporary or permanent ostomy for at least 2 months and spoke Turkish. Participants were asked to complete the sentence: "Stoma is like…/similar to… because…." The researchers used content analysis to evaluate participants' responses. Interpretation of the metaphors developed by participants was carried out in five phases: coding, example metaphor compilation, theme development, ensuring trustworthiness, and transferring.

RESULTS

Participants expressed a total of 17 unique and 10 repeated metaphors for the concept of "stoma." These metaphors were grouped under three different themes: positive (lifesaving), negative (punishment/enemy), and neutral (temporary/necessity for life). The most commonly used metaphors were life, savior, comfort, difficulty, fear, punishment, and necessity.

CONCLUSIONS

Individuals with an ostomy mostly had negative metaphorical associations with stomas. The authors recommend that hospitals implement multifaceted interventions to bring positive metaphors to individuals with ostomies.

Life with a stoma across five European countries-a cross-sectional study on long-term rectal cancer survivors

PURPOSE

Stoma-related problems are known to be important to patients and potentially affect everyday life. The prevalence of stoma-related problems in rectal cancer survivors remains undetermined. This study aimed to examine aspects of life with a long-term stoma, stoma management, and stoma-related problems and explore the impact of stoma-related problems on daily life.

METHODS

In total, 2262 patients from 5 European countries completed a multidimensional survey. Stoma-related problems were assessed using the Colostomy Impact score. Multivariable regression analysis, after adjusting for potential confounding factors, provided odds ratio (OR) and 95% confidence intervals (CI) for stoma-related problems' association with restrictions in daily life.

RESULTS

The 2262 rectal cancer survivors completed the questionnaire at a median of 5.4 years (interquartile range 3.8-7.6) after stoma formation. In the total sample, leakage (58%) and troublesome odour (55%) were most prevalent followed by skin problems (27%) and pain (21%). Stoma-related problems were more prevalent in patients with parastomal bulging. A total of 431 (19%) reported feeling restricted in daily activities in life with a stoma. Leakage, odour, skin problems, stool consistency, and frequent appliance changes were significantly associated with restrictions in daily life. The highest risk of experiencing restrictions was seen for patients having odour (OR 2.74 [95% CI: 1.99-3.78]) more than once a week and skin problems (OR 1.77 [95% CI: 1.38-2.27]).

CONCLUSION

In this large cohort with rectal cancer, stoma-related problems were highly prevalent and impacted daily life. Supportive care strategies should entail outreach to patients with a long-term stoma.

CONSTRUÇÃO E VALIDADE DA ESCALA DO NÍVEL DE ADAPTAÇÃO DA PESSOA COM ESTOMIA

Objetivo:Construir e validar o conteúdo da escala de verificação do nível de adaptação da pessoa com estomia. Método: Estudo metodológico envolvendo duas etapas: construção baseada em duas revisões integrativas da literatura e estudo qualitativo com pessoas com estomia; e validade de conteúdo com juízes dos seguintes critérios: comportamental, objetividade, relevância, clareza, simplicidade, variedade em relação à linguagem; realização do teste-piloto com o grupo-alvo; correção léxica e gramatical e nova submissão para o índice de validade de conteúdo. Resultados: Na primeira etapa, treze itens receberam sugestões de melhoria, três itens foram unificados por similaridade e um foi excluído. Após os ajustes, alcançou-se consenso dos juízes quanto à representatividade dos itens e à permanência nos modos a partir dos critérios avaliados. A população-alvo julgou os itens como de fácil entendimento ocorrendo em seguida correção gramatical e lexical. Conclusão: A escala apresentou evidência de validade de conteúdo demonstrando consenso entre os juízes e a população-alvo.

CONSTRUCTION AND VALIDITY OF THE ADAPTATION LEVEL SCALE OF THE PERSON WITH OSTOMY

Objective: To construct and validate the content of the scale for verifying the level of adaptation of the person with ostomy. Method: Methodological study involving two stages: construction based on two integrative literature reviews and qualitative study with people with stomas; and content validity with judges of the following criteria: behavioral, objectivity, relevance, clarity, simplicity, variety in relation to language; carrying out the pilot test with the target group; lexical and grammatical correction and resubmission to the content validity index. Results: in the first stage, thirteen items received suggestions for improvement, three items were unified by similarity and one was excluded. After the adjustments, a consensus was reached among the judges regarding the representativeness of the items and permanence in the modes based on the evaluated criteria. The target population judged the items as easy to understand, followed by grammatical and lexical correction. Conclusion: The scale presented evidence of content validity demonstrating consensus between the judges and the population.

Stakeholder engagement and participation in the design, delivery, and dissemination of the ostomy self-management telehealth (OSMT) program

PURPOSE

Stakeholder engagement is increasingly integrated into clinical research processes. We conducted a mixed methods analysis to describe stakeholders' (peer ostomates, ostomy nurses, telehealth engineers) perceptions of their engagement and participation in a multisite, randomized trial of a telehealth-delivered curriculum for cancer survivors with ostomies.

METHODS

Stakeholder notes were analyzed using narrative analysis. We constructed a 15-item survey that assessed the following areas: adherence to stakeholder engagement principles, engagement/influence throughout the study process, impact on perceived well-being, and satisfaction. Stakeholders were invited to complete the survey anonymously. Quantitative survey data were tabulated through summary statistics.

RESULTS

Across intervention sessions, an average of 7.7 ± 1.4 stakeholders attended and 2.6 ± 1.4 submitted a note per session. The survey response rate was 73% (11/15). Stakeholders reported high agreement that the study adhered to engagement principles (91% reciprocal relationships, 100% co-learning, partnership, and transparency/honesty/trust). They felt highly engaged (18% moderate, 73% great deal) and that they had influence on study initiation (27% moderate, 55% great deal), intervention delivery (9% moderate, 82% great deal), fidelity assessment (18% moderate, 73% great deal), analysis and interpretation (55% moderate, 27% great deal), and dissemination (45% moderate, 45% great deal). They reported high overall satisfaction with roles (91% great deal), believed the program was helpful for participants (91%), and that serving on study team benefited their own well-being (100%).

CONCLUSIONS

Our strategy of stakeholder inclusion led to high engagement, input, satisfaction, and belief in success of program, which could be mirrored in other trials.

Autocuidado de pessoas com estomias intestinais

Objetivo: compreender as dificuldades enfrentadas pelas pessoas com estomias intestinais a partir das vivências de autocuidado. Método: trata-se de estudo descritivo, qualitativo, realizado com 30 pessoas com estomias intestinais, em um Centro Especializado em Reabilitação no Rio Grande do Norte, de abril a junho de 2017. A entrevista semiestruturada foi gravada, transcrita e os dados coletados foram analisados seguindo os pressupostos da análise de conteúdo de Bardin. Resultados: a partir das vivências de autocuidado mencionadas pelos participantes, emergiram as dificuldades agrupadas nas categorias: higiene e manuseio do equipamento coletor; necessidades de cuidado com a pele periestomal; equipamento coletor e os episódios de vazamento; convívio social após a estomia; dificuldades e potencialidades da assistência de Enfermagem. As pessoas com estomias apresentaram dificuldades relacionadas à limpeza do estoma, recorte do equipamento coletor, aparecimento de complicações periestomiais, vazamentos de efluentes, afastamento de atividades sociais e informações insuficientes sobre o autocuidado. Considerações Finais: diante das dificuldades encontradas, torna-se necessário refletir sobre as mudanças nas práticas assistenciais para desenvolver o autocuidado da população com estomias, as quais podem se beneficiar do uso de tecnologias educativas instituídas desde o período pré-operatório. Este estudo contribui para a compreensão das experiências de autocuidado vivenciadas por essa população a serem abordadas pela enfermagem na promoção da educação em saúde. Além disso, espera-se que o estudo subsidie pesquisas com novas estratégias para fortalecer a assistência a esse público e o avanço da ciência de Enfermagem.

Factors predictive of optimal peristomal skin status in patients with an ostomy: a secondary analysis

Peristomal skin problems are common in ostomy patients and are connected to decreased quality of life and patient independence, as well as increased treatment costs. This study analysed the factors related to peristomal skin changes in order to better define the clinical profile of patients with optimal peristomal skin status. Secondary analysis of data from a nationwide, cross-sectional, retrospective, multicentre study performed in Spain (Uses and Attitudes in Ostomy) (Bueno Cruz et al, 2021) evaluated clinical data, including demographics, preoperative stoma site marking, type of ostomy, device used, frequency of leakage and scores from the Ostomy Skin Tool (OST) and quality of life (QoL) questionnaires. Risk factors for peristomal skin changes were analysed using multivariate analysis, and a predictive nomogram to anticipate optimal peristomal skin status (defined here as discolouration (D), erosion (E), and tissue overgrowth (T) (DET) score of 0) was developed. Some 871 patients with an ostomy using different commercial devices in Spain were evaluated. Multivariate analysis to predict optimal peristomal skin status revealed leakage frequency, patient age, type of ostomy, preoperative siting and type of baseplate used were independent predictors of peristomal skin status. Optimal peristomal skin care should be a treatment goal for nurse specialists in stomal therapy, and its individual influencing variables should be taken into account by nurses specialising in ostomy care.

Programmatic Costs of the Telehealth Ostomy Self-Management Training: An Application of Time-Driven Activity-Based Costing

OBJECTIVES

Programmatic cost assessment of novel clinical interventions can inform their widespread dissemination and implementation. This study aimed to determine the programmatic costs of a telehealth Ostomy Self-Management Training (OSMT) intervention for cancer survivors using Time-Driven Activity-Based Costing (TDABC) methodology.

METHODS

We demonstrated a step-by-step application of TDABC based on a process map with core OSMT intervention activities and associated procedures and determined resource use and costs, per unit procedure. We also assessed per-patient costs from a payer perspective and provided estimates of total hours and costs by personnel, activity, and procedure.

RESULTS

The per-patient cost of the OSMT was $1758. Personnel time accounted for 91% of the total cost. Site supervisor and information technology technician time were the most expensive personnel resources. Telehealth technical and communication equipment accounted for 8% of the total cost. Intervention coordination and monitoring efforts represented most of the total time cost (62%), followed by the intervention delivery (35%). The procedures with the highest cost were communication via phone or virtual meetings (24%), email exchanges (18%), and telehealth session delivery (18%).

CONCLUSIONS

Future efforts to replicate, disseminate, and implement the OSMT intervention should anticipate funding for nonclinical components of the intervention, including coordination and monitoring, and consider how these activities can be performed most efficiently. For institutions without established telemedicine programs, selection of videoconferencing platforms and adequate staffing for participant technical support should be considered. Our step-by-step application of TDABC serves as a case study demonstrating how interventionists can gather data on resource use and costs of intervention activities concurrently with their collection of trial data.

Factors associated to quality of life in people with intestinal stomas

OBJECTIVE

To assess the quality of life of people with intestinal stoma and its association with sociodemographic and clinical characteristics.

METHOD

Cross-sectional and analytical study conducted with people with intestinal stoma. An instrument was used for sociodemographic and clinical characterization: COH-QOL-OQ, validated in Brazil.

RESULTS

The sample included 152 people with stomas. There were significant differences among all dimensions (p-value < 0.01) of quality of life. The dimension spiritual well-being had the highest mean, with 6.69 (±1.56), followed by the psychological well-being dimension, 5.00 (±1.94), social well-being, 4.63 (±1.83), and physical well-being, 4.54 (±1.77). Marital status, religion, type of stoma, and permanence had statistically significant associations with dimensions of quality of life (p-value < 0.05).

CONCLUSION

The assessment of quality of life in people with intestinal stoma presented lower scores in the physical, social, and psychological dimensions. There was an association between better quality of life scores and people with definitive ileostomy, in a domestic partnership and practicing other religions.

"Living with a Stoma": Exploring the Lived Experience of Patients with Permanent Colostomy

INTRODUCTION

Living with a permanent colostomy brings severe changes in patients' lives. The general health status as well as the personal, social and professional life of patients are significantly affected.

AIM

The aim of the present study was to investigate the lived experience of patients undergoing permanent colostomy.

MATERIAL AND METHODS

A qualitative research design based on interpretive phenomenology was carried out. Semi-structured interviews were conducted as the data collection method to obtain in-depth information regarding the research topic. The study sample consisted of eight (8) patients who had undergone a permanent colostomy. The data analysis was performed by the method of content analysis.

RESULTS

From the analysis of the data, three main themes emerged, namely: (A) Experiencing a traumatic event; (B) Living a new reality; (C) Efforts to improve quality of life. Five subthemes were formulated which were encompassed within the respective main themes accordingly.

CONCLUSION

Patients with permanent colostomy face significant life changes that are experienced in a traumatic way. Issues such as autonomy, family and organizational support, self-management and empowerment can significantly improve the patients' quality of life. Further research, regarding caregivers' experience, improved community nursing care as well as nurses' views on the needs of colostomy patients and their families, is suggested.

Sociodemographic characteristics and self-care management knowledge of patients with an ostomy

BACKGROUND

An increasing number of patients worldwide are living with an ostomy. Among them, self-care management skills and stoma self-care abilities are associated with better quality of life.

AIMS

To identify the sociodemographic and clinical characteristics of Italian ostomy patients and investigate their knowledge of stoma management.

METHODS

A questionnaire was used to gather the sociodemographic and clinical data of 433 adult patients. Participants responded to a nine-item survey assessing their knowledge of stoma management.

FINDINGS

Respondents reported having received extensive or adequate information in 64.4% of cases, and the remaining 35.6% reported receiving little or no information at any time. The health professional who imparted at least adequate information was a stoma nurse specialist in 32.1% of cases, usually during admission (24.0%) or before and during admission (19.6%).

CONCLUSION

This study demonstrated that most patients received adequate information regarding the ostomy.

[How do patients manage their urostomy in everyday life? A questionnaire survey]

INTRODUCTION

The complications of stoma and peristomal are encountered by nearly 80% of patients within two years of surgery. The objective of this study was to evaluate the practical modalities of daily management of stoma and possible skin complications in a series of patients with non-continent urinary stoma.

METHODS

Monocentric study by questionnaires including all patients with non-continent urinary stoma between 2007 and 2019 in a French university center. The STOMA-QOL and a self-report questionnaire with 15 specific questions were used.

RESULTS

Among the 87 patients included in the analysis whose median age was 71 years, 57.5% used a 2-piece system, 69% used leg or thigh pockets, 74.7% were self-sufficient in emptying their stoma pockets. Autonomy on cutaneous support change was 38%. 62.1% of patients reported a peristomal skin event and 74.7% reported leaking stoma. In multivariate analysis, BMI>30, the presence of leaks and physical activity were significantly associated with the onset of peristomal skin events.

CONCLUSION

This study sheds light on the practical modalities of management of urinary stoma and the occurrence of skin complications related to stoma in terms of frequency and predisposing factors. The results obtained are likely to guide practitioners in the information of future operations and in the management of complications of urinary stoma.

LEVEL OF EVIDENCE

III.

'Because Everybody is so Different': a qualitative analysis of the lived experiences and information needs of rectal cancer survivors

OBJECTIVE

To (1) characterise (A) the lived experiences and (B) information needs of patients with rectal cancer; and (2) compare to the perceived lived experiences and information needs of colorectal surgeons.

DESIGN

We conducted 1-hour semistructured qualitative interviews, dual independent transcript coding and thematic analysis.

SETTING/PARTICIPANTS

Interviews included rectal cancer survivors (stages I-III), some accompanied by caregivers, at Dartmouth-Hitchcock Medical Center and experienced colorectal surgeons.

RESULTS

We performed 25 interviews involving 30 participants, including 15 patients with 5 caregivers, plus 10 physicians. Two major themes emerged. First, patients reported major impacts on their lives following rectal cancer, including on their everyday lives and leisure activities; identity, self-confidence and intimacy; mental health, especially anxiety. These impacts were mediated by their medical experiences, lifestyle and attitudes. Second, the diversity of effects on patients' lives means that care, counselling and information needs should be personalised for a better medical experience and outcomes. Surgeons did not report knowledge of the full range of patient experiences and reported limited counselling in key areas, particularly concerning intimacy and mental health.

CONCLUSION

Rectal cancer diagnosis, treatment and survivorship dramatically affect all people, regardless of which surgical treatment they undergo. Effects are varied and necessitate customised care, counselling and information, which surgeons are not currently providing. Because rectal cancer affects every part of patients' lives, they need holistic support and information. Patients would benefit from substantial support after treatment as they establish a new normal.

Ostomy Self-Management Training Intervention for Cancer Survivors: Technology-Related Findings from a Randomized Trial

BACKGROUND

Ostomy Self-Management Telehealth (OSMT) intervention by nurse-educators and peer-ostomates can equip new ostomates with critical knowledge regarding ostomy care. A telehealth technology assessment aim was to measure telehealth engineer support requirements for telehealth technology related (TTR) incidents encountered during OSMT intervention sessions held via a secure cloud videoconferencing service, "Zoom for Healthcare".

OBJECTIVE

This paper examines technology challenges, issues, and opportunities encountered in the use of telehealth in the setting of an intervention RCT for cancer survivors living with a permanent ostomy.

METHODS

The Arizona Telemedicine Program (ATP) provided telehealth engineering support for 105 scheduled 90-120-minute OSMT sessions over a two-year period. OSMT groups included up to 15 participants, comprised of four to six ostomates, four to six peer-ostomates, two nurse educators, and one telehealth engineer. OSMT session TTR incidents were recorded contemporaneously in detailed notes by research study staff. TTRs were categorized and tallied.

RESULTS

102 of 105 (97%) OSMT sessions were completed as scheduled. Three OSMT sessions were not held due to non-technology related reasons. Of the 93 ostomates who participated in OSMT sessions, 80 (86%) completed their OSMT curriculum. TTR incidents occurred in 35.3% of completed sessions with varying disruptive impact. Zero sessions were cancelled or rescheduled due to TTR incidents. Disruptions resulting from TTR incidents were minimized by following TTR incident prevention and incident response plans.

CONCLUSIONS

Telehealth videoconferencing technology can enable ostomates to participate in ostomy self-management education by incorporating dedicated telehealth engineering support. OSMT potentially greatly expands availability of ostomy self-management education to new ostomates.

CLINICALTRIAL

Ostomy Telehealth For Cancer Survivors (PCORI) NCT02974634.

The development of a behaviour questionnaire for stoma self-management for persons with bladder cancer and an ileal conduit

AIMS

To develop and preliminarily test the reliability and validity of a behaviour questionnaire for stoma self-management for patients with bladder cancer after radical cystectomy and ileal conduit.

DESIGN

A psychometric instrument validation study conducted in two phases.

METHODS

The initial version of behaviour questionnaire was developed based on guidelines for people living with a stoma. Five experts validated the content of the preliminary 29-item questionnaire. A cross-sectional survey was then conducted in Beijing for preliminary reliability and validity tests between 4 December 2017-28 April 2018. A total of 151 participants in the survey, 147 of whom completed the study and 16 completed a 2-week test-retest reliability test.

RESULTS

The content validity indices were satisfied. A principal component analysis with direct oblimin rotation was performed. Sixteen items were retained, and three factors were identified, namely, pouching system change, emotional management, and role management. The 16-item questionnaire showed acceptable internal consistency and test-retest reliability. The mediational effect of self-management behaviour on the relationship between self-efficacy and stoma quality of life was confirmed via convergent validity testing.

CONCLUSION

The behaviour questionnaire for stoma self-management appears to have adequate initial reliability and validity. More observational and interventional studies need to be conducted for further evaluation of its psychometric properties.

IMPACT

This study developed a reliable instrument to measure self-management behaviours for persons living with a stoma after radical cystectomy and ileal conduit. The questionnaire has practical value for both healthcare providers and researchers working in this field. The 16-item questionnaire can be administered quickly in clinical practice. Based on the questionnaire and the elicited mediational model, psycho-education programs tailored to improve self-management should be designed, implemented, and re-inspected regarding their effectiveness for the target population in China.