Coping and acceptance: the greatest challenge for veterans with intestinal stomas

Self-management goals of cancer survivors with an ostomy

OBJECTIVES

Ostomies due to cancer surgery impose complex and enduring care challenges that necessitate cancer survivors" self-management. The objective of this analysis is to evaluate ostomates' self- management goals using a qualitative approach.

METHODS

A multi-site randomized controlled trial testing the Ostomy Self-Management Training program (OSMT) was delivered via telehealth to a group of cancer survivors with an ostomy randomized to either the OSMT program with goal setting or usual care (UC), without goal setting. Goals were classified by type and frequency according to a modified City of Hope Health-Related Quality of Life framework (physical, psychological, social, spiritual, ostomy-specific, and healthcare quality domains), using a directed and systematic content analysis approach.

RESULTS

The 524 self-management goals analyzed by domain frequencies physical (29.4%), ostomy specific (29.0%) and social well-being (25.0%) were predominant. Managing other health issues (7.6%), psychological issues (6.0%), and spiritual well-being issues (3.0%) were next. Common self-management themes were ostomy care independence (87.5%), handling cancer-related issues (62.5%), achieving acceptance (56.2%), resuming physical activity (43.0%), and maintaining fluid/diet balance (43.0%).

DISCUSSION/CONCLUSION

Goal-setting offers insights into self-management concerns of cancer survivors with ostomies. Results demonstrate the broad aspects of self-management ostomates face.

PRACTICE IMPLICATIONS

Self-management training with patient goal-setting may be used to help ostomates with cancer and their health care providers identify areas for needed education and support.

Does Resilience Predict Ostomy Adjustment in Patients With Permanent Ostomy?

PURPOSE

This study aimed to evaluate associations between resilience and ostomy adjustment in a group of patients with a permanent ostomy.

DESIGN

Descriptive, correlational study.

SUBJECTS AND SETTING

One hundred participants were interviewed; most were male (N = 56; 56%), married (N = 77; 77%), illiterate (N = 46; 46%), and self-employed (N = 35; 35%). The most frequent condition leading to ostomy surgery was colorectal cancer (N = 24; 24%). A majority (N = 43; 43%) had been diagnosed with cancer 1 to 5 years before data collection, and 35 (35%) had lived with an ostomy for 1 to 5 years. Participants were recruited from an ostomy clinic of in Kerman, located in southeastern Iran. Data were collected from August to October 2019.

METHODS

Data were collected via interviews. A questionnaire, developed for purposes of this study, was developed that included items querying demographic and pertinent clinical characteristics and 2 validated instruments, the Resilience Scale and the Ostomy Adjustment Inventory-23 (OAI-23). Data were analyzed using t tests, analysis of variance, Pearson correlation coefficient, and linear regression.

RESULTS

The mean score for ostomy adjustment was 43.37 (SD = 11.57) indicating less than optimal adjustment to life with an ostomy. The mean score of the Resilience Scale was 104.56 (SD = 25.98); most participants (n = 67, 67%) had very low and low resilience. Resilience was weakly associated with ostomy adjustment; specifically, participants who scored higher on the Resilience Scale tended to score higher on the OAI-23 (r = 0.32, P = .006). Linear regression indicated that resilience had the greatest predictive effect on ostomy adjustment (P = .004).

CONCLUSIONS

Results suggest that higher levels of resilience may facilitate adjustment to a permanent ostomy. Findings indicate that nurses should design and implement programs to aid ostomy adjustment via resilience assessment.

The prevalence of anxiety and depression in patients with ostomy: A systematic review and meta-analysis

AIM

The prevalence of anxiety and depression in patients with ostomy is reported differently. The aim of this systematic review and meta-analysis is to estimate the global prevalence of anxiety and depression in patients with ostomy.

METHOD

A systematic search of Embase, Proquest, Scopus, PubMed and Web of Science (ISI) databases was conducted from January 1990 up to 5 May 2021. A total of 3392 records were retrieved and 18 studies were ultimately included. Two reviewers independently assessed full-text of articles according to predefined criteria. A random-effects model was used to estimate the prevalence of anxiety and depression and I² index was used to assess the heterogeneity of the studies. Subgroup analysis and mea-regression were conducted to explore potential sources of heterogeneity. The review protocol is registered in PROSPERO and is available online. Data analysis was performed using R software version 4.3.1.

RESULTS

In this study, the pooled prevalence of anxiety was 47.60% (95% CI, 29.94-65.26) and the pooled prevalence of depression was 38.86% (95% CI, 29.29-48.43). The subgroup analysis showed the prevalence of anxiety and depression in different regions was not significantly different (p = 0.854, p = 0.143 respectively). Nevertheless, the highest and lowest prevalence of anxiety were in Asia and the America 51.79% and 32.69%, respectively and the highest and lowest prevalence depression were in Asia with 49.80% and Europe with 26.77%, respectively.

CONCLUSION

The finding of this study showed the global prevalence of anxiety and depression in patients with ostomy is high. Therefore, all health care providers who deal with these patients should use appropriate psychological strategies, techniques and interventions to reduce anxiety and depression in these patients.

The Quality of Life of Patients with Colorectal Carcinoma and Stoma

Surgical treatment and formation of a stoma can be lifesaving for colorectal cancer patients. However, the quality of life is often impaired in patients with stoma. The goal of this study is to determine the quality of life of patients with stoma and cancer, and the relationship between the quality of life and characteristics of these patients.

The study was conducted from 2018 to 2020 and included a total of 64 patients of both sexes with colorectal cancer and temporary or permanent stoma. The European Organization for Research and Treatment of Cancer with Quality of Life Questionnaire (EORTC QLQC29-30) and the anonymous WHO Quality of Life Questionnaire SF-36 were used for self-assessment of quality of life.

Our study included 39 (61.0%) men and 25 (39.0%) women. 24 patients (37.5%) had colostomy, 14 patients (21.9%) had ileostomy, and 26 patients (40.6%) underwent surgery for resection of colorectal cancer without stoma. A significant number of women were in the group of patients with a permanent stoma (p = 0.01). There was no statistically significant difference in the assessment of general health (p = 0.680) and quality of life (p = 0.721) during the past month in relation to gender. Patients without a stoma rated their general health better compared to those with stoma and the difference reached statistical significance (p = 0.035). There was no statistically significant difference in the assessment of quality of life between the group of patients with stoma and without stoma, as well as between the patients of different age groups.

Patients with stoma rated their general health as worse, but not their quality of life.

Ostomy-related problems and their impact on quality of life of Saudi ostomate patients: A mixed-methods study

AIM AND OBJECTIVE

The aim of this study is to explore the health-related quality of life outcomes and ostomy-related obstacles among patients with ostomy in Saudi Arabia.

BACKGROUND

Negative effects on quality of life for patients following ostomy creation are a globally important health concern. Paucity of understanding factors that influenced quality of care after ostomy surgery hinders the ability of healthcare providers to offer appropriate care to improve patient's quality of care.

METHODS

This mixed-methods study was undertaken through survey (COHQOL-Q Arabic version) for collecting the quantitative data (n = 421) and semi-structured interview for collecting qualitative data (n = 12). This study employed STROBE and GRAMMS checklists.

RESULTS

Multiple health-related quality of life challenges was indicated by Saudi patients with intestinal stomas. Ostomy surgery interferes with religious practice in Muslim people, particularly obtaining Hajj worship and fasting for Ramadan. The overall QOL mean score was moderate level (M = 7.57) for ostomy patients in Saudi Arabia. The highest domain mean score was the social well-being (M = 7.84) and the lowest in the physical well-being (M = 7.18). Reshaping of religious practices, apprehension and adaptation to living with a stoma were the most common themes that participants discussed related to ostomy issues they experienced following ostomy surgery.

CONCLUSION

The study findings reported a greater understanding of challenges that patients with stoma experience in Saudi Arabia. The process of the adaptation and the change of their lifestyle also affects patient's quality of life. The healthcare providers can use the study results to create a supportive intervention strategy that needed for maximise QOL for people with stoma.

RELEVANCE TO CLINICAL PRACTICE

This study identifies issues associated with stoma creation among Saudi people and can help in planning and providing the required nursing care which may support in the reduction of predictable problems. Recommendations for future studies related to nursing professional practice are indicated.

A new stoma for an older person-An association with quality of life and physical function: A systematic review

BACKGROUND

Older people are more likely to have a stoma postabdominal surgery than younger people. Few studies have examined the effect of a stoma on older people. The aim of this review was to explore the effect of a stoma on functional independence of an older person. We explored secondary outcomes of poststoma formation length of hospital stay, quality of life and factors affecting stroma independence.

METHODS

An exploratory systematic review was developed by our multidisciplinary group including an expert patient, colorectal surgeon, stoma nurse, physiotherapist, geriatrician, and methodologist. Four databases were searched including studies with participants 60 years old or older, who had undergone abdominal surgery for any pathology resulting in an abdominal stoma.

RESULTS

We identified 857 studies, of which we included 25 in the final review incorporating 6972 participants (average age 67.4 years). There was a strong association between presence of stoma and (1) worse physical function (standardized MD = 0.7; 95% CI 0.21-1.19; I²  = 95) and (2) worse quality of life (standardized MD = 1.61; 95% CI 0.5-2.72, I²  = 98). The same effect was seen in fecal ostomy and urinary diversion. Few studies measured stoma independence and only one examined factors affecting this. No studies examined length of stay.

CONCLUSIONS

Stoma have a negative association with the physical function and quality of life of older people. Future studies should focus on identifying modifiable factors that may affect physical function, quality of life, and stoma independence.

Adaptation and psychometric evaluation of the Stoma-QOL questionnaire among Chinese rectal cancer patients with colostomy

AIM

The purpose of this study was to translate the Stoma-quality of life into Chinese and evaluate its psychometric properties in Chinese patients.

BACKGROUND

Quality of life is an important issue for patients with colostomy, and its appropriate and precise measurement is beneficial to promoting better care. The Stoma-quality of life questionnaire has been widely used; however, the validity and reliability of its Chinese version has not been determined.

DESIGN

A cross-sectional validation study was conducted.

METHODS

We translated the Stoma-quality of life into Chinese using standardized methods. Then it was psychometrically tested on a convenience sample of 513 patients with colostomy. Construct validity was evaluated via exploratory factor analysis and confirmatory factor analysis. Reliability was measured with Cronbach's alpha and the split-half Spearman-Brown coefficient.

RESULTS

The content validity, the Cronbach's α coefficient and the Spearman-Brown split-half reliability coefficient indicated adequate validity and reliability. The exploratory factor analysis yielded four common factors, and the cumulative variance contribution rate was 67.5%. Moreover, the confirmatory factor analysis showed a good model fit.

CONCLUSION

This study confirmed that the Chinese version of Stoma-quality of life is an effective and reliable measurement for evaluating the quality of life of patients with colostomy.

Quality of life among ostomy patients: A narrative literature review

AIM AND OBJECTIVE

This study aims to identify and summarise factors related to ostomy patients' experiences and how these impact the perceived quality of life for those patients.

BACKGROUND

Ostomy formation is a common therapeutic technique used to treat different colorectal diseases such as colorectal cancer. Although surgical intervention and ostomy formation may prolong a patient's life, it may cause many problems in their daily lifestyle and affect their quality of life. The surgical creation of an ostomy has a significant impacts on a patient's quality of life from multiple perspectives, including physical, psychological, social and spiritual aspects.

DESIGN

A narrative literature review, using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline).

METHODS

This review analysis of search filters was conducted in the following databases: PubMed (MEDLINE), CINAHL, Embase, ProQuest, Science Direct, Scopus, and PsycINFO. A validation data set of 283 research articles between January 2000 and December 2019 were used to identify the impact of stoma surgery on patients' quality of life.

RESULT

Thirty-seven studies were identified as suitable for inclusion in this literature review. The results of the review indicate that quality of life (QoL) in patients who have an ostomy is influenced by many modifiable factors. Exercise, preoperative stoma site identification, family support, maintenance of social networks, education, spirituality and financial stability are all potentially modifiable factors that can improve the QOL for ostomy patients.

CONCLUSION

This review has identified multiple challenges that ostomy patients experience, which were clustered according to physical, psychological, social and spiritual challenges.

RELEVANCE TO CLINICAL PRACTICE

This study identifies issues associated with stoma creation and can help in planning and providing the required nursing care which may assist in the reduction of predictable challenges. Recommendations for future research related to nursing practice are stated.

Sociodemographic and clinical features and quality of life in stomized patients

Objectives To identify users with an intestinal ostomy concerning their sociodemographic and clinical characteristics, and to determine the scores for quality of life according to the domains of the questionnaire City of Hope.

Method This is a household, descriptive, transversal, quantitative-approach survey, accomplished with 30 registered users at the Ostomy Association of the State of Paraíba, Brazil. A specific form for ostomy patients was applied, and data analysis was performed with the use of the software Statistical Package for Social Sciences (SPSS) version 20.0. This study was approved by CAAE No. 17224613.8.0000.5183.

Results Most participants were over 60 years, were Catholics, with elementary education, an income up to three minimum wages, married or in a stable relationship, with almost all quality of life scores above the midpoint of the range of the variables of the domains surveyed by the questionnaire City of Hope.

Conclusion The questionnaire led to the conclusion that the respondents with ostomy had a satisfactory quality of life.

[Digestive stomas: which professional impact?]

Introduction

les stomies digestives constituent l´aboutissement d´un certain nombre d´interventions chirurgicales. Elles peuvent être temporaires ou définitives. Le patient porteur de stomie se trouve confronté à des aléas d´ordre physique et psychologique. Il nécessite donc une adaptation aux changements et une acceptation de la situation qu´elle soit temporaire ou définitive. Le but de ce travail est d´évaluer l´impact des stomies digestives sur la qualité de vie des patients et leur retentissement professionnel.

Méthodes

il s´agit d´une étude rétrospective, menée de janvier 2010 à décembre 2014. Au cours de cette période 115 patients avaient eu des stomies digestives. Parmi ces patients, soixante étaient en âge d´activité professionnelle, avaient un emploi fixe et avaient repris leurs travail; ils constituent l´effectif de notre étude. Le recueil des données était réalisé par un questionnaire spécifique: le questionnaire généraliste SF-36 réalisé en post opératoire.

Résultats

le score moyen pour la qualité de vie globale pour les patients stomisés était 41. Quarante patients avaient une mauvaise qualité de vie avec un score SF-36 qui était inférieur à 50. Notre étude a démontré que les patients stomisés ont éprouvé des difficultés de fonctionnement dans des situations de travail. Quarante-huit patients décrivaient une gêne directement liée à la stomie lors de l´exercice de leurs activités professionnelles. Les causes évoquées étaient d´ordre physique dans 6 cas et d´ordre psychologique dans 3 cas. Six patients étaient mutés vers des postes plus adaptés à leur situation.

Conclusion

l´objectif de la prise en charge des patients porteurs de stomie digestive doit être la réintégration sociale et professionnelle adéquate. Ceci ne peut se concevoir qu´en impliquant le médecin de travail, le psychologue, le stomathérapeute et les associations dans cette prise en charge.

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.

Healthy behaviors are associated with positive outcomes for cancer survivors with ostomies: a cross-sectional study

BACKGROUND

Cancer survivors (CS) with ostomies may face challenges in sustaining physical activity (PA) levels and maintaining healthy diets. This analysis describes lifestyle behaviors and their relationships with health-related quality of life (HRQOL) in CS with ostomies.

METHODS

This is a cross-sectional, secondary analysis of a multisite randomized self-management education trial for CS with ostomies. The baseline self-reported measures were queried on aerobic PA and diet using the City of Hope Quality of Life Ostomy measure, and the Self-Efficacy to Perform Self-Management Behaviors questionnaire (SE). PA was compared against the American Cancer Society PA guidelines for CS. Relationships between PA and HRQOL were evaluated using multiple linear regression, stratified by BMI.

RESULTS

Among 200 responders, fewer than 20% met or exceeded the PA guideline for cancer survivors; overall, confidence in the ability to perform gentle or aerobic PA was moderate (6/10 on the SE). Overall HRQOL (p = 0.038), psychological well-being (p = 0.017), and physical strength (p = 0.025) were associated with increased PA. Almost half (48.7%) of CS reported a special diet. CS with urostomies were less likely to report diet adjustments after their ostomy surgeries (OR: 0.16, 95% CI [0.08-0.38]) than CS with fecal ostomies.

CONCLUSIONS

Better HRQOL is associated with PA guideline achievement among CS with ostomies. Additionally, diet adjustments were reported more frequently in CS with fecal ostomies. Our findings bear clinical relevance for designing ostomy self-management and lifestyle recommendations for CS with ostomies.

IMPLICATIONS FOR CANCER SURVIVORS

The evaluation of lifestyle behaviors may be an especially important focus for CS with ostomies.

Development and psychometric evaluation of the colostomy disgust scale in patients with colostomy

OBJECTIVE

To establish and validate the Colostomy Disgust Scale (CDS) for assessing disgust in colostomy patients.

DESIGN

Triphasic, cross-sectional psychometric study.

SETTING

A total of 423 patients with colostomy (222 first samples and 201 s samples) were recruited from a tertiary hospital between January 2015 and April 2016.

METHODS

Three phases were undertaken: (a) item generation, (b) item selection and (c) evaluation and validation. The evaluation and validation of the CDS were performed through feasibility and initial item analysis, exploratory factor analysis, confirmatory factor analysis and internal consistency.

RESULTS

Following item generation and item selection, a 22-item CDS was generated. Principal axis factoring indicated a two-factor solution for the proposed CDS model, which was also verified by confirmatory factor analysis. Moreover, the proposed CDS had a high internal consistency.

CONCLUSION

The CDS is a self-report instrument with initial evidence for its validity and reliability. It is a promising tool to identify the triggers of disgust in colostomy contexts, which can be of great importance for promoting the mental health of colostomy patients.

Studying the effect of structured ostomy care training on quality of life and anxiety of patients with permanent ostomy

Patients with ostomy are faced with several physical, psychological, and social challenges and need to be prepared to overcome these challenges. Studies have shown that training plays an important role in helping patients to adapt with ostomy, live with it, and improve their psychological well-being and quality of life (QOL). Therefore, the present study aimed to determine the effect of structured ostomy care training on QOL and anxiety of the patients with permanent ostomy. In this randomised clinical trial study, 60 eligible participants were recruited from the only ostomy clinic in Kerman, Iran. They were selected using a purposive sampling method and randomly assigned to either a control group that received routine ostomy care or an intervention group that attended oral and practical training and a question and answer session by a trained ostomy nurse and received an ostomy information booklet besides their routine care. Outcome variables were anxiety and QOL in general and its physical, mental, social, and spiritual dimensions in detail. By using the anxiety subscale of Hospital Anxiety and Depression Scale (HADS) and City of Hope-quality of life [COH-QOL], data were collected before and 2 months after intervention in both groups. Data were analysed by SPSS version 19 using χ², analysis of variance (ANOVA), independent t, and paired t test and multiple regression analysis. The results showed that the intervention group had significantly lower mean scores in anxiety (P = .001) and a higher mean score in overall QOL (P = .009) compared with the control group. The most significant increase was observed for psychological, social, and physical aspects, and the least was in the spiritual aspect, all of which improved after intervention. After controlling the effects of confounding variables such as age, ostomy period, and number of children, the structured training programme still had a positive effect on QOL. Structured ostomy care training, including face-to-face education and personal practice of using ostomy equipment, along with written material provided by the ostomy nurse specialist, may lead to an increase in the overall QOL and a decrease in the perceived anxiety level in patients. This type of training is not routinely delivered to ostomy patients in our health care setting, so it is feasible to prepare surgical wards and to educate nurses to work with their patients before and after ostomy creation. Furthermore, to ease patients' religious concerns, we recommend counselling, and the support of religious leaders in the Muslim community may play a key role to adaptation regarding religious matters after ostomy surgeries and alleviate patients' concerns.

Concept analysis of coping with multiple sclerosis

OBJECTIVE

The concept of coping with disease appears frequently in the literature; however, there is no precise definition of coping. The aim of this study is to clarify coping concept, and to identify its attributes, antecedents, and consequences in patients with multiple sclerosis.

METHODS

Rodgers' evolutionary method of concept analysis was used to clarify the concept of coping. A literature review was conducted with key terms 'multiple sclerosis', 'coping', 'adjustment', and 'deal with'. After searching databases, 1370 papers were found for the period 1995-2017. Finally, 55 articles and texts were selected for analysis. Data analysis was carried out using thematic analysis. An independent researcher checked the process to ensure credibility and reduce personal bias.

RESULTS

Coping with multiple sclerosis is a multidimensional concept with three main attributes: maintenance of emotional balance, acceptance of the disease, and self-regulation. Social support, awareness toward the disease, attitude toward the disease, and religious-spiritual beliefs were found as antecedents. Health promotion, adherence to treatment regimen, independence in personal life and social relationships, and improvement of family relationships were found as consequences of these attributes.

CONCLUSION

These findings not only add to the body of knowledge in health science, but also serve as an important motivation for further theory development and research in this context. Nurses and health professions can also benefit from a deeper understanding of coping concept in providing and planning healthcare for these patients.

Improving Health-Related Quality of Life of Patients With an Ostomy Using a Novel Digital Wearable Device: Protocol for a Pilot Study

BACKGROUND

Ostomy surgeries involving the placement of an ostomy bag (eg, colostomy, ileostomy, urostomy, etc) have been shown to have a negative impact on health-related quality of life. To date, no studies have been conducted examining what impact, if any, wearable biosensors have on the health-related quality of life of ostomy patients.

OBJECTIVE

In the present study, we plan to assess the quality of life of ostomy patients using the Ostom-i alert sensor, a portable, wearable, Bluetooth-linked biosensor that facilitates easier ostomy bag output measurements. We hypothesize that using the Ostom-i alert sensor will result in an improved, ostomy-specific, health-related quality of life as compared to baseline measurement before the use of the sensor.

METHODS

A total of 20 ostomy patients will be screened and recruited to participate in this prospective, observational, cross-over pilot study using an Ostom-i alert sensor for one month. The primary outcome of this study will compare ostomy-specific, health-related quality of life at baseline (prior to Ostom-i alert sensor use) to ostomy-specific, health-related quality of life after 2 and 4 weeks of Ostom-i use by utilizing the City of Hope Quality of Life Questionnaire for Patients with an Ostomy. Secondary outcomes of general health-related quality of life and adjustment to ostomy will be evaluated using the Medical Outcomes Study 36-item short form health survey and the Olbrisch Ostomy Adjustment Scale Short Form 2.

RESULTS

The project was funded by the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University School of Medicine. Enrollment is currently underway and data analysis is expected to be completed in 2018.

CONCLUSIONS

Proposed benefits of mobile, internet-linked personal health monitors, such as the Ostom-i, include a reduction in the cost of care by reducing resource utilization and infection rates, improving patient-provider communication, reducing time spent as an inpatient as well as improved quality of life. Prior studies have demonstrated decreased health-related quality of life in patients with an ostomy bag. We aim to examine the extent to which the Ostom-i alert sensor affects the health-related quality of life of its users. The Ostom-i alert sensor has the potential to improve quality of life of users by giving them the freedom and confidence to partake in daily activities with the knowledge that they can check how full their ostomy bag is in a private, discrete manner.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02319434; https://clinicaltrials.gov/ct2/show/NCT02319434 (Archived at WebCite at http://www.webcitation.org/6xhFDThmq).

The relationship between resilience and quality of life in patients with a drainage enterostomy

Impact and adjustment to a drainage enterostomy are measured mainly through health indicators. To investigate the relationship between resilience and adaptation to the placement of a drainage enterostomy. Prospective observational study with a sample of 125 patients (64 men/36 women) with a temporary or permanent drainage enterostomy and a mean age of 66.72 years. High quality of life (mean, 80.5) and resilience (mean, 79.57) scores and a positive relationship between both were found. There seems to be a positive relationship with general quality of life and health-related quality of life. The logistic regression model shows that the main predictor as regards health-related quality of life is resilience.

Costs of an ostomy self-management training program for cancer survivors

OBJECTIVE

To measure incremental expenses to an oncologic surgical practice for delivering a community-based, ostomy nurse-led, small-group, behavior skills-training intervention to help bladder and colorectal cancer survivors understand and adjust to their ostomies and improve their health-related quality of life, as well as assist family caregivers to understand survivors' needs and provide appropriate supportive care.

METHODS

The intervention was a 5-session group behavior skills training in ostomy self-management following the principles of the Chronic Care Model. Faculty included Wound, Ostomy, and Continence Nurses (WOCNs) using an ostomy care curriculum. A gender-matched peer-in-time buddy was assigned to each ostomy survivor. The 4-session survivor curriculum included the following: self-management practice and solving immediate ostomy concerns; social well-being; healthy lifestyle; and a booster session. The single family caregiver session was coled by a WOCN and an ostomy peer staff member and covered relevant caregiver and ostomate support issues. Each cohort required 8 weeks to complete the intervention. Nonlabor inputs included ostomy supplies, teaching materials, automobile mileage for WOCNs, mailing, and meeting space rental. Intervention personnel were employed by the University of Arizona. Labor expenses included salaries and fringe benefits.

RESULTS

The total incremental expense per intervention cohort of 4 survivors was $7246 or $1812 per patient.

CONCLUSIONS

A WOCN-led group self-help ostomy survivorship intervention provided affordable, effective, care to cancer survivors with ostomies.

Psychometric Properties of the Chinese Version of the Acceptance of Chronic Health Conditions (Stoma) Scale for Patients With Stoma

BACKGROUND

Formation of a stoma is a common outcome in surgical treatment of colorectal cancer. A higher acceptance of stoma was shown to improve quality of life of patients. No instrument in Chinese is available that can be used to measure the acceptance of stoma among patients with colorectal cancer.

OBJECTIVES

The aims of this study were to translate and test the psychometric properties of Chinese version of Acceptance of Chronic Health Conditions (ACHC) (Stoma) scale.

METHODS

A sample of 100 Chinese-speaking patients with stoma was recruited from a public tertiary care hospital in Singapore. The scale was translated into Chinese and reviewed by an expert panel for semantic equivalence and content validity testing. Convergent validity was established by exploring correlations between scores of the Chinese version of the ACHC (Stoma) scale and those of the 5-level version of European Quality of Life Questionnaire-5 Dimensions. Reliability was assessed by internal consistency and test-retest reliability.

RESULTS

The newly translated scale had high content validity (content validity index = 94%) and acceptable internal consistency (Cronbach's α = .846). The test-retest reliability was satisfactory with an intraclass coefficient of 0.997. A positive correlation was found between both scores on ACHC (Stoma) scale and EQ-5D utility score (r = 0.63, P < .01) and EQ-5D global visual analog scale (r = 0.70, P < .01).

CONCLUSIONS

The Chinese version of the ACHC (Stoma) scale demonstrated satisfactory content validity, good convergent validity, and adequate internal consistency and stability.

IMPLICATIONS FOR PRACTICE

This scale can be used as a convenient screening tool in clinical settings to assess the level of acceptance in Chinese-speaking patients with stoma.

A cross-sectional study of quality of life in a cohort of enteral ostomy patients presenting to a tertiary care hospital in a developing country in South Asia

Background

Enteral ostomy creation affects the quality of life (QOL) of stoma patients significantly. Studying the QOL and its determinants is important as it may help in the early identification of those with poor QOL leading to appropriate intervention. This study was aimed to assess the possible contributory factors of QOL of stoma patients.

Methods

A cross sectional study was conducted among 43 ostomy patients who presented for follow up at a surgical clinic of a tertiary care hospital in Sri Lanka over a period of 1 year. Relevant demographic and ostomy related data were collected using an interviewer administered questionnaire. Stoma quality of life scale (Stoma-QOL) and stoma care self-efficacy scale (SCSE) which are validated questionnaires were used to assess QOL and self-efficacy in managing stoma respectively. Associations were established using independent samples t test and Spearman’s correlation.

Results

The median age of the study participants was 47.5 years (range 18–83). The median follow up duration was 38 months (range 6–183). The mean overall QOL score was 53.07 ± SD 12.68. Approximately 70% of the study participants scored less than 60. Higher QOL was associated with female sex, colostomies, comfortable income and satisfactory sexual activity. Significantly lower overall QOL was found in those who reported a significant change in the style of dressing (p < 0.05), those who felt depressed (p < 0.05), and those who had thoughts of self-harm soon after surgery (p < 0.05). There was a significant positive correlation between QOL and self-efficacy (p < 0.01). Those who took longer time to learn to take care of the stoma had lower QOL (p < 0.05).

Conclusions

The overall QOL score was considerably low in our study. The QOL was significantly associated with self-efficacy which indicates the importance of patient education and training during follow up visits to maintain a higher QOL. Furthermore integrating with other non-surgical specialities to address multi-dimensional problems including psychosocial and sexual aspects may be helpful to achieve a better QOL.

Living with digestive stomas: strategies to cope with the new bodily reality

OBJECTIVE

the objective in this study was to describe the strategies developed by digestive stoma patients to cope with their situation.

METHOD

a qualitative and descriptive study was undertaken, involving 21 stoma patients living in the provinces of Málaga and Granada (Spain). The informants were selected in accordance with criteria of appropriateness and diversity, through intentional sampling. The data were collected by means of semistructured interviews.

RESULTS

the content analysis revealed three categories around which the distinct strategies were developed: Self-care, Adaptation to the bodily change and Self-help.

CONCLUSION

the strategies developed are focusing on achieving the effective management of the stoma and are closely linked with the achievement of autonomy. Discovering the strategies applied is fundamental for the nursing professionals to offer high-quality care, centered on people and their process.

A study of long-term complications associated with enteral ostomy and their contributory factors

BACKGROUND

Complications of ostomy significantly affect the quality of life of ostomates. There is little evidence on the rate of long-term complications in ostomates, especially from the developing countries which include Sri Lanka. This study was aimed to describe the long-term complications of enteral ostomies and their contributory factors.

METHODS

A retrospective analysis was carried out on 192 patients who underwent ostomy creation over a period of 5 years. Data on type of complications, age, sex, type of ostomy, type of surgery and perioperative care by enteric stoma therapist were gathered. Associations were established using Chi square test and multiple logistic regression.

RESULTS

Out of 192 patients, only 146 patients presented regularly for follow up. The mean follow up duration was 28 months (range: 3-183). Around 34.2% developed surgical long-term complications related to the ostomy. Common complications were prolapse (n = 24, 16.4%), skin excoriation (n = 22, 15.1%) and parastomal hernia (n = 14, 9.6%). Overall complication rate was significantly less in loop ostomies (p < 0.05) and defunctioning ostomies (p < 0.05). Skin excoriation was significantly high in males (p < 0.05) and in ileostomies (p < 0.001). Parastomal hernia was commoner in end ostomies (p < 0.05). Perioperative care by enteric stoma therapist reduced the overall and specific complications (p < 0.001).

CONCLUSION

The overall complication rate in our cohort of patients was 34.2%. The perioperative care of a stoma therapist may be very effective in preventing complications particularly in a setting with limited resources.

Exploration of health status, illness perceptions, coping strategies, and psychological morbidity in stoma patients

PURPOSE

We employed the Common Sense Model (CSM) of illness perceptions to examine the relative contribution of illness perceptions, stoma self-efficacy, and coping strategies in explaining anxiety and depression symptoms in patients with a fecal ostomy. The CSM suggests that the consequences of illness activity, such as psychological distress, are influenced by an individual's illness perceptions as well as what coping strategies they engage in.

DESIGN

Descriptive, cross-sectional questionnaire-based study.

SUBJECTS AND SETTING

One hundred fifty adults with a stoma (54 males, and 96 females; mean age 44 years) completed an online survey.

METHODS

Several instruments were used to measure study outcomes, including the Health Perceptions Questionnaire, Brief Illness Perceptions Questionnaire, Carver Brief Coping Questionnaire, Stoma Self-Efficacy Scale, and the Hospital Anxiety and Depression Scale. Participants were advised of the study through online forums containing a link to the survey. Outcome measures used in the current study are valid and reliable and have been extensively used in medically ill patients.

RESULTS

Using structural equation modeling, the final model provided an excellent fit to the data (χ23= 16.53, P = .22, χ/N = 1.27, SRMR < 0.03, RMSEA < 0.05, GFI > 0.97, CFI > 0.99). There was a direct pathway from health status to illness perceptions months since surgery directly influenced health status, illness beliefs, and adaptive emotion-focused coping (β= .81, P < .001). Several indirect (mediating) pathways were also identified. Illness perceptions mediated the relationship between health status and stoma self-efficacy and maladaptive and adaptive emotion-focused coping. Maladaptive coping mediated the relationship between illness perceptions and depression and anxiety, and adaptive emotion-focused coping mediated the relationship between illness perception and depression. The final model provided support for the CSM, in that illness perceptions were directly related to illness status, and that both illness perceptions and coping strategies directly influenced anxiety and depression. More specifically, maladaptive coping style (eg, ignore problems) exacerbated depression and anxiety symptoms, while self-efficacy and emotion-focused coping style (eg, seek advice) ameliorate depression, but not anxiety. Months since surgery was associated with improved health status, reduced poorer illness perceptions, and increased emotional-focused coping.

CONCLUSIONS

Illness perceptions and coping were found to mediate anxiety and depression. The results confirm that how individuals perceive their illness and what coping strategies they engage in impacts their psychological well-being. Study findings support the need for designing targeting psychological interventions based on individual illness perceptions and self-efficacy rather than exclusively focusing on coping strategies in patients with a stoma.

A chronic care ostomy self-management program for cancer survivors

BACKGROUND

Individuals with ostomies experience extensive changes in health-related quality of life (HRQOL) and daily routine. Patients and families are typically forced to use trial and error to improve self-management.

METHODS

This is a longitudinal one-group design pilot study of a five-session ostomy self-care curriculum based on the Chronic Care Model to improve HRQOL and self-management for cancer survivors with ostomies. Participants were surveyed to evaluate each session. Multiple instruments were administered to examine outcomes at baseline, post-intervention, and at 6-month follow-up (Patient Activation Measure, self-efficacy, Hospital Anxiety and Depression Scale, Ways of Coping, Group Health Association of America Satisfaction with ostomy care survey, and the City of Hope Quality of Life Ostomy). Changes from pre-intervention to post-intervention and pre-intervention to follow-up were evaluated with paired t-tests. Text responses were coded and evaluated for important themes and recommendations.

RESULTS

Thirty-eight subjects participated in the study. Most had a history of rectal cancer (60.5%) or bladder cancer (28.9%). Participants rated the overall program high (4.4-4.8 on 5-point scale). Text feedback indicated that participants enjoyed the group forums, wanted more participants, and more hands-on training. Scores on multiple surveys were shown to be improved and sustained, including patient activation (p = 0.0004), self-efficacy (p = 0.006), total HRQOL (p = 0.01), physical well-being (p = 0.005), and social well-being (p = 0.002). Survivor anxiety was significantly reduced by follow-up (p = 0.047).

CONCLUSIONS

This self-management ostomy program can help cancer survivors with ostomies adapt to their stoma. Initiating this program in the community setting would be beneficial to many cancer survivors.

The Ostomy Adjustment Scale: translation into Norwegian language with validation and reliability testing

PURPOSE

The purpose of this study was to adapt the Ostomy Adjustment Scale to a Norwegian version and to assess its construct validity and 2 components of its reliability (internal consistency and test-retest reliability).

SUBJECTS AND SETTING

One hundred fifty-eight of 217 patients (73%) with a colostomy, ileostomy, or urostomy participated in the study. Slightly more than half (56%) were men. Their mean age was 64 years (range, 26-91 years). All respondents had undergone ostomy surgery at least 3 months before participation in the study.

METHODS

The Ostomy Adjustment Scale was translated into Norwegian according to standard procedures for forward and backward translation. The questionnaire was sent to the participants via regular post. The Cronbach alpha and test-retest were computed to assess reliability. Construct validity was evaluated via correlations between each item and score sums; correlations were used to analyze relationships between the Ostomy Adjustment Scale and the 36-item Short Form Health Survey, the Quality of Life Scale, the Hospital Anxiety & Depression Scale, and the General Self-Efficacy Scale.

RESULTS

The Cronbach alpha was 0.93, and test-retest reliability r was 0.69. The average correlation quotient item to sum score was 0.49 (range, 0.31-0.73). Results showed moderate negative correlations between the Ostomy Adjustment Scale and the Hospital Anxiety and Depression Scale (-0.37 and -0.40), and moderate positive correlations between the Ostomy Adjustment Scale and the 36-item Short Form Health Survey, the Quality of Life Scale, and the General Self-Efficacy Scale (0.30-0.45) with the exception of the pain domain in the Short Form 36 (0.28). Regression analysis showed linear associations between the Ostomy Adjustment Scale and sociodemographic and clinical variables with the exception of education.

CONCLUSIONS

The Norwegian language version of the Ostomy Adjustment Scale was found to possess construct validity, along with internal consistency and test-retest reliability. The instrument is sensitive for sociodemographic and clinical variables pertinent to persons with urostomies, colostomies, and ileostomies.

Dietary and Behavioral Adjustments to Manage Bowel Dysfunction After Surgery in Long-Term Colorectal Cancer Survivors

BACKGROUND

Bowel dysfunction is a known complication of colorectal cancer (CRC) surgery. Poor bowel control has a detrimental impact on survivors' health-related quality of life (HRQOL). This analysis describes the dietary and behavioral adjustments used by CRC survivors to manage bowel dysfunction and compares adjustments used by survivors with permanent ostomy to those with anastomosis.

METHODS

This mixed-methods analysis included pooled data from several studies that assessed HRQOL in CRC survivors. In all studies, CRC survivors with or without permanent ostomies (N = 856) were surveyed using the City of Hope Quality of Life Colorectal Cancer tool. Dietary adjustments were compared by ostomy status and by overall HRQOL score (high vs. low). Qualitative data from 13 focus groups and 30 interviews were analyzed to explore specific strategies used by survivors to manage bowel dysfunction.

RESULTS

CRC survivors made substantial, permanent dietary, and behavioral adjustments after surgery, regardless of ostomy status. Survivors who took longer after surgery to become comfortable with their diet or regain their appetite were more likely to report worse HRQOL. Adjustments to control bowel function were divided into four major strategies: dietary adjustments, behavioral adjustments, exercise, and medication use.

CONCLUSIONS

CRC survivors struggled with unpredictable bowel function and may fail to find a set of management strategies to achieve regularity. Understanding the myriad adjustments used by CRC survivors may lead to evidence-based interventions to foster positive adjustments after surgery and through long-term survivorship.

Surviving colorectal cancer: long-term, persistent ostomy-specific concerns and adaptations

PURPOSE

The purpose of this article was to describe persistent ostomy-specific concerns and adaptations in long-term (>5 years) colorectal cancer survivors with ostomies.

SUBJECTS AND SETTINGS

Thirty-three colorectal cancer survivors who participated in 8 gender- and health-related quality of life stratified focus groups and 130 colorectal cancer survivors who provided written comments to 2 open-ended questions on ostomy location and pouch problems participated in the study. Data were collected on health maintenance organization members in Oregon, southwestern Washington, and northern California.

METHODS

Qualitative data were analyzed for the 8 focus groups and written comments from 2 open-ended survey questions. Discussions from the focu s groups were recorded, transcribed, and analyzed using content analysis. Written content from the open-ended questions was derived from a mailed questionnaire on health-related quality of life in survivors with ostomies and analyzed using content analysis.

RESULTS

Discussions related to persistent ostomy-related issues more than 5 years after formation were common. Persistent ostomy-related issues were focused on clothing restrictions and adaptations, dietary concerns, issues related to ostomy equipment and self-care, and the constant need to find solutions to adjust and readjust to living with an ostomy.

CONCLUSIONS

Ostomy-specific concerns persist 5 years and more for long-term colorectal cancer survivors after initial ostomy formation. Adaptations tend to be individualized and based on trial and error. Findings underscore the need to develop long-term support mechanisms that survivors can access to promote better coping and adjustment to living with an ostomy.

Relationship between health status, illness perceptions, coping strategies and psychological morbidity: a preliminary study with IBD stoma patients

BACKGROUND AND AIMS

Individuals living with IBD and a stoma are at an increased risk of anxiety and depression and it is likely that several factors mediate these relationships, including illness perceptions and coping strategies. Using the Common Sense Model (CSM), this study aimed to characterize the mediators of anxiety and depression in an IBD stoma cohort.

METHODS

Eighty-three adults (23 males) with a stoma (25 ileostomy, 58 colostomy; 26 emergency, 57 planned, 55 permanent, 28 temporary) completed an online survey. Health status was measured with the Health Orientation Scale (HOS), coping styles assessed with the Carver Brief COPE scale, illness perceptions explored with the Brief Illness Perceptions Questionnaire (BIPQ), and anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS).

RESULTS

Combining the questionnaire data using structural equation modeling resulted in a final model with an excellent fit (χ(2) (11)=12.86, p=0.30, χ(2)/N=1.17, SRMR<0.05, RMSEA<0.05, GFI>0.96, CFI>0.99). Consistent with the CSM, health status directly influenced illness perceptions, which in turn, influenced coping (emotion-focused and maladaptive coping). Interestingly, months since surgery was found to influence illness perceptions and emotion-focused coping directly, but not health status. While depression was influenced by illness perceptions, emotion-focused coping and maladaptive coping, anxiety was only influenced by illness perceptions and maladaptive coping.

CONCLUSIONS

The preliminary results provide further evidence for the complex interplay between psychological processes. In terms of directions for psychological interventions, a focus on identifying and working with illness perceptions is important.

Determining the coping strategies of individuals with epilepsy

PURPOSE

The purpose of the present study was to determine whether the coping styles of patients with epilepsy are associated with certain demographic, clinical, and psychosocial variables.

METHODS

A survey of 200 patients using several tests including the Brief-COPE was conducted.

RESULTS

Nine subscales of the Brief-COPE achieved acceptable internal consistency and were employed in study analysis. Using principal component analysis, six subscales correlated well with one another, representing engagement-type coping strategies. The other three also correlated well, representing disengagement-type strategies. As a group, our patients favored engagement-type strategies. On univariate analysis, increased age, being African-American, receiving disability benefits, and work status were associated with the use of engagement-type strategies, while on multiple linear regression, only age and race were independently associated. Low BMQ-S scores, low income level, and not driving were associated with the use of disengagement-type strategies both on univariate and multivariate analyses.

CONCLUSION

Among patients with epilepsy, certain demographic and psychosocial variables are associated with particular coping styles.

Development of a chronic care ostomy self-management program

Each year a percentage of the 1.2 million men and women in the United States with a new diagnosis of colorectal cancer join the 700,000 people who have an ostomy. Education targeting the long-term, chronic care of this population is lacking. This report describes the development of a Chronic Care Ostomy Self-Management Program, which was informed by (1) evidence on published quality-of-life changes for cancer patients with ostomies, (2) educational suggestions from patients with ostomies, and (3) examination of the usual care of new ostomates to illustrate areas for continued educational emphases and areas for needed education and support. Using these materials, the Chronic Care Ostomy Self-Management Program was developed by a team of multi-disciplinary researchers accompanied by experienced ostomy nurses. Testing of the program is in process. Pilot study participants reported high satisfaction with the program syllabus, ostomy nurse leaders, and ostomate peer buddies.

Living with faecal incontinence: follow-up to a research project

This paper reports on a descriptive qualitative five-year follow-up to an initial UK-based grounded theory study entitled 'Living with Faecal Incontinence.' Both studies collected data using in-depth guided interviews. The aim of the follow-up study was to identify any changes including adaptation and establish determining factors for people with faecal incontinence. Of the 22 participants in the original study, 11 joined the follow-up. Of these, nine participants demonstrated degrees of adaptation, assisted by symptom improvement using practical means or accepted what cannot be changed, downgrading their aspirations. One, having progressed, had become static in an intermediate position, while another displayed little adaptation. Health professionals can assist adaptation by being aware of clinical interventions to improve symptoms and practical means available. Where appropriate, the use of role models may help. Role model effectiveness, together with further long-term investigation into living with faecal incontinence, provide topics for future research.

Couples’ Resolution of an Infertility Diagnosis Before Undergoing in Vitro Fertilization

Although the use of assisted reproductive technology has today become more familiar, the suffering associated with the experience of infertility remains. This study assesses the emotional resolution of couples faced with an infertility diagnosis by examining their narratives. Fifty-seven couples were recruited from fertility clinics to participate in a semistructured interview prior to in vitro fertilization. Two aspects of the couples’ reactions to the infertility diagnosis were assessed: (1) each individual’s capacity to acknowledge the emotional reality of the diagnosis (diagnosis resolution) and (2) the couple’s ability to construct a shared meaning of the infertility diagnosis experience (narrative co-construction). Associations between these aspects and self-reported marital satisfaction, infertility-related stress, and diagnosis-related variables were analyzed. 73.7% of women and 61.4% of men had acknowledged the emotional reality of the diagnosis, and their scores for narrative co-construction were comparable to reference samples. Marital satisfaction, but not infertility-related stress, was associated with diagnosis resolution and narrative co-construction. The results indicate the importance of detecting couples with fewer individual and marital resources needed to face the reality of the diagnosis. A couple’s capacity to perceive the infertility diagnosis as a shared problem is also essential for dealing with this common life event.

Factors that influence low back pain in people with a stoma

PURPOSE

People with a stoma believe that there is a link between their surgery and low back pain (LBP).

AIM

To explore factors relating to (i) core stability in people with a stoma and LBP and (ii) biopsychosocial factors related to LBP.

METHODS

Adults with an ileostomy and LBP (n = 17) completed (i) a range of standardised instruments, (ii) clinical tests and (iii) an ultrasound scan of right and left transversus abdominis (TrA).

RESULTS

The findings showed moderate pain and disability: RMDQ: median = 12 (IQR: 9.5-13), EQ-5D health state: mean = 6.9 (±1.75), BPI pain severity: median = 4.5 (IQR: 2.87-5.4). The TrA contraction was less on the operated than the unoperated side and this was linked to less control for BKFO to the operated side, and the presence of a parastomal hernia. Co-morbidities were associated with greater balance problems during the stork test (p < 0.05). Men had more fear avoidance (p < 0.05) on the FABQ regarding physical activity.

DISCUSSION

Abdominal function may be altered after stoma surgery leading to reduced ability to perform functional tasks and a possible increased risk of back pain. These results should be viewed with caution due to the small sample size.

Positive correlation of employment and psychological well-being for veterans with major abdominal surgery

BACKGROUND

Intestinal stomas (ostomies) have been associated negatively with multiple aspects of health-related quality of life. This article examines the relationship between employment status and psychological well-being (PWB) in veterans who underwent major bowel procedures with or without ostomy.

METHODS

Veterans from 3 Veterans Affairs (VA) medical centers were surveyed using the City of Hope ostomy-specific questionnaire and the Short Form 36 item Veteran's version (SF-36V). Response rate was 48% (511 of 1,063). Employment and PWB relationship was assessed using multiple regression with age, income, SF-36V physical component summary (PCS), and employment status as independent variables.

RESULTS

Employed veterans reported higher PWB compared with unemployed veterans (P = .003). Full-time workers also reported higher PWB than part-time or unemployed workers (P = .001). Ostomy was not an independent predictor of PWB.

CONCLUSIONS

Employment among veterans after major abdominal surgery may have intrinsic value for PWB. Patients should be encouraged to return to work, or do volunteer work after recovery.

Quality of life in ostomy patients: a qualitative study

PURPOSE

Therapeutic procedures may not only treat disease but also affect patient quality of life. Therefore, quality of life should be measured in order to assess the impact of disease and therapeutic procedures. To identify clients' problems, it is necessary to assess several dimensions of quality of life, including physical, spiritual, economic, and social aspects. In this regard, we conducted a qualitative study to explore quality of life and its dimensions in ostomy patients referred to the Iranian Ostomy Association.

METHODS

Fourteen patients were interviewed about their quality of life dimensions by purposeful sampling. Data were gathered by semistructured interviews and analyzed using the content analysis method.

RESULTS

Nine main themes emerged using this approach, including physical problems related to colostomy, impact of colostomy on psychological functioning, social and family relationships, travel, nutrition, physical activity, and sexual function, as well as religious and economic issues.

CONCLUSION

The findings of the study identified a number of challenges in quality of life for patients with ostomy. The results can be used by health care providers to create a supportive environment that promotes better quality of life for their ostomy patients.