Multinational survey on living with an ostomy: prevalence and impact of peristomal skin complications

Evaluating the Application of Nail Polish as an Ostomy Baseplate: A Comparative Analysis With Conventional Ostomy Pastes in the Market and a Clinical Trial

BACKGROUND

Peristomal skin complications are prevalent among patients with ostomies and significantly impact their quality of life. Ostomy care is crucial for patients with ostomies because it ensures proper adhesion and protects and reduces the peristomal skin complications.

OBJECTIVES

To assess the effectiveness of nail polish as a novel skin barrier and compare its performance with the commonly available ostomy barriers in the market.

DESIGN

Phase I randomized controlled trial.

SETTINGS

A single trauma and surgery center.

PATIENTS

Forty patients who were hospitalized for ostomy implantation were enrolled. Twenty cases were included in each group.

MAIN OUTCOME MEASURES

The use of nail polish as a baseplate was tested against the common ostomy pastes. Over 6 months, the study enrolled 40 patients who required loop ileostomy and were followed up for 8 weeks. Postoperative evaluation was performed using the City of Hope-Quality of Life ostomy and 36-Item Short Form questionnaires, as well as physical examinations conducted 1 day after surgery and at 4 and 8 weeks after surgical treatment.

RESULTS

Forty patients were included in the study. At all 3 time points, significant differences were observed in 36-Item Short Form scores, time, and costs spent on ostomy care. The intervention group experienced fewer peristomal skin complications (skin itching, redness, inflammation, and burning) and skin allergies at the first and second time points (p < 0.05). Furthermore, none of the patients in the intervention or control group experienced rare complications such as folliculitis, candidiasis, contact dermatitis, or pyoderma gangrenosum.

LIMITATIONS

Single institution.

CONCLUSIONS

The utilization of nail polish as a baseplate reduces skin allergies, peristomal skin complications, and the time and financial resources spent on ostomy care. Furthermore, using nail polish has demonstrated promising results in patients' quality of life. Consequently, using nail polish emerged as the preferred choice among study participants. See the Video Abstract .

EVALUANDO LA APLICACIN DE ESMALTE DE UAS COMO PLACA BASE DE OSTOMA UN ANLISIS COMPARATIVO CON PASTAS DE OSTOMA CONVENCIONALES EN EL MERCADO EN UN ENSAYO CLNICO

ANTECEDENTES:Las complicaciones de la piel periestomal son frecuentes entre los pacientes con ostomías y afectan significativamente su calidad de vida. Los cuidados de la ostomía son cruciales para los pacientes ostomizados, ya que garantizan una adhesión adecuada y protegen y reducen las complicaciones de la piel periestomal.OBJETIVOS:Evaluar la eficacia del esmalte de uñas como nueva barrera cutánea y comparar su rendimiento con las barreras de ostomía comúnmente disponibles en el mercado.DISEÑO:Ensayo clínico aleatorizado de fase I.ENTORNO:Un único centro de traumatología y cirugía.PACIENTES:Se incluyeron cuarenta pacientes hospitalizados para la implantación de una ostomía. Se incluyeron veinte casos en cada grupo.MEDIDAS DE RESULTADO PRINCIPALES:Se probó el uso de esmalte de uñas como placa base frente a las pastas de ostomía comunes. Durante un periodo de 6 meses, el estudio incluyó a 40 pacientes que necesitaban una ileostomía en asa y fueron sometidos a un seguimiento de 8 semanas. La evaluación postoperatoria se llevó a cabo mediante los cuestionarios City of Hope-quality of life ostomy y SF-36, así como mediante exámenes físicos realizados 1 día después de la cirugía y a las 4 y 8 semanas del tratamiento quirúrgico.RESULTADOS:Se incluyeron en el estudio cuarenta pacientes. En los 3 puntos temporales, se observaron diferencias significativas en las puntuaciones SF-36, el tiempo y los costos dedicados al cuidado de la ostomía. El grupo de intervención experimentó menos complicaciones cutáneas periestomales (picor, enrojecimiento, inflamación y quemazón de la piel), así como alergias cutáneas en el primer y segundo momento (p < 0,05). Además, ninguno de los pacientes del grupo de intervención ni del de control experimentó complicaciones poco frecuentes como foliculitis, candidiasis, dermatitis de contacto o pioderma gangrenoso.LIMITACIONES:Una sola institución.CONCLUSIÓN:La utilización de esmalte de uñas como placa base reduce las alergias cutáneas, las complicaciones cutáneas periestomales y el tiempo y los recursos económicos dedicados al cuidado de la ostomía. Además, el uso de esmalte de uñas ha demostrado resultados prometedores en la calidad de vida de los pacientes. En consecuencia, la utilización de esmalte de uñas resultó ser la opción preferida entre los participantes en el estudio. (Traducción-Dr. Aurian Garcia Gonzalez).

Management of adult intestinal stomas: The 2023 French guidelines

AIM

Digestive stoma are frequently performed. The last French guidelines have been published twenty years ago. Our aim was to update French clinical practice guidelines for the perioperative management of digestive stoma and stoma-related complications.

METHODS

A systematic literature review of French and English articles published between January 2000 and May 2022 was performed. Only digestive stoma for fecal evacuation in adults were considered. Stoma in children, urinary stoma, digestive stoma for enteral nutrition, and rare stoma (Koch, perineal) were not included.

RESULTS

Guidelines include the surgical landmarks to create digestive stoma (ideal location, mucocutaneous anastomosis, utility of support rods, use of prophylactic mesh), the perioperative clinical practice guidelines (patient education, preoperative ostomy site marking, postoperative equipment, prescriptions, and follow-up), the management of early stoma-related complications (difficulties for nursing, high output, stoma necrosis, retraction, abscess and peristomal skin complications), and the management of late stoma-related complications (stoma prolapse, parastomal hernia, stoma stenosis, late stoma retraction). A level of evidence was assigned to each statement.

CONCLUSION

These guidelines will be very useful in clinical practice, and allow to delete some outdated dogma.

Development of a leakage impact assessment for patients with a stoma, who may be impacted by leakage

For people living with a stoma leakage is unpredictable. Despite advances in stoma products, leakage can lead to soiling and this, along with worrying about leakage, can significantly affect patients' everyday lives and impact their quality of life. It is also associated with excessive product use and increased healthcare resources. Leakage therefore remains a major unmet need for many people living with a stoma. To address this, Coloplast Ltd in collaboration with the authors and a broader group of stoma care nurses have worked together to develop a first version of the Leakage Impact Assessment. This assessment is intended to identify patients who struggle with leakage and leakage worry, and who might benefit from the reassurance that a new digital leakage notification system, Heylo™, can provide. This article reviews the evidence for leakage and its impact on people living with a stoma and outlines the development process for the assessment.

Changes in the quality of life of adults with an ostomy during the first year after surgery as part of the Best Practice Spotlight Organisation® Programme

The aim was to analyse changes in the perceived quality of life of patients with an ostomy during the first year after surgery at two or three follow-ups. This is a prospective study of a cohort of 55 patients who were ostomised between June 2021 and September 2022 and cared for under the recommendations set out in the Registered Nurses' Association of Ontario® best practice guideline Supporting Adults Who Anticipate or Live with an Ostomy as part of the Best Practice Spotlight Organisation® (BPSO®) programme. The Stoma Quality of Life tool was used. A univariate analysis was performed to identify variables associated with a non-improvement in quality of life. Variables showing p < 0.1 were included in a multivariate model. Patients with an ostomy exhibited a moderate-to-good perception of quality of life in both the personal and social dimensions, with no worsening over the first year. Being female (OR = 10.32) and being younger (OR = 0.89) were associated with a higher risk of no improvement in quality of life. The most frequent complications were urinary leakage (p = 0.027) and dermatitis (p = 0.052) at first follow-up; and parastomal hernia (p = 0.009) and prolapse (p = 0.05) at third follow-up. However, they did not lead to a worsening of quality of life, suggesting that these patients were adequately supported under the BPSO® programme.

Psychometric validation of the Ostomy Skin Tool 2.0

Background

Peristomal skin complications (PSCs) pose a major challenge for people living with an ostomy. To avoid severe PSCs, it is important that people with an ostomy check their peristomal skin condition on a regular basis and seek professional help when needed.

Aim

To validate a new ostomy skin tool (OST 2.0) that will make regular assessment of the peristomal skin easier.

Methods

Seventy subjects participating in a clinical trial were eligible for the analysis and data used for the validation. Item-level correlation with anchors, inter-item correlations, convergent validity of domains, test-retest reliability, anchor- and distribution-based methods for assessment of meaningful change were all part of the psychometric validation of the tool.

Results

A final tool was established including six patient reported outcome items and automatic assessment of the discolored peristomal area. Follow-up with cognitive debriefing interviews assured that the concepts were considered relevant for people with an ostomy.

Conclusion

The OST 2.0 demonstrated evidence supporting its reliability and validity as an outcome measure to capture both visible and non-visible peristomal skin complications.

The economic burden of stomas in the UK: a retrospective observational study of health records and hospital encounters

BACKGROUND

Stomas divert waste from the small intestine (ileostomy), large intestine (colostomy) or ureters (urostomy), and complications are common.

AIMS

This study evaluated healthcare resource utilisation (HCRU) and costs of stomas from a UK perspective.

METHODS

This was a retrospective observational study of adults with new stomas (New Stoma Group) or new/existing stomas and >6 months of follow-up (Established Stoma Group) using health records linked with hospital encounters (January 2009-December 2018). Age- and sex-matched controls were identified for each stoma case (1:50).

FINDINGS

Both the New (n=8533) and Established (n=9397) stoma groups had significantly higher HCRU (all P<0.0001) and associated costs (all P<0.01), driven by inpatient admissions. New Stoma Group: colostomy versus controls, £3227 versus £99 per person; ileostomy, £2576 versus £78 per person; and urostomy, £2850 versus £110 per person (all P<0.0001). Findings were similar in the Established Stoma Group.

CONCLUSION

Stomas are associated with a substantial economic burden in the UK driven by hospital care. (Supplementary data tables can be obtained from the authors.).

Moving towards in pouch diagnostics for ostomy patients: exploiting the versatility of laser induced graphene sensors

The development of a 3D printed sensor for direct incorporation within stoma pouches is described. Laser induced graphene scribed on either side of polyimide film served as the basis of a 2 electrode configuration that could be integrated within a disposable pouch sensor for the periodic monitoring of ileostomy fluid pH. The graphene sensors were characterised using electron microscopy, Raman spectroscopy, DekTak profilometry with the electrochemical properties investigated using both cyclic and square wave voltammetry. Adsorbed riboflavin was employed as a biocompatible redox probe for the voltammetric measurement of pH. The variation in peak position with pH was found to be linear over pH 3-8 with a sub Nernstian response (43 mV/pH). The adsorbed probe was found to be reversible and exhibited minimal leaching through repeated scanning. The performance of the system was assessed in a heterogeneous bacterial fermentation mixture simulating ileostomy fluid with the pH recorded before and after 96 h incubation. The peak profile in the bacterial medium provided an unambiguous signal free from interference with the calculated pH before and after incubation (pH 5.3 to 3.66) in good agreement with that obtained with commercial pH probes.

Graphical abstract

Supplementary Information

The online version contains supplementary material available at 10.1007/s10853-023-08881-x.

Healthcare resource use and associated costs for patients with an ileostomy experiencing peristomal skin complications

Peristomal skin complications (PSCs) have a significant impact on quality of life and ostomy treatment costs. This study aimed to assess the healthcare resource use for patients with an ileostomy and PSCs symptoms. Two surveys were developed and, after validation by healthcare professionals and patients, data were collected on healthcare resource use while not experiencing any PSCs symptoms and while experiencing complications of various severities, as defined by the modified Ostomy Skin Tool. Costs applied to resource use were assigned from relevant United Kingdom sources. Additional healthcare resource use associated with PSCs, relative to no complications, was estimated to result in a total cost per instance of £258, £383, and £505 for mild, moderate, or severe PSC, respectively. The average estimated total cost per complication instance, weighted across mild, moderate, and severe PSCs, was £349. Severe-level PSCs were associated with the highest cost, because of the treatment-level required and the longer duration of symptoms. There is potential for clinical benefits and economising in stoma care if interventions are implemented that reduce the incidence and/or severity of PSCs.

Cultural Adaptation and Validation of the Ostomy Skin Tool to the Brazilian Portuguese

PURPOSE

To adapt the Ostomy Skin Tool (discoloration, erosion, and tissue overgrowth) to the Brazilian culture and to analyze psychometric properties of the adapted version.

DESIGN

Psychometric (methodologic) evaluation of the instrument.

SUBJECTS AND SETTING

Three ostomy/enterostomal therapy nurses evaluated the extent and severity of peristomal skin conditions in a sample of 109 adults 18 years or older with peristomal skin complications. These participants were receiving care in an ambulatory care center in outpatient health services in Sao Paulo and Curitiba, Brazil. In addition, interobserver reliability was measured using a group of 129 nurse participants who attended the Brazilian Congress of Stomatherapy held from November 12 to 15, 2017, in Belo Horizonte, a city located in the state of Minas Gerais, Brazil. Nurse participants assessed the descriptions of peristomal skin complications of the Portuguese version, using the same photographs used in the original DET score, purposely placed out of original order.

METHODS

The study was performed in 2 stages. The instrument was translated into Brazilian Portuguese by 2 bilingual translators, and back-translated into English. The back-translated version was sent to one of the developers of the instrument for additional evaluation. During stage 2, content validity was evaluated by 7 nurses with expertise in ostomy and peristomal skin care. Convergent validity was evaluated by correlating the severity of peristomal skin complications to pain intensity. Discriminant validity was evaluated based on type and time of ostomy creation, presence of retraction, and preoperative stoma site marking. Finally, interrater reliability was evaluated using standardized photograph evaluation reproduced in the same sequence as the original English language version of the instrument, along with paired scores from assessment of adults living with an ostomy generated by an investigator and nurse data collectors.

RESULTS

The Content Validity Index for the Ostomy Skin Tool was 0.83. Levels of mild agreements were obtained for the nurses' observations in the evaluation of peristomal skin complications using standardized photographs (κ= 0.314). In contrast, moderate to almost perfect agreements were obtained when scores were compared in the clinical setting (κ= 0.48-0.93, according to the domains). Positive correlations between the instrument and pain intensity (r = 0.44; P = .001) indicate convergent validity of the adapted version of the Ostomy Skin Tool. In contrast, analysis of discriminant validity was mixed and definitive conclusions about this form of construct validity cannot be made based on this study.

CONCLUSION

This study supports convergent validity and interrater reliability of the adapted version of the Ostomy Skin Tool.

Using peristomal body profile assessment to improve leakage-related quality of life for individuals with an ostomy

BACKGROUND

Improper fitting between peristomal body profile and ostomy product(s) is one of the main reasons for leakage among individuals with an ostomy.

AIM

To evaluate clinical usability of the Body Assessment Tool developed by Coloplast that is available free of charge. The aim was also to study how changing to product(s) that were best suited to an individual, guided by peristomal body profile, affected the number of leakages and individuals' quality of life.

METHODS

The study consisted of questionnaires administered before and after the study, which spanned 4-5 weeks. A total of 22 nurses and 68 individuals with an ostomy participated in four Nordic countries.

FINDINGS

Of the 22 nurses, 21 recommended use of the tool. A shift to best fitting ostomy product(s) resulted in a significant decrease in the number of leakages (from 5.9 to 1.8 per 7 days) and a substantial improvement in quality of life.

CONCLUSION

The findings support the use of the Body Assessment Tool in clinical practice and the results showed that optimally fitting ostomy product(s) reduced the number of leakages and increased individuals' quality of life.

Leakage of stomal effluent outside the baseplate leads to rise in product usage and health professional interactions

BACKGROUND

Leakage of stomal effluent outside the baseplate that soils clothes or bedsheets is a common problem for many people with a stoma and significantly impacts their quality of life.

AIM

To understand behavioural changes for people experiencing faecal leakage outside the baseplate regarding the usage of pouching systems, supporting products and interactions with health professionals.

METHODS

Retrospective, self-reported questionnaire.

FINDINGS

Respondents on average experienced 1.1 incidents of faecal leakage outside the baseplate per fortnight. In periods with issues of leakage, 21% of respondents had been in contact with health professionals, 40% increased their use of pouching systems, 25% increased their use of existing supporting products, and 21% included additional supporting products to their change routine. The increased use of healthcare resources was estimated to cost £32.47 in the 3 weeks following a leakage incident.

CONCLUSION

Incidents of leakage outside the baseplate lead to increased use of healthcare resources.

Peristomal Skin Complications in Ileostomy and Colostomy Patients: What We Need to Know from a Public Health Perspective

BACKGROUND

Peristomal skin complications (PSCs) are the most common skin problems seen after ostomy surgery. They have a considerable impact on a patient's quality of life and contribute to a higher cost of care.

METHODS

A systematic review was conducted, querying three databases. The analysis was performed on international studies focused on the clinical-epidemiological burden of PSCs in adult patients with ileostomy/colostomy.

RESULTS

Overall, 23 studies were considered. The main diseases associated with ostomy surgery were rectal, colon and gynecological cancers, inflammatory bowel diseases, diverticulitis, bowel obstruction and intestinal perforation. Erythema, papules, skin erosions, ulcers and vesicles were the most common PSCs for patients with an ostomy (or stoma). A PSCs incidence ranging from 36.3% to 73.4% was described. Skin complications increased length of stay (LOS) and rates of readmission within 120 days of surgery.

CONCLUSIONS

PSCs data are still limited. A knowledge of their burden is essential to support health personnel and decision-makers in identifying the most appropriate responses to patients' needs. Proper management of these complications plays a fundamental role in improving the patient's quality of life. A multidisciplinary approach, as well as increased patient education and their empowerment, are priority measures to be implemented to foster a value-based healthcare.

Results of an audit of the Peristomal Body Profile Assessment Tool

BACKGROUND

Leakage is the number one concern for people with an ostomy. The 2019 Ostomy Life Study, a global study of more than 5000 ostomates, showed that 92% of people living with a stoma worry about leakage. Getting the right stoma appliance for each patient is key to increasing patient quality of life.

AIM

The study was designed to assess the use of the Peristomal Body Profile Assessment Tool in helping choose the most appropriate stoma products for a given patient, decreasing incidents of leakage and peristomal skin complications.

METHODS

A multi-centre (33 sites, 147 patients) low-interventional clinical investigation was conducted in which the use of the Peristomal Body Profile Assessment Tool was evaluated as a tool to reduce incidents of leakage, increase peristomal skin health and increase patient quality of life. A focus group of randomised participating clinicians (n=16) was held to explore the audit results.

RESULTS

The assessment tool most often took between 2 and 5 minutes to complete. It supported clinicians in selecting the right appliance for each patient, avoiding leakages and preventing associated peristomal skin complications. The assessment tool helped improve the accuracy and quality of documentation in the patients' medical/nursing notes, increasing the quality and continuity of care. Participants reported that using the assessment tool helped reduce care costs by reducing the need for product changes, supporting product usage and return patient visits.

CONCLUSION

Use of the Peristomal Body Profile Assessment Tool helped clinicians choose the most appropriate stoma appliance the first time, resulting in patients having healthier peristomal skin, fewer leakages, more confidence in their stoma appliance and a higher quality of life.

An ostomy baseplate with a skin-protection technology reduces peristomal skin complications: a randomized controlled trial (the ATTRACT study)

BACKGROUND

Peristomal skin complications (PSCs) are the predominant complication for people living with a stoma, negatively affecting their health-related quality of life (HRQoL). PSCs may also have an impact on healthcare costs for society with more visits to healthcare professionals and increased consumption of products and treatment strategies, which amplifies the need for new strategies to reduce or prevent PSCs.

OBJECTIVES

To evaluate the performance of an ostomy baseplate with a skin-protection technology. The target group comprised people living with a stoma with liquid faecal effluent, who struggled with PSCs.

METHODS

A randomized, controlled, open-labelled, cross-over trial was conducted from September 2021 to February 2022 in five different countries. Each participant tested the investigational product against a comparator product (SenSura® Mio). The Ostomy Skin Tool 2.0 was used to evaluate the peristomal skin and HRQoL was measured using the Dermatology Life Quality Index (DLQI) questionnaire. Data were analysed in mixed repeated-measures models.

RESULTS

A total of 79 adult participants (mean age 54.5 years, female 45.6%) were included in the intention-to-treat (ITT) population. A significant reduction in PSCs (P = 0.015) and HRQoL (P = 0.035) was found for the investigational product when compared with the comparator product. Also, significantly more study participants preferred the investigational product when compared with the comparator product (P = 0.017).

CONCLUSIONS

The investigational product, an ostomy baseplate with a skin-protective technology, reduced PSCs and improved the HRQoL of people living with a stoma with liquid faecal effluent. Consequently, the investigational product was the preferred ostomy appliance of the participants. Thus, the product investigated in this study may be a new solution to be included in everyday clinical practice to overcome leakage-induced PSCs for people living with a stoma.

Prevalence of leakage and its negative impact on quality of life in people living with a stoma in the UK

BACKGROUND

People with a stoma are reported to experience leakage, which negatively impacts patient quality of life (QoL).

AIM

To assess the impact of leakage experienced by individuals with a stoma in the UK.

METHODS

Data were analysed from 301 patients living in the UK who completed a questionnaire concerning the physical and psychosocial impact of living with a stoma.

FINDINGS

Most respondents had had their stoma for more than 5 years. Nine out of 10 worried about leakage to varying degrees and half the respondents accepted that this was a worry they had to live with. Almost 70% experienced leakage onto clothes within the preceding year, and 28% experienced this monthly. Peristomal skin complications were experienced by 82% of respondents, the severity of which correlated with reductions in QoL.

CONCLUSION

Despite the consequential negative impact of leakage on QoL, individuals are not seeking advice to resolve leakage-related issues, including from their specialist stoma care nurse.

Peristomal Complications

Patients with new ostomies are being discharged from the hospital without enough hands-on training for ostomy care. Maintaining healthy peristomal skin is one of the greatest challenges for patients with an ostomy. Unfortunately, peristomal complications are very common and affect quality of life. It is important that home healthcare clinicians maintain competency in ostomy care, so they have the knowledge and skills necessary to prevent and treat peristomal complications. This article focuses on peristomal skin assessment as well as prevention and treatment of common peristomal complications.

Quality Assessment of the Clinical Practice Guidelines of Ostomy Care Based on the AGREE II Instrument

Objectives

To assess the quality of clinical practice guidelines (CPGs) of ostomy care, and to analyze the status quo and challenges of guideline development.

Methods

CPGs of ostomy care were systematically searched in relevant guideline websites and electronic databases, including PubMed, ProQuest, Web of Science, CNKI, VIP, WANFANG, and SinoMed, from January 1, 2012, to November 24, 2021. Two appraisers used the Appraisal of Guidelines for Research and Evaluation, 2nd edition (AGREE II) instrument to assess the quality of the included CPGs independently and objectively. The consistency of assessment was calculated using intraclass correlation coefficients (ICC).

Results

A total of 5 CPGs relevant to ostomy care were assessed by AGREE II and the general quality of them was good. There were two CPGs of grade A and three CPGs of grade B. The domain scope and purpose (87.78%) had the highest scores, followed by the clarity of presentation (87.22%), the rigor of development (69.17%), stakeholder involvement (68.33%), and editorial independence (65.00%), and the lowest was applicability (55.42%). The overall assessment score was 5.40. All the ICCs for the AGREE II appraisal conducted by the two appraisers were >0.75.

Conclusions

The five CPGs of ostomy care have the potential to be adopted in clinical practice. However, they still have some room for improvement, especially in the applicability domain. The development of ostomy care CPGs should follow the evidence-based progress and methodology of guideline formulation specifications while considering the effects of the CPGs and the practical issues.

The Ostomy Skin Tool 2.0: a new instrument for assessing peristomal skin changes

BACKGROUND

Peristomal skin complications (PSCs) are frequently reported postoperative complications. PSCs can present visibly or as symptoms such as pain, itching or burning sensations.

AIM

To develop a new tool that can capture a range of sensation symptoms together with visible complications and an objective assessment of discolouration in the peristomal area.

METHOD

Consensus from qualitative interviews with health professionals and people with an ostomy, and input from expert panels, formed the basis of a patient-reported outcome (PRO) questionnaire. A decision tree model was used to define a combined score including PRO and objectively assessed discolouration area.

FINDINGS

Six elements were included in the PRO questionnaire and four health states representing different severity levels of the peristomal skin were defined.

CONCLUSION

The Ostomy Skin Tool 2.0 is a sensitive tool that can be used to follow changes in the peristomal skin on a regular basis and thereby help prevent severe PSCs.

Challenges faced by people with a stoma: peristomal body profile risk factors and leakage

AIM

The Ostomy Life Study 2019 aimed to obtain a better understanding of the challenges faced by people with stoma.

METHODS

Online survey with participants from 17 countries.

FINDINGS

Of the 54 614 individuals invited to take part, 5187 responded; 62% of the respondents avoided physical and social activities because of their stoma and 37% had never consulted their stoma care nurse to have the fit of their stoma product checked. In a subgroup receiving questions on leakage (n=4209), output under the baseplate and leakage onto clothes were experienced within the previous month by 76% and 26% of respondents, respectively. Higher chance of leakage was associated with an irregular stoma shape and peristomal body profile; a stoma level at or below the skin surface; and the presence of creases, folds and other changes in the peristomal area.

CONCLUSION

Leakage and access to a stoma care nurse to provide the necessary care and guidance remain important concerns for individuals with a stoma.

Impact of stoma leakage in everyday life: data from the Ostomy Life Study 2019

BACKGROUND

Many people with a stoma experience leakage of stomal effluent.

AIM

To investigate the impact of leakage on individuals with a stoma.

METHODS

The Ostomy Life Study 2019 included a survey concerning experiences with stomal effluent leakage and the validated Ostomy Leak Impact tool.

FINDINGS

Respondents with frequent leakage episodes were significantly more affected emotionally and they were feeling less in control than those who rarely or never experienced leakage. The emotional impact of experiencing leakage onto clothes appeared to last up to 1 year after the last leakage incidence. Because of worrying about leakage users increased their product usage and, of those who were in employment, 65% reported that leakage and the related worry influenced their ability to work.

CONCLUSION

Most people with a stoma were emotionally impacted by experiencing leakage, especially by leakage outside the baseplate (resulting in soiled clothes). New solutions are warranted that can help reduce the impact of leakage.

Utilities associated with stoma-related complications: peristomal skin complications and leakages

AIM

Peristomal skin complications (PSCs) and leakages are major issues for people living with a stoma. The purpose of this study is to understand how these stoma-linked complications impact health-related quality of life (HRQoL) in a UK population.

MATERIALS AND METHODS

The study used time trade-off (TTO) methodology to quantify health state utilities associated with two stoma-related complications: PSC and leakages. Respondents assessed 10 different health states with different PSC severity levels (no, mild, moderate or severe PSC) and frequencies of leakage events (2, 12 or 48 leakages onto clothes per year, and no leakage due to a digital solution). The average disutility value for each health state was also assessed. The study was conducted via a web-based survey in the UK adult general population.

RESULTS AND LIMITATIONS

The analysis included 758 respondents. Respondents considered living with a stoma with no PSC to be more favorable than the other health states. Severe pain, itching and/or burning (PIB) was associated with the largest disutility compared to no PSC. The disutility (0-1 scale) compared to no PSC was 0.287 (p < .0001), 0.106 (p < .0001) and 0.025 (p=.0005) for PIB scores of 8, 5 and 2, respectively, on a 1-10 scale. More frequent leakage events were associated with lower utility. The utility decreases compared to no PSC were 0.114 (p < .0001), 0.057 (p < .0001) and 0.022 (p < .0001) for 48, 12 and 2 leakage events per year, respectively. The health state with a digital notification solution that notifies the user before a leakage event happens was considered as good as no PSC.

CONCLUSIONS

Experiencing mild, moderate, and severe levels of PSC or leakage onto clothes is associated with a significant reduction in HRQoL compared to no PSC and/or no leakage. Stoma appliances that reduce the skin complications or keep leakage from reaching the clothes are likely to improve HRQoL.

Perception of leakage: data from the Ostomy Life Study 2019

BACKGROUND

Leakage is a common problem for people with a stoma.

AIM

To investigate how people with a stoma and stoma care nurses perceive different patterns of effluent under the baseplate.

METHODS

The Ostomy Life Study 2019 included a user survey and a nurse survey covering experiences of leakage and the perception of leakage.

FINDINGS

Most people with a stoma perceived effluent reaching outside the baseplate as leakage (88-90%), whereas effluent close to the stoma only was not perceived as leakage by the majority (81-91%). Effluent covering major parts of the baseplate was perceived as leakage by most respondents with a colostomy or ileostomy (83%), whereas fewer respondents with a urostomy perceived this as leakage (57%). Most of the nurses (70%) did not perceive effluent close to the stoma as leakage.

CONCLUSION

This study revealed that effluent confined to the area next to the stoma is generally not perceived as leakage.