Analysis on effect of psychological nursing combined with extended care for improving negative emotions and self-care ability in patients with colorectal cancer and enterostomy: A retrospective study.

This study investigates the effectiveness of combining psychological nursing with extended nursing in patients with colorectal cancer who have undergone enterostomy. Conducted from January 2021 to January 2022, this retrospective study involved 78 patients split into 2 groups of 39 each. The control group received standard nursing care, while the observation group benefitted from both psychological and extended nursing. The evaluation focused on anxiety, depression, sleep quality, mental resilience, and self-care abilities. Results, 3 months postdischarge, indicated that the observation group had significantly lower scores in the Hamilton Depression Rating Scale and the Pittsburgh Sleep Quality Index, and higher scores in the Connor-Davidson Resilience Scale and the Enterostomal Self-Care Ability Scale, compared to the control group (P < .05). The findings suggest that integrating psychological nursing with extended care significantly improves mood, sleep quality, psychological resilience, and self-care capabilities in these patients.

Associations between preparedness, perceived stress, depression, and quality of life in family caregivers of patients with a temporary enterostomy.

PURPOSE: To investigate the preparedness, perceived stress, risk of depression, and quality of life of family caregivers of patients receiving a temporary enterostomy, to provide a reference for improving the long-term care and quality of life of patients receiving a temporary enterostomy. METHODS: We enrolled 181 family caregivers of patients in a hospital in China from 2021 to 2023. Responses to the General Information Questionnaire, the Chinese Caregiver Preparedness Scale, the Chinese Perceived Stress Scale, the Chinese bilingual version of the Patient Health Questionnaire-2, and the 12-item Short Form Survey were collected online. RESULTS: Pearson's correlation analysis revealed that family caregivers' risk of depression was negatively correlated with their preparedness, the physical component summary score, and the mental component summary score but was positively correlated with perceived stress. Multiple linear regression analysis identified factors influencing caregiver preparedness. CONCLUSIONS: These findings help healthcare personnel to identify high-risk individuals among family caregivers of patients receiving a temporary enterostomy. This provides a basis for formulating well-planned, dynamic health education programs that meet patients' needs for disease-related knowledge and care.

The impact of stoma management education on the self-care abilities of individuals with an intestinal stoma.

An intestinal stoma is a surgically formed exteriorisation of the large or small bowel on to the anterior abdomen wall, to enable faeces to be excreted from the body. Patients living with a stoma may encounter physical, psychological, and social barriers and challenges. Stoma self-management education is essential to improving self-care competence, and patients who perceive the benefits of self-management education show a better adjustment to living with a stoma. This literature review explored the effectiveness of patient education interventions in improving the self-care knowledge and skills of patients living with an ostomy. The findings from the nine studies reviewed showed that self-management education approaches are effective in improving patients' self-care. The application of different approaches to ostomy self-management education, such as a transtheoretical model, chronic care model, telehealth and multimedia-based programmes - helped improve patients' self-care ability. The review also found that patients needed at least 3 months to develop the skills and maintain their ability to self-care. In addition, two education sessions provided to patients in hospital pre-discharge appeared sufficient for improving and maintaining self-care abilities. Where patients received education in hospital post-surgery, 2 or 3 sessions over 7 days were found to be sufficient to provide them with stoma care skills. Education sessions based on the transtheoretical model and chronic care model or telehealth helped maintain and reinforce self-care behaviours following discharge.

Relationship among self-concept clarity, social support, and psychological resilience in Chinese patients with an enterostomy: A cross-sectional study and structural equation model analysis.

PURPOSE: This study was to explore the relationship between self-concept clarity, social support, and psychological resilience in Chinese enterostomy patients. METHODS: A cross-sectional, descriptive study was conducted from October 2019 to April 2020 among enterostomy patients visiting the stoma clinic and inpatients with an enterostomy in general surgery of three tertiary grade A hospitals in Guangzhou, China. Patients (n=201) were required to complete paper questionnaires, including sociodemographic information, the 10-Item Resilience Scale Specific to Cancer, Self-concept Clarity Scale, and Social Support Rating Scale. Multiple linear regression analyses and structural equation modeling were conducted to explore the effect of self-concept clarity and social support on psychological resilience. RESULTS: Psychological resilience was at a median level among enterostomy patients, with a mean score of 38.21 (SD, 7.24). Education level (ß = 1.032, P = .004), own acceptance of stoma (ß = 2.445, P < .001), social support (ß = 206, P = .001) and self-concept clarity (ß = 0.285, P < .001) were factors related to psychological resilience, explaining 33.1% of the variance of psychological resilience. It was also shown that self-concept clarity exerted its direct positive effect on social support (ß = 0.098, SE = 0.025, BC 95%CI = 0.047/0.143), and it also had an indirect positive effect on psychological resilience through mediating social support (ß = 0.193, SE = 0.033, BC 95%CI = 0.121/0.245). CONCLUSIONS: This study suggests that self-concept clarity has an indirect positive effect on psychological resilience by influencing social support in enterostomy patients. Medical staff should strive to improve the self-concept clarity as a new means to enhance patients' psychological resilience, especially focusing on patients' social support, education level and own acceptance of enterostomy.

The correlation between intimate relationship, self-disclosure, and adaptability among colorectal cancer enterostomy patients.

ABSTRACT: The postoperative physiological changes and psychological pressure of cancer patients affect the patient's adaptability to the disease, and thus affect the spousal intimate relationship. This study aimed to evaluate the correlation between spousal intimate relationship, self-disclosure, and adaptability among colorectal cancer (CCI) patients with enteric stoma.This cross-sectional study selected patients with CCI in Henan Province from February 2018 to October 2020. The Marital Adjustment Test (MAT), the Distress Disclosure Index scale, and the Ostomy adjustment inventory-20 scale were used to collect relevant data of the participants. A Pearson correlation analysis was used to test the correlation between variables, and multiple stepwise regression analysis was used to test the influence of general information on the intimate relationship, self-disclosure, and adaptability.Among the respondents, 42.6% had a spousal intimate relationship problem, 58.4% had a low or moderate level of self-disclosure, and 90.8% were at a low or moderate level of adaptation. Education background, self-care ability, and postoperative time were associated with a couple's intimate relationship. Average monthly household income, gender, and place of residence were associated with self-disclosure. Self-care ability, average monthly household income, postoperative time, and educational background were associated with adaptation.Healthcare workers should provide more health education training to guide CCI enterostomy patients to express their thoughts and feelings with each other increase self-disclosure, so as to enhance their intimate relationship then improve their adoption to ostomy, finally elevate their quality of life.

Correlation between self-efficacy and self-esteem in patients with an intestinal stoma.

BACKGROUND: Patients with an intestinal stoma experience psychological difficulties, including disturbances in self-efficacy and self-esteem. There is evidence that they are interdependent. AIM: This study aimed to determine the correlation between self-efficacy and self-esteem in patients with an intestinal stoma. METHODS: A descriptive-correlational study was conducted with 155 patients with an intestinal stoma. Participants were selected using convenience sampling. Data were collected using demographic questions, the stoma self-efficacy scale and the Rosenberg self-esteem scale, and analysed using descriptive and analytical statistics. FINDINGS: Seventy-nine men and 76 women took part; the 50-70 years age group had the highest proportion of participants. Regarding diagnosis, 52.26% had cancer and 45.81% had inflammatory bowel disease or related conditions. Pearson's correlation coefficient indicated a positive, significant correlation between total self-efficacy and its dimensions with self-esteem (P<0.001; r=0.54). CONCLUSION: Self-efficacy is positively correlated with self-esteem in patients with an intestinal stoma. It is recommended that educational interventions are planned and implemented to boost self-esteem and self-efficacy in these patients.

The association between personality trait and the development of postoperative complications in enterostomized patients. Systematic review of literature.

AIM: To investigate the presence of association between the personality trait and the onset of postoperative complications in patients undergoing enterostomy packaging. MATERIALS AND METHODS: Systematic review of the literature. RESULTS: Type D personality traits and those with a low tendency to optimism and temperament (ex. anxiety-depressive syndrome) would seem to be associated with an increased risk of developing postoperative psychiatric morbidity and reduced levels of health-related quality of life (HRQoL) in enterostomized patients for colorectal cancer (CRC). Also, type-D personality, has been associated with greater risk of multiple comorbidities including an increased risk of heart failure unrelated to other sociodemographic causes 32-34-35. Personality with little tendency to optimism may represent a predictive factor on the development of psychological suffering one year after the diagnosis of CRC 3. Patients with personality traits associated with reduced levels of life satisfaction and / or reduced coping capacity require longer hospitalization time 26. DISCUSSION: Several studies highlight the presence of association between personality traits oriented to performance, persistence and extroversion and outcomes in various areas of surgery 14,2,-27,30. However, in almost all cases, the outcomes measured do not correspond to the early post-operative complications defined in the inclusion criteria but to mediumlong term psychological and rehabilitative outcomes. CONCLUSIONS: From the review study, no sources were found concerning the association between the personality trait and the onset of early postoperative complications in enterostomised patients, highlighting, furthermore, a lack of data on the subject involving the entire field of abdominal surgery. KEY WORDS: Personality trait, Enterostomy, Post-operative complications.

Cancer Survivorship at the Intersections of Care and Personhood.

Surviving colorectal cancer following ostomy surgery with an intestinal stoma presents numerous challenges to the cultural category of full adult personhood. The foremost is managing unpredictable bowel activity. The technical management of the ostomy facilitated by biomedical specialists, is essential for personhood realignment. This article focuses on how some female long-term cancer survivors manage and adapt to this new fecal habitus by mobilizing various assemblages of care - receiving care, continuing to provide particular gendered forms of care, and returning to caregiving roles. These interdependent practices of care realign personhood, or at the very least, minimize the assaults that having an ostomy presents to the cultural category of full adult personhood.

Sexual Experience and Stigma Among Chinese Patients With an Enterostomy: A Cross-sectional, Descriptive Study.

Colorectal cancer is common in China, and studies on the sexuality of patients with an ostomy are limited, particularly information about the relationship between sexual experience and stigma. PURPOSE: A study was conducted to assess the association between sexual experience and stigma in Chinese patients with an enterostomy. METHOD: A cross-sectional, descriptive study was conducted between May 2017 and August 2018 among patients with an ostomy at 3 general hospitals. Patients 18 to 70 years old with a history of ostomy surgery more than 1 month prior, who had a regular sexual partner, and were willing to provide informed consent were eligible to participate; persons with mental illness, preoperative sexual dysfunction (SD), or tumor recurrence or metastasis were excluded. Study participants completed a paper-and-pencil questionnaire including demographic (gender, educational level, occupation, geographic place of residence, and monthly family income) and ostomy-related (type of ostomy, time since ostomy surgery, insurance coverage, ostomy-related complications, and sexual guidance) information. Sexual experience was assessed using the 5-item Chinese version of the Arizona Sexual Experience Scale (C-ASEX) (range 5 to 30; scores >19 reflect sexual dysfunction). Stigma (internalization of perceived shameful experience) was assessed using the 24-item, Likert-type Chinese version of the Social Impact Scale (C-SIS) (score range 24 to 96; lower scores indicate less stigma). Quantitative data from the questionnaires were deindentified and entered into statistical software for analysis by 2 researchers. Multivariate regression analysis was used to assess the associations among sexual experience, stigma, and other factors. RESULTS: Of the 240 questionnaires distributed, 187 (77.9%) were completed and included in the final analysis. The average C-ASEX score was 22.77 ± 6.78, and 118 participants (63.1%) had SD. The average C-SIS score was 59.36 ± 11.20, indicating a moderate level of stigma. A significant association was found between sexual experience and stigma (B = 0.101, P = .006). Sexual experience perceptions were determined by sexual guidance needs (B = 3.179, P <.001), geographic area of residence (B = -2.087, P = .014), receipt of sexual guidance (B = -2.989, P = .001), and insurance coverage (B = 1.822, P = .015). CONCLUSION: Health care workers should strive to reduce the stigma of having a stoma and offer sexual guidance as a means to improve quality of sexual life. Particular attention should be paid to the sexual well-being of persons living in rural areas and those paying for medical expenses out of pocket.

A Descriptive, Cross-sectional Study Among Chinese Patients to Identify Factors that Affect Psychosocial Adjustment to an Enterostomy.

Physiological, psychological, and social problems may affect adaptation to living with a stoma. A descriptive, cross-sectional study was conducted between March 2017 and June 2017 among patients culled from a manufacturer's database to identify factors that influence psychosocial adjustment in Chinese patients with an enterostoma. Patients with a history of ostomy surgery ≥1 month prior and who were ≥18 years of age, completed a primary school education, and able to communicate in Chinese were eligible to participate unless they had a history of psychosis, cognitive impairment, or participation in other research programs. After providing informed consent, participants completed a questionnaire that addressed demographic (age, gender, employment, educational level, marital status, medical payment method, living status, and area of residence) and stoma-related (date of surgery, preoperative stoma siting, ostomy appliance type, peristomal complications, regular defecation, stoma self-care ability, stoma-related communication with medical staff, level of understanding regarding stoma knowledge and care skills, appliance change knowledge/experience, and leakage history) factors. Social support was assessed using the 10-item Social Support Revalued Scale (SSRS), and 3 dimensions of adjustment (acceptance, continuous worry, and positive life attitude) were assessed using the 20-item Chinese version of the Ostomy Adjustment Inventory (OAI). Questionnaires were administered via an online survey platform. Data were analyzed descriptively, and single-factor analysis and stepwise multiple linear regression were applied to identify the factors that influenced the adjustment level. Incomplete (missing >2 questions), incorrect, or hastily completed (within 600 seconds) records were excluded from analysis. Of the 1109 persons who returned the questionnaire, 1010 (91.1%) completed the entire survey (564 men [55.8%] and 446 women [44.2%], mean age 56.62 ± 15.62 years); 823 (81.5%) had a colostomy and 187 (18.5%) had an ileostomy. The OAI dimension continuous worry was negatively and significantly associated with all 3 dimensions of the SSRS, including subjective support (r = 0.259), objective support (r = 0.259), and utilization of support (r = 0.289), while the dimension acceptance was positively associated with both subjective support (r = 0.082) and objective support (r = 0.074) (all P values <.05). Using multiple linear regression, residence area, peristomal complication, regular defecation, leaking, self-care ability, communication with medical staff regarding ostomy, understanding knowledge or skill needed for stoma care, utilization of social support, and total score of social support were found to be significantly associated with ostomy adjustment level (all P values <.05). Patients living in an urban area, with no history of peristomal complications, who had regular defecation, had not experienced leaking, had better self-care ability, frequently communicated with medical staff, had a high level understanding about knowledge or skill of stoma, and had higher social support scores had higher adjustment scores. Knowledge of the factors that enhance or hinder adaptation of the patient to the ostomy is an important tool in the clinician's care armamentarium.

Psychological aspects of patients with intestinal stoma: integrative review.

OBJECTIVE: to analyze evidences of psychological aspects of patients with intestinal stoma. METHOD: integrative review with search of primary studies in the PsycINFO, PubMed, CINAHL and WOS databases and in the SciELO periodicals portal. Inclusion criteria were: primary studies published in a ten-year period, in Portuguese, Spanish or English, available in full length and addressing the theme of the review. RESULTS: after analytical reading, 27 primary studies were selected and results pointed out the need to approach patients before surgery to prevent the complications, anxieties and fears generated by the stoma. The national and international scientific production on the experience of stomized patients in the perioperative moments is scarce. CONCLUSION: it is recomendable that health professionals invest in research on interventions aimed at the main psychological demands of stomized patients in the perioperative period, respecting their autonomy on the decisions to be made regarding their health/illness state and treatments.

Determinants of self-efficacy and quality of life in patients with temporary enterostomy: a cross-sectional survey.

AIMS AND OBJECTIVES: To identify determinants of self-efficacy and quality of life in patients with temporary enterostomy. BACKGROUND: Anterior resection with temporary enterostomy is the preferred treatment for patients with rectal cancer, which may impair patients' quality of life. So far, most studies have focused on quality of life in patients with permanent enterostomy, but few studies have looked at that in those with temporary enterostomy. Self-efficacy may determine quality of life in these patients, but few studies have identified determinants of self-efficacy and quality of life. DESIGN: Multicentre, cross-sectional survey and regression analysis to identify determinants of self-efficacy and quality of life. METHODS: A convenience sample of patients undergoing temporary enterostomy at five hospitals in Guangdong Province (China) were surveyed at least four weeks after stoma surgery using validated Chinese versions of internationally recognised questionnaires, including a Stoma Self-Efficacy Scale and the City of Hope Quality of Life-Ostomy Questionnaire. Backward multiple regression analysis was performed to identify whether quality of life was determined by self-efficacy and other clinico-demographic characteristics. RESULTS: Of the 180 questionnaires distributed, 149 (82·8%) were returned, and 135 (75%) were used in the final analysis. Mean global quality of life was 5·40 ± 1·58, and mean global self-efficacy was 79·59 ± 20·21. Significant determinants of self-efficacy and quality of life were identified (ß = 0·62, p < 0·01). Quality of life was determined by type of enterostomy (ß = 0·18, p = 0·01) and payment method (ß = 0·14, p = 0·03). CONCLUSIONS: Quality of life may be determined by self-efficacy, type of enterostomy and payment method, after temporary enterostomy. RELEVANCE TO CLINICAL PRACTICE: Promoting stoma-related self-efficacy in patients with temporary enterostomy may improve their quality of life. Healthcare providers should focus on quality of life in those either with temporary loop ileostomy or entirely self-funded for medicine.

Psychological aspects of patients with intestinal stoma: integrative review / Aspectos psicológicos de pacientes estomizados intestinais: revisão integrativa / Aspectos psicológicos de pacientes ostomizados intestinales: revisión integrativa

ABSTRACT Objective: to analyze evidences of psychological aspects of patients with intestinal stoma. Method: integrative review with search of primary studies in the PsycINFO, PubMed, CINAHL and WOS databases and in the SciELO periodicals portal. Inclusion criteria were: primary studies published in a ten-year period, in Portuguese, Spanish or English, available in full length and addressing the theme of the review. Results: after analytical reading, 27 primary studies were selected and results pointed out the need to approach patients before surgery to prevent the complications, anxieties and fears generated by the stoma. The national and international scientific production on the experience of stomized patients in the perioperative moments is scarce. Conclusion: it is recomendable that health professionals invest in research on interventions aimed at the main psychological demands of stomized patients in the perioperative period, respecting their autonomy on the decisions to be made regarding their health/illness state and treatments.

RESUMO Objetivo: analisar as evidências sobre os aspectos psicológicos de pacientes estomizados intestinais. Método: revisão integrativa com a busca de estudos primários nas bases de dados PsycINFO, PubMed, CINAHL e WOS e no portal de periódicos SciELO. Adotou-se como critérios de inclusão: estudos primários publicados no período de 10 anos, nos idiomas português, espanhol ou inglês, disponíveis na íntegra e que responderam à questão norteadora da revisão. Resultados: após leitura analítica, 27 estudos primários foram selecionados, cujos resultados apontaram a necessidade de abordar os pacientes antes da cirurgia para prevenir as complicações, angústias e medos suscitados pela estomia. A produção científica nacional e internacional sobre a vivência do paciente estomizado no perioperatório é escassa. Conclusão: sugere-se investimentos dos profissionais de saúde na condução de pesquisas de intervenções direcionadas para as principais demandas psicológicas do paciente estomizado no perioperatório, respeitando a sua autonomia sobre as decisões a serem tomadas em relação ao seu estado de saúde/doença e tratamentos.

RESUMEN Objetivo: analizar las evidencias sobre los aspectos psicológicos de pacientes ostomizados intestinales. Métodos: revisión integrativa, con la búsqueda de estudios primarios en las bases de datos, PsycINFO, PubMed, CINAHL y WOS y en el portal de periódicos SciELO. Fueron adoptados como criterios de inclusión: estudios primarios publicados en el período de diez años, en los idiomas portugués, español o inglés, disponibles en la íntegra y en los cuales se respondió a la pregunta guía de la revisión. Resultados: después de la lectura analítica, 27 estudios privados fueron seleccionados, cuyos resultados señalaron la necesidad de abordar los pacientes antes de las cirugías para prevenir complicaciones, angustias y miedos suscitados por la ostomía. La producción científica nacional e internacional sobre las vivencias del paciente ostomizado en el perioperatorio es escasa. Conclusión: se sugiere invertir en los profesionales de salud en la conducción de investigaciones de intervenciones dirigidas a las principales demandas psicológicas del paciente ostomizado en el perioperatorio, respetando su autonomía sobre las decisiones a ser tomadas en relación a su estado de salud/enfermedad y tratamiento.

Psychosocial predictors of health outcomes in colorectal cancer: a comprehensive review.

BACKGROUND: A diagnosis of colorectal cancer (CRC) and its long-term treatment may lead to significant psychological distress and impaired health-related quality of life (HRQoL) for a significant proportion of patients. METHODS: We searched the PubMed/MEDLINE electronic database for available literature on the associations between personality characteristics, depression, psychological distress and HRQoL in CRC. Additional references were identified through the citation tracking of the included articles. RESULTS: Recent evidence indicates that Type-D (distressed) personality may predict distress among CRC patients. Additionally, other personality traits, such as specific ego defense mechanisms, influence the coping responses and HRQoL. Although the presence of a stoma has been linked to the development of depressive symptoms and impairment in HRQoL in CRC patients, more prospective studies are necessary to confirm these associations. Sense of coherence (SOC) has both a moderating and mediating effect on health (especially mental health and HRQoL), and preliminary data indicate that SOC may be an independent predictor of CRC survival. CONCLUSIONS: The interplay between personality variables during the elaboration of "the impaired role" is complex, and the assessment of personality traits may be incorporated into a comprehensive psychosomatic evaluation of CRC patients. More well-designed prospective investigations are necessary to establish the contributory role of personality dimensions for the development of and protection from distress and impairment in the HRQoL of CRC patients, which could eventually lead to the development of psychosocial interventions that are personalized to this patient population (for example, manual-based psychotherapies).

Patients with colorectal cancer: relationship between demographic and disease characteristics and acceptance of disability.

AIM: This article is a report of a study conducted to examine acceptance of disability among patients with colorectal cancer and its relationships to other disease-related factors. BACKGROUND: Colorectal cancer had become the third leading cause of cancer death worldwide. Recently, the topic of acceptance of disability in patients with chronic disease, especially cancer, has attracted enormous attention because the higher acceptance, the better coping with disease and the better quality of life after therapy. METHOD: A cross-sectional study was carried out with 110 patients with colorectal cancer recruited from a medical centre in northern Taiwan in 2008. Data were collected using the Acceptance of Disability Scale. Descriptive statistics, Pearson correlations and multiple linear regression analysis were used for analysis. FINDINGS: Participants reported moderate levels of acceptance of disability. The regression model showed that those with shorter disease duration, stoma, lower educational level (below 9th grade), or in Duke C1 stage or above reported lower levels of acceptance, and these variables accounted for 25% of the total variance. CONCLUSION: The results suggest that acceptance of disability (i) is a useful construct to examine in future studies on psychosocial adaptation to cancer, and (ii) can be integrated into a clinical intervention programme of providing holistic care to patients with colorectal cancer.

Influence of intestinal stoma on spiritual quality of life of U.S. veterans.

PURPOSE: To examine spiritual quality of life (QOL) of veterans with intestinal ostomies. DESIGN: Mixed-method cross-sectional. METHODS: Male veterans with total scores in the upper (n = 59) and lower (n = 61) quartiles of the City of Hope Quality-of-Life-Ostomy survey provided spiritual QOL data. Analyses included chi-square and analysis of variance with significance set at p < .05. Content analysis was used to explicate narratives and focus groups. RESULTS: The high spiritual QOL group was more likely to be married, older, and report more years since surgery (each p < .0001). Upper quartile participants had more favorable scores for several spiritual QOL domains (all p < .0001). Qualitative comments reflected high or low total QOL scores. CONCLUSIONS: Spiritual QOL is influenced by an intestinal stoma. Qualitative comments lend insight into the meaning of spirituality items. Findings can assist in the provision of holistic care in this population.

Stoma surgery for colorectal cancer: a population-based study of patient concerns.

OBJECTIVE: The difficulties and concerns of colorectal cancer patients with an ostomy are not well documented. This study describes the difficulties experienced by colorectal cancer patients with a temporary or permanent ostomy over the 2-year period following their diagnosis. Patients' satisfaction with the information provided to them by their healthcare providers was also assessed. METHODS: Colorectal cancer patients with an ostomy (N 5332) recruited through a cancer registry completed telephone interviews at approximately 5, 12, and 24 months following diagnosis. RESULTS: Painful or irritated peristomal skin and odor and noise from the appliance were the most commonly reported stoma-related difficulties. The proportion of participants reporting these difficulties decreased over time. Provision of preoperative information was comprehensive, and satisfaction with preoperative information was high. However, 34% of patients said they were not seen by an ostomy nurse prior to surgery. CONCLUSIONS: The ostomy nurse may be ideally placed to initiate, develop, and implement survivorship care plans for colorectal cancer patients.

Sexual health and quality of life among male veterans with intestinal ostomies.

PURPOSE: This secondary analysis was conducted to expand our understanding of the challenges men with ostomies face regarding intimate relationships and sexual functioning. We examined quantitative and qualitative data to examine sexual functioning, intimate relationships, and health-related quality of life (HR-QOL) among military veterans who are living with an intestinal stoma. SETTING: Three Veterans Health Administration sites. SAMPLE: Four hundred eighty-one male veterans. METHODS: Case-control, mixed-methods design; cases were those who had ostomies for at least 2 months, and controls had a similar major intestinal surgical procedure that did not result in an ostomy. Quantitative and qualitative data on sexual functioning, relationships, and other dimensions of HR-QOL were collected using the modified City of Hope Quality of Life-Ostomy questionnaire. RESULTS: The overall response rate was 49%. Prevalence of erectile dysfunction was significantly higher among ostomates compared with controls (P < .001). Although a greater proportion of veterans with ostomies reported being sexually active before surgery compared with controls (P < .001), the proportion of men who had resumed sexual activity after surgery is significantly lower among the ostomy group (P = .015). Compared with veterans with ostomies who did not resume sexual activity after surgery, those who were sexually active reported a higher total HR-QOL score and higher scores on all 4 modified City of Hope Quality of Life-Ostomy dimensions (psychological, social, physical, and spiritual well-being). Veterans with ostomies who had resumed sexual activity after their ostomy also reported that their ostomy had caused significantly less interference with social activities, less isolation, less interference with their personal relationships, and less interference with their ability to be intimate. These men also reported less difficulty adjusting to the ostomy. Results of qualitative analyses showed that problems with intimacy and sexual function are among the greatest challenges faced by ostomates. CONCLUSION: Presence of an ostomy was associated with lower rates of sexual activity and higher erectile dysfunction. The lower rates of sexual activity and sexual satisfaction were related to the social and psychological dimensions of HR-QOL among men with ostomies. Interventions to address sexual concerns of male ostomates and their partners may prevent decrements to HR-QOL for these patients. IMPLICATIONS FOR PRACTICE: Results of the study have implications for the clinical nurse specialist role in supporting and educating patients with ostomies to minimize the negative impact of an intestinal ostomy on sexual health and HR-QOL. Implications also relate to the need to educate current and future nurses about the importance of assessing sexual health.

Health related quality of life six months following surgical treatment for secondary peritonitis--using the EQ-5D questionnaire.

BACKGROUND: To compare health related quality of life (HR-QoL) in patients surgically treated for secondary peritonitis to that of a healthy population. And to prospectively identify factors associated with poorer (lower) HR-QoL. DESIGN: A prospective cohort of secondary peritonitis patients was mailed the EQ-5D and EQ-VAS 6-months following initial laparotomy. SETTING: Multicenter study in two academic and seven regional teaching hospitals. PATIENTS: 130 of the 155 eligible patients (84%) responded to the HR-QoL questionnaires. RESULTS: HR-QoL was significantly worse on all dimensions in peritonitis patients than in a healthy reference population. Peritonitis characteristics at initial presentation were not associated with HR-QoL at six months. A more complicated course of the disease leading to longer hospitalization times and patients with an enterostomy had a negative impact on the mobility (p = 0.02), self-care (p < 0.001) and daily activities: (p = 0.01). In a multivariate analysis for the EQ-VAS every doubling of hospital stay decreases the EQ-VAS by 3.8 points (p = 0.015). Morbidity during the six-month follow-up was not found to be predictive for the EQ-5D or EQ-VAS. CONCLUSION: Six months following initial surgery, patients with secondary peritonitis report more problems in HR-QoL than a healthy reference population. Unfavorable disease characteristics at initial presentation were not predictive for poorer HR-QoL, but a more complicated course of the disease was most predictive of HR-QoL at 6 months.

The impact of surgery for colorectal cancer on quality of life and functional status in the elderly.

PURPOSE: Colorectal cancer is a common diagnosis in the elderly. Frequently concerns arise about outcomes after surgery, and little is known about postoperative quality of life in this older group after major bowel surgery. The objective of this study was to compare quality of life and functional status of elderly patients (older than aged 80 years) who have undergone surgery for colorectal cancer with a younger (younger than aged 70 years), procedure-matched control group. METHODS: Patients in the case (older than aged 80 years) and control groups (younger than aged 70 years) were identified from the colorectal cancer database at Mount Sinai Hospital, Toronto, Canada. All had treatment for colorectal cancer within the last five years. Patients were surveyed by mail using the European Organization for Research and Treatment of Cancer quality of life scales specific to cancer and colorectal cancer (EORTC-C30 and EORTC-CR38) and the Short Form-36. Student's t-test was used to test differences. RESULTS: There were 29 patients in each of the groups. The current average ages were 83.2 (standard deviation=2.79) years, and 67.7 (standard deviation=5.1) years, respectively. The two groups scored similarly on the European Organization for Research and Treatment of Cancer quality of life scales in all domains except physical functioning, functional role, micturition, and stoma-related problems. Similarly, the mean scores of the Short Form-36 were similar with the exception of the vitality domain. Most patients did not require special assistance or alternate living arrangements after discharge from the hospital, and most patients seemed to be able to return to their preoperative level of functioning. However, stoma care was a greater concern to the elderly. CONCLUSIONS: Elderly patients older than aged 80 years who are selected for surgery have a quality of life comparable to younger patients in most respects. Therefore, colorectal cancer surgery may be offered to the highly functioning elderly with the expectation of a good quality of life postoperatively.