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.

Self-efficacy and Associated Factors in Patients With Temporary Ostomies: A Cross-sectional Survey.

PURPOSE: To examine stoma self-efficacy (SE) and its association with health-related quality of life (HRQOL) and social support in patients with temporary ostomies. SUBJECTS AND SETTING: Convenience sampling was used to recruit 150 patients from 5 hospitals in Guangdong province, China, who had been living with a temporary ostomy for at least 1 month. DESIGN: Cross-sectional survey. METHODS: Respondents completed a questionnaire that included ostomy-related sociodemographic and clinical data, and Chinese language versions of several validated instruments, the Stoma Self-efficacy Scale (C-SSES), City of Hope-Quality of Life-Ostomy Questionnaire (C-COH-QOL-OQ), and Perceived Social Support Scale (C-PSSS). RESULTS: Of the 150 questionnaires distributed, 122 (81.3%) were returned, and 111 (74%) had sufficiently complete responses to be included in the final analysis. The average score from the C-SSES was 78.55 ± 14.72 (mean ± standard deviation) for total stoma SE; 85.6% of respondents showed low or moderate self-efficacy related to ostomy care. The scores from the C-SSES were 39.36 ± 7.72 for stoma care SE and 23.33 ± 6.69 for social SE. Stoma care SE was significantly associated with HRQOL domains, psychological well-being (B = 2.09, P < .01), social well-being (B = 1.16, P < .05), significant other support (B = 1.19, P < .01), and friend support (B = 0.72, P < .01). Social SE was associated with education level (B = 2.84, P < .01), HRQOL domains, psychological well-being (B = 1.88, P < .01), social well-being (B = 1.17, P < .01), and family support (B = 0.48, P < .01). CONCLUSIONS: Persons with temporary ostomies reported low or moderate levels of SE, suggesting the need to focus on HRQOL aspects of psychological and social well-being, as well as social support. We hypothesize that interaction with other ostomy patients, especially those with long-term enterostomy experience or those trained through ostomy organizations, may improve stoma SE.

Unusually large paraganglioma complicated with successive catecholamine crises: A case report and review of the literature.

Background: Paragangliomas are rare neuroendocrine tumors that could secret catecholamines. Hypertension and heart failure caused by the catecholamine crisis are fatal cardiovascular events. However, silent paragangliomas that lack typical symptoms of catecholamine pose a significant diagnostic challenge. Case summary: A 45-year-old woman who presented with more than 1-year history of abdominal discomfort was suspected of having a gastrointestinal stromal tumor by a local hospital since a vast metastatic mass occupied her left abdomen. Thus, she was recommended to our hospital. After completing the gastroscopy, she unexpectedly developed acute heart failure and was transferred to the Intensive Care Unit (ICU) where the initial diagnosis of paraganglioma was considered through path. However, a second catecholamine crisis due to constipation led to acute heart failure again. After anti-heart failure therapy and rigorous preoperative preparation, surgery was arranged to remove the tumor. Postoperative pathology confirmed the paraganglioma, and the patient was discharged from the hospital in good condition. Conclusion: We reported a rare case of huge retro-peritoneal paraganglioma with successive catecholamine crises and acute heart failure. This was probably the largest retro-peritoneal paraganglioma since the 1980s. Besides, we were the first to use surgical drawing to illustrate its complex anatomical adjacent relationship of retro-peritoneal paraganglioma. Our case emphasizes the inclusion of extra-adrenal paraganglioma in the differential diagnosis of retroperitoneal tumors. In suspected paragangliomas, catecholamine testing is preferable to invasive procedures including gastroscopy and biopsy to avoid triggering a catecholamine crisis. Surgical resection is the primary treatment. We highlight the priority of dealing with the venous reflux branches of the tumor to prevent the release of catecholamines into the blood. In particular, preoperative preparation plays a vital role in managing paraganglioma. Moreover, it is necessary to schedule genetic testing and clinical follow-up due to the metastatic potential of paragangliomas.

Effects of Evidence-Based Continuing Care Bundle on Health Outcomes in Rectal Cancer Patients With Temporary Stomas: A Multicenter Randomized Controlled Trial.

BACKGROUND: The patients with temporary stomas after anterior resection for rectal cancer may experience significant impact on their health outcomes, and hence continuing care is necessary and important for these patients. However, the effects of some single continuing care interventions remain unclear. Continuing care bundle may be an effective approach to address this uncertainty. OBJECTIVE: The aim of this study was to investigate the effects of an evidence-based continuing care bundle on selected health outcomes in patients with temporary stomas after anterior resection for rectal cancer. METHODS: This was a multicenter randomized controlled trial. A total of 124 patients with temporary stomas after anterior resection for rectal cancer were recruited from 4 general tertiary hospitals in Guangzhou, China, and were randomly assigned to a control group or an intervention group. Both groups received usual care, whereas the intervention group additionally received evidence-based continuing care bundle. Self-efficacy, quality of life, and stoma-related complications were collected at baseline and 4 and 12 weeks after surgery. Satisfaction and outcomes of stoma reversal were collected at the end of the observation. RESULTS: The intervention group had significantly improved the self-efficacy (F = 11.88, P = .001), quality of life (F = 17.99, P < .001) over time, satisfaction (t = 4.08, P < .001), and outcomes of stoma reversal (χ2 = 5.93, P = .015) and reduced the incidence of complications (P < .05). CONCLUSIONS: Evidence-based continuing care bundle can be an effective method to improve the health outcomes among these patients. IMPLICATION FOR PRACTICE: By using the evidence-based continuing care bundle, nurses can help these patients improve their health outcomes in stoma-specific nursing.