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Xi Z, Rong CM, Ling LJ, Hua ZP, Rui G, Fang HG, Long W, Zhen ZH, Hong L. The influence of stigma and disability acceptance on psychosocial adaptation in patients with stoma: A multicenter cross-sectional study. Front Psychol 2022; 13:937374. [PMID: 36571011 PMCID: PMC9773876 DOI: 10.3389/fpsyg.2022.937374] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 11/15/2022] [Indexed: 12/13/2022] Open
Abstract
Background The stoma can cause serious physical and psychological distress to the patient, leading to an inability to live a normal life; although it effectively improves the 5-year survival rate of patients. Objective The purpose of this study is to explore the status of stigma and disability acceptance of patients with stoma and their influences on psychosocial adaptation. Design A multicenter cross-sectional study. Methods A total of 259 patients with stoma in 6 hospitals from southeast China were enrolled. And this research adhered to the STROBE guideline and approved by the Ethics Committee of Fu Jian Provincial Hospital. The ostomy adjustment inventory-20、acceptance of disability scale and social impact scale were used to collect data. The hypothetical path model was tested using the SPSS version 22.0 software and AMOS version 26.0 software. Results Stigma, disability acceptance and psychosocial adaptation was associated. The sense of stigma was severe (72.76 ± 12.73), the acceptance of disability was medium (179.24 ± 32.29) and the psychosocial adaptation was poor (38.06 ± 8.76). Also, the hypothesis model of this study fitted the data well (AGFI = 0.967>0.08; χ 2/df = 1.723, p = 0.08 > 0.05), and the results showed that disability acceptance positively affected psychosocial adaptation; while stigma negatively affected psychosocial adaptation, and disability acceptance mediated between stigma and psychosocial adaptation (p < 0.01). Conclusion The stigma and disability acceptance of patients with stoma are serious problems that are closely related to their psychosocial adaptation. Medical staff should take some interventions based on different paths to reduce stoma patients' stigma and guide them to improve disability acceptance, thus to improve the level of psychosocial adaptation of patients with stoma.
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Affiliation(s)
- Zhang Xi
- Department of Gastroenterology, Fujian Provincial Hospital, Sheng li Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Chen M. Rong
- Sheng li Clinical Medical College of Fujian Medical University, The School of Nursing, Fujian Medical University, Department of Nursing, Fujian Provincial Hospital, Fuzhou, China
| | - Lin J. Ling
- Graduate School, Fujian Medical University, Nursing School of Fujian Medical University, Fuzhou, China
| | - Zeng P. Hua
- Department of Plastic and burn, Fujian Provincial Hospital, Sheng li Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Gao Rui
- Department of Pathology, Fujian Provincial Hospital, Sheng li Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Huang G. Fang
- Department of Gastroenterology, Fujian Provincial Hospital, Sheng li Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Wang Long
- Department of Gastroenterology, Fujian Provincial Hospital, Sheng li Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Zhuo H. Zhen
- Department of Gastroenterology, Fujian Provincial Hospital, Sheng li Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Li Hong
- Sheng li Clinical Medical College of Fujian Medical University, The School of Nursing, Fujian Medical University, Department of Nursing, Fujian Provincial Hospital, Fuzhou, China,*Correspondence: Li Hong,
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Saati M, NasiriZiba F, Haghani H. The correlation between emotional intelligence and self-esteem in patients with intestinal stoma: A descriptive-correlational study. Nurs Open 2021; 8:1769-1777. [PMID: 33626242 PMCID: PMC8186678 DOI: 10.1002/nop2.818] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 12/28/2020] [Accepted: 01/29/2021] [Indexed: 12/02/2022] Open
Abstract
Aim Patients with intestinal stoma would experience some periods of psychological disorders such as self‐esteem disturbances. Self‐esteem is one of the most important factors affecting the patient's mental health. It is suggested that factors such as emotional intelligence could be related to self‐esteem. This study seeks to determine the correlation between emotional intelligence and self‐esteem in patients with an ostomy. Design This was a descriptive‐correlational study. Methods This study was conducted on 155 patients with intestinal stoma referring to the selected hospitals affiliated to Iran University of Medical Sciences and Iranian Ostomy Association in 2018. The patients were selected using convenience sampling method. The study tools included demographic characteristics form, Rosenberg self‐esteem scale and Schutte emotional intelligence questionnaire. Data analysis was performed in SPSS v.16 using descriptive and inferential statistics, including variance analysis and independent t test. Results Participants included 79 women and 76 men with the most frequency of age between 50–70 years old. 52.26% of the cases had cancer and 45.81% of the cases had inflammatory bowel disease and other related diseases. Pearson correlation coefficient results showed a positive and significant correlation between total emotional intelligence and self‐esteem (r = .56) (p = <.001).
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Affiliation(s)
- Maryam Saati
- Nursing and Midwifery SchoolIran University of Medical SciencesTehranIran
| | - Fariba NasiriZiba
- ET.WOCNMedical Surgical Department, Nursing and Midwifery SchoolIran University of Medical SciencesTehranIran
| | - Hamid Haghani
- Biostatistics DepartmentHealth SchoolIran University of Medical SciencesTehranIran
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Keller R, Mazurak N, Fantasia L, Fusco S, Malek NP, Wehkamp J, Enck P, Klag T. Quality of life in inflammatory bowel diseases: it is not all about the bowel. Intest Res 2021; 19:45-52. [PMID: 32093437 PMCID: PMC7873402 DOI: 10.5217/ir.2019.00135] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/27/2019] [Accepted: 12/23/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND/AIMS The inflammatory bowel diseases (IBD), ulcerative colitis (UC), and Crohn's disease (CD) are chronic diseases mostly affecting young patients. As they are diseases accompanying patients for their entire life, and the quality of life (QUOL) interacts with disease activity, improving QUOL should be one of the main goals of therapy. This study aims to identify factors contributing to good or impaired QUOL. METHODS Questionnaires addressing health-related QUOL and other psychological and social features were positioned on our institutions' webpage and on the webpage of the largest self-help group for IBD in Germany. Patients were subdivided according to their QUOL score with a cutoff of <60. We used the Short Inflammatory Bowel Disease Questionnaire, the Assessment of the Demand for Additional Psychological Treatment, and the Fear of Progression Questionnaire Short Form. RESULTS High numbers of patients in both subgroups showed an impaired QUOL (87.34% in UC, 91.08% in CD). Active extraintestinal manifestations, smoking, high fear of progression and high demand for psychotherapy were associated with reduced QUOL. In addition, polypharmacological interventions did not result in a good QUOL, but ostomies are linked to improved QUOL especially in CD patients. CONCLUSIONS Scores used in clinical day-to-day-practice mainly focusing on somatic factors do not sufficiently address important aspects concerning QUOL. Most importantly, extraintestinal manifestations show a hitherto underestimated impact on QUOL.
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Affiliation(s)
- Ronald Keller
- Division of Gastroenterology, Hepatology, Infectious Diseases, Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany
| | - Nazar Mazurak
- Division of Psychosomatic Medicine and Psychotherapy, Department of Internal Medicine VI, University Hospital Tübingen, Tübingen, Germany
| | - Laura Fantasia
- Division of Gastroenterology, Hepatology, Infectious Diseases, Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany
| | - Stefano Fusco
- Division of Gastroenterology, Hepatology, Infectious Diseases, Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany
| | - Nisar P Malek
- Division of Gastroenterology, Hepatology, Infectious Diseases, Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany
| | - Jan Wehkamp
- Division of Gastroenterology, Hepatology, Infectious Diseases, Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany
| | - Paul Enck
- Division of Psychosomatic Medicine and Psychotherapy, Department of Internal Medicine VI, University Hospital Tübingen, Tübingen, Germany
| | - Thomas Klag
- Division of Gastroenterology, Hepatology, Infectious Diseases, Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany
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4
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Celentano V, O'Leary DP, Caiazzo A, Flashman KG, Sagias F, Conti J, Senapati A, Khan J. Longer small bowel segments are resected in emergency surgery for ileocaecal Crohn's disease with a higher ileostomy and complication rate. Tech Coloproctol 2019; 23:1085-1091. [PMID: 31664551 PMCID: PMC6872825 DOI: 10.1007/s10151-019-02104-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 10/17/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Repeated intestinal resections may have disabling consequences in patients with Crohn's disease even in the absence of short bowel syndrome. Our aim was to evaluate the length of resected small bowel in patients undergoing elective and emergency surgery for ileocolic Crohn's disease. METHODS A prospective observational study was conducted on patients undergoing surgery for ileocolonic Crohn's disease in a single colorectal centre from May 2010 to April 2018. The following patients were included: (1) patients with first presentation of ileocaecal Crohn's disease undergoing elective surgery; (2) patients with ileocaecal Crohn's disease undergoing emergency surgery; (3) patients with recurrent Crohn's disease of the distal ileum undergoing elective surgery. The primary outcomes were length of resected small bowel and the ileostomy rate. Operating time, complications and readmissions within 30 days were the secondary outcomes. RESULTS One hundred and sixty-eight patients were included: 87 patients in the elective primary surgery group, 50 patients in the emergency surgery group and 31 in the elective redo surgery group. Eleven patients (22%) in the emergency surgery group had an ileostomy compared to 10 (11.5%) in the elective surgery group (p < 0.0001). In the emergency surgery group the median length of the resected small bowel was 10 cm longer than into the group having elective surgery for primary Crohn's disease. CONCLUSIONS Patients undergoing emergency surgery for Crohn's disease have a higher rate of stoma formation and 30-day complications. Laparoscopic surgery in the emergency setting has a higher conversion rate and involves resection of longer segments of small bowel.
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Affiliation(s)
- V Celentano
- Colorectal Unit, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK.
- University of Portsmouth, Portsmouth, UK.
| | - D P O'Leary
- Colorectal Unit, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - A Caiazzo
- University of Campania "Luigi Vanvitelli", Naples, Italy
| | - K G Flashman
- Colorectal Unit, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - F Sagias
- Colorectal Unit, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - J Conti
- Colorectal Unit, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - A Senapati
- Colorectal Unit, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - J Khan
- Colorectal Unit, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
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5
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Abstract
Crohn's disease (CD) is a chronic inflammatory condition of the gastrointestinal tract resulting in progressive tissue damage, which can result in strictures, fistulae, and abscesses formation. The triggering mechanism is thought to be in the fecal stream, and diversion of this fecal stream is sometimes required to control disease when all other avenues of medical and surgical management have been exhausted. Fecal diversion can be temporary or permanent with the indications being defunctioning a high-risk anastomosis, as a result of a surgical complication, for disease control, or due to severe colonic, rectal, or perianal disease. The incidence of ostomy formation in CD has increased epidemiologically over time. The primary indication for ostomy formation is severe perianal fistulizing disease. However, while 64% of patients have an early clinical response after diversion for refractory perianal CD, restoration of bowel continuity is attempted in only 35% of patients, and is successful in only 17%. The current review discusses the indications for ostomy creation in complex CD, strategies for procedure selection, and patient outcomes.
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Affiliation(s)
- John P Burke
- Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland.,Department of Surgery, Royal College of Surgeons in Ireland, Dublin 2, Ireland
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Hwang JH, Yu CS. Depression and resilience in ulcerative colitis and Crohn's disease patients with ostomy. Int Wound J 2019; 16 Suppl 1:62-70. [PMID: 30793856 DOI: 10.1111/iwj.13076] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/31/2018] [Accepted: 01/02/2019] [Indexed: 12/20/2022] Open
Abstract
The purpose of this study is to identify the degree of depression and resilience in ulcerative colitis (UC) and Crohn's disease (CD) patients with ostomy and describe the correlation between depression and resilience in UC and CD patients with ostomy. 24 UC patients and 66 CD patients with ostomy were recruited from Metropolitan Hospital in Seoul, Korea. The total mean scores of depression and resilience in UC patients were 13.42 and 123.75, respectively, and in CD patients with ostomy they were 14.24 and 119.18, respectively. Depression and resilience in UC patients with ostomy were not correlated with general characteristics. Depression in CD patients with ostomy correlated with marital status (t = 2.27, P = 0.027), economic status (F = 3.98, P = 0.012), sleep disorder (t = 4.73, P < 0.001), and sleep time (t = 2.11, P = 0.039). Resilience in UC patients with ostomy correlated with religion (t = 2.47, P = 0.016), marital status (t = -3.61, P = 0.001), economic status (F = 4.06, P = 0.011), and sleep disorder (t = -3.11, P = 0.003). Significant negative correlation was found between depression and resilience in UC (r = -0.668, P < 0.001) and CD patients with ostomy (r = -0.604, P < 0.001). We recommend counselling to wound ostomy continence nurses (WOCNs) about their goal setting, facilitating adaptation of disease and ostomy in clinical setting. And we expect that WOCNs adopt a formalised and tailored long-term approach or program to follow up for UC and CD patients with ostomy.
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Affiliation(s)
- Ji H Hwang
- Department of Nursing, ASAN Medical Center, Seoul, Korea
| | - Chang S Yu
- Division of Colon and Rectal Surgery, Department of Surgery, ASAN Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Beese SE, Harris IM, Dretzke J, Moore D. Body image dissatisfaction in patients with inflammatory bowel disease: a systematic review. BMJ Open Gastroenterol 2019; 6:e000255. [PMID: 30899537 PMCID: PMC6398870 DOI: 10.1136/bmjgast-2018-000255] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 11/19/2018] [Accepted: 12/02/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND AND AIMS Little is known about the relationship between inflammatory bowel disease (IBD) and body image. The aim of this systematic review was to summarise the evidence on body image dissatisfaction in patients with IBD across four areas: (1) body image tools, (2) prevalence, (3) factors associated with body image dissatisfaction in IBD and (4) association between IBD and quality of life. METHODS Two reviewers screened, selected, quality assessed and extracted data from studies in duplicate. EMBASE, MEDLINE, PsycINFO and Cochrane CENTRAL were searched to April 2018. Study design-specific critical appraisal tools were used to assess risk of bias. Narrative analysis was undertaken due to heterogeneity. RESULTS Fifty-seven studies using a body image tool were included; 31 for prevalence and 16 and 8 for associated factors and association with quality of life, respectively. Studies reported mainly mean or median scores. Evidence suggested female gender, age, fatigue, disease activity and steroid use were associated with increased body image dissatisfaction, which was also associated with decreased quality of life. CONCLUSION This is the first systematic review on body image in patients with IBD. The evidence suggests that body image dissatisfaction can negatively impact patients, and certain factors are associated with increased body image dissatisfaction. Greater body image dissatisfaction was also associated with poorer quality of life. However, the methodological and reporting quality of studies was in some cases poor with considerable heterogeneity. Future IBD research should incorporate measurement of body image dissatisfaction using validated tools.
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Affiliation(s)
| | | | - Janine Dretzke
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - David Moore
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Ayaz-Alkaya S. Overview of psychosocial problems in individuals with stoma: A review of literature. Int Wound J 2018; 16:243-249. [PMID: 30392194 DOI: 10.1111/iwj.13018] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 09/29/2018] [Accepted: 10/06/2018] [Indexed: 01/17/2023] Open
Abstract
This literature review was conducted to summarise empirical evidence relating to psychosocial health following ostomy surgery during hospitalisation and after discharge. Both qualitative and quantitative studies were searched from 2000 to 2017 using PubMed, CINAHL, Ebrary, Elsevier, Science Direct, and Scopus. Twenty-seven articles were included that examined the patient's psychosocial health following colostomy or ileostomy surgery. Among the 27 included studies, 11 adopted qualitative research methods and 16 used quantitative designs. Most of the studies were conducted to determine psychosocial problems and emotions of the individuals, their adaptation to the stoma, and their quality of life. Most of the psychosocial problems identified in these studies were poor body image perception and self-respect, depression, sexual problems, and lower psychosocial adaptation. This literature review has illustrated the patient's psychosocial health following stoma surgery. Further studies exploring the effect of psychosocial interventions could be planned.
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Affiliation(s)
- Sultan Ayaz-Alkaya
- Faculty of Health Sciences, Department of Nursing, Gazi University, Ankara, Turkey
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Zangenberg MS, El-Hussuna A. Psychiatric morbidity after surgery for inflammatory bowel disease: A systematic review. World J Gastroenterol 2017; 23:8651-8659. [PMID: 29358872 PMCID: PMC5752724 DOI: 10.3748/wjg.v23.i48.8651] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 09/14/2017] [Accepted: 10/17/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To examine the evidence about psychiatric morbidity after inflammatory bowel disease (IBD)-related surgery. METHODS PRISMA guidelines were followed and a protocol was published at PROSPERO (CRD42016037600). Inclusion criteria were studies describing patients with inflammatory bowel disease undergoing surgery and their risk of developing psychiatric disorder. RESULTS Twelve studies (including 4340 patients) were eligible. All studies were non-randomized and most had high risk of bias. Patients operated for inflammatory bowel disease had an increased risk of developing depression, compared with surgical patients with diverticulitis or inguinal hernia, but not cancer. In addition, patients with Crohn's disease had higher risk of depression after surgery compared with non-surgical patients. Patients with ulcerative colitis had higher risk of anxiety after surgery compared with surgical colorectal cancer patients. Charlson comorbidity score more than three and female gender were independent predictors for depression and anxiety following surgery. CONCLUSION The review cannot give any clear answer to the risks of psychiatric morbidity after surgery for IBD studies with the lowest risk of bias indicated an increased risk of depression among surgical patients with Crohn's disease and increased risk of anxiety among patients with ulcerative colitis.
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Affiliation(s)
- Marie Strøm Zangenberg
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Køge 4600, Denmark
| | - Alaa El-Hussuna
- Department of Surgery, Aalborg University Hospital, Aalborg 9100, Denmark
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Jayarajah U, Samarasekera DN. 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. BMC Res Notes 2017; 10:75. [PMID: 28137299 PMCID: PMC5282704 DOI: 10.1186/s13104-017-2406-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 01/25/2017] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
- Umesh Jayarajah
- Department of Surgery, Faculty of Medicine, University of Colombo, P.O. Box 271, Kynsey Road, Colombo 8, Western Province, Sri Lanka
| | - Dharmabandhu N Samarasekera
- Department of Surgery, Faculty of Medicine, University of Colombo, P.O. Box 271, Kynsey Road, Colombo 8, Western Province, Sri Lanka.
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11
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Zhang M, Hong L, Zhang T, Lin Y, Zheng S, Zhou X, Fan R, Wang Z, Zhang C, Zhong J. Illness perceptions and stress: mediators between disease severity and psychological well-being and quality of life among patients with Crohn's disease. Patient Prefer Adherence 2016; 10:2387-2396. [PMID: 27920505 PMCID: PMC5125764 DOI: 10.2147/ppa.s118413] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Disease severity, illness perceptions, coping strategies, stress, psychological well-being, and quality of life were reported to have close relationships. According to the Common Sense Model, illness perceptions and coping strategies could mediate the relationship between illness stimuli and illness outcomes such as psychological health and quality of life. Stress was also associated with the individual's disease severity, anxiety, depression, and quality of life. OBJECTIVES The study aimed to explore the influencing factors of illness outcomes, and to what extent illness perceptions, coping strategies, and stress mediate the relationship between disease severity and anxiety, and depression and quality of life. METHODS Our study included 159 patients with Crohn's disease who were attending a tertiary hospital outpatient clinic or who were hospitalized. Disease severity was measured with the Crohn's Disease Activity Index. Illness perceptions were measured with the Brief Illness Perceptions Questionnaire. Coping strategies were measured with the Carver Brief Coping Questionnaire. Stress was measured with the Perceived Stress Questionnaire. Anxiety and depression were measured with the Hospital Anxiety and Depression Scale. Quality of life was measured with the Inflammatory Bowel Disease Questionnaire. RESULTS Disease severity, illness perceptions, maladaptive coping, stress, anxiety, depression and quality of life were significantly correlated with each other among patients with Crohn's disease. Using structural equation modeling to describe the inner relationship of the aforementioned variables, an excellent-fitted model was drawn. (χ2[10]=13.83, P=0.18, χ2/N=1.38, standardized root mean square residual [SRMR] <0.05, root mean square error of approximation [RMSEA] <0.05, goodness of fit index [GFI] >0.97, comparative fit index [CFI] >0.99). Disease severity had a direct influence on illness perceptions. Illness perceptions had a direct influence on stress. Both illness perceptions and stress had direct influences on anxiety, depression, and quality of life, while maladaptive coping did not directly influence anxiety, depression, or quality of life. Stress had a direct influence on maladaptive coping. Quality of life was also directly influenced by disease severity and anxiety. CONCLUSION Interrelationships between disease stimuli, disease perceptions and management and disease outcomes could be found in patients with Crohn's disease. Illness perceptions and stress mediated an individual's disease severity and anxiety, depression and quality of life, while coping strategy was not an applicable mediator.
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Affiliation(s)
| | | | | | - Yun Lin
- Department of Gastroenterology
| | | | | | | | | | - Chenli Zhang
- Exclusive Medical Center, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
- Chenli Zhang, Exclusive Medical Center, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197 Ruijin Er Road, Shanghai 200025, People’s Republic of China, Tel +86 21 6437 0045 ext 600907, Email
| | - Jie Zhong
- Department of Gastroenterology
- Correspondence: Jie Zhong, Department of Gastroenterology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197 Ruijin Er Road, Shanghai 200025, People’s Republic of China, Tel +86 21 6437 0045 ext 600907, Email
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Abstract
INTRODUCTION Although medical management of Crohn's disease has changed in recent years, it is unclear whether surgical management has altered. We examined rate changes of surgical interventions, stoma constructions, and subset of ileostomy and colostomy constructions. MATERIALS AND METHODS We reviewed the Nationwide Inpatient Sample database from 1988 to 2011. We examined the number of Crohn's-related operations and stoma constructions, including ileostomies and colostomies; a multivariable logistic regression model was developed. RESULTS A total of 355,239 Crohn's-related operations were analyzed. Operations increased from 13,955 in 1988 to 17,577 in 2011, p < 0.001. Stoma construction increased from 2493 to 4283, p < 0.001. The subset of ileostomies increased from 1201 to 3169, p < 0.001 while colostomies decreased from 1351 to 1201, p = 0.05. Operation percentages resulting in stoma construction increased from 18 to 24 %, p < 0.001. Weight loss (OR 2.25, 95 % CI 1.88, 2.69) and presence of perianal fistulizing disease (OR 2.91, 95 % CI 2.31, 3.67) were most predictive for requiring stoma construction. CONCLUSIONS Crohn's-related surgical interventions and stoma constructions have increased. The largest predictors for stoma construction are weight loss and perianal fistulizing disease. As a result, nutrition should be optimized and the early involvement of a multidisciplinary team should be considered.
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13
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Abstract
Inflammatory bowel disease (IBD) causes severe physical symptoms and is also associated with psychological comorbidities. Abnormal anxiety levels are found in up to 40% of patients with IBD. Anxiety symptoms are often related to flares of IBD but may persist in times of remission. Detection of anxiety disorder (AD) in patients with IBD can be challenging. Patients with anxiety may also exhibit symptoms in keeping with functional gastrointestinal disorders (FGID). Evidence for the effectiveness of pharmacological and psychological therapies for anxiety stems from patients without IBD. Studies in patients with IBD have either been small or shown negative results. In light of this, a combined approach involving IBD physicians to improve disease control and psychologists or psychiatrists to treat anxiety is advised. This review examines the evidence of anxiety issues in IBD with a focus on extent of the problem, risk factors for anxiety, and the effectiveness of interventions.
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Affiliation(s)
- Ayman S Bannaga
- Department of Gastroenterology, Doncaster Royal Infirmary, Doncaster, UK
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14
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A mixed-method study on the generic and ostomy-specific quality of life of cancer and non-cancer ostomy patients. Support Care Cancer 2014; 23:1689-97. [PMID: 25430480 DOI: 10.1007/s00520-014-2528-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 11/17/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The aim of this study is to compare the generic and ostomy-specific quality of life (QoL) between cancer and non-cancer ostomy patients using a mixed-method design. METHODS All patients with an ostomy participating in the Stomapanel of the Dutch Ostomy Association were asked to complete a generic (RAND-36) and ostomy-specific (Stoma-QoL) QoL questionnaire. In addition, open-ended questions on symptoms, restrictions or adaptations influencing daily life were included. The generic and ostomy-specific QoL between cancer and non-cancer ostomy patients were compared using linear regression analyses. Qualitative responses were analysed using content analysis. RESULTS In total, 668 patients were included: 379 cancer patients (80 % colorectal, 17 % bladder and 3 % other) and 289 non-cancer patients (38 % colitis ulcerosa, 22 % Crohn's disease and 40 % other) with a colostomy (55 %), ileostomy (31 %) and/or urostomy (16 %). Adjusted for gender, age, type of ostomy and time elapsed since ostomy surgery, cancer ostomy patients scored higher (better) on Stoma-QoL (β = 2.1) and all RAND-36 domains (9.1 < β ≤ 19.5) except on mental health compared to non-cancer ostomy patients. Of the 33 themes coded for in the content analysis, fatigue or sleeplessness, leakages, pain, bladder or bowel complaints, physical functioning or activity, travelling or being away from home, other daily activities (including work), clothing and diet were among the 10 most frequently reported themes, although ranking differed between both patient groups. Besides, cancer ostomy patients frequently reported on the impact on (engaging in a) relationship or sexual intimacy and non-cancer ostomy patients frequently reported to be relieved of symptoms and restrictions in daily life. CONCLUSIONS Cancer patients reported better generic and ostomy-specific QoL than non-cancer ostomy patients. In both cancer and non-cancer ostomy patients, fatigue or sleeplessness, leakages, pain, bladder or bowel complaints, physical functioning or activity, travelling or being away from home, other daily activities (including work), clothing and diet were among the 10 most common reported themes influencing daily life. However, the ranking of these 10 most common themes was different in both patient groups.
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Costa VF, Alves SG, Eufrásio C, Salomé GM, Ferreira LM. Assessing the body image and subjective wellbeing of ostomists living in Brazil. ACTA ACUST UNITED AC 2014. [DOI: 10.12968/gasn.2014.12.5.37] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Viviane Ferreira Costa
- Undergraduate Students in Nursing at Sapucaí Valley University (UNIVÁS), Pouso Alegre, Brazil
| | - Suellen Garcia Alves
- Undergraduate Students in Nursing at Sapucaí Valley University (UNIVÁS), Pouso Alegre, Brazil
| | - Cremilda Eufrásio
- Adjunct Professor of the Undergraduate Program at Sapucaí Valley University (UNIVÁS), Pouso Alegre, Brazil
| | - Geraldo Magela Salomé
- Adjunct Professor of the Professional Master's Program in Applied Health Sciences, at Sapucaí Valley University (UNIVÁS), Pouso Alegre, Brazil
| | - Lydia Masako Ferreira
- Full Professor, Division of Plastic Surgery, Federal University of São Paulo (UNIFESP), Brazil
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