Napovedni dejavniki in spremljanje kakovosti življenja bolnikov po vstavitvi črevesne stome

Konjevoda, Vesna (author), Petek, Davorina (mentor), Zelić, Marko (co-mentor)

Uvod Bolniki s stomo se pogosto srečujejo s težavami s samozavestjo, delazmožnostjo, socialno stigmo, depresijo, družbeno izolacijo, občutki izgube nadzora ter zapleti, ki so povezani z delovanjem stome. Še vedno ni znano, zakaj se nekateri posamezniki na stomo prilagodijo hitreje in bolje kot drugi. S prepoznavanjem napovednih dejavnikov in njihovega medsebojnega vpliva, lahko vplivamo na z zdravjem povezano kakovost življenja (HRQOL) bolnikov s stomo. Cilji Določiti, kako je kakovost življenja povezana s stomo pri bolnikih s KRK in KVČB, kako se QoL spreminja med obdobjem prilagajanja po operaciji ter določiti dejavnike, povezane z QoL v tem istem obdobju. Metode V prvem delu študije smo analizirali vprašalnik CoH-QoL-OQ, ki sta ga rešila 302 sodelujoča bolnika s stomo. Druga faza je bila sestavljena iz prospektivno longitudinalne multicentrične študije kvalitativno/kvantitativnega tipa (mešani metodi). Kontrolna skupina je bila sestavljena iz 36 sodelujočih s KRK in stomo, v preiskovalni skupini pa smo imeli 35 sodelujočih z KVČB in stomo. Rezultati Vse podlestvice vprašalnika CoH-QoL nakazujejo na visoko stopnjo notranje doslednosti (0,73-0,89), celotna lestvica pa ima najvišji Cronbachov količnik alfa (0,95), kar pomeni, da je na hrvaškem vzorcu, v smislu doslednosti, CoH –QoL zanesljivo orodje. Ponavljajoče se meritve ANOVA kažejo povečanje zaznanega QoL, povezano s časom, ki je pretekel od postopka oblikovanja stome. ANOVA kaže statistično pomemben porast vseh točk COH po 6 mesecih (F (1.46) = 14.227, p <0.001) v obeh skupinah (KRK in KVČB). Kar nakazuje na ohranitev višje kakovosti življenja obeh skupin 6 mesecev po vstavitvi stome. Po 6 mesecih je prišlo do statistično pomembnega povišanja v podlestvici fizične aktivnosti (F(1,64) = 31.483, p<0.001), kjer je bilo zvišanje očitnejše v skupini KVČB v primerjavi s sodelujočimi v skupini KRK ((F(1,64) = 9.793, p = 0.056); statistično pomemben porast smo po 6 mesecih opazili tudi v psihološki (F(1,60) = 26.164, p<0.001) ter v socialni podlestvici (F(1,54) = 14.061, p<0.001) po 6 mesecih pri obeh skupinah. Sodelujoči v skupini z rakom so imeli pomembno višjo povprečno število pridruženih psihičnih in duševnih bolezni (t = 2,349, df = 66, p = 0.022). Za bolnike z KVČB se je duševna komponenta vprašalnika SF-12 (MCS) izkazala kot edini statistično pomembni napovedni dejavnik (model razloži 27% kriterija variance Adj. R2 = 0.269, F = 8.351, p = 0.009), kar pomeni, da se pri bolnikih z KVČB, ki bolj občutijo spremembe v lastnem mentalnem zdravju, bolj pozitivno poviša CoH-QoL-OQ. Edini napovednik, ki predvidi QOL pri bolnikih z rakom mesec dni po operaciji, je stopnja depresije pred operacijo. Bolniki s KVČB, ki imajo po 6 mesecih boljšo kakovost spolnega življenja, imajo tudi pozitiven porast v CoH-QoL. Bolniki s KVČB, pri katerih je njihov izbrani zdravnik pregledal stomo, imajo nižje zaznan QOl. Za bolnike, diagnosticirane z rakom, je statistično pomemben le en napovedni dejavnik in to je, ali je kirurg pregledal stomo (Adj R2 = 0.217, F = 5.146, p = 0.040). Zaključek CoH-QoL-OQ je veljavno orodje za merjenje QOL pri bolnikih s stomo v Republiki Hrvaški. Na podlagi raziskav lahko zaključimo, da se višji QOL začne vzdrževati po 6 mesecih po vstavitvi stome pri obeh skupinah bolnikov (KVČB in KRK). Sodelujoči v skupini bolnikov z rakom so imeli pomembno višje povprečno število pridruženih psihičnih in duševnih bolezni, pri katerih so potrebovali dodatno pre- in pooperativno podporo in izobraževanje. Mesec dni po posegu formacije stome, je pri večini bolnikov glavni izziv predvsem spopadanje z duševnimi boleznimi in prilagajanje na novo situacijo. Čez čas (po 6 mesecih) še vedno obstajajo določene težave, povezane s stomo, prav tako je potrebna profesionalna pomoč v sklopu HRQOL. Bolniki, ki razvijejo zaplete, povezane s stomo, imajo slabši QOL.

• Language: Slovenian
• Keywords: stoma, QOL, HRQOL, napovednik, KRK, KVČB
• Work type: Doctoral dissertation
• Organization: MF - Faculty of Medicine
• Year: 2022
• PID: 20.500.12556/RUL-136049
• COBISS.SI-ID: 105709827
• Publication date in RUL: 09.04.2022

Secondary language

• Language: English
• Title: The predictors and monitoring of quality-of-life in patients having undergone intestinal ostomy procedure

Abstract

Background. Stoma patients are concerned about problems related to self-esteem, work ability, social stigma, depression, social isolation, feelings of loss of control and complications related to the functioning of the ostomy. It is still not clear why some people adjust to ostomy better and faster than others. By identifying predictors and their mutual influence, we can affect the health related quality of life (HRQOL), of persons with ostomy. Aim. To determine how quality of life is associated with stoma in patients with CRC and IBD, further how QOL changes during the period of adaptation after surgery and to identify factors related to QoL in the same time period. Methods. In the first part of the study was carried out the validation of the CoH-QoL-OQ questionnaire conducted on 302 participants with ostomy. The second phase consisted of a prospective longitudinal multicenter study of qualitative/quantitative type (mix methods). The control group consisted of 36 participants with CRC and ostomy, while the experimental group consisted of 35 participants with IBD and ostomy. Results. All subscales of CoH-QoL_OQ show high level of internal consistency (0.73–0.89), and the total scale has the highest Cronbach alpha score (0.95), meaning that in the Croatian sample the CoH-QoL-OQ is a reliable instrument in terms of item consistency. Repeated ANOVA measuring show increase in perceived QOL related to the time elapsed since the ostomy procedure. ANOVA shows a statistically significant increase in COH overall score after 6 months (F (1.46) = 14.227, p <0.001) in both groups (CRC and IBD), indicating increased perceived quality of life in both groups 6 months after ostomy placement. After 6 months, a statistically significant increase in physical subscale scores was observed (F(1,64) = 31.483, p<0.001), where in the IBD group the increase was more pronounced compared to CRC participants (F(1,64) = 9.793, p = 0.056); a statistically significant increase in psychological subscale scores after 6 months (F(1,60) = 26.164, p<0.001), as well as a significant increase in social subscale scores after 6 months (F(1,54) = 14.061, p<0.001) in both groups. Only in spiritual subscale scores there was no statistically significant shift (F(1,65) = 4.423, p = 0.064). Participants in the cancer group had a significantly higher average number of coexisting physical and mental illnesses (t = 2,349, df = 66, p = 0.022). For patients diagnosed with IBD, the mental component of the SF-12 questionnaire (MCS) proved to be the only significant predictor, (the model explains 27% of variance criteria; Adj. R2 = 0.269, F = 8.351, p = 0.009), which implies that patients with IBD with increased experience of their own mental health will also experience a positive increase in CoH-QoL-OQ. The only predictor that predicts QOL in cancer patients one month after surgery is the level of depression before surgery. After 6 month, patients with IBD who experience increased sexual activity satisfaction will also experience a positive increase in CoH-QoL. Patients with IBD whose GP has seen a stoma have a lower perception of QOL. For patients diagnosed with cancer, only one predictor is statistically significant, and that is whether the surgeon saw the stom (Adj R2 = 0.217, F = 5.146, p = 0.040). Conclusion. CoH-QoL-OQ is a valid instrument for measuring QOL of persons with ostomy in the Republic of Croatia. Based on this research it can be concluded that there is an increased perceived QOL in both groups (IBD and CRC) 6 months after ostomy placement. Participants in the cancer group had a significantly higher average number of coexisting physical and mental illnesses, indicating additional pre-and post-operative support and education is needed. One month after ostomy procedure, the main challenges are related to the coping with mental health problems and adjustment to the new situation. Over time (after 6 months), there are still some ostomy-related difficulties and professional help is needed also in the context of HRQOL. Patients who develop ostomy-related complications will have poorer QOL.

• Keywords: ostomy, QOL, HRQOL, predictor, CRC, IBD