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.
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