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Acceptance of disease and the quality of life in patients with enteric stoma

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Szpilewska K., Juzwiszyn J., Bolanowska Z., Bolanowska Z., Milan M., Chabowski M., Janczak D.
Polish Journal of Surgery
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2018
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vol. 90(1)
13-17
EN
Introduction. The main reason of the emergence of enteric stoma is colorectal cancer. Enteric stoma is a serious health, as well as life problem. In Poland, there are about 6,000 stoma surgeries yearly. It changes the functioning of patients, restricts their daily activity and influences their quality of life significantly. Therefore, in the modern treatment process, all spheres of human life and its surroundings are considered. The evaluation of the quality of life and the level of acceptance of the disease enables us to identify the regions in which patients require attention and help, as well as places to which health promotion among patients with a stoma should be directed. The aim of the study was the evaluation of the acceptance of the disease and the quality of life in patients with colostomy. Material and methods. The study conducted between February 2015 and February 2016 included101 patients with enteric stoma of the Provincial Specialist Hospital in Wrocław at Kamieńskiego St. in the departments of General Surgery with the Subdivision of Traumatology and Orthopedic Surgery, Subdivision of Metabolic Surgery, Subdivision of Endocrine Surgery and Oncological Surgery . Two anonymous questionnaires, i.e., health-related quality of life (HRQoL) and acceptance of illness scale (AIS), were used. 60% (61 people) were women, and 40% (40 people) were men. The mean age was 48; the youngest respondent was 20 years old, and the oldest was 79 years old. 17% of the respondents had primary education, 25% - vocational, 33% - secondary and 26% - university-level. Results. The most common reason for the emergence of a stoma among the respondents was colon cancer (44%), followed by: mechanical bowel onstruction (26%), intestinal damage following injuries (25%), inflammatory bowel disease (6%). The quality of life of patients with colostomy was evaluated in view of their health condition, postoperative recovery, everyday limitations, and self-evaluation. The majority of participants pointed to the deterioration of their quality of life. A higher level of acceptance of the disease was revealed in men as 75% of men, and 61% of women acceptted their health status. The education level also influences the acceptance of the disease, as 41% participants with higher education, and only 6% participants with primary education did not accept their health status. We revealed some social factors influencing the quality of life and the acceptance of the disease, i.e., gender, age, education, job, and place of living. Conclusions. Gender and education have an impact on the level of the acceptance of the disease, but they do not influence the quality of life. The acceptance of the disease is connected with the quality of life in patients with a stoma. The higher the level of acceptance of the disease, the better the quality of life. Research indicates the need to deepen patients’ education regarding their functioning in society.
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Therapeutic Management of Stoma Complications in Selected Patients

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Trzciński R., Kresińska-Kaba T., Dziki A.
Polish Journal of Surgery
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2013
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vol. 85
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issue 9
496-504
EN
Stoma complications occur in 21-75% of patients, and 30% of them require redo surgery within 10 years after previous surgical treatment. Medical treatment is successful in most cases with no need for surgery. However, severe stoma complications are the real challenge for medical team and require an individual approach to each patient. The aim of the study was to report stoma patients with severe complications of both ileo- and/or colostomy and present different options of medical treatment. Material and methods. Between March 2005 and April 2007 we treated 8 patients with severe stoma complications at the Department of General and Colorectal Surgery, Medical University of Łódź. There were 4 patients with colostomy, 3 patients with ileostomy and one patient with both ileo- and colostomy. The mean age of patients was 56,7 years (range 30-68 years). Results. In all patients we achieved either complete stoma-related wound healing or we observed substantial progress of wound healing with medical treatment. No patient required surgery for stoma complications. Conclusions. Stoma complications still occur in spite of adherence to rules of stoma care and surgical technique. Most of them can be treated conservatively. Much emphasis is put on close team work comprising doctors and nurses in the treatment of severe stoma complications.
3
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Quality of life of patients on chronic parenteral nutrition before and after gastrointestinal tract continuity restoration

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Ławiński M., Kot-Mielczarska E., Gradowska A.
Polish Journal of Surgery
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2015
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vol. 87
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issue 4
153-159
EN
The issue of the quality of life considering patients with a temporary or permanent intestinal stoma, as well as the necessity for chronic parenteral nutrition at home remain a poorly understood problem. Daily care of the intestinal stoma and the need to comply with sterile procedures required for parenteral nutrition require such patients to commit their time, which secondarily is associated with the broad aspects of social and personal life. The aim of the study was to analyse the quality of life considering patients with intestinal stomas subjected to chronic parenteral nutrition, before and after gastrointestinal tract continuity restoration. Material and methods. The survey was conducted between May and July, 2014 on a group of 71 patients (33 female and 38 male) who were under the care of the Department of General Surgery and Clinical Nutrition, Warsaw Medical University, operated during the period between 2007 and July, 2014 with a present stoma (32 patients - 45%), as well as after stoma closure (39 patients - 55%). The analysed questionnaire contained 31 questions, and the SF-36 questionnaire was additionally used, determining the quality of life. Results. Analysis of the study material showed differences in the quality of life, considering three most important determinants. Significantly worse assessment of the quality of life was reported by patients with a stoma and subject to intravenous nutrition (83.2±30.5), as compared to those after stoma closure subject to normal nutrition (52.3±33.8). Based on the SF-36 questionnaire differences between patients with a stoma and those without amounted to t(69)=2.84 (p=0.006) demonstrating that those with a stoma reported a lower quality of life. Analysis between younger and older patients, based on the SF-36 questionnaire (t(62.87)=2.49; p=0.016) showed that younger patients achieved lower results, considering dissatisfaction with life (61.55±27.5), as compared to the elderly (80.8±36.9). Conclusions. The group of patients without a stoma seem to be more independent- the vast majority do not use the help of family members (43.6%), or friends (64.1%). Patients with a stoma more often withdraw from social life. The factor that mostly reduces the quality of life is the presence of a stoma, which impairs daily functioning a lot more than the sterile procedures associated with parenteral nutrition. All patients after stoma closure consider that their overall functioning has significantly improved.
4
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Selected psychosocial aspects of life of patients with a stoma

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Nowicki A., Farbicka P.
OncoReview
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2016
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vol. 6
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issue 2
A72-76
EN
Cancer causes huge problems, physical and mental nature mainly. In particular, we cannot forget about the functioning of these patients in the social and spiritual spheres. The increasing trend of incidence of rectal cancer makes the disease is becoming a priority for doctors, nurses and psycho-oncologists. Despite the increasing quality of medical services, patients face a number of problems associated with cancer treatment, which may result in formation of a colostomy. The procedure, which is necessary to save the patient’s life, is often perceived by them as “mutilation”. Acceptance of the disease and satisfaction of life in patients with a stoma after the operation for rectal cancer are dependent on many factors. Social support, living conditions and the time elapsed since creation of the stoma have great impact. “Stoma nurse” plays an extremely important role. Seeing the difficulties in adapting the stoma she should verify the patient’s pessimism as to his/her own self, develops a sense of responsibility from minor to major issues and strengthen a sense of independence.
5
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Severe Course of Crohn's Disease Complicated with Multiple Peristomal Fistulas

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Banaszkiewicz Z., Kłopocka M., Jawień A.
Polish Journal of Surgery
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2009
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vol. 81
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issue 4
198-202
EN
To date healthy male, 51, was admitted to hospital for abdominal pain and body weight loss of 10 kilograms within 6 weeks. Soon after admittance the patient's condition deteriorated and he was operated on for ileus. The Hartman's resection of sigmoid colon was the option for obstructive tumour. First signs of stoma complications were being reported from day 16 on and soon overt multiple fistula formation was diagnosed. Systemic and site treatment was involved (5-ASA, steroids). Nevertheless, the patient's condition was not improving within following 8 months, which led to succeeding hospitalisations, finally, infliximab therapy was the successful one. On patient's demand the hind-gut reconstruction was performed. Partial resection of involved bowel and stoma followed by end-to-end hind-gut reconstruction was the option. Up to now (i.e. 8 months after the reconstruction) the patient remains in good condition.
6
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Ocena jakości życia pacjentów z kolostomią

61%
Gęsicka K., Rychlewska M., Siemianowska T.
Innowacje w Pielęgniarstwie i Naukach o Zdrowiu
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2019
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vol. 4
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issue 2
9-29
EN
Introduction. The first mention of stoma dates back three tousand years. With time the techniques, mechanism as well as reasons for stoma have changed. The emotions and feelings that accompany the stoma remain unchanged. It may seem that the developments in health technologies and medical studies have given the opportunity to provide effective treatment in the case of diseases originally considered incurable and the number of people with stoma will decrease. Unfortunately, following the civillisation development the number of cases of colorectal cancer is growing, which constitues a major cause of stoma. Studies devoted to the quality of life have grown in significance in recent years and this is due to holistic and interdisciplinary approach towards patients. Studies on the quality of life are not only about the dispaly of patient care but also a sign of commitment of people representing different professions , both within the fields of humanities and medicine. Aim. The aim of the study is to analyze selected objective and subjective factors affecting the quality of life in patients with stoma. Material and Methods. The diagnostic survey togethether with a survey was used to make the study more specific. Also a questionnaire on the quality of life in patients with stoma was a research tool. A Chi- squere test ( Pearson's test ) was used in statistical analysis. The collected data were estimated using the Spearman rank correlation. The respondents consisted of 82 people with stoma at different stages after post-operative treatement, inlcuding 38 women (46,34% ≈ 46%) and 44 (53,66% ≈ 54%) man. Results. The results obtained together with their analysis stated that the quality of life in respondets is low. Socio-demographic factors such as : gender, education and place of residence are directly proportional to the results and have a significant impact on the assesment of the respondents' quality of life. Statistical analisys showed that social support is of great importance to the respondents and contributes significantly to their assesment of the quality of life. Conclusion. Patients with stoma have reduced quality of life. This is due to objective socio-economic factors, clinical evaluation of the disease as well as subjective assesment of quality of life . It is also particularly important if a patient is a member of Polish Ostomy Association and can rely on their support.
PL
Wstęp. Pierwsze wzmianki dotyczące stomii jelitowej pochodzą sprzed trzech tysięcy lat. Z upływem czasu zmieniły się techniki, mechanizm jak i przyczyny wyłonienia kolostomii, lecz emocje towarzyszące jej wytworzeniu pozostały na porównywalnym poziomie. Wydawać by się mogło, że skoro szybki rozwój nauk medycznych dał możliwość efektywnego leczenia chorób wcześniej uznanych za nieuleczalne, to zmniejszy się również liczba osób z wyłonioną kolostomią. Niestety, w następstwie szybkiego rozwoju cywilizacyjnego zwiększa się liczba zachorowań na raka jelita grubego, co z kolei stanowi główną przyczynę wytworzenia stomii jelitowej. W ostatnich latach, badania dotyczące oceny jakości życia znacznie zyskały na znaczeniu ze względu na holistyczne i interdyscyplinarne spojrzenie na sytuację chorego. Badania nad jakością życia są nie tylko przejawem troski o dobro pacjenta, lecz także wyrazem zaangażowania ludzi reprezentujących wiele zawodów, zarówno medycznych jak i humanistycznych. Cel. Celem pracy jest analiza wybranych obiektywnych oraz subiektywnych czynników, wpływających na ocenę jakości życia osób z wyłonioną kolostomią. Materiał i metody. W badaniach zastosowano metodę sondażu diagnostycznego. Jako technikę dla skonkretyzowania zamiarów badawczych wybrano ankietę. Za narzędzie badawcze posłużył charakterystyczny dla oceny jakości życia - kwestionariusz ankiety. Do analizy statystycznej wykorzystano test niezależności chi – kwadrat (zwany inaczej testem Pearsona) służący sprawdzaniu hipotez. W opracowaniu danych wykorzystano również korelację rang Spearmana (rho – Spearmana). Badaną grupę stanowiły 82 osoby z kolostomią w różnym okresie po leczeniu operacyjnym, w tym 38 kobiet (46,34% ≈ 46%) i 44 (53,66% ≈ 54%) mężczyzn. Wyniki. Na podstawie otrzymanych wyników i ich analizy stwierdzono, że jakość życia wśród respondentów jest niska. Czynniki socjodemograficzne takie jak: płeć, wykształcenie, miejsce zamieszkania są wprost proporcjonalne i wywierają na tę ocenę istotny wpływ. Analiza statystyczna wykazała również znaczący wpływ otrzymywanego wsparcia społecznego ma wpływ na ocenę jakości życia. Wnioski. Osoby z wytworzoną kolostomią reprezentują obniżony poziom jakości życia. Na taki stan rzeczy, w takim samym stopniu, wywierają wpływ obiektywne czynniki społeczno – ekonomiczne, kliniczna ocena choroby jaki subiektywne poczucie jakości życia. Szczególne znaczenie wywiera przynależność chorych do Polskiego Towarzystwa Stomijnego oraz wsparcie otrzymywane od jego członków.
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