RF2 - Factors Influencing Patients' Perceived Stoma Self Efficacy

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Purpose/Background: Estimates suggest over 100,000 patients undergo operations resulting in an ileostomy or colostomy annually in the United States. The incidence of diverticular disease and inflammatory bowel disease has been increasing in the United States, while there are about 140,000 new cases of colorectal cancer per year. The recovery period after these operations involves significant psychosocial and physical adjustments for patients as they learn to live with a stoma site while also recovering from major surgery. A patient’s ability to care for their stoma site positively influences their quality of life and decreases complication rates with their stoma. Bekkers et al designed a stoma self efficacy (SSE) score, which gives insight into how patients feel they can care for their stoma site properly and safely. In this study, we investigated factors predicting higher scores on the SSE scale.

Methods/Interventions: Patients who had surgery involving the creation/revision of an ileostomy or colostomy from June 1, 2016 to May 31, 2021 were eligible and contacted to complete the SSE survey with a few questions added by the research team: if they still have their stoma, if they knew someone with a stoma before their surgery, if they have a disability that makes it difficult to care for the stoma, and if they went home with home health services. Upon completion of the survey, a chart review was conducted to determine the indication, operative team, if they met with an ostomy care nurse (OCN) and were site marked, if the decision to create a stoma was planned or emergent, and discharge destination. This data was then used to construct a linear model.

Results/Outcomes: There were 244 operations involving the creation/revision of an ileostomy or colostomy. 63 of these patients had deceased, 5 patients were below the age of 18, and 9 of the operations were on patients previously identified within the report, leaving 167 eligible patients. 34 patients completed the survey in its entirety (response rate: 20.4%). Based on the univariate linear model, factors that significantly predicted higher SSE scores included preop appointment with an OCN (estimate = 12.747, R2 = 0.29, p = 0.001), if a stoma was a planned outcome (estimate = 6.953, R2 = 0.27, p = 0.001), and if they had preop marking (estimate= 13.613, R2 = 0.26, p = 0.002). VNA services (estimate = 6.445), preop OCN appointment (estimate 9.015), and preop site marking (estimate = 7.832) all contributed to a multivariate model (adjusted R2 = 0.36, p = 0.001).

Conclusion/Discussion: Preop appointment with an OCN, preop marking for a stoma site, and a stoma as a planned outcome were independent predictors of higher scores on the SSE scale, while VNA services, OCN appointments, and site marking maintain predictive value in a multivariate model. Thus, when possible, patients should get marked and have a preop appointment with an OCN to maximize SSE. In addition, if a stoma is a known possibility before surgery, the preop planning should be done to maximize perceived SSE.