QS303 - Interventions for Improving Preoperative and Inpatient Ostomy Care

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Purpose/Background: Preoperative and inpatient education for patients and caregivers is vital for ostomy-related care as new and recurring complications can negatively impact quality of life. The purpose of this study is to identify targets for interventions in the preoperative and inpatient discharge phases for ostomy care through qualitative interviews of ostomy patients, caregivers, and providers.

Methods/Interventions: Semi-structured phone interviews were conducted with patients with a new ostomy within one year of surgery, their reported caregivers, and ostomy care providers including surgeons and inpatient, outpatient, and stoma care nurses. Patients were purposively recruited to represent varying levels of health literacy. Interview guides focused on barriers to ostomy care through patient and caregiver experiences and the resources utilized or missing in the preoperative and inpatient discharge phases. Interviews were transcribed and thematically coded using inductive content analysis via NVivo12 software. .

Results/Outcomes: A total of 53 interviews were conducted including 20 patients, 16 caregivers, and 17 providers. Patient’s average age was 62 (stdev 13); 70% (n = 14) were female, 60% (n = 12) were White, 45% (n = 9) had a cancer diagnosis, and 45% (n=9) had limited health literacy. Most caregivers identified as spouses (75%) and as female (75%). The mean age for providers was 44 years with average 13 years of experience with ostomy patients. Six overall themes were identified for the preoperative and inpatient discharge phases (Figure). In the preoperative phase, three themes were identified: ‘not knowing what to expect regarding an ostomy’, ‘overwhelming amount of new information regarding an ostomy’, and ‘patient’s ability to understand their health condition’. Patients and providers both highlighted important subtheme barriers related to lack of expectations regarding activities of daily living, such as showering, intimacy, diet modifications, and clothing options. Similarly, patients and providers both described subtheme barriers related to overwhelming amounts of information on who to contact and how to navigate online resources. In the inpatient phase, three themes were identified: ‘challenges with ostomy appliance’, ‘not knowing the best supplies to use’, and ‘lack of patient acceptance or maladjustment’. Caregivers and providers focused on barriers related to the skills needs for ostomy-care, such as cleaning the bag, cutting the right stoma size, and skin care, when discussing ‘challenges with ostomy appliance’. Patients, caregivers, and providers collectively focused most on supply preference, consistency, and quality when discussing ‘not knowing the best supplies to use’. All participants described both physical and emotional barriers when discussing ‘lack of patient acceptance or maladjustment’.

Conclusion/Discussion: Patients with a new ostomy, their caregivers, and ostomy care providers report six key barriers to preoperative and inpatient ostomy care surrounding expectations, knowledge, understanding, practical application, supplies, and acceptance of ostomy care. These barriers represent the necessary targets for future interventions to improve preoperative and inpatient ostomy care.