Effect of a Mobile Patient Education Application on Adjustment to Stoma and Development of Peristomal Skin Lesions: A Quasi-Experimental Study

BACKGROUND: Patients with a stoma face difficulties in everyday life. A mobile application (app) may assist them in managing their stoma and adjusting to change. PURPOSE: This study developed a mobile app for patients with a stoma and evaluated its effectiveness in improving psychosocial adjustment, self-care, and prevention of peristomal skin lesions. METHODS: The research utilized a quasi-experimental design and was conducted using a posttest control group. The study consisted of 60 patients who had undergone surgery in 3 university hospitals in Istanbul, Turkey, from November 2018 through December 2019. The experimental group (n = 30) used the STOMA-M mobile app, and the control group (n = 30) used an educational booklet that contained images and text that correlated to the content found in the app. Data collection was carried out using an individual characteristics assessment form, Ostomy Adjustment Inventory (OAI-23), Peristomal Skin Lesions Assessment and Classification Instrument, and a stoma care training evaluation form in the first and third months after discharge. Data were analyzed using IBM SPSS Statistics 22.0 software. RESULTS: Sociodemographic characteristics of individuals in the experimental and control groups were similar; 70% (n = 42) required stoma placement because of cancer treatment. More than half of the participants (53.3%; n = 32) had an ileostomy, and 78.3% (n = 47) had a temporary, open stoma. The experimental group’s OAI-23 score, social engagement subscale score, stoma care status, and satisfaction with education e high. The OAI-23 scores in the control group were not significant, and their anger subscale score and the score of item 16, Caring for my stoma is difficult, decreased in the third month compared with baseline. Peristomal skin lesions did not develop in the control group at the third month of follow-up. CONCLUSION: The levels of adjustment to stoma, ability to care for the stoma themselves, and satisfaction with education received were higher in individuals using the mobile app compared with those using the printed booklet. However, the app was not effective in preventing peristomal skin lesions. Additional studies are needed to determine what features of a mobile app may be useful for preventing such lesions.

Factors predictive of optimal peristomal skin status in patients with an ostomy: a secondary analysis

Peristomal skin problems are common in ostomy patients and are connected to decreased quality of life and patient independence, as well as increased treatment costs. This study analysed the factors related to peristomal skin changes in order to better define the clinical profile of patients with optimal peristomal skin status. Secondary analysis of data from a nationwide, cross-sectional, retrospective, multicentre study performed in Spain (Uses and Attitudes in Ostomy) ( Bueno Cruz et al, 2021 ) evaluated clinical data, including demographics, preoperative stoma site marking, type of ostomy, device used, frequency of leakage and scores from the Ostomy Skin Tool (OST) and quality of life (QoL) questionnaires. Risk factors for peristomal skin changes were analysed using multivariate analysis, and a predictive nomogram to anticipate optimal peristomal skin status (defined here as discolouration (D), erosion (E), and tissue overgrowth (T) (DET) score of 0) was developed. Some 871 patients with an ostomy using different commercial devices in Spain were evaluated. Multivariate analysis to predict optimal peristomal skin status revealed leakage frequency, patient age, type of ostomy, preoperative siting and type of baseplate used were independent predictors of peristomal skin status. Optimal peristomal skin care should be a treatment goal for nurse specialists in stomal therapy, and its individual influencing variables should be taken into account by nurses specialising in ostomy care.

Stoma care appliances: an overview

A core aim in stoma care is to ensure the appliance (also known as a pouch or bag) establishes and maintains a secure seal, and so identifying the appropriate appliance for an individual ostomate is vital. This article presents a summary of the latest available range of stoma appliances on the market. There are two types of pouching systems: one and two piece. There are three main types of stoma appliances: closed, drainable and urostomy. Stoma care nurses need to be well informed about stoma appliance innovation, so that they can advise patients on what appliance is best for them. It is also the role of a stoma care nurse to educate patients on the technique for appliance application. If a patient is wearing an inappropriate appliance or they have a poor application technique, this can result in stoma complications, such as leakage and/or sore peristomal skin.

Impact of convex ostomy appliances on leakage frequency, peristomal skin health and stomal protrusion

Aim: The Convexity in Ostomy (ECOS) study measured the impact of soft convex ostomy appliances on leakage frequency, peristomal skin health, and patient satisfaction, as well as stomal protrusion and body profile. Methods: This prospective non-randomised controlled trial included people with a stoma, divided into a control group using a convex appliance throughout (Alterna Confort Convex or Easiflex Confort Convex Light, Coloplast A/S, Humlebæk, Denmark), and an intervention group who were using a flat appliance at baseline before switching to a convex appliance for the rest of the study. Leakage frequency was counted within the past 2 weeks; peristomal skin health was assessed using the discolouration, erosion and tissue overgrowth (DET) Ostomy Skin Tool; and patient satisfaction was measured with a 0-10 Likert scale of self-reported satisfaction with the appliance. Measurements were taken at three visits: baseline (V1), 2-8 weeks (V2) and 6 months (V3). The Kruskal-Wallis and analysis of variance (ANOVA) tests were used for comparison. Multiple regression analysis was used to evaluate the effect of independent variables on the change in leakage frequency and DET score between baseline and 6 months. Findings: Of 253 participants screened, 245 completed the follow-up, with 151 in the intervention group and 94 in the control group. Mean leakage frequency period went from 5.85 ± 5.55 (V1) to 0.63 ± 1.42 (V2) and 0.23 ± 0.75 (V3) (p<.0001). Mean DET score changed from 4.8 ± 3.47 (V1) to 1.41 ± 2.17 (V2) and 0.54 ± 1.57 (V3) (p<.0001). Mean satisfaction changed from 6.0 ± 2.25 (V1) to 8.6 ± 1.14 (V2) and 9.17 ± 0.93 (V3) (p<.0001). From V1 to V3, the proportion of patients with a depressed peristomal area went from 45.7% to 31.4%, a normal peristomal area went from 45.3% to 65.3%, stoma protrusion went from 31.4% to 47.3% and stoma retraction went from 28.6% to 15.5%. By group, mean leakage frequency decreased in the intervention group by 7.65, from 7.57 to 0.11, and in the control group by 2.37, from 2.94 to 0.46 (p<0.0001). Multiple ANOVA analysis confirmed independent variables in reducing leakage to be initiating convexity and appliance coupling. By group, mean DET score decreased in the intervention group by 4.82, from 5.24 to 0.42, and in the control group by 3.52, from 4.34 to 0.76. Multiple ANOVA analysis showed independent variables for DET score to be initiating convexity, emergency surgery and stoma siting. Conclusion: People with a stoma experiencing repeated leakage benefitted from shifting from a flat to a soft convex appliance in terms of leakage frequency, peristomal skin health, stomal protrusion and body profile.

The presurgical controlling nutritional status (CONUT) score is independently associated with severe peristomal skin disorders: a single-center retrospective cohort study

While nutritional interventions may potentially lower the risk of peristomal skin disorders (PSDs) and their exacerbation, no previous studies have evaluated the relationship between PSDs and nutritional status using the Controlling Nutritional Status (CONUT) score. The purpose of this study was to assess the impact of preoperative nutritional status on stoma health, and determine risk factors for postoperative PSDs, including severe PSDs. A retrospective analysis was performed of 116 consecutive patients with rectal cancer who underwent radical surgery with ileostomy or colostomy creation. PSDs were diagnosed in 32 patients (27.6%); including 10 cases (8.7%) that were defined as severe based on the ABCD-stoma score. Multivariable logistic regression showed that smoking (odds ratio [OR] 3.451, 95% confidence interval [CI] 1.240–9.607, p = 0.018) and ileostomy (OR 3.287, 95% CI 1.278–8.458, p = 0.014) were independent risk factors for PSDs. A separate multivariable logistic regression analysis of risk factors for severe PSDs, found that the only independent risk factor was the CONUT score (OR 10.040, 95% CI 1.191–84.651, p = 0.034). Severe PSDs are associated with preoperative nutritional disorders, as determined by the CONUT score. Furthermore, nutritional disorders may increase the severity of PSDs, regardless of the stoma type.