THE IMPACT OF EDUCATION ON QUALITY OF LIFE (QOL) OF PATIENTS WITH COLOSTOMY

PERIOPERATIVE NURSING (2024), VOLUME 13, ISSUE 2 Samara et al. 120 www.spnj.gr ΑΝΑΣΚΟΠIKH ΕΡΓΑΣΙΑ H ΕΠΙΔΡΑΣΗ ΤΗΣ ΕΚΠΑΙΔΕΥΣΗΣ ΣΤΗΝ ΠΟΙΟΤΗΤΑ ΖΩΗΣ ΑΣΘΕΝΩΝ ΜΕ ΚΟΛΟΣΤΟΜΙΑ Παυλίνα Σαμαρά, Γεωργία Φασόη Μεταπτυχιακό πρόγραμμα: Θεραπεία και Φροντίδα Τραυμάτων και Ελκών, Τμήμα Νοσηλευτικής, Πανεπιστήμιο Δυτικής Αττικής DOI: Cite as Περίληψη Εισαγωγή: Η διαβίωση με κολοστομία παρουσιάζει διάφορες προκλήσεις, επηρεάζοντας τόσο τη σωματική όσο και την ψυχολογική ευεξία των ασθενών. Σκοπός της ανασκόπησης ήταν η επίδραση της εκπαίδευσης στην ποιότητα ζωής των ατόμων με κολοστομία. Μεθοδολογία: Πραγματοποιήθηκε ανασκόπηση στις βάσεις δεδομένων PubMed, Scopus, Google Scholar, χρησιμοποιώντας ειδικές λέξεις-κλειδιά. Αποτελέσματα: Τα ευρήματα έδειξαν ότι η εκπαίδευση βελτιώνει την ποιότητα ζωής των ασθενών με στομία. Οι εξατομικευμένες εκπαιδευτικές παρεμβάσεις από εκπαιδευμένους επαγγελματίες υγείας ενδυναμώνουν τους ασθενείς, ενισχύουν τις ικανότητές τους για αυτοφροντίδα και ανακουφίζουν το άγχος, προωθώντας τελικά την ανεξαρτησία και την αισιοδοξία όσον αφορά στη διαχείριση της νόσου. Οι χώροι υγειονομικής περίθαλψης πρέπει παρέχουν προτεραιότητα στην εφαρμογή εκπαιδευτικών προγραμμάτων για την ευημερία των ασθενών με στομία. Συμπεράσματα: Η εκπαίδευση είναι απαραίτητη για τη βελτίωση της ποιότητας ζωής των ασθενών με κολοστομία, παρέχοντας τη δυνατότητα να ζήσουν μια ανεξάρτητη ζωή παρά την κατάστασή τους. Η μελλοντική έρευνα θα πρέπει να διερευνά καινοτόμες εκπαιδευτικές παρεμβάσεις για τη βελτίωση των αποτελεσμάτων και της ικανοποίησης των ασθενών. Λέξεις κλειδιά: Κολοστομία, εκπαίδευση ασθενών, ποιότητα ζωής, αυτοφροντίδα. Υπεύθυνος Αλληλογραφίας: Παυλίνα Σαμαρά, Ηφαίστου 7 Νίκαια, Τηλ.6976820649 e-mail :[email protected] PERIOPERATIVE NURSING (2024), VOLUME 13, ISSUE 2 Samara et al. 121 www.spnj.gr REVIEW ARTICLE THE IMPACT OF EDUCATION ON QUALITY OF LIFE (QOL) OF PATIENTS WITH COLOSTOMY Pavlina Samara, Georgia Fasoi Postgraduate program: Wound and Ulcer Treatment and Care, Department of Nursing, University of West Attica, Athens, Greece. Abstract Introduction: Living with colostomia presents various challenges, affecting both the physical and psychological wellbeing of patients. Purpose: This review explored the impact of educational intervention on quality of life (QoL) of patients with colostomy. Methodology: A review was performed in electronic databases PubMed, Scopus, Google Scholar, using specific keywords. Results: The findings showed that patient education significantly improves QoL of patients with a stoma. Individualized educational interventions delivered by trained health professionals empower patients, enhance their self-care abilities, and relieve stress, ultimately promoting independence and optimism in managing their disease. Thus, healthcare settings should prioritize the implementation of comprehensive educational programs to support the holistic well-being of ostomy patients. Conclusions: Education is essential to improve QoL of colostomy patients, enabling them to live a satisfying and independent life despite their condition. Future research should explore innovative educational interventions to further improve patient outcomes and satisfaction. Keywords: Colostomy, patient education, quality of life, self-care, psychological adaptation Corresponding author: Pavlina Samara, 7 Ifestou Street, Nikaia, Τηλ.6976820649 e-mail :[email protected] PERIOPERATIVE NURSING (2024), VOLUME 13, ISSUE 2 Samara et al. 122 www.spnj.gr Introduction Colostomy is the standard treatment option for Colorectal cancer, globally.1 According to estimates from the US and China, approximately 1 million people live with a stoma in each country, and 700,000 people in Europe.2 Data from UK and Sweden suggest that 25– 32% of patients undergoing surgery will acquire a colostomy.3,4 Quality of life (QoL) is limited in patients after stoma surgery.5–7 Patients with rectal cancer not having a colostomy experience higher QoL levels compared with those who had.5 Differences in QoL between patients with and without a colostomy may persist for more than 2 to 5 years.7 QoL is a multidimensional and subjective concept that is difficult to be defined and measured. In healthcare environments, the main reason for measuring QoL is to promote patient-centered care, which ensures the integration of their preferences in disease management and participation in decision-making. QoL measurement provide a framework for clinical monitoring, assessing changes in life during treatment and exploring effectiveness of treatment. 8,9 Patients who are well educated about the purpose of colostomy are equipped to deal with challenges associated with daily life changes. As a result, patients are more likely to actively engage in their own well-being and adhere to prescribed care, thus leading to better overall health outcomes. Empowering patients through education is a fundamental element that enhances their ability to adapt, manage and live a fulfilling life after colostomy. 10,11 Furthermore, education plays a critical role in addressing the psychosocial impact of colostomy surgery. More in detail, patients experience a range of emotions, including embarrassment and a reduced sense of body image. Education provides strategies for coping with emotional challenges.11 The aim of this review was to explore the impact of education on quality of life (QoL) of patients with a colostomy. Methodology A review was conducted, examining studies that were carried out mainly in the last five years, on a global scale, regarding the issue under study. The review was carried out in the databases PubMed, Scopus, Google Scholar, using specific keywords: Colostomy, patient education, quality of life, self-care, psychological adaptation. Results Living with a stoma is seriously affecting patients’ QoL which is attributed to variety of factors such as diarrhea, odor or leakages from the specific area. Meanwhile, stoma results in body image changes, social restrictions while is triggering physical and emotional burden.12,13 For example, a study conducted by Zewude et al.,13 in Ethiopia among 39 males (60.9%) and 25 females (39.1%) with mean age 49.3 ±17.5 showed that more than 50% reported feelings of depression following stoma surgery. Approximately, 70% of patients had adjusted their dietary style due to stoma and only 34% resumed sexual activity. Factors such as type of ostomy (temporary/permanent), adjustment in dietary style due to stoma, depression, change in diet for not passing gas in public, and change in clothing style had significant effects on overall QoL and its subscales. Indeed, patients with stoma experience physical impairment, deranged body function and emotional trauma, which further minimize their ability for self care and limit their social or sexual life.14 All the aforementioned parameters reduce QoL directly or indirectly and place education in the forefront of clinical practice. In Taiwan, the study conducted by Ko et al.,15 showed that multimedia patient education delivered via laptop enhanced self-care skills and QoL in patients with stoma compared with conventional education. PERIOPERATIVE NURSING (2024), VOLUME 13, ISSUE 2 Samara et al. 123 www.spnj.gr Furthermore, noticed the scalability of multimedia interventions and recommended their inclusion in early postoperative care. The study by Heydari et al.,16 in Iran showed that preoperative education combined with postoperative support programs improves QoL. The study used various tools and methods to improve QoL of patients with stomas, such as lectures, presentations and Internet tools. The interventions were tailored to different target groups, including patients, caregivers or both, and focused on physical therapies, self-care and psychological support. Involving family caregivers and using telephone or smart communication for follow-up improves patient outcomes. The study by Ganjalikhani et al.,12 in Iran showed that structured education in ostomy care reduces anxiety and improves QoL. The most significant increase was observed for psychological, social, and physical aspects, and the least for spiritual aspects. Structured ostomy care training, including face-to-face education and personal practice of using ostomy equipment, along with written material provided by ostomy nurses, may lead to an increase in patients’ overall QoL and a decrease in their anxiety level. The same researchers highlighted the importance of education provided by trained ostomy nurses to address the physical, psychological, and social health needs of patients. It is important for healthcare settings to incorporate comprehensive educational programs for ostomy patients to enhance their well-being. Similarly, the results of Mohamed et al.,17 showed that education exerts a positive impact on enhancing all aspects of QoL and self-efficacy dimensions for both adult and adolescent patients with colostomy. Education targets physical, psychological, social and spiritual well-being and provides detailed guidance on colostomy care, physical activity, psychological resilience, social participation and prevention of complications. In China, the study by Ran et al.,18 indicated low QoL among patients with colon cancer after colostomy. However, participants who attended self-care courses reported improvement in the social domain of QoL compared to those who did not attend. This suggests that self-care educational programs tailored to the needs and educational level of patients with colostomy may improve their QoL. In Greece Stavropoulou et al.,19 demonstrated that patients with permanent colostomies face significant challenges in their daily lives, affecting their mental and social well-being. In particular, the study demonstrates the role of nurses in providing education, support and empowerment to patients with ostomies, thus facilitating their adaptation to new way of living. Furthermore, it suggests that early diagnosis and management of anxiety and other mental health disorders is crucial to improve patient care. Interestingly, personalized educational interventions provided by trained health professionals empower patients, enhance their self-care skills, and alleviate anxiety, ultimately promoting independence and optimism in disease management. Stoma specialist nurses are essential to support patients through the period of adaptation to life with a stoma since they are in contact with patients before, after, and during the medical process. Nurses ought to provide care interventions that have significant effects on patients’ QoL.15 Last but not least, provision of detailed information has gained a growing recognition of QoL issues in patients with chronic and life threatening disease. Frequently information needs include practical problems associated with everyday activities or even financial issues. Additionally, the content of information may vary according to gender and education level before and after procedures. Discharge planning that integrates information is critical in ensuring both the quality of care and patients’ QoL.20,21 Given that colostomy influences body image, it is easily understandable that strengthening self concept in these vulnerable group of patients may improve their QoL and help them adapt to treatment process.22 PERIOPERATIVE NURSING (2024), VOLUME 13, ISSUE 2 Samara et al. 124 www.spnj.gr The primary goal of each educational intervention is to help people to adopt a more positive attitude to the disease. Conclusions Literature review highlights the significant impact of patient education on QoL among patients with ostomies. Across study designs and populations, several key themes emerge, highlighting that educational interventions may improve patient outcomes. First and foremost, structured education stands out as a cornerstone in addressing multifaceted challenges faced by ostomy patients. Whether delivered through multimedia platforms, individualized sessions with healthcare professionals, or educational guidelines, these interventions consistently lead to improved selfcare knowledge and skills, reduced stress levels, and improved QoL. Furthermore, the literature highlights the importance of a holistic approach to patient education, which includes not only physical aspects but also psychological and social dimensions. In addition, involving family caregivers are emerging as strategies for expanding educational interventions and promoting ongoing patient engagement. By equipping patients with the necessary knowledge and skills to effectively manage their condition, healthcare settings can facilitate patient empowerment, autonomy, and ultimately a sense of independence and optimism regarding the course of their disease. References 1. Yuan ZX, Ma TH, Wang HM, Zhong QH, Yu XH, Qin QY, Wang JP, Wang L. 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