Application of continuous nursing under the health belief model in prophylactic colostomy for rectal cancer

doi:10.21203/rs.3.rs-3244444/v1

Download PDF

Article

Application of continuous nursing under the health belief model in prophylactic colostomy for rectal cancer

https://doi.org/10.21203/rs.3.rs-3244444/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

Background: To explore the effects of continuous nursing based on the health belief model on the rehabilitation of patients undergoing anterior rectal resection and preventive colostomy.

Methods: From September 2020 to October 2021, 80 patients who met the inclusion criteria for preventive enterostomy were randomly divided into the observation and control groups. Patients in both groups were followed up for 3 months after discharge from the hospital. The control group was given routine follow-ups, and the observation group was given continuous nursing intervention under the guidance of the health belief model. Adaptability to colostomy, colostomy self-efficacy, colostomy complications, quality of life after colostomy, and defecation control ability after colostomy were observed in the two groups.

Results: There were no significant differences in sex, age, tumor stage, tumor location, or educational level between the two groups (P > 0.05). Three months after intervention, colostomy adaptability and colostomy self-efficacy scores in the observation group were higher than those in the control group (132.38±8.33 and 101.26±9.4, respectively). The quality of life scores after colostomy in the observation group were higher than those in the control group at 1 month (49.2±6.99) and 3 months (59.85±5.16) after discharge, and the incidence of postoperative complications in the observation group was 20% lower than that in the control group (P < 0.05). The scores of defecation control ability at 1 month (21.25±11.05) and 3 months (17.475±9.808) after colostomy in the observation group were lower than those in the control group (P< 0.05).

Conclusion: Continuous nursing interventions based on the health belief model can improve colostomy adaptability, colostomy self-efficacy, quality of life, and defecation function after colostomy in patients with rectal cancer undergoing anterior rectal resection with prophylactic colostomy.

Health sciences/Diseases

Health sciences/Health care

Rectal cancer

Health belief model

Continuous nursing intervention

Preventive enterostomy

According to global cancer statistics, colorectal cancer incidence is second only to lung and breast cancers and is the third most common malignant tumor worldwide [1]. With improvements in surgical technology and the popularization of comprehensive treatment, preserving the anus in patients with low rectal cancer is now possible. In order to prevent postoperative anastomotic leakage, preventive stoma has become the main surgical method [2]. However, the hospitalization time for patients with ostomies is short, and an increasing number of patients need to learn ostomy-related nursing skills after discharge. Continuous nursing refers to a series of nursing services designed according to time and environment that can effectively improve patients' self-care ability when they change medical places or services and prevent adverse consequences. Studies have shown that patients with rectal cancer after colostomy have a low level of knowledge about colostomy [4–6], and it is difficult for them to complete self-management, which directly affects their quality of life after discharge [7]. The health belief model (HBM), proposed by social cognitive scientists in 1958, is a theoretical framework that influences people's behavior [8]. It can change people's behavior by improving cognition. It is an educational health promotion model that aims to help patients improve their cognition of diseases, change bad habits, follow healthy behaviors, and realize self-care. We combined the health belief model with continuous nursing, effectively improving patient rehabilitation. The study is as follows.

1.1 Research object

Patients who underwent anterior rectal resection and prophylactic colostomy in the Department of Gastroenterology of a third-class hospital in Hefei between 2020.09 and 2021.10 were selected as the study subjects. Inclusion criteria: ① In accordance with the diagnostic criteria of rectal cancer [9]; ② Prophylactic colostomy was performed in the first stage; ③ There were no operation-related complications, such as intestinal obstruction, anastomotic leakage, etc. ; ④ patients knew their own diagnosis and condition; ⑤ All voluntarily signed informed consent. The exclusion criteria: ① Patients of other serious systemic diseases; ② Patients) disturbance of consciousness and communication. Eighty eligible patients were randomly divided into control (n = 40) and observation (n = 40) groups. There were no significant differences in sex, age, tumor stage, tumor location, or educational level between the two groups (P > 0.05, Table 1). This study was approved by the Ethics Committee of the First Affiliated Hospital of USTC (No. 2022-RE-284).

Table 1

General situation of patients in the two groups(n,x̄ ± s)
Group		Observation group	Control group	χ² / t	P
n		40	40
Sex	male	19	22	0.450	0.502
Sex	female	21	18	0.450	0.502
Average age (years)		58 ± 12.87	62.13 ± 11.96	1.068	0.463
Tumor TNM stage	Phase II	14	12	0.228	0.633
Tumor TNM stage	Phase Ⅲ	26	28	0.228	0.633
Distance from tumor to anal margin (cm)		8.62 ± 2.02	8.76 ± 2.16	0.232	0.631
Education level	Illiteracy	9	10	0.949	0.814
	Primary school	17	14
	Junior high school	7	10
	High school and above	7	6

1.2 Method

Patients in both groups underwent primary laparoscopic anterior rectal resection plus terminal ileostomy in the same treatment group, and a secondary colostomy was performed 3 months later. Routine nursing was performed during hospitalization, including diet nursing, medication guidance, levator ani muscle training, colostomy nursing, and conduit nursing. Control group: Routine follow-up was performed after discharge. This included telephone, home, network, and outpatient follow-ups primarily to address patients' health problems. Observation group: Continuous nursing based on the HBM was performed based on routine follow-up, which aimed to change patients' unreasonable belief in the disease and emphasize the initiative of patients' self-management. Theoretical basis: The health belief model mainly comprises four parts: susceptibility to disease, severity, behavioral benefits, and behavioral disorders, and forms health beliefs and adopts healthy and beneficial behaviors. The theoretical framework is illustrated in Fig. 1.

1.2.1 Intervention plan

Continuous nursing based on the HBM started from the first-stage operation to 3 months after discharge from the second-stage operation, which was divided into two stages. The first stage is from the first stage of stoma operation to 3 months after discharge, which mainly focuses on stoma nursing and levator ani training and evaluates patients' stoma adaptability, self-efficacy, quality of life, and complication rate. In the second stage, from the second stage of the stoma return operation to 3 months after discharge, we mainly focused on levator ani training and evaluated levator ani training compliance and defecation function. Establish an HBM data manual for patients and dynamically grasp the change process and influencing factors of patient behavior.

1.2.2 Intervention form

Before the first-stage operation is discharged from the hospital, two intensive lectures will be given. The trained nursing staff will give lectures, each lasting 30 minutes, and the time and form of follow-up after discharge will be the same as those of the control group. Telephone follow-up: once a week, lasting 15 minutes; outpatient follow-up, once a month; home follow-up, once a month; network follow-up, preventive stoma communication group; and real-time online communication guidance.

1.2.3 Intervention contents

(1) Self-care knowledge education: Explain disease-related knowledge to patients so that they can understand the risk factors that may affect the quality of life after anterior gastrectomy with terminal ileostomy and explain the severity of anterior gastrectomy syndrome in typical cases. An increase in defecation frequency or difficulty in defecation seriously affects the quality of life and even results in permanent enterostomy. Explain the basic knowledge of ileostomy, the replacement method of the ostomy bag, the diet after ostomy, the common complications and prevention methods, and attach pictures of ostomy complications to intuitively show patients and their families the consequences caused by improper nursing, and thus bring physiological, psychological, and economic burdens so that patients can fully realize the susceptibility and severity of diseases and the benefits brought by correct behaviors, thus laying a foundation for the formation of reasonable beliefs.

(2) Formation of health beliefs: Helps patients analyze the significance of compliance and self-care, insists on the benefits of levator ani training for disease rehabilitation, and insists on long-term levator ani training to improve the defecation function of patients after anterior rectal resection. At the same time, help patients analyze the difficulties and obstacles that may be encountered in self-care and training and solve the problems and obstacles in self-care and levator ani training of patients by telephone, home visit, outpatient service, QQ group, etc. during the follow-up process to promote health beliefs.

(3) Promote behavior change: Instruct and urge patients to perform levator ani training 30 times in the morning and evening and maintain it for 5–10 seconds after each anal contraction. Telephone follow-ups were conducted to understand the nursing status of patients with stomas, defecation characteristics, and the occurrence of stoma complications. Praise and affirm those who can correctly care for the stoma and insist on levator ani training to strengthen their correct behavior, and the causes of stoma complications were analyzed. If patients are too old or obese, they should contact their families for active help. If the stoma position is poor (located near scars or skin folds and depressions) or the stoma is low, depressions, or other reasons, the stoma maker will come to the site to guide them and choose appropriate stoma nursing supplies, and then evaluate the stoma nursing behavior of the patients or their families again during the subsequent telephone follow-up. For those who are too old to undergo regular levator ani training on time, guide their families to supervise, or set their mobile phones to alarm three times a day. Patients with poor defecation function recovery due to short-term training, lack of levator ani training, or failure to reach the prescribed frequency must be made aware that only long-term levator ani training, form health belief, and adherence to correct behavior can improve the defecation function of patients after colostomy. Patients with good defecation function recovery should continue postoperative exercises.

1.2.4 Evaluation indicators

1.2.4.1 Colostomy adaptation

The ostomy adjustment scale (OAS) was developed by Olbrisch in 1983 to measure patient adaptation after enterostomy [10]. The scale included physiological function (12 items), mental status (13 items), and social communication (9 items). The lowest and highest scores were 34 and 204, respectively. The higher the score, the better the patient’s adaptability to colostomy. The Cronbach's alpha for the scale was 0.95. Patients in the two groups were investigated on the day of discharge and 3 months after discharge.

② Colostomy self-efficacy scale [11]: This scale includes two dimensions (colostomy care efficacy and social efficacy) and six separate items (efficacy of diet choices, confidence in sexual life, confidence in sexual life satisfaction, confidence in heavy physical labor, confidence in maintaining vitality, confidence in colostomy). Each item was scored from "lack of confidence, a little confidence, confidence" in turn, with a total score of 28–140, a score of < 65 as low efficiency, 66–102 as medium efficiency, and ≥ 103 as high performance. Cronbach's coefficients of the two dimensions were 0.94 and 0.95, respectively. Patients in the two groups were investigated on the day of discharge and 3 months after discharge.

1.2.4.2 Quality of life of patients after colostomy [12]

The quality of life of patients after colostomy was evaluated using the Quality of Life Scale of Patients after Colostomy, composed of 20 items in four dimensions (psychological burden, social communication, colostomy management, and daily living). Each item is scored from 1–4 points, with a total score of 20–80. The half-and-half reliability of the scale was 0.865, and Cronbach’s coefficient of the scale was 0.893. Patients in the two groups were investigated 1 month after discharge from prophylactic colostomy and 3 months after discharge.

1.2.4.3 Incidence of colostomy complications

The incidence of colostomy complications, including fecal dermatitis, ostomy retraction, mucosal separation of the stoma, and subcutaneous infection of the stoma, was counted from primary prophylactic colostomy to second-stage colostomy.

1.2.4.4 Compliance with levator anus training

Compliance with levator anus training was divided into three levels: do it on time, do it occasionally, and do not do it. The investigation was conducted before and after the interventions.

1.2.4.5 Defecation function

The Chinese version of the LARS was used to evaluate defecation function. The LARSS scale [13] was developed by Danish scholars in 2012 and translated into Chinese by Cao Lanyu in 2013. The test-retest reliability intragroup correlation coefficient (ICC), evaluator reliability ICC, and scale content validity ratio (CVR) were 0.9615, 0.9394, and 0.90, respectively. There were five items in the scale, and the scores for each item were as follows: exhaust incontinence (0, 4, 7), loose stool incontinence (0, 3, 3), defecation times (4, 2, 0, 5), sense of urgency (0, 11, 11), and sense of urgency (0, 11, 16). The total score on the scale was 0–42. According to the score, anterior rectal resection syndrome was divided into three degrees, 0–20 as asymptomatic, 21–29 as mild symptoms, and 30–42 as severe symptoms. Patients in the two groups were evaluated at 2 weeks, 1 month, and 3 months after colostomy.

1.2.5 Statistical methods

Data were entered into Excel and imported into SPSS16.0 statistical software for analysis and processing. Counting data are expressed as percentages, and the chi-square test was used for comparison between groups. The measurement data were expressed as means and standard deviations, and comparisons between groups were performed using t-tests. This difference was statistically significant (P < 0.05). Analysis of variance of repeated measurement data was used to measure multiple time points of the same index, and the difference was considered statistically significant (P < 0.05).

2.1 Comparison of stoma adaptability between two groups before and after intervention

Three months after discharge from the primary operation, the total stoma adaptability scores in the observation group were higher than those in the control group (P < 0.05); as shown in Table 2.

Table 2

Adaptability scores of patients after ostomy in the two groups(x̄ ± s)
Group	Control group		Observation group		t	P
Group	Before intervention	After intervention	Before intervention	After intervention	t	P
Physiological function	36.55 ± 8.35	43.03 ± 5.87	35.03 ± 6.46	49.28 ± 4.49	0.902/5.222	< 0.001*
Psychological status	32.33 ± 9.59	36.2 ± 10.07	34.15 ± 8.73	43.93 ± 6.46	0.873/3.866	< 0.001*
Social interaction	29.38 ± 10.6	32.48 ± 9.78	27.86 ± 8.18	39.16 ± 6.52	0.699/3.559	0.001*
Adaptive total score	97.66 ± 15.93	111.7 ± 13.67	96.7 ± 12.93	132.38 ± 8.33	0.297/8.065	< 0.001*
Note: * was the comparison between the two groups after intervention.

2.2 Comparison of stoma self-efficacy between two groups before and after intervention

Three months after discharge from the first-stage operation, the total scores of self-efficacy, stoma care efficiency, social efficacy, confidence in sexual life, confidence in engaging in heavy physical labor, and confidence in maintaining vitality in the observation group were all higher than those in the control group, with significant difference (P < 0.05); however, there was no significant difference in the scores of diet choice and confidence in self-care after ostomy (P > 0.05), as shown in Table 3.

Table 3

Comparison of stoma self-efficacy between two groups before and after intervention (x̄ ± s)
Group	Before intervention		t	P	After intervention		t
	Control group	Observation group			Control group	Observation group
Efficacy of stoma care	40.55 ± 11.46	40.8 ± 12.63	0.233	0.152	42.33 ± 7.15	50.13 ± 5.65	5.346	0.000
Social effectiveness	26.53 ± 11.00	27.15 ± 11.53	0.571	0.581	26.43 ± 7.89	31.85 ± 7.09	3.192	0.002
Efficiency of diet choice	3.08 ± 1.25	3.18 ± 0.95	1.251	0.052	3.23 ± 0.94	3.5 ± 1.16	1.151	0.253
Confidence in sex life	1.75 ± 0.94	1.80 ± 0.71	0.12	0.089	1.83 ± 0.67	2.78 ± 1.11	4.593	0.000
Confidence in heavy manual labor	2.75 ± 1.34	2.23 ± 0.88	0.319	0.472	2.9 ± 0.969	3.35 ± 0.94	2.085	0.040
Confidence in keeping alive	2.65 ± 1.51	2.40 ± 1.36	0.247	0.451	2.6 ± 1.16	3.28 ± 1.16	2.570	0.012
Confidence in self-care after ostomy	2.35 ± 1.17	2.23 ± 0.91	0.697	0.581	3.05 ± 1.05	3.28 ± 1.43	0.792	0.423
Total self-efficacy score	80.88 ± 16.03	80.33 ± 14.28	0.16	0.205	83.2 ± 11.95	101.26 ± 9.4	7.310	0.000

2.3 Comparison of postoperative quality of life between two groups of ostomy patients

One month and three months after discharge from the first-stage operation, the total scores of quality of life and the scores of all dimensions of the patients in the observation group were higher than those in the control group, and the difference was statistically significant (P < 0.05), as shown in Table 4.

Table 4

The quality of life scores of patients with stomas in the two groups 1 and 3 months after discharge from primary operation (x̄ ± s)
Group	1 month after discharge		t	P	3 months after discharge		t	P
	control group	observation group			control group	observation group
Psychological burden	15.23་3.9	19.6 ± 5.21	4.193	0.000	16.13 ± 4.68	25.75 ± 4.62	9.14	0.000
Management of stoma	8.33 ± 1.69	10 ± 3.11	2.956	0.004	9.78 ± 2.41	11.5 ± 2.97	2.812	0.006
Daily living	8.03 ± 2.95	9.45 ± 2.69	2.23	0.029	9.25 ± 3.11	10.83 ± 3.11	2.151	0.035
Social interaction	7.75 ± 2.32	10.15 ± 2.07	4.821	0.000	8.68 ± 2.65	12.73 ± 1.86	7.817	0.000
Total score of quality of life	39.33 ± 5.97	49.2 ± 6.99	6.712	0.000	43.83 ± 7.16	59.85 ± 5.16	11.878	0.000

2.4 Comparison of the incidence of colostomy complications between the two groups

The number of colostomy-related complications in the observation group was less than that in the control group 3 months after the primary operation, and the difference was statistically significant (P < 0.05), as shown in Table 5.

Table 5

Incidence of colostomy complications in two groups of patients after one-stage operation (n,%)
Group	n	Complications				Cases
		Fecal dermatitis	Ostomy retraction	Mucosal separation of stoma	Subcutaneous infection of stoma
Control group	40	13(32.5)	2(5)	1(2.5)	2(5)	18(45)
Observation group	40	5(12.5)	1(2.5)	1(2.5)	1(2.5)	8(20)
χ2						5.698
P						0.017

2.5 Comparison of levator ani training compliance between the two groups

After the intervention, the proportion of levator ani muscle training in the observation group was significantly higher than in the control group (P < 0.05), as shown in Table 6.

Table 6

Compliance with levator ani training before and after intervention in the two groups (n,%)
Group	Before intervention			After intervention
	Do it on time	Do it occasionally	None	Do it on time	Do it occasionally	None
Control group	8(20)	22(55)	10(25)	9(22.5)	24(60)	7(17.5)
Observation group	6(15)	25(62.5)	9(22.5)	33(82.5)	6(15)	1(2.5)
χ2	0.530			29.014
P	0.767			0.000

2.6 Comparison of the ability of defecation control after secondary colostomy between the two groups

The LARSS score of the observation group was higher than that of the control group 2 weeks after the secondary colostomy; however, the LARSS score of the observation group was lower than that of the control group 1 and 3 months after surgery. The analysis of variance of repeated measurement showed that the effect of time on the results was not statistically significant (P > 0.05), as shown in Table 7.

Table 7

LARS score of patients in two groups (x̄ ± s)
Group	n	2 weeks after operation	1 month after operation	3 months after operation
Control group	40	30.67 ± 5.44	27.05 ± 6.1	22.87 ± 5.75
Observation group	40	28.45 ± 9.84	20.5 ± 11.05	14.92 ± 10.43
t		1.235	3.239	4.167
P		0.222	0.002	0.000

3.1 Necessity of continuous nursing intervention for patients with anterior rectal resection with prophylactic terminal ileostomy

Prophylactic colostomy is generally performed approximately 3 months after surgery, and some patients face problems such as increased defecation frequency, poor defecation control ability, and incomplete defecation. Although colostomy complications affect the timely repayment of prophylactic colostomy, many complications can be effectively prevented through correct nursing with shortened hospitalization time. It is difficult for patients and their families to master professional colostomy nursing during hospitalization; therefore, continuous nursing is vital for preventive colostomy patients. Presently, there is a serious deficiency in the number and proportion of community nurses in our country, a lack of stoma specialist nurses, and patients with a high degree of trust in large hospitals. In addition, there is a certain demand for the continuation of previous therapeutic sexual relationships. Therefore, the continuous nursing model is based on the hospital-community-family ternary linkage model [15], which extends the hospitalization service to the family and community and is the concern and response to the patient’s health problems and needs during the transfer period. Paying attention to the problems related to the quality of life of patients with anterior rectal resection and preventive colostomy is the most feasible and necessary for patients with anterior rectal resection and preventive colostomy at the present stage.

3.2 Continuous nursing intervention under the guidance of the health belief model can improve the colostomy adaptability and self-efficacy of preventive colostomy patients

This study shows that through continuous nursing intervention under the health belief model, colostomy adaptability and self-efficacy scores in the observation group were higher than those in the control group after 3 months, which is consistent with the results of Yao et al. [16]. Self-efficacy refers to an individual’s expectation of the ability to accomplish specific tasks [17]. The self-efficacy of patients undergoing colostomy consists of two aspects: social function and colostomy management function. According to the health belief model, this study adopted a variety of follow-up models and multiple information channels to educate and strengthen the relevant knowledge of colostomy diet, activity, pocket replacement, prevention and management of complications, etc., make patients clear about the importance of correct nursing methods in preventing complications and improving the quality of life, promote patients to have health beliefs, and enhance their confidence in nursing colostomy. Thus, patients can better integrate themselves into their social lives. By enhancing patients’ sense of self-efficacy and improving their confidence in dealing with diseases, they can accelerate the self-adaptation process and reduce their psychological and social burden. Through continuous nursing education, patients can fully understand the disease, improve disease awareness, and make the patients adjust their ability to adapt to the environment, including physical, psychological, and social aspects. The results showed that although the adaptation score in the observation group was significantly higher than that in the control group, it was still low, which may be related to the temporary characteristics of preventive colostomy. Many patients believe that their stoma exists for a short time and depend too much on their families.

3.3 Continuous nursing intervention under the health belief model can improve patients' compliance with levator ani muscle training and improve defecation function

The results of this study showed that exercise compliance was higher in the observation group than in the control group after the intervention. Levator ani muscle training refers to the recovery of the muscle and its innervation nerve function through active contraction of the pelvic floor muscle to control voiding and defecation function. It usually takes 3–6 months after prophylactic colostomy. Long-term adherence to levator anus muscle training can effectively improve defecation function. The health belief model helps patients form correct cognitions and promotes the independent adoption of healthy behaviors. During this period, we mainly followed up and intervened by telephone to allow patients to fully understand the benefits of adhering to levator anus training and mastering correct training methods. The reasons for failure to adhere, such as physical and psychological factors, were analyzed according to different reasons for personalized guidance. Patients were urged to adhere to levator anus training to improve compliance.

3.4 Effect of continuous nursing intervention under the health belief model on the incidence of colostomy complications

The excretion of enterostomy is large, and the excreta contains a variety of digestive enzymes, which are more irritating to the skin; in addition, the position of the proximal opening of some double-lumen stomas is relatively low, close to the skin, making nursing more difficult. Improper nursing leads to fecal dermatitis after leakage, which affects pocket adhesion, forming a vicious circle [18]. As prophylactic colostomy is generally accepted approximately 3 months after surgery, many patients do not attach importance to the study of colostomy nursing methods and mostly rely on their family members for colostomy nursing. After colostomy, some patients also face problems such as increased defecation frequency, poor defecation control ability, and inexhaustible defecation. In the traditional nursing model, patients cut off contact with the hospital immediately after discharge. Once complications occur, the readmission rate is high, medical expenses increase, and even affect the timely repayment of preventive colostomies. Many complications can be effectively prevented through correct nursing; however, with the shortening of hospitalization time, it is difficult for patients and their families to master professional colostomy nursing during hospitalization. Therefore, continuous nursing care is essential for patients undergoing prophylactic colostomies. This study showed that the number of colostomy-related complications in the observation group was lower than that in the control group from post-colostomy to 3 months after discharge. Continuous nursing based on the health belief model adopts various forms of follow-up to solve the action obstacles of health behaviors and promote health beliefs, which can effectively reduce the occurrence of colostomy complications.

3.5 Effect of continuous nursing intervention on patients' quality of life under the health belief model

Even if preventive colostomy exists for a short time, it still impacts patients’ psychological, physiological, and social communication. Some patients in the survey said they were unwilling to go out for daily social activities before the colostomy was returned. After the intervention, the quality of life scores in the observation group were higher than those in the control group in terms of psychological burden, colostomy management, daily life, and social communication; the psychological burden and social communication scores in the observation group were significantly higher than those in the control group. The continuous nursing group built a good platform for colostomy patients through a network QQ group, and communication among the peers of patients who underwent colostomy, alleviating their feeling of loneliness. Faced with a colostomy, standardized telephone follow-up can provide timely psychological counseling for patients with psychological problems, make them more likely to accept themselves, form a good state of mental health, improve their self-care ability, and improve their quality of life.

Continuous nursing based on the health belief model reflects purposeful and predictable holistic nursing, with the focus extending from the patient's discharge to the patient's smooth passage through the stoma period and successful acceptance of the stoma return operation. Through health education and guidance in different periods, patients can identify complications in time and take effective measures to correct them, which greatly reduces the incidence of complications, helps patients return to society and their families, reduces the readmission rate, and saves medical resources [19]. This model could also be implemented in hospitals. This study was limited to Hefei, and the number of research objects was limited. In the future, the sample size should be increased to improve the credibility of the results. In the future, patients with low training compliance in the levator ani can be targeted to analyze the causes and correlations to implement more refined nursing care.

Ethics approval and consent to participate

The study was conducted strictly in accordance with the Declaration of Helsinki and approved by the research ethics committee of The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China (protocol no. 2022-RE-284), all participant under investigation have signed written informed consent.

Consent for publish

Not applicable

Availability of data and materials

The data used to support the findings of this study are available from the corresponding author upon request.

Competing interests

The authors declare that they have no competing interests.

Funding

None.

Authors Contributions

LS, and JL designed the study, participated in the field investigation phase, and wrote the airicle.

LS onceptualized and designed the study, and investigated and revised the manuscript.

HZ and AC participated in the field investigation phase.

All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Acknowledgements

None.

Bray F, Ferlay J, Soerjomataram I, et al. Global Cancer Statistics 2018: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. Ca Cancer J Clin.2018;68(6):394–424. doi:10.3322/caac.21492.
Gao JL, An YB, Wang D, et al. Current status of research on short-term quality of life after sphincteric-saving surgery in rectal cancer patients. Chinese Journal of Gastrointestinal Surgery. 2020;23(4):415–420. doi: 10.3760/cma.j.cn.441530-20190525-00219.(in Chinese)
Shortell SM, Rundall TG, Hsu J. Improving patient care by linking evidence-based medicine and evidence-based management[J]. JAMA, 2007, 298(6):673–676. doi: 10.1001/jama.298.6.673
Klasko-Foster LB, Kiviniemi MT, Jandorf LH, et al. Affective components of perceived risk mediate the relation between cognitively-based perceived risk and colonoscopy screening. J Behav Med. 2020;43(1):121–130. doi: 10.1007/s10865-019-00049-w
Wenzel A. Basic Strategies of Cognitive Behavioral Therapy. Psychiatr Clin North Am. 2017;40(4):597–609. doi:10.1016/j.psc.2017.07.001
Xian H, Zhang Y, Yang Y, et al. A Descriptive, Cross-sectional Study Among Chinese Patients to Identify Factors that Affect Psychosocial Adjustment to an Enterostomy. Ostomy Wound Manage. 2018;64(7):8–17.
O'Regan P, McCarthy G, O'Reilly S, et al. Cancer-related fatigue and self-care agency: A multicentre survey of patients receiving chemotherapy. J Clin Nurs. 2019;28(23–24):4424–4433. doi:10.1111/jocn.15026
Pretty J, Rogerson M, Barton J. Green Mind Theory: How Brain-Body-Behaviour Links into Natural and Social Environments for Healthy Habits. Int J Environ Res Public Health. 2017;14(7):706. doi:10.3390/ijerph14070706.
Hospital Authority of National Health and Family Planning Commission of the People′s Republic of China; Chinese Society of Oncology. Zhonghua Wai Ke Za Zhi. 2018;56(4):241–258. doi:10.3760/cma.j.issn.0529-5815.2018.E001.
Olbrisch ME.Development and validation of the ostomy adjustment scale[J].Rehab Psychol,1983,28(1):3–12. https://doi.org/10.1037/h0090996
Bekkers MJ, Van Knippenberg FC, Van Den Borne HW, et al. Prospective Evaluation of Psychosocial Adaption to Stoma Surgery:The Role of Self-Efficacy. Psychosom Med,1996;58(2):183–191. doi: 10.1097/00006842-199603000-00013
Lim SH, He HG, Chan SWC. Psychometric Properties of the Chinese Version of the Acceptance of Chronic Health Conditions (Stoma) Scale for Patients With Stoma. Cancer Nurs. 2017;40(4):E42-E49. doi:10.1097/NCC.0000000000000411.
Emmertsen KJ, Laurberg S.Low anterior resection syndrome score: development and validation of a symptombased scoring system for bowel dysfunction after low anterior resection for rectal cancer[J]. Ann Surg, 2012,255(5):922–928. doi: 10.1097/SLA.0b013e31824f1c21
Eid Y, Bouvier V, Dejardin O, et al. 'French LARS score': validation of the French version of the low anterior resection syndrome (LARS) score for measuring bowel dysfunction after sphincter-preserving surgery among rectal cancer patients: a study protocol. BMJ Open. 2020;10(3):e034251. doi:10.1136/bmjopen-2019-034251.
Cheng F, Xu Q, Dai XD, Yang LL. Evaluation of the expert patient program in a Chinese population with permanent colostomy. Cancer Nurs. 2012;35(1):E27-E33. doi:10.1097/NCC.0b013e318217cbe9.
Xu S, Zhang Z, Wang A, Zhu J, Tang H, Zhu X. Effect of Self-efficacy Intervention on Quality of Life of Patients With Intestinal Stoma. Gastroenterol Nurs. 2018;41(4):341–346. doi:10.1097/SGA.0000000000000290.
Bekkers MJ,van Knippenberg FC,van den Borne HW,et al. Prospective evaluation of psychosocial adaptation to stoma surgery: the role of self-efficacy. Psychosomatic medicine, 1996,58(2):183–191. doi: 10.1097/00006842-199603000-00013
Rathnayake MM, Kumarage SK, Wijesuriya SR, et al. Complications of loop ileostomy and ileostomy closure and their implications for extended enterostomal therapy: a prospective clinical study. Int J Nurs Stud. 2008;45(8):1118–1121. doi:10.1016/j.ijnurstu.2007.07.015.
Donald F, Kilpatrick K, Reid K, et al. Hospital to community transitional care by nurse practitioners: A systematic review of cost-effectiveness. Int J of Nurse Stud, 2015, 52(1): 436–451. doi: 10.1016/j.ijnurstu.2014.07.011.

No competing interests reported.

Download PDF

Version 1

posted

You are reading this latest preprint version

Application of continuous nursing under the health belief model in prophylactic colostomy for rectal cancer

Status:

Version 1

Abstract

Figures

Background

Objects and methods

1.1 Research object

1.2 Method

1.2.1 Intervention plan

1.2.2 Intervention form

1.2.3 Intervention contents

1.2.4 Evaluation indicators

1.2.4.1 Colostomy adaptation

1.2.4.2 Quality of life of patients after colostomy [12]

1.2.4.3 Incidence of colostomy complications

1.2.4.4 Compliance with levator anus training

1.2.4.5 Defecation function

1.2.5 Statistical methods

Results

2.1 Comparison of stoma adaptability between two groups before and after intervention

2.2 Comparison of stoma self-efficacy between two groups before and after intervention

2.3 Comparison of postoperative quality of life between two groups of ostomy patients

2.4 Comparison of the incidence of colostomy complications between the two groups

2.5 Comparison of levator ani training compliance between the two groups

2.6 Comparison of the ability of defecation control after secondary colostomy between the two groups

Discussion

Conclusion

Declarations

References

Additional Declarations

Status:

Version 1