Establishment of evaluation index system of high output health education for patients with middle and low rectal cancer undergoing preventive ileostomy

doi:10.21203/rs.3.rs-4664665/v1

Download PDF

Research Article

Establishment of evaluation index system of high output health education for patients with middle and low rectal cancer undergoing preventive ileostomy

https://doi.org/10.21203/rs.3.rs-4664665/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

Objective We aimed to establish an evaluation index system for health education among high output stoma patients with low anterior resection of rectal cancer and preventive ileostomy.As a theoretical basis,this system may be applied by the clinical nurses to carry out targeted health education and guidance among prophylactic ileostomy patients with hight output stoma and to evaluta the effect of health education.

Methods From January to April 2024, We constituted a scientific research team, including clinical medical experts, ostomy nurses and international ostomies,et al,based on the theory of Knowledge-Belief-Practice.Literature review semi-structured interviews，as well as the Delphi method and Multi-dimensional Analytic Hierarchy Process，were used to establish a framework of the evaluation index system and set weighted value for each evaluation index.

Results The response rates of the 2 rounds of expert consultations are 75.0% and 86.7%.The expert authority coeddicients are 0.873 and 0.969, respectively.The total Kendall harmony coefficients of the 2 rounds of expert consultations are 0.267~0.338 and 0.377~0.397(P <0.05).As a result，we built up an evaluation index system of health education which comprised 3 first-level indexes，13second-level indexes and 63 third-level indexes for high output stoma patients with low anterior resection of rectal cancer and preventive ileostomy.

Conclusion The evaluation index system may provide evidence and a practice tool for clinical nurses in conducting a comprehensive and efficient evaluation of health education among high output stoma patients with low anterior resection of rectal cancer and preventive ileostomy.

rectal cancer

prophylactic ileostomy

high output stoma

health Education

Effect Evaluation Indicators

Rectal cancer (rectal cancer RC) is the third most common malignancy in the world, and surgery is the only cure. With the improvement of surgical techniques and equipment, 73.3%~77.0% of RC patients have the chance of anal-preserving surgery[2]. Prophylactic stoma, also known as protective stoma or diversion stoma, refers to the of temporary terminal ileostomy or transverse colostomy after low anterior resection to achieve the purpose of fecal diversion[3]. Meta-analysis showed that prophylactic enterostomy can significantly reduce the risk of anastomotic fistula and reoperation in patients after anal preservation surgery [4]. Compared with colostomy, ileostomy has a lower wound infection rate and stomy prolapse rate, and stomy surgery is safer, but it is also more likely to have high output stoma (HOS) problem [5]. The incidence of HOS is as high as 23.8%, which is characterized by the discharge of large amounts of watery feces through stoma, leading to complications such as water and electrolyte loss, malnutrition, fecal hydrodermatitis. 80% of HOS patients have moderate reduction in glomerular filtration rate, leading to acute renal failure, requiring continuous drug treatment and increasing the risk of rehospitalization [6–8]. The perfect health education evaluation system has a guiding role in health education for nurses and has a positive impact on patients' self-care skills and improvement of their condition [9]. Under the background of accelerated rehabilitation surgery, science is very important to preventive ilepatients system health education, but the current health education during hospital focus on the basic knowledge of stoma, etc., content complex focus is not prominent or single, and domestic lack of clinical guidelines and management about HOS consensus, nurses on the overall cognitive level of HOS is poor, the lack of unified specification of HOS related health education effect evaluation index system, lead to the lack of targeted health education, HOS patients symptom management ability is poor, often delay [10–15]. Therefore, this study constructed an evaluation index system of health education effect suitable for the high displacement of patients after low anterior resection of rectal cancer, which provides a basis for the systematic and accurate evaluation of health education effect.

Aim

This study constructed an evaluation index system of health education effect suitable for the high displacement of patients after low anterior resection of rectal cancer, which provides a basis for the systematic and accurate evaluation of health education effect.

Design

based on the theory of Knowledge-Belief-Practice.Literature review semi-structured interviews, as well as the Delphi method and Multi-dimensional Analytic Hierarchy Process, were used to establish a framework of the evaluation index system and set weighted value for each evaluation index.

1.1 Set up a research group

The research team is composed of 11 people, including 1 professor engaged in clinical nursing research, 1 associate professor engaged in clinical nursing research, 1 chief physician of gastrointestinal surgery, 1 head nurse of gastrointestinal surgery, 2 wound ocenterologists, 2 chief nurses of gastrointestinal surgery, and 3 graduate nursing students. The research team is responsible for consulting and analyzing the literature, designing the interview outline, determining the interview objects and the letter experts, making the expert letter consultation form, sorting out and analyzing the feedback results of each round of expert letter consultation, and making group discussions to determine whether the indicators need to be added, modified and deleted.

1.2 Preliminary formulation of a rating system

1.2.1 Theoretical basis

This study, under the guidance of "knowledge, trust and practice theory" [16], constructed the evaluation index system of high displacement health education in patients with preventive ileostomy for rectal cancer. This theory holds that knowledge is the basis of positive attitude, positive belief is the driving force for behavior change. purposeful and planned educational activities can improve the knowledge level of patients and change their attitude and behavior, thus improving their health status and quality of life^[9]。

1.2.2 Literature search

With "rectal cancer" "sphincter-preserving/anal-sparing surgery/sphincter-saving surgery" "temporary ostomy/temporary diversion stoma/prophylactic stoma/ileostomy/diverting loop ileostomy/ileostomy diarrhea/preventive terminal ileostomy/high output stoma "" health education/education/health need*/nursing need*/care need*/information need*/information preference "" evaluat*" For the search terms, Search CNKI, Wanfang database and VIP database and other Chinese databases, PubMed, Wound, Ostomy and Continence Nurses Society(WOCNS), American Society of Colon and Rectal Surgeons( ASCRS), Web of Science, Cochrane Library and other English databases. The search period is until April 7, 2024. Inclusion criteria: ① The study topic was related to high displacement of ileostomy after rectal cancer; ② in Chinese or English. Exclusion criteria: ① duplicate, inaccessible full text; ② abstract, conference paper and research plan. The preliminary search obtained 4832 related articles, including 4119 articles, including 2243 in English and 1876 in Chinese. According to the titles, abstracts and full texts, 52 articles were selected, including 31 in English and 21 in Chinese. Two people read the literature carefully and wrote the first draft of the evaluation indicators. Through the research team discussion, they determined the three first-level indicators of health knowledge, health belief, health behavior, 18 second-level indicators and 82 third-level indicators according to the theory of knowledge, trust and practice.

1.2.3 Semi-structured interview

Using the objective sampling method, from January 2024 to March 2024,10 patients with high displacement of rectal cancer and 5 stoma nurses in a grade a hospital in Shanxi Province were selected for semi-structured interviews.

Inclusion criteria were: (1) Patients: ① 24 h prophylactic ileostomy displacement > 1 500 mL; ② volunteered to join the study and signed informed consent.(2) Nurses: ① has worked in colorectal and anal surgery for 10 years; ② has obtained the qualification certificate of stoma specialist nurse; ③ is highly motivated for this study and is willing to participate in this investigator.

The interview outline is as follows: (1) Patients: ① What difficulties do you encounter in enterstomy flow management?② From the perspective of health education, what help do you want medical to give?③ What is your attitude on enterostomy flow management?(2) Nurses: ① What health guidance do you think should be given for patients with high displacement stoma?② Does your department have a targeted evaluation tool for the health education of enterostomy high displacement management? What do you think are the evaluation indicators?

Face-to-face interviews were conducted after obtaining informed consent from experts and patients, ranging from 20 to 30 min, and the interview materials were recorded and audio-recorded by the interviewer. After the interview, the researchers use Colaizzi 7 step analysis to the interview data analysis, according to the results of the index, added "improve sleep quality method" "home nutrition assessment and monitoring method" "liquid, food intake calculation" "near hospital enterostomy health knowledge lecture or sunshine home activities" 20 level 3 indicators. Finally, the research team initially constructed the evaluation index system (draft) of high output health education for medium and low rectal cancer, including 3 first-level indicators, 18 second-level indicators and 102 third-level indicators.

1.3 Expert letter inquiry

1.3.1 Design the letter questionnaire

The expert letter inquiry questionnaire consists of three parts.① Letter to experts: introduce the research purpose, method, questionnaire filling instructions and time.② Expert evaluation form of the effect evaluation system of high discharge health education for patients with preventive ileostomy of rectal cancer.③ Basic information table of experts: including gender, age, education background, professional title, unit name, working field, working years, etc.④ Self-evaluation table of expert familiarity degree, judgment basis and influence degree.

1.3.2 Consultation with experts for selection

In this study, 20 experts from 10 Grade A hospitals in 5 provinces including Beijing, Shanxi, Henan, Shaanxi and Hunan provinces were selected for letter inquiry. Expert selection criteria: ① Clinicians should work in colorectal and anal surgery in a third-class hospital for 10 years; ② obtained internationally certified stoma therapist certificate or nurses participating in the training of stoma nurses; ③ All experts need bachelor degree or above, intermediate or above title; ④ have high enthusiasm in this study and are willing to participate in this investigator.

1.3.3 Implementation of expert letter consultation

From March to April 2024, the researchers sent the first round of expert letter inquiry questionnaire to all the experts through wechat and email, and asked the experts to return the letter questionnaire one week later. The research team modified the indicators according to the expert opinions and item screening criteria, formed the second round of expert letter inquiry form, and distributed them to the experts, inviting the experts to demonstrate the newly formed indicators again. And the mean < 3.5 and coefficient of variation > 0.25 [17].

1.4 Statistical analysis

The data were analyzed and processed by the Excel 2010, SPSS 26, and yaahp 10.3 statistical software..0 The frequency and composition ratio of expert age and working years are expressed by mean and standard deviation. The activity of experts is expressed by using the recovery rate of valid questionnaires and the submission rate of questionnaire opinions. The coefficient of expert authority degree (Cr) is determined by the judgment basis coefficient (Ca) and the familiarity degree coefficient (Cs). The calculation formula is: Cr = (Ca + Cs) / 2, and Cr 0.7 is taken as the acceptable range. The degree of concentration of expert opinion is expressed by the mean and standard deviation of index importance; the degree of coordination of expert opinion is expressed by the coefficient of variation and Kendall harmony coefficient, and P < 0.05 is significant. The hierarchical analysis method was adopted to determine the Satty scale by the difference of the importance assignment mean of the second round of expert letter inquiry, the index judgment matrix was constructed, and the weight of each index, combination weight and consistency coefficient (CR value) [18] were calculated.

2.1 Basic information of experts

Finally, 15 experts participated in the first round of letter inquiry, and 13 experts participated in the second round of letter inquiry. The age of the experts was (49.00 ± 4.28), working years (24.93 ± 4.04), 14 associate senior or above (93.33%), 9 graduate degree (60.00%); the second round was (48.54 ± 4.43), with working years (24.46 ± 4.16), 12 associate senior or above (92.31%), and 8 master degree or above (61.54%).

2.2 The degree of experts’activeness, authority and opinion coordination

In the first round of letter inquiry, 20 questionnaires were issued, and 15 valid questionnaires were recovered. The recovery rate of valid questionnaires was 75.0%, and 10 (66.6%) experts gave suggestions for modification. In the second round, a total of 15 letter questionnaires were issued, and 13 valid questionnaires were collected. The recovery rate of the valid questionnaires was 86.7%, and 3 (23.08%) experts proposed suggestions for modification. In the first round, Ca was 0.873, Cs 0.920, and Cr 0.897; in the second round, Ca was 0.969, Cs 0.938, and Cr 0.954. The degree of coordination of expert opinions in 2 rounds is shown in Table 1 to 2.

Table 1

Degree of coordination of expert opinions in round 1 (n = 15)
project	Index number	Kendall W	Chi square value	free degree	P value
Level 1 indicators	3	0.267	8.000	2	0.018
Secondary indicators	18	0.314	80.093	17	< 0.001
Level 3 indicators	102	0.338	512.027	101	< 0.001

Table 2

Degree of coordination of expert opinions in round 2 (n = 13)
project	Index number	Kendall W	Chi square value	free degree	P value
Level 1 indicators	3	0.397	10.333	2	0.006
Secondary indicators	13	0.382	59.657	12	< 0.001
Level 3 indicators	63	0.377	303.614	62	< 0.001

2.3 Results of two rounds of expert letter consultation

The first round of expert letter consultation

After the first round of expert letter inquiry, according to the index selection criteria, expert opinions and team meeting discussion. The indicators are revised, and the specific content is as follows: ① Delete 43 indicators. Five secondary indicators such as "movement management", "odor management" and "sexual life management", and 39 tertiary indicators such as "rectal cancer type", "low anterior resection syndrome symptoms" and "surgical mode" were deleted.② Add 4 indicators. Add four three-level indicators: "the type and dosage of food that can be adjusted", "the time and frequency of eating", "the methods and techniques of psychological adjustment ability" and "guiding patients to choose the appropriate ostomy chassis according to the change of ostomy morphology".③ Revised 14 indicators. Revised 14 three-level indicators, such as "light physical activity type" to "appropriate activity type", "prepare a stoma replacement box" to "reasonable placement of items required for stoma replacement", etc.

The second round of expert letter consultation

After the second round of expert letter inquiry, according to the index selection criteria, expert opinions and team meeting discussion. Revised the indicators, the specific content is as follows: modify 9 indicators. Modify nine level 3 indicators, such as "dehydration symptoms treatment" and "sodium, magnesium and other electrolyte imbalance processing" combined into "identify water electrolyte imbalance after timely medical treatment", "correct clean stoma skin and follow the doctor's advice use stoma skin protective agent" adjustment to "according to the skin around the stoma correctly choose stoma protection powder, skin protective agent leakage ring", etc. The revised index system for evaluating the effect of high-displacement health education in patients with low anterior resection of rectal cancer includes 3 first-level indicators, 13 second-level indicators and 63 third-level indicators.

2.4 Index weight

According to the second round of experts enquiry to the importance of index score and saaty scale respectively build 1 level index judgment matrix, three level index judgment matrix, 13 level index judgment matrix, using yaahp 10.3 statistical software of the index weight and combination weight, consistency test and the maximum characteristic value, see Table 3 ~ 5.

3.1 The construction process of the effect evaluation index system of high-output health education for patients with prophylactic ileostomy of rectal cancer are scientific and reliable

this research, The preliminary construction of the evaluation index system of high displacement health education for patients with rectal cancer preventive ileostomy (draft) is a systematic and comprehensive search of the situation of high displacement ilestomy in patients with indwelling preventive ileostomy after anal preservation, Literature on health education and health needs, On the basis of the semi-structured interview with patients with high stoma displacement and the framework guidance of "knowledge, practice and trust theory", To ensure that the evaluation indicators align with the cognition and needs of health education recipients, It realizes the logical progression of knowledge, belief and behavior.

The experts included in this study include clinical medical experts, ostomy nurses and international ostomists. All of them have more than 10 years of working experience and are familiar with the treatment and care of patients with enterostomy. The recovery rate of valid questionnaires in the two rounds of expert letter consultation was 75% and 86.7% respectively, and 66.6% and 23.08% of experts proposed modification, indicating that experts were highly motivated to participate in this letter consultation. The Cr of two rounds of correspondence was 0.897 and 0.954, indicating that the authority of experts involved was strong; the significance test of Kendall harmony coefficient of all levels of correspondence was statistically significant (P < 0.05), indicating the good coordination degree of expert opinions. In addition, this study calculated that the CR values of all levels were < 0.1, indicating that the weight allocation of the index system is reasonable. Therefore, the evaluation index system of high displacement health education for patients with rectal cancer guided by the theory and combining the Delphi expert letter inquiry method and hierarchical analysis method is scientific and reliable.

3.2 The evaluation index system for the effect of high-output health education in patients with preventive ileostomy of rectal cancer has a good specialty

The establishment of this research index was closely developed around the high displacement of enterostomy, and 13 secondary indicators were established through two rounds of expert correspondence letters. The effect evaluation of health education is carried out from basic disease knowledge, and finally to daily nutrition and diet guidance, electrolyte management and other subtle aspects, and makes a comprehensive evaluation of patients' knowledge mastery and the establishment of health behavior, so as to lay a solid foundation for improving their self-care ability, reducing the occurrence of adverse complications and improving the quality of life.

3.3 The evaluation index system for the effect of high-output health education in patients with preventive ileostomy of rectal cancer has good practicability

In the present study, the establishment of health knowledge had the largest weight, followed by health behavior and the smallest weight of health belief, which is consistent with the results of evaluating the effect of health education in patients with nasopharyngeal cancer radiotherapy and chemotherapy[18]. It shows that health knowledge is the foundation of health belief cultivation and the establishment of health behavior. In the clinical work, nursing staff should pay attention to the mastery of patients 'disease-related knowledge, carry out targeted health education, improve the mastery of patients' health knowledge, and lay a solid foundation for the subsequent health belief establishment and health behavior cultivation.

Among the 13 secondary indicators, the diet and nutrition-related knowledge combination had the largest weight of 0.161. Because the colon has strong absorption capacity, ileostomy may occur in the early stage, which usually leads to dehydration or electrolyte abnormalities, including the absence of ileostomy displacement, which will significantly increase the risk of readmission, the incidence of malnutrition, and deep vein thrombosis, which will become permanent stoma [15, 19–21]. Therefore, preventive diet nutrition related health education is very important for patients with [22]. On the one hand, nurses should inform the patients of the assessment and monitoring methods of home nutrition status, so as to realize the importance of daily displacement monitoring and diet control, and enhance their self-care ability; on the other hand, they should emphasize the daily dietary taboos and precautions, and increase dietary fiber and other foods to achieve the purpose of fecal displacement control. The water and electrolyte management combination weight is followed by 0.138. Studies have shown that dehydration in patients with ileostomy can significantly increase the incidence of postoperative complications and increase the risk of acute renal failure and electrolyte disturbances[23]. Therefore, in the process of health education, nurses should emphasize the methods and importance of daily stoma displacement monitoring, so that they can master the correct way of liquid supplement and identify the symptoms of water and electrolyte imbalance early, avoid the harm caused by wrong drinking water due to low sodium dehydration and thirst, and seek medical treatment in time to reduce the occurrence of adverse reactions. The weight of knowledge combination about stoma and surrounding skin care ranked third at 0.120, indicating that stoma and surrounding skin care also plays an important role in the health education evaluation index system for patients with preventive ileostomy. Due to the high displacement of ileostomy, the continuous irritation of excreta to the skin around the stoma, the patient has an increased risk of fecal hydrodermatitis, leading to skin redness and ulceration [14]. Therefore, in addition to informing patients of routine stoma care measures, nurses should focus on the knowledge of skin cleaning around the stoma so that they have the self-care ability; secondly, patients should be taught to correctly choose the skin protection powder, skin protection agent, leakage protection ring, and the appropriate stoma chassis to reduce the irritation of the skin.

3.4 The construction of the index system for evaluating the effect of high-output health education in patients with preventive ileostomy of rectal cancer is of great significance

At present nursing staff and patients with enterostomy high displacement related knowledge and nursing ability is low, and health education effect directly affects the curative effect and prognosis, on the basis of the theory of scientific and reasonable health education evaluation index system can ensure the implementation of health education, improve the patient's health consciousness and self care ability, get the best health education effect [10, 18]. Therefore, this study construction of the rectal cancer preventive ileostomy patients with high displacement health education effect evaluation index system for nursing staff to carry out targeted health education system guidance, according to the index system monitoring patients with high displacement preventive ileostomy related health education quality, understand the deficiency of health education, and at the same time provide the basis for nursing quality improvement.

This study had several limitations. First, this study was performed in the context of the Chinese health care system. Our inferences may not necessarily be relevant for patients in other parts of the world. Second, in Delphi expert consultation, the selection of experts is crucial, and the experts selected in this study were from only ten hospitals. It still cannot represent the whole situation of the whole country because of the enormous area of China. The views of the included Delphi panelists may also differ from those of experts who did not participate. To try to minimize this limitation, a comprehensive search can be conducted among more experts from more hospitals.

Based on this study, through literature search, semi-structured interview, including 3 primary indicators, 13 secondary indicators, 63 tertiary indicators, can provide a unified standard for the comprehensive and systematic evaluation of health education. In the future, an empirical study on the evaluation of the effect of high displacement health education in patients with rectal cancer preventive ileostomy can be carried out, so as to provide guidance for the comprehensive evaluation of the effect of patients' health education and carry out targeted health education.

Table 3 Results of first-level index weights and consistency tests
First-level indicators	Importance assignment (score, x̄ ± s)	coefficient of variation	weight	The biggest characteristic root	CR price
Health knowledge reconstruction	4.923±0.277	0.056	0.528	3.054	0.0516
Health belief cultivation	4.462±0.519	0.146	0.140
Health behavior establishment	4.846±0.376	0.077	0.333

Table 4 Results of secondary index weights and consistency test
Second-level indicators	Importance assignment (score, x̄ ± s)	coefficient of variation	weight	combination weight	The biggest characteristic root	CR price
1-1 Knowledge of prophylactic ileostomy	4.692±0.480	0.102	0.101	0.053	6.197	0.031
1-2 Knowledge of the high output of the stoma	4.846±0.376	0.077	0.180	0.095
1-3 Knowledge of dietary nutrition	5.00	0.000	0.306	0.161
1-4 Knowledge related to daily life	4.769±0.439	0.092	0.136	0.072
1-5 Knowledge of skin care in and around the stoma	4.923±0.277	0.056	0.228	0.120
1-6 Knowledge of drug therapy	4.308±0.480	0.112	0.050	0.026
2-1 Cognition	4.846±0.376	0.077	0.594	0.083	3.0536	0.052
2-2 Health motivation	4.462±0.519	0.116	0.249	0.035
2 -3 Self-efficacy	4.385±0.506	0.115	0.157	0.022
3-1 Water-based electrolyte management	5.00	0.000	0.416	0.138	4.071	0.027
3-2 Dietary nutrition management	4.846±0.376	0.077	0.293	0.097
3-3 Management of the stoma and its surrounding skin	4.769±0.439	0.092	0.185	0.062
3-4 Psychosocial adjustment	4.538±0.519	0.114	0.107	0.036

Table 5 Results of tertiary index weights and consistency tests
Third-level indicators	Importance assignment (score, x̄ ± s)	coefficient of variation	weight	combination weight	The biggest characteristic root	CR price
1-1-1 The definition of a prophylactic enterostomy	4.462±0.519	0.116	0.163	0.009	3.001	0.009
1-1-2 Prophylactic ileostomy type	4.538±0.519	0.114	0.297	0.016
1-1-3 Enterostomy return time	4.769±0.439	0.092	0.540	0.029
1-2-1 Definition of stoma high emissions	4.154±0.376	0.090	0.056	0.005	5.114	0.026
1-2-2 Rate and cause of high stoma discharge	4.231±0.439	0.104	0.075	0.015
1-2-3 High incidence of ileostomy	4.538±0.519	0.114	0.153	0.007
1-2-4 Symptoms and signs of dehydration	5.00	0.000	0.358	0.034
1-2-5 Symptoms and signs of electrolyte imbalance	5.00	0.000	0.358	0.034
1-3-1 Type of food that aggravates high excretion of ileostomy	4.923±0.277	0.056	0.212	0.034	7.342	0.042
1-3-2 Type of fluid supplementation (e. g. low sodium broth, vegetable juice, diluted juice)	4.923±0.277	0.056	0.212	0.034
1-3-3 Vitamin B12 deficiency symptoms	4.846±0.376	0.077	0.144	0.023
1-3-4 Assessment and monitoring methods of home nutritional status	4.923±0.277	0.056	0.213	0.034
1-3-5 Calculation and monitoring method of home diet intake	4.615±0.506	0.110	0.066	0.011
1-3-6 can adjust the type of food, dosage	4.769±0.439	0.092	0.110	0.018
1-3-7 Time and frequency of eating	4.154±0.376	0.090	0.044	0.007
1-4-1 The appropriate type of activity	4.308±0.480	0.112	0.076	0.005	6.154	0.025
1-4-2 Notes for traveling	4.154±0.376	0.090	0.057	0.004
1-4-3 Choice of clothing types	4.385±0.506	0.115	0.107	0.007
1-4-4 Home bath precautions	4.615±0.506	0.110	0.180	0.013
1-4-5 Methods to improve sleep quality	4.846±0.376	0.077	0.332	0.024
1-4-6 Methods and techniques of psychological adjustment ability	4.692±0.480	0.102	0.252	0.018
1-5-1 manufacturing pocket replacement method and steps	4.923±0.277	0.056	0.361	0.044	5.072	0.016
1-5-2 Observation and evaluation of the color and morphology of the normal enterostomy	4.846±0.376	0.077	0.272	0.033
1-5-3 Characteristics of ileostomy excreta	4.538±0.519	0.114	0.097	0.012
1-5-4 Clinical manifestations of fecal hydrodermatitis	4.769±0.438	0.092	0.173	0.021
1-5-5 fecal water dermatitis	4.538±0.519	0.114	0.097	0.012
1-6-1 Type of commonly used antisecretory and antidiarrheal drugs	4.462±0.519	0.116	0.140	0.012	3.054	0.052
1-6-2 Metformin was stopped by metformin	4.923±0.277	0.056	0.528	0.014
1-6-3 Enterocoated coated drugs or slow-release capsules use other drugs instead	4.769±0.439	0.092	0.333	0.009
2-1-1 Understand the importance of accepting body image changes	4.692±0.480	0.102	0.123	0.010	7.175	0.021
2-1-2 Correct understanding of the importance of ileostomy emission monitoring	4.923±0.277	0.056	0.241	0.020
2-1-3 Know the importance of daily water and electrolyte supplementation	4.923±0.277	0.056	0.241	0.020
2-1-4 Know the importance of skin monitoring	4.846±0.376	0.077	0.182	0.015
2-1-5 Know the importance of medical medication	4.462±0.519	0.116	0.063	0.005
2-1-6 Correct understanding of the importance of food type selection	4.538±0.519	0.114	0.087	0.007
2-1-7 Know the importance of enterostomy review	4.462±0.519	0.116	0.063	0.005
2-2-1 can actively seek help and confidently deal with adverse reactions from high displacement stoma	4.692±0.480	0.102	0.098	0.003	6.108	0.017
2-2-2 Early correct identification of high flow status of ileostomy	4.769±0.439	0.092	0.157	0.005
2-2 – 3 Early recognition of dehydration symptoms	4.923±0.277	0.056	0.250	0.009
2-2-4 Early recognition of the symptoms of electrolyte imbalance	4.923±0.277	0.056	0.222	0.008
2-2 – 5 Early recognition of vitamin B12 deficiency symptoms	4.769±0.439	0.092	0.175	0.006
2-2-6 Early recognition of the symptoms of fecal hydrodermatitis	4.692±0.480	0.102	0.098	0.003
2-3-1 Accept yourself and be willing to vent psychological pressure	4.538±0.519	0.114	0.500	0.011	2.000	<0.001
2-3-2 Willing to adjust the dietary structure and lifestyle habits	4.538±0.519	0.114	0.500	0.011
3-1-1 Monitor the ileostomy excretion and urine volume	5.00	0.000	0.333	0.046	3.000	<0.001
3-1-2 Daily supplement with electrolyte water	5.00	0.000	0.333	0.046
3-1-3 Seek timely medical attention after identifying the water and electrolyte imbalance	5.00	0.000	0.333	0.046
3-2-1 Increase the semi-factor diet (such as porridge, soup, mud, etc.), reduce gastrointestinal peristalsis and digestive tract secretion, and increase the residence time of food in the intestine to promote water absorption	4.538±0.519	0.114	0.107	0.010	6.224	0.036
3-2-2 Reduce the intake of high sugar, high sodium and high fat foods	4.846±0.376	0.077	0.245	0.024
3-2-3 Vitamin B12 supplementation is correct as prescribed	4.846±0.376	0.077	0.245	0.024
3-2-4 A low-fiber diet for 4-6 weeks after surgery, after which by gradually increasing dietary fiber-rich foods	4.462±0.519	0.116	0.063	0.006
3-2 -5 Increase of food intake with high water content	4.846±0.376	0.077	0.245	0.024
3-2-6 Increase the frequency of eating, eat less and more meals, eat slowly, prevent enterostomy blockage and reduce air intake	4.462±0.519	0.116	0.094	0.015
3-3-1 Reasonably place the items required for stoma replacement	4.769±0.439	0.092	0.140	0.009	4.061	0.023
3-3-2 Change or empty the pocket correctly	4.923±0.277	0.056	0.120	0.044
3-3-3 The stoma protective powder, skin protective agent and leakage protection ring are correctly selected according to the skin conditions around the stoma	5.00	0.000	0.330	0.020
3-3-4 Select the appropriate stoma chassis according to the stoma shape change	5.00	0.000	0.333	0.020
3-4-1 Talk to the medical staff voluntarily	4.846±0.376	0.077	0.245	0.009	6.162	0.026
3-4-2 Actively seek psychological counseling during low self-esteem and depression	4.846±0.376	0.077	0.245	0.009
3-4-3 Perceived benefits of prophylactic ileostomy for disease treatment	4.769±0.439	0.092	0.177	0.006
3-4-4 Actively return to normal work and life	4.692±0.480	0.102	0.140	0.005
3-4-5 Overcome the fear of enterostomy injury or increased displacement	4.615±0.506	0.110	0.097	0.003
3-4-6 Attend the enterostomy health knowledge lecture or sunshine home activity held by the nearby hospital	4.615±0.506	0.110	0.097	0.003

CRediT authorship contribution statement

Zhang Siyuan Gao Huanling: Conceptualization, Methodology, Data curation, Formal analysis, Writing. Liu lihong: Methodology, Writing – Original draft preparation. Li Hongmei: Formal analysis, Writing – Revised draft preparation, Datacuration. Chen weijing: Conceptualization, Methodology,Data collection, Writing – Original and Revised draft preparation. Allauthors had full access to all the data in the study, and the corresponding author had final responsibility for the decision to submit for publication.The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

Ethics statement

This study was reviewed and approved by the Ethics Committee of Fenyang College, Shanxi Medical University (2024036). The study was conducted in accordance with the Declaration of Helsinki . All participants provided written informed consent.

Funding

This study received no external funding.

Declaration of competing interest

The authors declare no conflict of interest.

Declaration of Generative AI and AI-assisted technologies in the

writing process

No AI tools/services were used during the preparation of this work.

Data availability statement

The data that support the findings of this study are available from the corresponding author, Gao huanling, upon reasonable request.

Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F: Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin 2021, 71(3):209-249.
Mohammed S, Anaya DA, Awad SS, Albo D, Berger DH, Artinyan A: Sphincter preservation rates after radical resection for rectal cancer in the United States veteran population: opportunity for improvement in early disease. Ann Surg Oncol 2015, 22(1):216-223.
Ostomy Professional Committee,Chinese Society of Coloproctology: Chinese expert consensus on protective ostomy for mid-low rectal cancer(version 2022). Chinese Journal of Gastrointestinal Surgery 2022, 25(6).
Pisarska M, Gajewska N, Małczak P, Wysocki M, Witowski J, Torbicz G, Major P, Mizera M, Dembiński M, Migaczewski M et al: Defunctioning ileostomy reduces leakage rate in rectal cancer surgery - systematic review and meta-analysis. Oncotarget 2018, 9(29):20816-20825.
Lightner AL, Pemberton JH: The Role of Temporary Fecal Diversion. Clin Colon Rectal Surg 2017, 30(3):178-183.
Fielding A, Woods R, Moosvi SR, Wharton RQ, Speakman CTM, Kapur S, Shaikh I, Hernon JM, Lines SW, Stearns AT: Renal impairment after ileostomy formation: a frequent event with long-term consequences. Colorectal Dis 2020, 22(3):269-278.
Takeda M, Takahashi H, Haraguchi N, Miyoshi N, Hata T, Yamamoto H, Matsuda C, Mizushima T, Doki Y, Mori M: Factors predictive of high-output ileostomy: a retrospective single-center comparative study. Surg Today 2019, 49(6):482-487.
Borucki JP, Schlaeger S, Crane J, Hernon JM, Stearns AT: Risk and consequences of dehydration following colorectal cancer resection with diverting ileostomy. A systematic review and meta-analysis. Colorectal Dis 2021, 23(7):1721-1732.
Hu Junfeng, Hou Peisen (Ed.); Yang Tingzhong, Mi Guangming, Fu Dongbo, Pan Fang Associate Editor: Contemporary health education and health promotion: Beijing：People's Medical Publishing House; 2005.
Zhang Q, Sun J, Wang D, Wang Q, Hu H: Knowledge, attitudes, practices and associated factors regarding high output stoma of ileostomy among colorectal surgical nurses: a multicentre cross-sectional study. Support Care Cancer 2023, 32(1):12.
XIE Zhifen , WEI Qingfeng, ZHENG Xiaolian, CAI Yulian, GONG Huping, ZHANG Shihui, AN Dong : Development of health education evaluation system for patients with colostomy based on KAP model. Chinese Journal of Health Education 2017, 33(06):544-547.
ZHAO Zeyin;DENG Yinghui;DING Ni;CHU Lili;HUAGN Rongkang;YE Xinmei: Research advances on high-output stoma of patients with enterostomy. Chinese Nursing Research 2020, 34(02):291-294.
Yang Fuxin, WANG Feixia, Zhong Zifeng, LI Weizhen, WANG Huafen: Progress of nursing management and pathway construction of high-displacement ileostomy. Journal of Nursing and Rehabilitation 2022, 21(11):94-97.
ZHAO Songxian;QIANG Wanmin;MA Xueling;WANG Yujue;BAI Yan: Symptoms experienced by parents with rectal cancer while carrying a prophylactic ileostomy:a qualitative study. Chinese Nursing Management 2021, 21(8).
Lin Hongyuan;Chen Jing;Liu Yingjie;Lin Meijiao;Liao Xiaoqin;Peng Shanling: Nutrition education for patients with rectal cancer undergoing prophylactic ileostomy. Journal of Nursing Science 2022, 37(10):10-14.
Huang Jingheng (Ed.) Health Education: Shanghai: Fudan University Press; 2003.
LUO Ruzhen;XIE Wenjun;LIU Yudian;ZHANG Xiaohong;LIU Yanhui: Development of evaluation index system for health education among adult acute leukemia patients with chemotherapy. Chinese Journal of Nursing 2019, 54(10):1482-1487.
LU Jiamei;LI Wei;LIAO Jinlian;HUANG Xiaojun;HU Kai;TANG Qiuming;LIANG Limin;FENG Yan;YANG Guirong;YANG Li: Establishment of an evaluation index system for health education among nasopharyngeal carcinoma patients with radio-chemotherapy. Chinese Journal of Nursing 2022, 57(08):942-950.
Ladefoged K, Olgaard K: Sodium homeostasis after small-bowel resection. Scand J Gastroenterol 1985, 20(3):361-369.
Arenas Villafranca JJ, López-Rodríguez C, Abilés J, Rivera R, Gándara Adán N, Utrilla Navarro P: Protocol for the detection and nutritional management of high-output stomas. Nutr J 2015, 14:45.
Migdanis A, Migdanis I, Koukoulis GD: Nutritional Considerations in Colorectal Surgery in Diverting Ileostomy Patients: A Review. Cureus 2023, 15(11):e48102.
Dong Ling, Ou Yulan, Yan Yuanyuan: Research progress of nutritional management in adult patients with ileostomy. Chinese General Practice Nursing 2024, 22(07):1240-1244.
Fish DR, Mancuso CA, Garcia-Aguilar JE, Lee SW, Nash GM, Sonoda T, Charlson ME, Temple LK: Readmission After Ileostomy Creation: Retrospective Review of a Common and Significant Event. Ann Surg 2017, 265(2):379-387.

No competing interests reported.

Download PDF

Version 1

posted

You are reading this latest preprint version

Establishment of evaluation index system of high output health education for patients with middle and low rectal cancer undergoing preventive ileostomy

Status:

Version 1

Abstract

Introduction

Methods

Aim

Design

1 Research methods

1.1 Set up a research group

1.2 Preliminary formulation of a rating system

1.2.1 Theoretical basis

1.2.2 Literature search

1.2.3 Semi-structured interview

1.3 Expert letter inquiry

1.3.1 Design the letter questionnaire

1.3.2 Consultation with experts for selection

1.3.3 Implementation of expert letter consultation

1.4 Statistical analysis

2 Results

2.1 Basic information of experts

2.2 The degree of experts’activeness, authority and opinion coordination

2.3 Results of two rounds of expert letter consultation

The first round of expert letter consultation

The second round of expert letter consultation

2.4 Index weight

3 Discussion

Limitations

Conclusion

Declarations

References

Additional Declarations

Status:

Version 1