ONS Connections: Ostomy risk factors and complications predicted by two instruments

PHOENIX—Two new instruments are valid and reliable in identifying risk factors and ostomy complications, according to research presented at the Oncology Nursing Society (ONS) Connections: Advancing Care Through Science conference.

In the United States, colorectal cancer is the third most common cancer that affects men and women. Among those diagnosed with rectal cancer, one in eight will receive a permanent colostomy, while many others will need a temporary ostomy. Though this surgery saves lives, ostomy complications are experienced by more than 70% of patients. Few valid, reliable, and clinically useful instruments are currently available to measure risk factors and complications of ostomy.

This prospective, longitudinal study of 71 adults who received fecal ostomies collected data prior to discharge and 30 to 60 days postoperatively. The study sought to develop and test the Ostomy Risk Factor Index (ORFI) and the Ostomy Complication Severity Index (OCSI). This study's goals were to estimate the reliability and validity of these indexes, identify risk factors contributing to the development of fecal ostomy complications, and describe the incidence and severity of early fecal ostomy complications.

More than 80% of the participants experienced ostomy complications. Ostomy complication scores were predicted by stoma/abdomen characteristics and body mass index. Ostomy adjustment had an inverse relationship with ostomy complications and a positive correlation with stoma care self-efficacy, indicating that “the higher the incidence and severity of of ostomy complications, the poorer the participants' adjustment to having an ostomy,” said Dr. Pittman. Intra-class correlation was excellent for both ORFI and OCSI, while both content validity and inter-rater reliability were acceptable for both.

“Patients with lower stoma care self efficacy at 30 to 60 days had higher incidence and severity of ostomy complications,” said Joyce Pittman, PhD, FNP-BC, CWOCN, during a presentation of the research at the ONS Connections meeting. “Those who were more confident in caring for their stoma, both at baseline and at follow-up, had better adjustment,” she added.
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