Efficacy of preoperative uro-stoma education on self-efficacy after Radical Cystectomy; secondary outcome of a prospective randomized controlled trial.

PURPOSE: Radical Cystectomy with a creation of an uro-stoma is first line treatment in advanced bladder-cancer. Enhancing or maintaining an individual's condition, skills and physical wellbeing before surgery has been defined as prehabilitation. Whether preoperative stoma-education is an effective element in prehabilitation is yet to be documented. In a prospective randomized controlled design (RCT) the aim was to investigate the efficacy of a standardised preoperative stoma-education program on an individual's ability to independently change a stoma-appliance. METHODS: A parent RCT-study investigated the efficacy of a multidisciplinary rehabilitation program on length of stay following cystectomy. A total of 107 patients were included in the intension-to-treat-population. Preoperatively, the intervention-group was instructed to a standardized stoma-education program consisting of areas recognized necessary to change a stoma appliance. The Urostomy Education Scale was used to measure stoma self-care at day 35, 120 and 365 postoperatively. Efficacy was expressed as a positive difference in UES-score between treatment-groups. RESULTS: A significant difference in mean score was found in the intervention group compared to standard of 2.7 (95% CI: 0.9; 4.5), 4.3 (95% CI: 2.1; 6.5) and 5.1 (95% CI: 2.3; 7.8) at day 35, 120 and 365 postoperatively. CONCLUSIONS: For the first time a study in a RCT-design have reported a positive efficacy of a short-term preoperative stoma intervention. Preoperative stoma-education is an effective intervention and adds to the evidence base of prehabilitation. Further RCT-studies powered with self-efficacy as the primer outcome are requested.

Validation of the urostomy education scale: the European experience.

Bladder cancer is the fourth most common cancer among European males. Once diagnosed with muscle invasive bladder cancer, a radical cystectomy is the first line treatment, which results in a urostomy. The placement of a urostomy and the care required impacts the patient's life. Previous research validated the Urostomy Education Scale as the first standardized tool capable of documenting the patients' level of stoma self-care skills and useful to guide patient education interventions. A Danish-Dutch Fellowship was established to support and provide further evidence of applicability of the Urostomy Education Scale.

The Urostomy Education Scale: a reliable and valid tool to evaluate urostomy self-care skills among cystectomy patients.

AIM: : The purpose of this study was to validate a quantitative scale for nurses to evaluate self-care skills among patients undergoing cystectomy with creation of a urostomy. SUBJECTS AND SETTINGS: Twelve patients undergoing cystectomy with formation of a urostomy participated in the research. The study took place at Aarhus University Hospital, Denmark-a bladder cancer center performing approximately 100 cystectomies annually. INSTRUMENT: The Urostomy Education Scale was developed in 2010 based on review of stoma care literature. Areas recognized as standard procedure in urostomy care were identified and categorized into 7 self-care skills necessary for changing the pouching system. The 7 skills were reaction to the stoma, removing the pouching system, measuring the stoma diameter, adjusting the size of the urostomy diameter in a new stoma appliance, skin care, fitting a new stoma appliance, and emptying procedure. Each skill is rated on a 4-point scale according to the patient's need of assistance from the nurse. Higher scores indicate a higher level of patient self-care skills related to changing a urostomy pouching system. METHODS: Content, criterion, and construct validity were evaluated by a panel of experts using the Delphi method in 2010. To test interrater reliability and criterion validity, 4 nurses attended 12 patient training sessions at different postoperative days. Each patient was taught how to change a urostomy appliance using a standardized approach. One experienced enterostomal therapy nurse acted as the instructor and 3 other nurses observed and scored the patient's self-care skills. The 3 nurses' scores were analyzed using Bland Altman Plots with Limits of Agreements.To test construct validity, patients were categorized into 3 groups. The mean score in each group was used to analyze differences between groups using one way analysis of variance. RESULTS: Analysis revealed that the Urostomy Education Scale distinguished urostomy self-care skills practice by beginners versus experienced patients (P= .01). Comparison of scores among the 3 nurses revealed no statistically significant differences. In addition, the Urostomy Education Scale demonstrated satisfactory reliability with Limits of Agreements ranging from -3 to 3; 86% of scores differed by 2 points or less. CONCLUSIONS: To our knowledge, the Urostomy Education Scale is the first validated tool for nurses to document the patient's level of urostomy self-care skills.

Terminal patients with urinary diversion: are there specific treatment or nursing care problems in the primary healthcare sector?

OBJECTIVE: To investigate the treatment and nursing care problems related to the type of urinary diversion in terminal patients experienced by the primary healthcare sector. METHODS: A questionnaire about treatment and nursing care problems related to urinary diversion was sent to general practitioners (GPs) and district nurse units (DNUs) that had been in contact with 1 of 71 patients who died following cystectomy in a 5-year period. The patients had 1 of 3 types of urinary diversion: ileal conduit (IC), Indiana pouch (IP), or Hautmann orthotopic neobladder (NB). RESULTS: Both GPs and DNUs reported significant difference in problems associated with the 3 types of urinary diversion favoring the IC (P = .049 and .025, respectively). However, clinical decisions about urinary diversion types are often based on incontinent versus continent diversions. When divided into continent versus incontinent diversions, the analysis revealed no differences in the number of problems (P = .31 and .052, respectively). Comparing IC and NB alone made the difference even less significant (P = .82 and .23, respectively). CONCLUSIONS: It seems that there are no major disadvantages with one type of urinary diversion when compared to the other as perceived by primary healthcare providers. Relevant and thorough information should be provided to GPs and DNUs in order to minimize problems with all forms of urinary diversion.