The structural relationships between quality of life and mental conditions in stoma patients

Abstract

Background: Peristomal wounds have a remarkable negative impact on the quality of life (QOL), including the social activities, of stoma patients. Although the number of stoma patients is increasing, the relationship between peristomal disorders and QOL is not widely understood. Objectives: The aim of this study was to elucidate the relationship between the QOL status of stoma patients and the condition of the peristomal skin through structural equation modeling (SEM), which could help provide a comprehensive overview of the factors affecting the health of such patients. Design: Observational study of prospectively collected data. Setting: This study was conducted in the colorectal unit of two educational hospitals in Sapporo, Japan. Patients and Methods: Outpatient patients with a stoma were recruited between July 11, 2019 and November 30, 2019. The relationship among the clinical variables were identified using SEM analysis. Sample Size: Sixty-seven consecutive stoma patients. Main Outcome Measures: The Ostomy Skin Tool [used to assess the discoloration, erosion, and tissue overgrowth (DET) score], Stoma-QOL, Hospital Anxiety and Depression Scale (HADS), and the EQ-5D-5L questionnaire were employed. Results: The observation period in the low DET score group was longer than that in the high DET score group. An SEM-derived path diagram, which exhibited high goodness-of-fit indices, revealed the relationships among the clinical factors. Patient satisfaction was positively associated with the Stoma-QOL score and negatively associated with the HADS-anxiety score but not the HADS-depression score. Conclusions: Peristomal skin disorders did not affect QOL or mental health status. The QOL scores of the patients with mild peristomal skin disorders markedly varied. Anxiety, but not depression, reduced the satisfaction of stoma patients and was alleviated over time. Limitations: A cross-sectional observational study cannot be used to precisely determine causal relationships. Conflict of Interest: The authors have no conflict of interest to declare.