Symptom Experiences of Bowel Problems, Management Strategies, and Management Outcomes in Patients with Colorectal Cancer after Surgery
Article Sidebar
Main Article Content
Abstract
Patients with colorectal cancer after surgery without colostomy are more likely to receive less information than those with colostomy. This notion may be due to health care providers focusing on patients with colostomies, who often need more care than individuals without one.Previous studies on the experiences of bowel problems were limited to the symptom perception not expanding to other dimensions of the symptom experience, including symptom evaluation anddistress. Inaddition,previous research studied on management strategies for bowel problems was still limited in its outcomes. Thus, studying symptom experiences of bowel problems,management strategies, and management outcomes is essential in this patient group. This descriptive research study aimed to describe symptom experiences, management strategies, and management outcomes in patients with colorectal cancer after surgery using the Symptom Management Theory as the conceptual framework.
The participants consisted of 60 patients with a new diagnosis of colorectal cancer who received treatment after surgery without colostomy;age equal to or over 18 years; participants aged over or equal to 60 years were screened for cognitive impairment by the Short Portable Mental Status Questionnaire developed by Pfeiffer.All of them sought follow-up at a university’s outpatient surgical department from June 2021 to June 2023. Data were collected using three questionnaires:1)the Personal Information,Health Status,Diseases,and Treatment Questionnaire;2) the Symptom Experience Questionnaire for Patients with Colorectal Cancer after Surgery;and 3) the Management Strategies and Outcome of Symptom Management in Patients with Colorectal Cancer after Surgery. These three instruments were developed by researchers from the literature review. The content validity index was validated by three experts: 1 physician expert in gastrointestinal system and colorectal surgery, 1 nursing faculty expert in gastrointestinal system and general surgery and 1 advanced practice nurse (APN) expert in wound and ostomy care. Two questionnaires, the Symptom Experience Questionnaire and the Management Strategies and Outcome of Symptom Management, were examined by three experts with CVIs of .85 and .80, respectively. They were also tested for face validity in 5 patients, who found them clearly relevant to what they measure,appropriate for the participants,and adequate for its purpose. The data were analyzed using descriptive statistics: frequency, percentage, mean, and standard deviation.
Results showed that participants’ ages ranged from 35 to 88 years, with a mean of 67.70 years (SD = 10.39). The three most common symptoms were flatus incontinence (48.30%), constipation(45.00%),and incomplete evacuation(41.70%). The top three most frequent symptoms were loose stool (mean = 2.74,SD = .99), incomplete evacuation (mean= 2.71, SD = .78), and constipation (mean = 2.65, SD = 1.02). The top three of symptom severity were anxiety(mean = 2.07,SD = .80), stool incontinence(mean = 2.05,SD = .50),and diarrhea (mean = 2.00,SD = .81). The three most common symptoms distress were flatus incontinence (mean = .80, SD = .94), constipation (mean = .80, SD = .97), incomplete evacuation (mean=.73,SD=.97)and abdominal bloating (mean=.73,SD=.99). Management strategies for physical were drugs used to reduce constipation (16.70%),abdominal bloating (8.30%), diarrhea (3.30%), and stool incontinence (1.70%). For the psychosocial aspect,participants used talking with spouses/friends or trusted relatives 3.30%. The mean effectiveness of all management strategies was quite high(mean = 3), ranging from 0 to 4. The results of this study serve as a basis for guiding nursing practice to promote nursing care plans and self-care for colorectal patients upon discharge from the hospital enabling them to manage bowel problems effectively.
Keywords: After surgery, Colorectal cancer, Management strategies, Management outcomes,Symptom experience
Author Contributions:
PS: Conceptualization, Method and design, Tool validation, Data collection, Data analysis,Writing and revising the manuscript
BS: Conceptualization, Method and design, Data analysis, Writing, revising, and editing the manuscript, Corresponding with the Editor-in-Chief
PP: Conceptualization, Method and design, Conclusion, Recommendation, Revising the manuscript
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
บทความ ข้อมูล เนื้อหา รูปภาพ ฯลฯ ที่ได้รับการตีพิมพ์ในรามาธิบดีพยาบาลสาร ถือเป็นลิขสิทธิ์ของวารสาร หากบุคคลหรือหน่วยงานใดต้องการนำทั้งหมดหรือส่วนหนึ่งส่วนใดไปเผยแพร่หรือเพื่อกระทำการใด ใด จะต้องได้รับอนุญาตเป็นลายลักษณ์อักษรจากรามาธิบดีพยาบาลสารก่อนเท่านั้น
References
International Agencyfor Researchon Cancer. Colorectal cancer estimated incidence, mortality and prevalence worldwide in 2022. [cited 2022 May, 14]. Available from:http://globocan.iarc.fr/Pages/fact_sheet_cancer.aspx
Hospital -Based Cancer Registry Thai National Cancer Institute; 2022 [cited 2022 May, 14]. Available from:https://www.nci.go.th / th/ cancer_record/download/Hosbased-2022-1.pdf
Martellucci J. Low anterior resection syndrome:a treatment algorithm.Dis Colon Rectum.2016;59(1):79-82.doi: 10.1097/ DCR.0000000000000495.
Ridolfi TJ, Berger N, Ludwig KA. Low anterior resection syndrome:current management and future directions.Clin Colon Rectal Surg. 2016;29(3):239-45. doi:10.1055/s-0036-1584500.
Yin L, Fan L, Tan R, Yang G, Jiang F, Zhang C, et al.Bowel symptoms and self-care strategies of survivors in the process of restoration after low anterior resection of rectal cancer. BMC Surg. 2018;18(1):35. doi:10.1186/s12893-018-0368-5.
Nikoletti S, Young J, Levitt M, King M, Chidlow C,Hollingsworth S. Bowel problems, self-care practices,and information needs of colorectal cancer survivors at 6 to 24 months after sphincter-saving surgery.Cancer Nurs.2008;31(5):389-98.doi: 10.1097/01.NCC.00003
04357.1b.
Pan LH, Tsai YF,Chen ML, Tang R,Chang CJ.Symptom distress and self-care strategies of colorectal cancer patients with diarrhea up to 3 months after surgery.Cancer Nurs. 2011;34(1):E1-9. doi: 10.1097/NCC.0b013e3181e3ca21.
Bohlok A, Mercier C, Bouazza F, Galdon MG, Moretti L, Donckier V,etal. The burden of low anterior resection syndrome on quality of life in patients with mid or low rectal cancer.Support Care Cancer. 2020;28(3):1199-1206.doi: 10.1007/s00520-019-04901-2.
Bartlett L,Nowak M,Ho YH.Impact offecal incontinence on quality of life.World J Gastroenterol. 2009;15(26):3276–3282.doi: 10.3748/ wjg.15.3276.
Dodd MJ, Janson S,Faucett J,Frolicher ES, Humphreys J, Lee K, et al. Advancing the science of Management.J Adv Nurs. 2001;33 (5): 668-76. doi:10.1046/j.1365-2648.2001.01697.x.
Larson PJ, Carrieri-Kohlman V, Dodd MJ, Douglas M,Faucett J, Froelicher E, et al. A model for symptom management. Image J Nurs Sch. 1994;26, 272-6.
Liehrb PR, Smith M. Middle range theory for nursing.3rd ed.Seiten:Springer Publishing Company; 2014.
Melinda SB, Susan LJ, Linda SF, Kathryn AL. Middle range theory for nursing. 4th ed. Seiten: Springer Publishing Company; 2018.
Yamane, T.Statistics, an introductory analysis. 2nd ed.,New York: Harper and Row; 1967.
Pfeiffer E. A Short Portable Mental Status Questionnaire of the assessment of organic brain deficit in elderly patients.J Am Geriatr Soc. 1975;23(10):433-41.
Intarasombat P, Monkong S, Churaitatsanee S,Vongterapak S,Prasanaikom W,Pronsawatchai P, et al.Comprehensive care of hospitalized older adults:transitional care from hospital to home. Ramathibodi NursingJournal. 1996; 19(2):194-205. (in Thai)
Schneider EC, Malin JL, Kahn KL, Ko CY, Adams J,Epstein AM.Surviving colorectal cancer:patient-reported symptoms 4 years after diagnosis. Cancer. 2007;110(9):2075-82.doi: 10.1002/cncr.23021.
Sutti P, Kimpee S, Danaidusadeekul S, Iramaneerat C.Relationship of symptom experience in symptom cluster’s experience with quality of life and symptom management strategies of postoperative colorectal cancer patients.Naresuan Phayao Journal. 2015;8(2): 107-12.Available from: https://li01.tci-thaijo.org/index.php/journalup/article/view/42607/35203. (in Thai)
Heetnaca W.Symptom clusters and their management in patients with colorectal cancer.[thesis].Prince of Songkha University, Songkhla, Thailand; 2007. (in Thai)
Knowles G, Sherwood L, Dunlop MG, Dean G, Jodrell D,McLean C,etal. Developing and piloting a nurse-led model of follow-up in the multidisciplinary management of colorectal cancer.Eur J Oncol Nurs.2007;11(3):212-23;discussion 224-7.doi: 10.1016/j.ejon.2006. 10.007.
