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IIR 02-221 – HSR&D Study

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IIR 02-221
Health Related Quality of Life in VA Patients with Intestinal Stoma
Robert S. Krouse MD MS
Southern Arizona VA Health Care System, Tucson, AZ
Tucson, AZ
Funding Period: July 2003 - June 2005

BACKGROUND/RATIONALE:
Health-related quality of life (HR-QOL) is increasingly being regarded as an important endpoint for chronic disease and cancer management. HR-QOL encompasses perceptions of both positive and negative aspects of physical, emotional, social, cognitive, and spiritual functioning as well as the discomfort and symptoms produced by disease or treatment. An understanding of the pattern of HR-QOL concerns for patients with colostomies can provide the basis for needed clinical interventions. There has been no previously published research within the VA examining HR-QOL issues related to intestinal stomas.

OBJECTIVE(S):
The immediate objectives are to identify health-related Quality of Life (HR-QOL) concerns specific to veterans with ileostomy and colostomy intestinal stomas and relate those concerns to underlying disease state, type of stoma, time with stoma, as well as other demographic characteristics. We also want to learn about the methods of adaptation used by, and skills required for, adaptation to ostomy, as well as challenges, which persist.

METHODS:
This is a descriptive multi-method study using 1) survey and 2) qualitative focus group data. The study is being coordinated at SAVAHCS, and performed at three VAMC sites: SAVAHCS, GLAHCS (West LA Campus), and Roudebush VAMC. The sample includes veteran patients in VA care with intestinal stomas and randomly selected matched controls with similar disease states, but without stomas. We surveyed 688 ostomates and their matched controls (820) based on our computer searches. We targeted racial and ethnic groups, length of time with ostomy, and ostomy type in order to perform sub-group analyses. Descriptive and multiple linear and logistic regressions will be used to describe and estimate the associations of predictors to HR-QOL. We then had eight focus groups drawn from the top and bottom survey HR-QOL quartile scores at the GLAHCS and Roudebush VAMC sites to explicate and deconstruct the etiologic associations and management strategies discovered in our survey data using content analysis.

FINDINGS/RESULTS:
We have completed accrual for Phase I and Phase II of our study, and are currently analyzing the results. We have had 506 usable survey responses (235 ostomates, 271 controls) for a total response rate of 34%. When we remove the patients who we were not able to reach based mainly on unreliable addresses, or were ultimately ineligible (such as related to death or previously had their ostomy removed), our response rate will likely be over 75%. There are many HR-QOL variables that are greatly different and surprisingly similar for cases and controls. Related to the focus groups at Roudebush (13) and GLAHCS (14), many themes have been identified in the initial coding of transcripts. These include common early and late problems, solutions to these problems, and recommendations for future patients.

IMPACT:
Anticipated impact is to generate targeted psychosocial interventions designed to facilitate adaptation to stomal challenges and factors impinging on HR-QOL in patients with stomas. Based on the results, a program of research will be developed to test interventions that address priority patient concerns and patient knowledge, attitudes and skills used to improve their QOL.

PUBLICATIONS:

Journal Articles

  1. Horner DJ, Wendel CS, Skeps R, Rawl SM, Grant M, Schmidt CM, Ko CY, Krouse RS. Positive correlation of employment and psychological well-being for veterans with major abdominal surgery. American journal of surgery. 2010 Nov 1; 200(5):585-90.
  2. Popek S, Grant M, Gemmill R, Wendel CS, Mohler MJ, Rawl SM, Baldwin CM, Ko CY, Schmidt CM, Krouse RS. Overcoming challenges: life with an ostomy. American journal of surgery. 2010 Nov 1; 200(5):640-5.
  3. Krouse RS, Grant M, Rawl SM, Mohler MJ, Baldwin CM, Coons SJ, McCorkle R, Schmidt CM, Ko CY. Coping and acceptance: the greatest challenge for veterans with intestinal stomas. Journal of psychosomatic research. 2009 Mar 1; 66(3):227-33.
  4. Baldwin CM, Grant M, Wendel C, Rawl S, Schmidt CM, Ko C, Krouse RS. Influence of intestinal stoma on spiritual quality of life of U.S. veterans. Journal of Holistic Nursing. 2008 Sep 1; 26(3):185-94; discussion 195-6; quiz 197-9.
  5. Pittman J, Rawl SM, Schmidt CM, Grant M, Ko CY, Wendel C, Krouse RS. Demographic and clinical factors related to ostomy complications and quality of life in veterans with an ostomy. Journal of Wound, Ostomy, and Continence Nursing : Official Publication of The Wound, Ostomy and Continence Nurses Society / Wocn. 2008 Sep 1; 35(5):493-503.
  6. Symms MR, Rawl SM, Grant M, Wendel CS, Coons SJ, Hickey S, Baldwin CM, Krouse RS. Sexual health and quality of life among male veterans with intestinal ostomies. Clinical Nurse Specialist Cns. 2008 Jan 1; 22(1):30-40.
  7. Jain S, McGory ML, Ko CY, Sverdlik A, Tomlinson JS, Wendel CS, Coons SJ, Rawl SM, Schmidt CM, Grant M, McCorkle R, Mohler MJ, Baldwin CM, Krouse RS. Comorbidities play a larger role in predicting health-related quality of life compared to having an ostomy. American journal of surgery. 2007 Dec 1; 194(6):774-9; discussion 779.
  8. Krouse RS, Grant M, Wendel CS, Mohler MJ, Rawl SM, Baldwin CM, Coons SJ, McCorkle R, Ko CY, Schmidt CM. A mixed-methods evaluation of health-related quality of life for male veterans with and without intestinal stomas. Diseases of The Colon and Rectum. 2007 Dec 1; 50(12):2054-66.
  9. Coons SJ, Chongpison Y, Wendel CS, Grant M, Krouse RS. Overall quality of life and difficulty paying for ostomy supplies in the Veterans Affairs ostomy health-related quality of life study: an exploratory analysis. Medical care. 2007 Sep 1; 45(9):891-5.
  10. Mitchell KA, Rawl SM, Schmidt CM, Grant M, Ko CY, Baldwin CM, Wendel C, Krouse RS. Demographic, clinical, and quality of life variables related to embarrassment in veterans living with an intestinal stoma. Journal of Wound, Ostomy, and Continence Nursing : Official Publication of The Wound, Ostomy and Continence Nurses Society / Wocn. 2007 Sep 1; 34(5):524-32.
  11. Krouse RS, Mohler MJ, Wendel CS, Grant M, Baldwin CM, Rawl SM, McCorkle R, Rosenfeld KE, Ko CY, Schmidt CM, Coons SJ. The VA Ostomy Health-Related Quality of Life Study: objectives, methods, and patient sample. Current Medical Research and Opinion. 2006 Apr 1; 22(4):781-91.
  12. Rosenfeld K. Palliative care assessment: what are we looking for? Gastroenterology clinics of North America. 2006 Mar 1; 35(1):23-39.
  13. Grant M, Ferrell B, Dean G, Uman G, Chu D, Krouse R. Revision and psychometric testing of the City of Hope Quality of Life-Ostomy Questionnaire. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation. 2004 Oct 1; 13(8):1445-57.


DRA: Health Systems
DRE: none
Keywords: Quality of life
MeSH Terms: none

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