Unpacking self-management in colorectal cancer with stoma patients: a comprehensive concept analysis
, 3, 4, 5, 6, 7
Abstract
Background: Self-management has become an important issue discussed by healthcare providers and healthcare systems due to the increase in chronic disease cases, the high cost of chronic disease conditions, and the limited time of health workers. This study aimed to comprehensively and specifically explore and clarify self-management in stoma patients with colorectal cancer. Identifying the key attributes, antecedents, and consequences of self-management in this population will increase understanding in creating strategies and providing more appropriate nursing interventions in improving patient’s quality of life.
Methods: This study used Walker and Avant’s concept analysis technique to investigate the concept of self-management in colorectal cancer stoma patients, which involves an eight-step process. Thematic analysis identified key attributes, antecedents, and consequences of self-management based on a review of relevant literature and existing theoretical frameworks.
Results: Self-management is described as the ability of a person with a chronic disease condition to manage symptoms, treatments, physical and psychosocial impact, and lifestyle changes that affect his life. Outcomes can be achieved if patients have personal/lifestyle characteristics, health status, resources, environmental characteristics, and health care system. The outcomes include improved self-care, self-efficacy, ability to change stoma bag, quality of life, self-management behavior, self-care attitude, self‑care behavior, and stoma proficiency.
Conclusions: Key attributes identified, such as managing skills, goal achievement, caring, and life satisfaction, highlight the need for nurses to equip patients with essential self-care knowledge and skills. By doing so, healthcare providers can enhance patient autonomy, reduce healthcare costs, and foster better health outcomes.
Keywords: colorectal cancerself-managementstoma
References
- Goldstine J, van Hees R, van de Vorst D, et al. Factors influencing health-related quality of life of those in the Netherlands living with an ostomy. Br J Nurs. 2019; 28(22): S10–S17.
- Malik T, Lee MJ, Harikrishnan AB. The incidence of stoma related morbidity — a systematic review of randomised controlled trials. Ann R Coll Surg Engl. 2018; 100(7): 501–508.
- United Ostomy Associations of America. Ostomy and continent diversion patient bill of rights, 2021. https://cdn-links.lww.com/permalink/jwocn/a/jwocn_2022_03_07_gleba_jwocn-d-22-00015_sdc1.pdf (12.07.2024).
- Burgess-Stocks J, Gleba J, Lawrence K, et al. Ostomy and continent diversion patient bill of rights: research validation of standards of care. J Wound Ostomy Continence Nurs. 2022; 49(3): 251–260.
- Jayarajah U, Samarasekera DN. A cross-sectional study of quality of life in a cohort of enteral ostomy patients presenting to a tertiary care hospital in a developing country in South Asia. BMC Res Notes. 2017; 10(1): 75.
- Zhang Yu, Xian H, Yang Y, et al. Relationship between psychosocial adaptation and health-related quality of life of patients with stoma: a descriptive, cross-sectional study. J Clin Nurs. 2019; 28(15-16): 2880–2888.
- Stavropoulou A, Vlamakis D, Kaba E, et al. “Living with a stoma”: exploring the lived experience of patients with permanent colostomy. Int J Environ Res Public Health. 2021; 18(16).
- Zewude WC, Derese T, Suga Y, et al. Quality of life in patients living with stoma. Ethiop J Health Sci. 2021; 31(5): 993–1000.
- Choudhary M, Kaur H. Experiences of living with intestinal ostomy: a qualitative meta-synthesis. Indian J Palliat Care. 2020; 26(4): 421–427.
- Krogsgaard M, Kristensen HØ, Furnée EJB, et al. Life with a stoma across five European countries-a cross-sectional study on long-term rectal cancer survivors. Support Care Cancer. 2022; 30(11): 8969–8979.
- Barlow J, Wright C, Sheasby J, et al. Self-management approaches for people with chronic conditions: a review. Patient Educ Couns. 2002; 48(2): 177–187.
- Clark N, Becker M, Janz N, et al. Self-Management of chronic disease by older adults. J Aging Health. 1991; 3(1): 3–27.
- Richard AA, Shea K. Delineation of self-care and associated concepts. J Nurs Scholarsh. 2011; 43(3): 255–264.
- Albulescu EL, Bratiloveanu T, Sandulescu S, et al. Role of a stoma nurse in the management of the specific stoma-related complications. Curr Health Sci J. 2024; 50(1): 5–11.
- Aryani R, Lalisang TJ, Dahlia D, et al. Self-management intervention model for optimizing psychological well-being in patients with colorectal stoma. J Konseling Pendidikan. 2023; 11(4): 349–360.
- Aryani R, Lalisang T, Dahlia D, et al. Exploring innovative approaches to self-management in colorectal cancer for enhancing quality of life and patient outcomes — a scoping review. SEEJPH. 2024; 29: 234–244.
- Martz E. Promoting self–management of chronic health conditions: theories and practice. New York: Oxford University Press; 2018.
- Van de Velde D, De Zutter F, Satink T, et al. Delineating the concept of self-management in chronic conditions: a concept analysis. BMJ Open. 2019; 9(7): e027775.
- Foley AS, Davis AH. A guide to concept analysis. Clin Nurse Spec. 2017; 31(2): 70–73.
- Walker LO, Avant KC. Strategies for theory construction in nursing. 6th ed. Pearson Education Inc; 2019.
- McKenna H. Building theory through concept analysis: Nursing theories and models. In: Routledge Essentials for Nurses. Hoboken: Taylor and Francis 2006: 289.
- Coleman K, Austin BT, Brach C, et al. Evidence on the chronic care model in the new millennium. Health Aff. 2009; 28(1): 75–85.
- McCorkle R, Ercolano E, Lazenby M, et al. Self-management: enabling and empowering patients living with cancer as a chronic illness. CA Cancer J Clin. 2011; 61(1): 50–62.
- California Office to Reform Education. Introduction to self-management. California; 2014.
- Nakagawa-Kogan H, Garber A, Jarrett M, et al. Self-management of hypertension: predictors of success in diastolic blood pressure reduction. Res Nurs Health. 1988; 11(2): 105–115.
- Alderson M, Starr L, Gow S, et al. The program for rheumatic independent self-management: a pilot evaluation. Clin Rheumatol. 1999; 18(4): 283–292.
- Wanless D. Securing our future health: taking a long-term view — final report. HM Treasury, London 2002.
- Ryan P, Sawin KJ. The individual and family self-management theory: background and perspectives on context, process, and outcomes. Nurs Outlook. 2009; 57(4): 217–225.e6.
- Thorne S, Paterson B, Russell C. The structure of everyday self-care decision making in chronic illness. Qual Health Res. 2003; 13(10): 1337–1352.
- Wilkinson A, Whitehead L. Evolution of the concept of self-care and implications for nurses: a literature review. Int J Nurs Stud. 2009; 46(8): 1143–1147.
- Schulman-Green D, Jaser SS, Park C, et al. A metasynthesis of factors affecting self-management of chronic illness. J Adv Nurs. 2016; 72(7): 1469–1489.
- Seo HW. Effects of the frequency of ostomy management reinforcement education on self-care knowledge, self-efficacy, and ability of stoma appliance change among Korean hospitalised ostomates. Int Wound J. 2019; 16 Suppl 1(Suppl 1): 21–28.
- Wen SL, Li J, Wang AN, et al. Effects of transtheoretical model-based intervention on the self-management of patients with an ostomy: A randomised controlled trial. J Clin Nurs. 2019; 28(9–10): 1936–1951.
- Goodman W, Allsop M, Downing A, et al. A systematic review and meta-analysis of the effectiveness of self-management interventions in people with a stoma. J Adv Nurs. 2022; 78(3): 722–738.
- Husnayain A, Ekadinata N, Sulistiawan D, et al. Multimorbidity patterns of chronic diseases among indonesians: insights from indonesian national health insurance (INHI) sample data. Int J Environ Res Public Health. 2020; 17(23).
- Goldsbury DE, Feletto E, Weber MF, et al. Health system costs and days in hospital for colorectal cancer patients in New South Wales, Australia. PLoS One. 2021; 16(11): e0260088.
