Cath Lab Digest

Self-esteem is potent concern for anyone, and emotion cannot be denied.
- Richard Cohen, writer, The New York Times, on his feelings about his temporary ileostomy, April 2001

Q uality of life. Three words that carry enormous weight in any person's life, but especially in a life lived with a stoma. These three words are lobbed about in nearly every professional discussion of outcomes or cost of ostomies, as well as in the process of developing clinical tools and standards. But do we really know what they mean and are we really paying attention to and measuring quality of life (QOL)? Most likely, relativity and perspective authentically define quality of life.

Christine Moffatt, RN, PhD, Center for Research and Implementation of Clinical Practice, Thames Valley University, London, England, gave two intriguing presentations at the recent Symposium on Advanced Wound Care in Baltimore, Maryland, regarding her research into QOL among patients with chronic wounds¹ and how healthcare professionals cope with "difficult" patients with nonhealing wounds.²

Many of the same QOL issues revealed in this research are equally applicable to ostomy patients. One patient referred to living with an ostomy as, "The Mental Battle of Living with an Ostomy." In today's environment of managed care, shrinking healthcare dollars, standardized guidelines, and inconsistencies among referring institutions, an ostomy patient's QOL is easily jeopardized. As Black cautions, "however far the science of medicine and surgery advances, the art of medicine will remain. The art of first identifying the patient's problem..."3 One ostomy patient writes, "God bless... every other doctor who is smart enough to know that healing takes place in the brain every bit as much as it does in the body."⁴

Technological advances begun in the 1950s were aimed at improving QOL for a person with an ostomy. Previously, neither the time, the funds, nor the inclination were available to conduct prolonged clinical trials and studies. Immediate solutions for urgent and fundamental problems were needed.⁵ At the time, the emphasis was more technical - how to perfect surgical techniques, how to improve ostomy pouching systems so they were more discreet and odor-proof, and how to treat and prevent peristomal skin breakdown.

Over the years, technological advances in surgical procedures, improvement in ostomy products, and emphasis on evidence-based practice and patient outcomes has renewed our interest in understanding the real-life impact of living with an ostomy. What happens in the patient's life after surgery, post treatment, and after an "adequate" pouching system has been selected? Is the pouching system really adequate if it is simply leakproof (ie, does "adequate" simply imply that a pouching system does not leak)? Can something as basic as a pouching system influence a patient's QOL? What impact does loss of sexual function, social isolation, depression, pain, and dietary restrictions have on an ostomy patient's life?