Institutional review board approval was obtained from Teachers College, Columbia University, New York, NY after the proposal for dissertation research was approved.
The investigator attended the 2009 United Ostomy Association of America (UOAA) Second National Conference in New Orleans, LA for the sole purpose of soliciting volunteers for study participation using convenience sampling methods. At the beginning of the conference, the coordinator of the UOAA informed attendees about the research and invited them to participate. A room was available for participants to complete the study any time during the 4-day conference. Interested individuals were provided a cover letter informing them participation was voluntary and anonymous, they had the right to withdraw at any time, and they could omit questions. Before surveys and consent forms were distributed, a description of the research study and participants rights was provided to each attendee by the program coordinator.
Persons who volunteered to participate were given a consent form and survey packet. The self-report surveys were stapled into one packet and were randomly ordered. The order was rotated to establish different sets, which then were labeled and assigned an identification number. A survey packet was handed to each voluntary participant with appropriate instructions.
Each participant received a blue or black pen, a large brown envelope in which to place their completed survey, and a survey packet containing the City of Hope-Quality of Life-Ostomy Questionnaire19 (COH-QOL-OQ) and a Demographic Data Survey. The consents and survey packets took approximately 30 minutes for the respondent to complete. The investigator stayed available to answer any questions and collected all completed consents separately from the survey packets. Respondents placed the survey instruments in a sealed brown envelope, which the investigator collected before leaving the conference venue.
Criteria for inclusion were: 1) age 18 years or older; 2) having a permanent colostomy, ileostomy, or urostomy; and 3) being able to read and write English.
Instruments. COH-QOL-OQ19 is a comprehensive, multidimensional, self-report instrument designed to assess QoL for individuals with intestinal ostomies. The instrument contains 2 quantitative sections: The Lifestyle Impact and the Quality of Life Impact sections. Both quantitative sections of the instrument were utilized for data collection; reliability and validity have been demonstrated on these sections.20
Lifestyle impact. The Lifestyle Impact Section consists of 31 descriptive Yes/No items organized into the following themes: 1) work-related, 2) health insurance, 3) sexual activity, 4) psychological support/concerns, 5) clothing, 6) diet, 7) time since surgery and adjustment (how long it took to be comfortable with ostomy care, diet, and how long it took your appetite to return), and 8) food groups. Each item answered Yes = 1 point and each No response = 0.
QoL impact. The QOL Impact Section is divided into 4 domains with 43 items as conceptualized in the COH-QOL Model (see Figure 1): physical well-being (items 1 to 11), psychological well-being (items 12 to 24), social concerns (items 26 to 36), and spiritual well-being (items 37 to 43). Each item is scored using a linear analogue scale in terms of problem severity, rated from 0 to 10.20 For example, respondents can rate physical strength between 0 (no problem) and 10 (severe problem). A number of items are reverse scored to protect against response bias, including items 1–12, 15, 18, 19, 22, 30, 32–34, and 37. A mean QoL score was obtained by adding all scaled times and dividing by 43. Scores range from 0 to 10, with 10 being the best quality of life.
Grant et al20 reported the psychometric analysis of the revised COH QOL OQ confirmed a 4-dimensional model and established initial reliability and validity; the authors also confirmed the scale may be utilized to describe adjustment to colostomy, ileostomy, or urostomy for adults.20
Demographic survey. The demographic data survey included information such as gender, year of birth, height, weight, race, and education, as well as illness/reason for surgery, years since first surgery, number of surgeries, ostomy type (colostomy, ileostomy or urostomy), and who performed preoperative stoma site marking.
Data analysis. Data were entered into the Statistical Package for Social Sciences, version 17 (SPSS, Chicago IL) and analyzed. Study variables included participant demographics, QoL scores, illness or reason for surgery, years since first surgery, number of surgeries, ostomy type (colostomy, ileostomy or urostomy), preoperative stoma site marking, and length of time to 3 adjustment points (ie, how long before they were comfortable with their ostomy, how long before they were comfortable with their diet, and how long before appetite returned).
Descriptive statistics (means, SDs, frequencies, percentages) were used to describe the demographic makeup of the sample as well as participant surgical history. Logistic regression analysis was used to determine the relationship between being marked by a WOC nurse and year of first stoma creation. Cross-tabulation analyses were conducted to determine the relationship between being marked by a WOC nurse and adjustment items from the Lifestyle Impact section. Pearson product moment correlations were used to assess the relationship between COH-QOL-OQ score and background variables of age, years since stoma was created, and years since most recent surgery. These correlations led to selection of covariates.
Analyses of covariance (ANCOVA) with Bonferroni post-hoc tests were used to determine the relationships between QoL and preoperative stoma site marking. These outcomes were compared among 4 groups: respondents who received no preoperative stoma site marking, persons who received preoperative stoma site marking by a WOC nurse, persons who received preoperative stoma site marking by a surgeon, and persons who received preoperative stoma site marking by someone other than an ostomy nurse or surgeon. Covariates of age, number of years since first surgery, and number of years since last surgery were used in all QoL analyses.