The study was conducted between October 5, 2017, and September 10, 2018, in the general surgical clinics of 2 training and research hospitals in a metropolitan city in Turkey. Using a prospective, descriptive design, all patients who met the the following inclusion criteria were enrolled; being an inpatient for surgery with a diagnosis of colorectal cancer, being willing to participate in the study, being older than 18 years of age, having no sensory loss such as vision or hearing, and being conscious and able to answer questions. Patients diagnosed with mental illness, mental disability, or impaired cognitive abilities were not eligible to participate.
Patients were interviewed immediately after admission to the preoperative clinic. The purpose and method of the study, expectations of the patient, and data collection forms were explained to the patients, and informed consent was obtained. The patients were informed that they would participate in the study preoperatively and postoperatively; that is, they would answer the questions in the data collection form preoperatively and at 1, 3, and 6 months after surgery.
Data collection form. The data collection form consists of 4 parts: the Sociodemographic Data Form, the Quality of Life Scale for Cancer Patients (EORTC QLQ-C30) Turkish Version 3.0), the Quality of Life Scale for Colorectal Cancer Patients (EORTC QLQ-CR29), and the Self-Care Agency Scale.
The Sociodemographic Data form was developed based on the literature and both researchers’ experience.2,22–24 The Sociodemographic Data Form consists of 5 questions about sociodemographic characteristics (age, sex, marital status, education level, and employment status) and 3 questions about postoperative health characteristics (a person to assist with activities of daily living, meeting daily needs [eg, eating, dressing, and bathing], and stoma type).
The EORTC QLQ-C30 was developed by the European Organisation for Research and Treatment of Cancer (EORTC) in 1987 as a cancer-specific quality of life scale, and the content validity and reliability study of the scale was conducted by Beser and Öz.25 The EORTC QLQ-C30 consists of 30 questions and evaluates 3 areas: general well-being, functional status, and symptom control. The Cronbach alpha coefficient of the scale is 0.9014. In this study, the Cronbach alpha coefficient of the scale was 0.865.
The EORTC QLQ-CR29 was developed specifically for colorectal cancer, and the Turkish validity and reliability study was conducted by Akduran.2 According to the Turkish validity and reliability results, the EORTC QLQ-CR29 has 4 dimensions: general health problems, urinary system pleasure, excretory system pleasure, and drug side effects. Low scores indicate an increased quality of life. The Cronbach alpha coefficient of the scale is 0.762 for the 31st through 47th items of EORTC QLQ-CR29, 0.738 for those with a stoma bag, 0.738 for those without a stoma bag, –1.178 (the value is negative due to negative mean covariance among the items) for EORTC QLQ-CR29 male sexuality, and 0.879 for EORTC QLQ-CR29 female sexuality. In this study, the Cronbach alpha coefficient of the EORTC QLQ-CR29 scale was 0.812. The coefficient was found to be 0.851 for general health problems, 0.797 for urinary system pleasure, 0.797 for excretory system pleasure, and 0.777 for drug side effects.
The Self-Care Agency Scale was developed by Kearney and Fleischer26 in English and consists of 43 items. The scale was adapted for use in Turkish adolescents by Nahcivan,27 and the number of items was reduced to 35. It is frequently used in current research in Turkey. The scale focuses on the self-assessment of self-care actions. It is a 5-point Likert-type scale, and each item is scored from 0 to 4 points. A high score obtained from the scale indicates a high self-care agency or self-care ability. The maximum score is 140. There is no cut-off value. The Cronbach alpha coefficient of the scale adapted by Nahcivan is 0.89. In this study, the Cronbach alpha coefficient of the scale was 0.927.
Ethical considerations. Written permission was obtained from the relevant institutions (number 41303261-799 E147, date: October 18, 2017, and number E148844, date: October 19, 2017). Ethics committee approval (number E.165232, November 20, 2017) was also obtained. In addition, written informed consent was obtained from the patients who participated in the study.
Implementation of research. The aim and method of the study were explained to the patients who met the research criteria during a face-to-face interview at the hospital by 1 of the researchers the day before the surgery and the Sociodemographic Data Form, quality of life scales (EORTC QLQ-C30 and EORTC QLQ-CR29), and Self-Care Agency Scale were completed. Patients completed the EORTC QLQ-C30, EORTC QLQ-CR29, and Self-Care Agency Scale face-to-face at the hospital within 1 month after surgery (on the fifth to seventh day and just before discharge), and via telephone at the third and sixth postoperative months. It took approximately 20 to 25 minutes to complete the data collection forms on paper.
Data management and analysis. Statistical analyses were conducted by a statistician using the SPSS 24.0 (IBM SPSS) software. Tables of frequency and descriptive statistics were used to interpret the findings. The independent sample t test, repeated measures test, Mann-Whitney U-test, and Friedman test were used.