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Systematic Review of Educational Interventions for Ostomates

Phatak, Uma R. M.D.1,2; Li, Linda T. M.D.3; Karanjawala, Burzeen M.D.1; Chang, George J. M.S., M.D.4; Kao, Lillian S. M.S., M.D.1,2,5

Diseases of the Colon & Rectum: April 2014 - Volume 57 - Issue 4 - p 529–537
doi: 10.1097/DCR.0000000000000044
Current Status

BACKGROUND: Stoma-related complications lead to increased hospital length of stay and readmissions. Although education of new ostomates is widely recommended, there is a lack of data regarding effective evidence-based educational interventions to prevent or decrease these complications.

OBJECTIVE: The aim of this study was to systematically review the literature for educational interventions for new ostomates designed to decrease stoma-related complications.

DATA SOURCES: PubMed was searched for studies on educational interventions for new ostomates.

STUDY SELECTION: Studies were included if they were in English, targeted adult stoma patients, and evaluated an educational intervention at the time of stoma creation.

INTERVENTION: Educational interventions were performed.

MAIN OUTCOME MEASURES: The outcomes of interest were length of stay, complications, and readmissions.

RESULTS: We found 1706 articles of which 7 met the inclusion criteria. Two were randomized controlled trials, and the rest were cohort studies. The overall quality of the studies was low. Each study used a unique intervention. However, all incorporated a specialized colorectal or ostomy nurse. Of the 5 studies that evaluated length of stay, 2 found a reduction in length of stay associated with the intervention, but 3 found no difference. Two studies found a reduction in complications, but 2 found no difference. Of the 3 studies that evaluated readmissions, none found a difference in the intervention group compared with the control group.

LIMITATIONS: This study is limited by the search of a single database and the inclusion of only English language studies.

CONCLUSION: Education is a key component of patient care; however, evidence to support an improvement in clinical outcomes is lacking. Further study is needed by the use of rigorous designs to craft a feasible educational intervention that will lead to improved patient care and outcomes.

1University of Texas Health Science Center, Department of General Surgery, Houston, Texas

2Center for Surgical Trials and Evidence-Based Practice, University of Texas Health Science Center, Houston, Texas

3Baylor College of Medicine, Michael E. DeBakey Department of Surgery, Houston, Texas

4University of Texas MD Anderson Cancer Center, Department of Surgical Oncology, Houston, Texas

5Center for Clinical Research and Evidence-Based Medicine, University of Texas Health Science Center, Houston, Texas

Funding/Support: Funded through an American Society of Colon and Rectal Surgeons Research Foundation Resident Initiation Grant (to U.R.P.), National Cancer Institute Research K07-CA133187 (to G.J.C.), and Core Grants CA16672 (MDACC).

Financial Disclosure: None reported.

Correspondence: Lillian S. Kao, M.S., M.D., Department of Surgery, University of Texas Health Science Center at Houston, 5656 Kelley St, Suite 30S62008, Houston, TX 77026. E-mail: Lillian.S.Kao@uth.tmc.edu

© 2014 The American Society of Colon and Rectal Surgeons