THE QUALITY OF LIFE OF THE PATIENTS WITH A COLOSTOMY IN TWO HOSPITALS IN HOCHIMINH CITY

OF VIETNAM AND ONE HOSPITAL IN SHIGA PREFECTURE OF JAPAN EVALUATED BY 36-ITEM SHORT FORM SURVEY (SF-36)

NGUYEN THI HIEN - RN - Choray Hospital

YOSHIHIRO ENDO - Shiga University of Medical Sciences

CR HUMC SUMS

2

Nội dung trình bày

1. Introduction 2. Objective

3. Method 4. Results and discussion

5. Conclusion 6. Recommendation

The central level hospitals

Provincial hospitals

Regional polyclinic

Medical service units in communes, precincts

The third healthcare

facilities

The first healthcare

facilities

The second healthcare

facilities

423 facilities

1319 facilities

10926 facilities

Sources： Vietnam MOH, Health Statistics Yearbook 2010

National hospital and specialized hospital :

46 facilities

CR-HUMCSUMS

Introduction

1. Introduction

Cancer is the second leading cause of death worldwide after heart disease.

Every year: 11 million new cancer cases, 7 million deaths due to colorectal cancer (WHO 2011)

In the world: colorectal cancer is a cancer in the

Top Ten.

In Vietnam: colorectal cancer is one of the five most common types of cancer.

1. CHORAY Hospital: (CR)Number of beds: 2404In patient one day: #2500 Out patient one day: #3500

2. HUMC Hospital: (YD)Number of beds: 400　

3.SUMS Hospital: (SUMS)Number of beds: 614　

Provide the best medical service for the patients

National hospitals

【 VIETNAM】 【 JAPAN】

Do not affect significantly to the QOL of stoma patients and stoma care in Vietnam?

　 Country Vietnam Japan　 Hospital CR-YD SUMS　WOCN

(-) 5 persons

　 Person in chargeNurses in department

Nurses in departmentand WOCN

　 Place Digestive surgery department Stoma outpatient care

　　　　　　 Content　

It depends on the doctor in charge

Education for patient and family is limited

Patient, family, regional collaboration, staff

education

1. Identify the status of the quality of life (QOL)

　　　 of the patients with colostomy in Vietnam

2. Determine the factors affecting the QOL at two

places

To improve the QOL of the patients with colostomy

Recommend an appropriate guidance and consultation

2. Objective and meaning

Research design: Cross-sectional design

Data collection perior: April, 2013 ～ Oct, 2013 (6 months)

Data collection place:

Vietnam: CHORAY Hospital,

　　　　　 HCM University of Medical and Pharmacy Hospital ,

Japan: Shiga University of Medical Science Hospital

Target Population: The discharged patients who have colostomy more than 1 month

Research ethic: Shiga University of Medical Science Ethic Committee (Approval number: 24-150)

3. Method

9

Software : SPSS 20.0

Analysis test : Mann- Whitney U test, Kruskal-Wallis

Statistical significant : p <0.05

Researcher and collaborators: interview the patients along to the contents of the questionnaire

Collaborator interviewed patient in SUMS Hospital

Researcher interviewed patient in CR Hospital

In SUMS HospitalIn Choray Hospital

1. Physical functioning (PF)

2. Physical role functioning　(RP)

3. Emotional role functioning (RE)

4. Bodily pain (BP)

The Short Form 36 Health Survey SF-36 (ver.2)8 subscales with 36 items

The score of each subscale is high that mean the QOL is good

SF-36： In Vietnam: used Vietnamese version In Japan: used Japanese version

5. Vitality (VT) 　6. Mental health (MH)　7. Social role functioning (SF)　8. General health perceptions

(GH)

Total CR-YD SUMS

(N=247) (n=194) (n=53)

　Gender (%) Male 71.1 60.4

Female 28.9 39.6

　 Age (years) Mean±SD 52.9±15.9 66.5±13.2

min-max 18 – 87 24 – 91　 Age stages (%) 18～ 29 age 10.8 1.9

30～ 54 age 37.1 9.4

55～ 64 age 27.3 30.2

≧65 age 24.7 58.5

　Work status (%) Yes 71.1 32.1

None 28.9 67.9　Medical insurance (%)

Yes 88.7 100

None 11.3 0

4. Results and Discussion

Total CR-YD SUMS(N=247) (n=194) (n=53)

Colostomy Duration (days)

Median 130 730Minimum 33 30Maximum 8952 11680

Colostomy Duration (4 grades)　 (%)

< 3 months 34.5 18.93 months ~ < 1 year 48.5 17.01 year ~ <5 years 14.4 43.4≧5 years 2.6 20.8

Disease with stoma : (%)

Cancer 65.5 69.8Trauma 14.4 0Familial Adenomatous Polyposis 2.1 0

Ulcerative colitis, Crohn's disease 1.6 17.0

Others (intestinal Obstruction ･Peritonitis…)

16.5 13.2

Preoperative explanation people　(%)

Doctor 　 65.5 　 39.6Doctor and nurse 0 　 54.7Nurse 0.5 　 1.9Family 24.7 0None 9.3 3.8

64.2

83.0

94.3

4. Results and Discussion

Total CR-YD SUMS

(N=247) (n=194) (n=53)The pouch types (%) Do themselves 　 23.2 0

Buying 　 51.1 100

Buying and do themselves 　 25.8 0The days they change pouch　(％ )

Everyday 　 17.5 1.9

Many time a day 　 50.5 5.7

2 ~ 6 days 　 28.4 88.7≧1 week 　 3.6 3.8

Stoma care (%)(stoma self care status)

Themselves 　 34.0 45.3

Other people 　 27.3 37.7

Themselves + others 　 38.7 17.0Consulting person (%) Medical staff 　 53.1 56.7

Acquaintance, family, friends 　 10.3 7.5

Patients with the same disease 　 6.2 9.4

None, examine by him/herself 　 30.4 26.4Attending stoma club (%) Yes 4.1 3.8

None 95.9 96.2

Yang, Journal of Nursing Research, Vol.19 (1), 2011

The average value of the subscale of Vietnamese healthy

females who living inTaiwan

The average value of the Sf-36 subscale of CR-YD

patients

RP

RE

BP

VT

MH

SF

GH

PF

1. PCS:　 Physical Component Score　2. MCS: Mental Component Score　

3. RCS: Role social Component Score

    PCS MCS RCS

    Median p Median p Median p

Gender a)

Male 38.6

ns

52.9

ns

28.8

nsFemale34.3 52.0 29.4

Age (years) b)

18～ 29 40.7

ns

51.3

ns

27.7

ns30～ 54 40.4 53.1 27.7

55～ 64 36.3 50.6 29.4

≧65 30.0 55.2 31.7

Colostomy Duration b)

<3 months 31.6

*

54.0

ns

26.4

*

3 months～ <1 year 39.8 51.2 30.5

1 year～ <5 years 36.5 52.8 33.1

≧5 years 41.9 50.436.5

•p < 0.05

(Fukumoto,2008)

(Kataoka,2004; Marcia,2011)

a) Mann-Whitney U Test　　 b) Kruskal-Wallis Test

    PCS MCS RCS

    Median p Median p Median p

Stoma care b)

themselves (1) 40.7

ns

50.7

*

29.7

nsget helping (2) 33.0 51.7 28.0

(1) + (2) 36.9 54.3 28.7

Changing ostomy pouch b)

Every day 38.8

*

54.7

ns

27.9

nsMany times a day 33.9 52.5 28.8

2～ 6day 43.3 51.3 30.5

≧1 week 33.1 56.3 29.8

Attending stoma club a)

Yes 46.1*

56.7ns

42.5*

None 37.2 52.0 28.7

a) Mann-Whitney U Test　 b) Kruskal-Wallis Test 　

•p value< 0.05

Factors potentially affecting the QOL in SUMS (1)　 　 PCS MCS RCS

　 　 Median p Median p Median p

Gender a)Male 49.3

ns57.2

ns43.6

nsFemale 43.5 55.3 50.7

Age (years) b)

18～ 29 　

*

　

ns

　

ns30～ 54 48.0 48.9 39.4

55～ 64 54.2 55.3 43.1

≧65 42.3 57.1 48.8

Colostomy Duration b)

<3 months 42.7

ns

54.1

ns

30.6

*3 months～ <1 year 54.0 60.8 42.2

1 year～ <5 years 48.3 56.2 44.9

≧5 years 48.9 60.0 55.0

a) Mann-Whitney U Test　 b) Kruskal-Wallis Test

　•p < 0.05

　 　 PCS MCS RCS

　 　 Median p Median p Median p

Stoma care b)

By themseves (1) 60.0

*

55.7

ns

43.1

nsget helping (2) 25.8 58 49.8

(1) + (2) 50.0 56.2 49.6

Changing pouch b)Many times a day 45.3

ns

53.5

ns

63

ns2～ 6 day 46.5 56.0 45.8

≧1 week 61.4 61.5 37

Attending stoma club a)

Yes 55.2ns

62.0ns

33.1ns

None 45.5 56.0 47.4

a) Mann-Whitney U Test　 b) Kruskal-Wallis Test

　•p < 0.05

1. In Vietnam

The QOL of the patients with a colostomy are lower than healthy Vietnamese people

2. Factors potentially affecting the QOL

1. Colostomy duration less 3 months (PCS,RCS)

2. Stoma care by themselves (MCS)

3. Not attend stoma patient club (PCS,RCS)

4. Many times to change pouch a day (PCS)

1. Colostomy duration less 3 monhs (RCS)

2. Can not care stoma by themselves (PCS)

3. > 65 ages (PCS)

VIETNAM JAPAN

5. Conclusion

6. RECOMMENDATION

Consulting carefully before colostomy

Guiding the stoma care before discharge

Introductions on how to use colostomy pouch

Opening stoma club in several hospital

Encouraging the patients to attending the

stoma club

Training the specialist nurse for

stoma care (WOCN)

Expanding the Vietnam ostomy

Association activities

Increasing the stoma care

training sessions

Creating opportunities for exchanging experience of patients

These photos were obtained the approval of the patients

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