1. CR HUMC SUMS
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
2. 2
Nội dung trình bày
1. Introduction 2. Objective
3. Method 4. Results and
discussion
5. Conclusion 6. Recommendation
3. Introduction
SUMS CR-HUMC
The central
level hospitals
Provincial
hospitals
Regional
polyclinic
Medical service units in
communes, precincts
The third
healthcare
facilities
The second
healthcare
facilities
The first
healthcare
facilities
National hospital and
specialized hospital :
46 facilities
423 facilities
1319
facilities
10926
facilities
Sources：Vietnam MOH, Health Statistics Yearbook 2010
4. 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.
5. National hospitals
【VIETNAM】【JAPAN】
1. CHORAY Hospital: (CR)
Number of beds: 2404
In 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
6. Country Vietnam Japan
Hospital CR-YD SUMS
WOCN (-) 5 persons
Person in charge Nurses in department Nurses in department
and WOCN
Place Digestive surgery
department Stoma outpatient care
Do not affect significantly to the QOL of stoma
patients and stoma care in Vietnam?
Content
It depends on the doctor
in charge
Education for patient and
family is limited
Patient, family, regional
collaboration, staff
education
7. 2. Objective and meaning
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
Recommend an appropriate
guidance and consultation
To improve the QOL of the patients with
colostomy
8. 3. Method
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)
9. 9
Software : SPSS 20.0
Analysis test : Mann- Whitney U test, Kruskal-
Wallis
Statistical significant : p <0.05
10. Researcher and collaborators:
interview the patients along to the contents of the
questionnaire
In Choray Hospital In SUMS Hospital
Collaborator interviewed patient in
SUMS Hospital
Researcher interviewed patient in
CR Hospital
11. The Short Form 36 Health Survey SF-36 (ver.2)
1. Physical functioning (PF)
2. Physical role functioning
(RP)
3. Emotional role functioning
(RE)
4. Bodily pain (BP)
8 subscales with 36 items
5. Vitality (VT)
6. Mental health (MH)
7. Social role functioning (SF)
8. General health perceptions
(GH)
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
12. 4. Results and Discussion
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
13. Total CR-YD SUMS
(N=247) (n=194) (n=53)
Colostomy Duration
(days)
Median 130 730
Minimum 33 30
Maximum 8952 11680
Colostomy Duration
(4 grades) (%)
< 3 months 34.5 18.9
3 months ~ < 1 year 48.5 17.0
1 year ~ <5 years 14.4 43.4
≧5 years 2.6 20.8
Disease with stoma :
(%)
Cancer 65.5 69.8
Trauma 14.4 0
Familial 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 39.6
Doctor and nurse 0 54.7
Nurse 0.5 1.9
Family 24.7 0
None 9.3 3.8
64.2
83.0
94.3
4. Results and Discussion
14. 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 0
The 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 17.0
Consulting 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 26.4
Attending stoma club (%) Yes 4.1 3.8
None 95.9 96.2
15. The average value of the
subscale of Vietnamese healthy
females who living inTaiwan
Yang, Journal of Nursing Research, Vol.19 (1),
2011
The average value of the
Sf-36 subscale of CR-YD
patients
PF
RP
RE
BP
VT
MH
SF
GH
17. PCS MCS RCS
Median p Median p Median p
Gender a)
Male 38.6
ns
52.9
ns
28.8
Female ns 34.3 52.0 29.4
Age (years) b)
18～29 40.7
ns
(Kataoka,2004; Marcia,2011)
51.3
ns
27.7
ns
30～54 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 50.4 36.5
(Fukumoto,2008)
•p < 0.05
a) Mann-Whitney U Test b) Kruskal-Wallis Test
18. PCS MCS RCS
Media
n p Median p Median p
Stoma care b)
themselves (1) 40.7
ns
50.7
*
29.7
get helping (2) 33.0 51.7 28.0 ns
(1) + (2) 36.9 54.3 28.7
Changing ostomy
pouch b)
Every day 38.8
*
54.7
ns
27.9
Many times a day 33.9 52.5 28.8 ns
2～6day 43.3 51.3 30.5
≧1 week 33.1 56.3 29.8
Attending stoma
club a)
Yes 46.1
*
56.7
ns
42.5
*
None 37.2 52.0 28.7
a) Mann-Whitney U Test b) Kruskal-Wallis Test
•p value< 0.05
19. Factors potentially affecting the
QOL in SUMS (1)
PCS MCS RCS
Median p Median p Median p
Gender a) Male 49.3
ns
57.2
ns
43.6
ns
Female 43.5 55.3 50.7
Age (years) b)
18～29
*
ns
ns
30～54 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
20. PCS MCS RCS
Median p Median p Median p
Stoma care b)
By themseves (1) 60.0
*
55.7
ns
43.1
get helping (2) 25.8 58 49.8 ns
(1) + (2) 50.0 56.2 49.6
Changing pouch b)
Many times a day 45.3
ns
53.5
ns
63
2～6 day 46.5 56.0 45.8 ns
≧1 week 61.4 61.5 37
Attending
stoma club a)
Yes 55.2
ns
62.0
ns
33.1
ns
None 45.5 56.0 47.4
a) Mann-Whitney U Test b) Kruskal-Wallis Test
•p < 0.05
21. 5. Conclusion
1. In Vietnam
The QOL of the patients with a colostomy are lower
than healthy Vietnamese people
2. Factors potentially affecting the QOL
VIETNAM JAPAN
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)
23. Consulting carefully before colostomy
Guiding the stoma care before discharge
Introductions on how to use colostomy
pouch
Opening stoma club in several hospital
24. Encouraging
the patients to
attending the
stoma club
Training the
specialist nurse for
stoma care (WOCN)
Expanding the
Vietnam ostomy
Association
activities
25. Increasing the
stoma care
training
sessions
Creating opportunities for exchanging
experience of patients
These photos were obtained the
approval of the patients
To introduce my research, I would like to briefly introduce the health care system of Vietnam and Japan.
VN health system includes 4 levels, from grassroots to referral hospital. Medical service units in communes, precincts and Regional polyclinic in Vietnam is equivalent the first healthcare facilities of Japan, Provincial hospital is equivalent the second healthcare facilities of Japan and the central level hospital is equivalent the third healthcare facilities of Japan.
In our research: 3 hospitals share one characteristic, that is: 3 hospitals are the highest-level hospitals in the country.
The hospital characteristics in this study:
SUMS Hospital has 614 beds, YD Hospital has 400 beds (now:750) and CR hospital has 2404 beds. In SUMS Hospital and YD Hospital, one patient one bed, but CR Hospital has not right to refuse the patients, so that although the bed number is 2404 but the patient is always up to 2500, so that some patients have to use stretchers or have to share one bed with other patients.
However, 3 facilities are the national hospitals and providing the best medical service for the patients.
About Background of stoma care status:
In SUMS hospital has a general surgery department, one Stoma outpatient care unit and 5 WOC Nurses (Wound Ostomy and Continence Nurse - WOCN), (whole country have 1.916 persons in 2014). They are consulting with patients and their’s families, link the network with regional nurse before discharging.
In CR hospital has not WOC Nurse, so almost of stoma care activities performing nurses in digestive department and depend on the doctor in charge. Education for patient and family is also limited.
So we think that: May affect significantly to the QOL of stoma patients and stoma care for patients in Vietnam?
Objective and meaning:
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 recommend an appropriate guidance and consultation in order to improve the QOL of the patients with colostomy
Research Method
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
Data analysis: SPSS 20.0
Target Population: The discharged patients who have colostomy more than 1 month
Research ethic: Shiga University of Medical Science Ethic Committee
Data collection strategy:
After receiving the permission of cooperation for researching,
researcher and collaborators interview the patients along to the contents of the questionnaire
Content of the questionnaire:
The Short Form 36 Health Survey have 8 subscales with 36 items.
In summary score has 3 subscales with: Physical Component Score (PCS) , Mental Component Score (MCS), and Role social Component Score (RCS). The score of each subscale is higher that mean the QOL is good.
In Vietnam: we used Vietnamese version
In Japan: we used Japanese version
Result and Discussion
Total sample is 247, CR-YD is 194 and SUMS is 53. In CR-YD, Male is 71.1% and female is 28.9%.
In SUMS, male is 60.4% and female is 39.6%. In this study, most of participant are male.
In CR-YD, mean of age is 52.9 years old. In SUMS, mean of age is 66.5 years old. In this, the age from 18~64 in CR-YD is 75.3%, among of them have to work, but in SUMS the age over 65 is 58.5%. So that, the participants in SUMS have not to work is 67.9% but in CR-YD the patients who have to work is 71.1%. And in SUMS, 100% the participants have medical insurance but in CR-YD in this study is 88.7%.
The median of Colostomy Duration in CR-YD is 130 day, the minimum is 33 days and the maximum is 8.952 days (#24 years). Besides, the median of Colostomy Duration in SUMS is 730 day, the minimum is 30 days and the maximum is 11.680 days (#31 years).
The Colostomy Duration less of 1 year in CR-YD is 83%, but in SUMS the Colostomy Duration more than 1 year is 64.2%.
And the Disease with stoma in CR-YD because of cancer is 65.5%, in SUMS is 69.8%. Most of the Disease with stoma in two places is cancer.
But in SUMS the cause of trauma to making stoma is 0%, but in CR-YD is 14.4%.
Preoperative explanation by Doctor and Doctor and nurse in SUMS is 94.3%, but in CR-YD, 65.5% explanation by Doctor, Doctor and nurse together to preoperative explanation for patients is 0%. On the other hand, because of the patients in CR-YD hospital 14.4% making stoma by emergency operating because of trauma, so that the doctor can not preoperative explain to patient directly, so that 24.7% preoperative explanation by their family.
About the pouch types: In SUMS, 100% the patient use the pouch which is fitting with their stoma status, but in CR-YD, 23.2% the patient are using the pouch which they do themselves, and 25.8% they use the pouch which they are buying for go out and they use the pouch which they do themselves when stay in home. Because of this reason, 88.7% the patients in SUMS, about 2~6 days they change stoma pouch one time, but in CR-YD, 50.5% the patients have to change the pouch many time a day.
About consulting for patient about the stoma problems: Both of CR-YD and SUMS are more than a half consulting by medical staff.
About attending stoma club: both of CR-YD and SUMS are more than 95% patients have not attending the stoma club or they don’t know about the present of the stoma club. Especially, in CR-YD, almost the patients who is attending the stoma club coming from YD hospital.
Because of the difference about the culture, wellbeing, patient characteristics… b/t VN and JP, so that we can not compare the QOL of the patients two countries directly, so that we use the previous research to compare the mean score of 8 subscale for the patient in CR-YD.
SF-36 is a measure that is used well in all over the world in order to evaluate the QOL of people. In Japan, it is the national standard value has been decided that 50 points. But it is not standard values are determined in Vietnam, so that in this study, we compared our study’s result with previous studies. Previous studies, in 2011, and that where the QOL survey of Taiwan residents Vietnamese women, QOL of the subjects of this study, compared to previous research, all of them have low value.
3 Summary Score of SF-36 are: Physical Component Score (PCS), Mental Component Score (MCS), Role social Component Score (RCS)
Next, I would like to introduce about the Factors potentially affecting the QOL in CR-YD:
All of 3 subscales PCS,MCS,RCS have no significance in Gender and Age. This thing is different with the result of Kataoka (2004) and Marcia (2011). They said that there are a difference with significance between male and female. I think may be the sample in this survey almost the male so that we had not a significant difference. I will expand the sample in the next studies.
The patients have a Colostomy Duration less than 3 months have lower score in PCS and RCS and the non-cancer patients with stoma have RCS lower than the cancer patients. (p&lt;0.05). This result is the same with Fukumoto result in 2008.
About stoma care: the patient have to care stoma by themselves have MCS lower than others (p&lt;0.05)
And the patients have to change stoma pouch many times a day, not attend the stoma club and have a accompanied disease have PCS lower than others with p&lt;0.05
About the Factors potentially affecting the QOL in SUMS:
All of 3 subscales PCS,MCS,RCS have no significance in Gender. This result is the same with the patients in CR-YD.
But in CR-YD have no significant difference about age but in SUMS: the patients who is more than 65 years old have PCS lower than other with p&lt;0.05.
In CR-YD: The patients have a Colostomy Duration less than 3 months have lower score in PCS and RCS but in SUMS: only lower score in RCS.
and the non-cancer patients with stoma have MCS lower than the cancer patients. (p&lt;0.05).
I think may be the sample in this survey almost the male so that we had not a significant difference. I will expand the sample in the next studies.
The patients have a Colostomy Duration less than 3 months have lower score in PCS and RCS and the non-cancer patients with stoma have RCS lower than the cancer patients. (p&lt;0.05). This result is the same with Fukumoto result in 2008.
About stoma care: the patient have not to care stoma by themselves have PCS lower than others (p&lt;0.05). This is different than the patients in CR-YD. Because I think that the patients in SUMS 58.5% &gt;65 years old, so it is influence the MCS of them. And the patients have a accompanied disease have PCS lower than others with p&lt;0.05. This result is the same with CR-YD. But the patients have to change stoma pouch many times a day, not attend the stoma club have not a difference in significance.
Conclusion
. In Vietnam: The QOL of the patients with a colostomy are lower than healthy Vietnamese people
. About the factors potentially affecting the QOL of the patients:
In Vietnam:
Colostomy duration less 3 months (PCS,RCS)
Colostomy by non-cancer (RCS)
Stoma care by themselves (MCS)
With other disease (PCS)
Not attend stoma patient club (PCS,RCS)
Many times to change pouch a day (PCS)
In Japan:
Colostomy duration less 3 monhs (RCS)
Colostomy by non-cancer (MCS)
Can not care stoma by themselves (PCS)
With other disease (PCS)
&gt; 65 ages (PCS)
RECOMMENDATION
To improve the QOL for the patients with colostomy:
Training the specialist nurse for stomacare (WOCN)
Consulting carefully before colostomy, guiding the stoma care before discharge
Expanding the Vietnam ostomy Association activities
Encouraging the patients to attending the stoma club
5. Increasing the stoma care training sessions
6. Creating opportunities for exchanging experience of patients
7. Opening stoma club in Choray Hospital
