临时肠造口的结直肠癌患者出院指导质量可正向预测其生活质量：以出院准备度和造口自我效能为中介。
Discharge teaching quality positively predicts quality of life in colorectal cancer patients with temporary enterostomy: The mediating role of readiness for hospital discharge and stoma self-efficacy.
机构信息
Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
出版信息
PLoS One. 2024 Jul 11;19(7):e0306981. doi: 10.1371/journal.pone.0306981. eCollection 2024.
OBJECTIVES
This study aimed to examine the mediating role of readiness for hospital discharge (RHD) and stoma self-efficacy (SSE) in the relationship between quality of discharge teaching (QDT) and health-related quality of life (HRQOL) in colorectal cancer patients with temporary enterostomy, and the gender difference of mediating effect.
BACKGROUND
It is not clear how RHD, QDT, SSE and HRQOL interact in colorectal cancer patients with temporary enterostomy.
METHODS
This was a prospective follow-up survey. 221 colorectal cancer patients with temporary enterostomy were conveniently recruited from a general hospital in Southeast China. The Quality of Discharge Teaching Scale, Readiness for Hospital Discharge Scale, Stoma Self-Efficacy Scale, and Stoma Quality of Life Scale were used to collect data. Pearson's correlation and structural equation models were used to analyze the data. SPSS 26.0 and Amos 28.0 software were used for analysis the collected data.
RESULTS
Regarding the relationship of QDT and HRQOL, only QDT-T had a direct effect among colorectal cancer patients with stomas (b = 0.233, P<0.001, percentile 95% CI = [0.145, 0.314]). However, both QDT-T and QDT-R can predict HRQOL indirectly through three paths: (1) the mediating role of SSE (b = 0.050, P = 0.009, percentile 95% CI = [0.013, 0.098]; b = 0.077, P = 0.008, percentile 95% CI = [0.021, 0.164]), (2) the mediating role of RHD (b = 0.044, P = 0.004, percentile 95% CI = [0.014, 0.085]; b = 0.044, P = 0.005, percentile 95% CI = [0.010, 0.102]), and (3) the chain mediating role of SSE and RHD (b = 0.030, P = 0.003, percentile 95% CI = [0.011, 0.059]; b = 0.047, P = 0.003, percentile 95% CI = [0.015, 0.103]). The similar chain mediating effect in male stoma patients was also found (b = 0.041, P = 0.002, percentile 95% CI = [0.016, 0.080]; b = 0.046, P = 0.004, percentile 95% CI = [0.011, 0.114]).
CONCLUSIONS
Stoma self-efficacy and readiness for hospital discharge played important intermediary roles in the relationship between quality of discharge teaching and health-related quality of life in colorectal cancer patients with stomas. Health care providers can design SSE-enhancing and RHD-enhancing discharge planning for colorectal cancer patients with temporary enterostomies.
目的
本研究旨在探讨准备出院（RHD）和造口自我效能（SSE）在结直肠癌临时肠造口患者的出院教学质量（QDT）和健康相关生活质量（HRQOL）之间的关系中的中介作用，以及这种中介作用的性别差异。
背景
在结直肠癌临时肠造口患者中，RHD、QDT、SSE 和 HRQOL 之间的相互作用尚不清楚。
方法
这是一项前瞻性随访调查。我们从中国东南部的一家综合医院方便地招募了 221 名结直肠癌临时肠造口患者。使用出院教学质量量表、准备出院量表、造口自我效能量表和造口生活质量量表收集数据。采用 Pearson 相关分析和结构方程模型进行数据分析。使用 SPSS 26.0 和 Amos 28.0 软件分析收集的数据。
结果
关于 QDT 和 HRQOL 的关系，只有造口 QDT-T 对结直肠癌造口患者有直接影响（b=0.233，P<0.001，百分位 95%CI=[0.145，0.314]）。然而，QDT-T 和 QDT-R 可以通过三条路径间接预测 HRQOL：（1）SSE 的中介作用（b=0.050，P=0.009，百分位 95%CI=[0.013，0.098]；b=0.077，P=0.008，百分位 95%CI=[0.021，0.164]），（2）RHD 的中介作用（b=0.044，P=0.004，百分位 95%CI=[0.014，0.085]；b=0.044，P=0.005，百分位 95%CI=[0.010，0.102]），和（3）SSE 和 RHD 的连锁中介作用（b=0.030，P=0.003，百分位 95%CI=[0.011，0.059]；b=0.047，P=0.003，百分位 95%CI=[0.015，0.103]）。在男性造口患者中也发现了类似的连锁中介作用（b=0.041，P=0.002，百分位 95%CI=[0.016，0.080]；b=0.046，P=0.004，百分位 95%CI=[0.011，0.114]）。
结论
造口自我效能和准备出院在结直肠癌造口患者的出院教学质量和健康相关生活质量之间的关系中起着重要的中介作用。医疗保健提供者可以为有临时肠造口的结直肠癌患者设计增强造口自我效能和准备出院的出院计划。
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