102 Chapter 4 DISCUSSION Providing adequate stoma care is essential for patients’ well-being and quality of life. This enables them to cope adequately with a stoma and reduces psychosocial problems and stoma-related morbidity. Although patients were generally satisfied with their received stoma care, several shortcomings were identified in preoperative information and care in acute and postoperative situations. As patients indicated that a mobile app may be beneficial, it may provide a sustainable solution to improve stoma care. Our findings identified five key themes in stoma care: 1) perioperative information provision, 2) the need for information applicable for all patients, 3) the shortage of opportunities for peer contact, 4) contact with healthcare providers, and 5) information about stoma materials. These problems, especially when combined, may affect patients’ insecurity and self-efficacy, and thereby their quality of life. All participants expected that an app would be useful, and be able to improve information provision and peer contact. They emphasised that it is essential that the app provides up-to-date and reliable information which can be consulted and searched anytime, and that the information is presented in a visually attractive way. Topics on mental health and sexuality deserve attention in the app, as this is usually insufficiently explained by caregivers, which has also been reported by other studies.5,20-22 Personalisation of the information could improve the relevance and user convenience of the app, mainly for the younger patients. However, it is challenging to consider all individual needs or hospital-specific protocols; therefore, it should be considered to limit personalisation to a few factors; triggered by important moments such as time of surgery and hospital discharge. Furthermore, patients expressed that fellow patient contact is important and that the app can improve peer contact. In other studies, patients also indicated that peer contact is essential.23 Peer contact in the app should considered to be designed as peer-to-peer chat contact next to the existing platforms in the Netherlands. Developing and maintaining a medical app is costly, as it must comply with the European Medical Device Regulation (MDR), incurring additional expenses.22 Therefore, spending of available budget to build app functionality is something to consider carefully. It's crucial to prioritize functionalities when allocating the limited available budget. What is nice to have, and what is a need to have? Participants suggested that cooperation with different stoma material suppliers could increase options in case of budget constraints. During the interviews, several expensive functionalities were suggested, such as the possibility to have direct contact with a stoma nurse, a ‘descriptive’ search function, and contact with expert-patients. Although the wish of having a ‘direct line’ with a stoma nurse is understandable, one should be careful not to build an app that interferes with the regular caregiver interaction or hospital policy in terms of having all patient advice solely being routed via the hospital electronic patient file; not accepting alternative routes.
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