113 5 A personalized app to improve quality of life of patients with a stoma: A protocol for a multicentre randomized controlled trial INTRODUCTION It is estimated that over 7000 new stomas are created annually in the Netherlands.1 The creation of an ileostomy or colostomy may be required for colorectal malignancy or inflammatory bowel disease. For the patient, having a stoma may negatively affect their self-image and daily functioning, which most likely will result in a reduced quality of life.2-4 Especially in the initial postoperative period, patients must adapt to the new situation. Coping with a stoma may be difficult, resulting in insecurities that can lead to psychosocial problems, such as depression, stress, anxiety, decreased social participation and sexual problems.5 Patients are also at risk of stoma-related morbidity (the incidence of which varies from 20% to 80%), with peristomal skin problems and leakages being the most common complications.6,7 Self-efficacy is associated with a reduction in psychosocial problems and stoma-related morbidities.8,9 Hence, patient education and guidance are crucial both pre- and postoperatively. Several educational stoma-care programs have been described in the literature, all of which have shown positive results in terms of psychosocial skills, self-efficacy and quality of life.10,11 However, providing personal and adequate stoma care both in and out hospital settings can be challenging. In general, Dutch patients were only moderately satisfied with the stoma care they received, and several shortcomings were reported in information provision, the postoperative care and contact with fellow peers.12,13 A tailored personalized mobile application (app) may be an important and eligible addition to regular stoma care to improve information provision and contact with fellow peers. 12,13 An app, if properly designed in terms of content and regulations, has great potential to provide support, whenever needed, to patients with a stoma. It is essential that the app provides up-to-date and reliable information which can be consulted and searched at any time, and that the information is presented in a visually attractive way.13 Reliable and easy to understand information on how to cope with a stoma and what is considered ‘normal’ and what is not, and the possibility for peer-to-peer contact between patients, may be very important in the perioperative phase, but also to fall back upon later. Access to such information at any time may facilitate acceptance, self-confidence and selfefficacy, and may help a patient regain control over their new situation, possibly resulting in a decreased demand for caregivers. By conducting this double-blind randomized controlled trial (RCT), we aimed to investigate whether personalized and timed guidance, as well as peer contact, in a patient-centred mobile application can significantly improve the quality of life of patients following placement of a stoma compared to patients with no personalized and timed guidance or peer contact.
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