137 6 Better Stoma Care using the Stoma App – does it help? DISCUSSION Providing adequate stoma care is essential to help patients cope with their stoma and improve their quality of life. To date, it is reported in literature that patients experience a lack of adequate and personalized information provision, postoperative care, and support, and are in need of contact with peer patients especially when they are out of hospital.13,14 To address these shortcomings and optimize stoma-care, a patient-centred mobile app tailored to meet the needs and preferences of stoma patients holds significant potential. This study examined the effects of having timely, individualised information and peer contact available via the Stoma App on patients with ileostomies or colostomies, as well as the value of having information that is both accessible and trustworthy. The intervention version of the Stoma App demonstrated a significant improvement in the stoma quality of life by 3.1 (p=0.038) in the multivariate analysis, at one month after surgery. This finding holds significant importance, especially considering that the immediate postoperative period is often characterized by various insecurities and psychosocial challenges.21 In this period, patients may not always have adequate self-efficacy, which may result in insecurity, social impairment, or isolation. In return, this may lead to an increase in emergency department visits without readmission (patients being insecure),22 or in contrast, and even worse, to an increase in readmission (patients waiting too long to present themselves). 23 In our study, the Stoma App showed significant improvement in the primary outcome measurement ‘quality of life’ after correction for confounders, but not in the secondary outcome measures. Interestingly, the intervention group had a significantly higher readmission rate one month after surgery. This was primarily due to operation related complications such as intra-abdominal abscess or ileus (Table 4). It is highly unlikely that stoma-related guidance or peer-contact have any influence on these complications. The significantly lower Karnofsky performance score before surgery in the intervention group may attributed to the higher readmission rate. Co-morbidities were less frequently reported in the intervention group in the same period. This may result from underreporting in the intervention group, as complications or readmissions are likely to obscure other problems. Two stoma-related apps have been described in literature with inconsistent user outcomes.24,25 These apps were less capacious in content and user interface than the Stoma App, lacking a proper (user-) design and development testing process. In contrast, development of the Stoma App was based on an assessment of the actual problems that patients themselves reported to encounter in stoma care and their specific needs and desired functionalities.13,14 To that end, we involved both patient associations and the stoma nurse association intensively. 26-28 Indeed, the target group and stakeholders were involved in the development of the app and in pilot testing, to ensure its usability and relevance. Possible features that the apps can offer to patients were explored in beta
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