140 Chapter 6 included in app maintenance –and what are agreeable timeframes for maintenance- when an app is in trial. This, to ensure adequate support also after build and registration in app stores.15 Although the developer possessed relevant certifications to ensure compliance to privacy and quality requirements, as well as having prior experience in the development of medical apps, the technical support and timely reaction time for this app proved to be inadequate. Especially for apps in medical trials, it is crucial to establish a solid agreement that obligates the developer to promptly detect and correct any technical problems that may arise. That said, even with the technical impairments now resolved, the intervention version of the app proved to be superior in supporting quality of life of stoma patients. Second, the intervention group had a significantly slightly worse preoperative clinical condition (and higher readmission rate) which may have negatively impacted the results. Third, the distribution of participants between the intervention and control groups was unequal, resulting from exclusions before receiving treatment (withdrawal, did not receive treatment), or because they did not receive an anticipated stoma. Consequently, this imbalance might have influenced the statistical significance of the results, as the differences in outcomes would need to be more substantial to be significant. Lastly, results may be biased as questionnaires were to be completed in the app itself. This method allowed participants to "click through" the questions quickly, potentially leading to less thoughtful answers and influencing the accuracy and reliability of the data collected. To further explore and address the need for optimization of the uptake and utilization of the app, we are investigating facilitators and barriers in patients’ and stoma nurses’ engagement using semi-structured interviews. It is advised by our participating stoma nurses and authors incorporate the app into the care pathway, as the app requires limited time from personnel, it simulates consistent engagement and utilization by stoma nurses. By doing so, to provide more patients with the benefits of the app. CONCLUSION The Stoma App – software as a medical device- improves the quality of life of stoma patients. This is a significant step forward in the optimization of stoma care. The app provides patients with ileostomies or colostomies with personalized support, peer contact if they need or desire to have such contact on a voluntary basis and a reliable, easily accessible base of information. This study demonstrated the app's effectiveness in improving stoma quality of life in the critical postoperative period. Considering the study outcomes and the minimal time commitment required from healthcare personnel, it is highly recommended that the app be integrated into standard stoma care pathways.
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