81 3 Patient satisfaction with stoma care and their expectations on mobile apps for supportive care DISCUSSION Although stoma care is of critical importance to the well-being and quality of life of patients, it is largely unknown whether current stoma care yields sufficient patient satisfaction and meets patients’ needs. It is necessary to understand patients’ perspectives and evaluate whether additional support to improve patient care is desired, and in what format. An app may provide a sustainable solution fitting patients’ individual needs, offering possible benefits such as push notifications and peer support- additional to information on paper. Assessing determinants influencing the willingness to use an app is essential to ensure proper design and implementation. Overall, patients scored their satisfaction with their received stoma care as 6.6 (scale of 0-10). Patient satisfaction was mostly influenced by being unaware of the chance of getting a stoma, indicating improper preoperative counselling, or an acute situation in which counselling could not take place. Patients who received a stoma in an acute situation were significantly less satisfied. These patients did not have or had limited preoperative counselling, and immediate postoperative care by a stoma nurse or a stoma-competent ward nurse could be limited, for instance, for patients who underwent surgery at the weekend. Hence, these patients missed much information and counselling, most likely to be given in an elective situation. In addition to acute situations, other variables also influenced satisfaction. The perioperative clinical condition and mental state may also negatively impact patients’ perception of the actual received stoma care in the immediate pre- and postoperative phase. In addition, patients who underwent surgery for a benign indication with underlying chronic disease reported lower satisfaction. These patients may have had a more severe and/or lengthy disease course or recovery, possibly influencing their reported satisfaction. In addition, patients who received an ileostomy were less satisfied. These patients likely experience more frequent changes in stoma materials, leakages, peristomal skin problems, and water/electrolyte imbalances, all of which impact daily life. Although these two associations were significant only in the two subgroups of the stratified analysis, they were expected to substantially affect patient satisfaction. Overall, men showed higher patient satisfaction than women, which is comparable with literature and may be explained that men and women value aspects of care differently.20-22 Older and highly educated patients were generally less satisfied. This may be explained by the fact that younger patients are likely to experience fewer comorbidities and complications, be more active, and participate in their own care; thus, young patients may have a more positive perception of the received care. Patients with decreased quality of life or psychosocial problems showed lower overall satisfaction. The psychological state may affect the patients’ expectations and experiences.23,24 Although most patients had a stoma for many years, they still consulted the internet regularly to search for information regarding their stoma and how to cope with it. A mobile
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