| Objective:The long-term quality of life in patients with enterostomy has increasingly become thefocus of nursing research in recent years. The population of this study is the patients withenterotomy. The purpose of this study, ifrstly, was to investigate their quality of life indifferent period after the colostomy surgery, and to explore the inlfuence of demographic,related disease documents, social support, self-efficacy, adjustment and emotional status ontheir quality of life. Secondly, this research aimed to compare the apparent difference andreal difference of quality of life in enterostomy patients in their different stages, as well asthe various inlfuences impacting on the quality of life through standardization anddecomposition analysis. This can provide the evidence of evaluating the real quality of lifein enterostomy patients in their different periods/stages by controlling the interferencefactors, also this can make recommendation for future treatment for the enterostomypatients.Methods:This research contains two sections: cross-sectional survey and standardizationand decomposition analysis.Section one:Through literature review and theory research approaches, the variableshave been found. It was determined that the dependent variable was the quality of life inenterostomy patients in different stages (<lyear>1?6year、>6year), the independentvariables included demographic, related medical documents, social support, self-efficacy,adjustment and emotional status. Using convenient sampling strategy,457patients withstoma participated in this study, and their level of the quality of life，self-eiffcacy,adjustment, social support and emotional status were investigated. Methods of one-wayanalysis of variance, personal correlation and multiple linear regression were used todetermined the factors which inlfuence the quality of life in patients with enterostomy indifferent time after stoma surgery.Section two:To compare the quality of life of patients with stoma in different time; todecompose the differences in observed outcome(quality of life) by analyzing the variousinlfuencing factors through standardization and decomposition analysis; and to determinethe real difference and the differences attributed to different compositions of confoundingfactors in different time for patients with enterostomy.Results:1、General backgrounds457patients have been divided into three groups, first group, patients post-surgery <lyear, second group, patients post-surgery1?6years, thirdgroup, patients post-surgery>6years.Gender: among the457patients, there are280males (61.3%) and177females(38.7%).Age: their average age is (61.61士12.76)；there are128patients (28.0%)>70years oldand329(72.0%) patients<70years old. There are83patients (18.5%) with religiousbeliefs，366patients (81.5%) without religious beliefs and8patients prefer not to say.Educational background:10patients prefer not to say,43(9.6%) have receivedformal education,73(16.3%)have received primary education,127(28.4%) have receivedsecondary education,102(22.8%) have received high school education,65(14.5%) havereceived diploma education,30(6.7%) have received degree education,5(1.1%) havereceived post-graduate education, and other2patients (0.4%).Marriage status:5prefer not to say,392(86.7%) married,5(1.1%) divorced,11(2.4%) single，30(6.6%) widowed,12(2.7%) refused to answer,2(0.4%) engaged.Employment status:54have not answered,71(17.6%) worked>40hours per week;17(4.2%) work<40hours per week，2(0.5%) full-time students?20(5.0%) permanentor temporary disables,1(0.2%) unemployment, and others (72.5%).Income level:4prefer not to say,64(14.1%)<500RMB per month,46(10.2%)>500?lOOORMBpermonth，36(7.9%)>1000?1500RMB per month，53(11.7%)〉1500?2000RMB per month，128(28.3%)>2000?2500RMB per month，51(11.3%)>2500?3000RMB per month，27(6.0%)>3000RMB per month；Independences:14(3.1%) with0independence,172(37.6%) with1independence,271(59.3%) with2or2plus independences；Accommodation:30(6.6%) living by its own，425(93.0%) living with families，2(0.4%) living in nursing homes；Smoking history:34(7.7%) have smoking histories,291(66.3%) have no smokinghistory,114(26.0%) give up smoking.2、Results of the level of quality of life in patients and inlfuencing factors in differentperiod after enterostomy The total score of quality of life was (5.42士0.09)、(5.18士0.08)、（5.05士0.14)，physical dimension(6.22士0.12)、(5.75土0.11)、(5.44士0.19)，psychological dimension(5.22士0.12)、(5.01±0.11)、（5.07士0.17)， socialdimension(4.79士0.11)、（4.59士0.12)、(4.55±0.18),spiritual dimension(5.65士0.10)、(5.63士0.13)、（5.26土0.19). Multiple regression analysis showed that, in population1，the variables of the total score of adjustment, self-eiffcacy, colostomy type, reception, locationbefore surgery, the conifdence of remaining vigorous, anxiety were entered the modelgradually, accounted for75.8%of the variances. In population2，the variables of the totalscore of adjustment, subjective support were entered the model gradually, accounted for57.9%of the variances.In population3，the total score of adjustment were entered themodel gradually, accounted for62.5%of the variances.3、SDAResults of two-sample standardization and decomposition analysis on the quality oflife between the time less than one year and one to six year The observed value waslower less than one year(5.1864) than one to six year(5.4294),the difference was notstatistically signiifcant t=l>.956,P0.05). After standardizing the sample compositions of theconfounding factors, the difference between two samples was statisticallysigniifcantt=2.734,P<0.05).Among all the confounding factors,self-care compositionplayed a crucial role， the self-care component effect was statisticallysigniifcant^t=3<.3528,P0.05).The percent distribution of effect of the self-care componentis-132.1806%，reducing the difference of quality of life between two sample. The percentdistribution of effect of social support is65.5553%，enlarging the difference.Results of two-sample standardization and decomposition analysis on the quality oflife between the time less than one year and over six year The observed value was lowerover six year(5.0612) than less than one year(5.4294)，the difference was statisticallysigniifcant t=-2.61,P<0.05). After standardizing the sample compositions of theconfounding factors, the difference between two samples was statisticallysigniifcantt=-4<.12,P0.05).Among all the confounding factors,self-care compositionplayed a crucial role,the self-care component effect was statisticallysigniifcant^t=3.3528,P<0.05).The percent distribution of effect of the self-care componentis-116.492%，reducing the difference of quality of life between two sample. The percentdistribution of effect of social support is37.8349%，enlarging the difference.Results of two-sample standardization and decomposition analysis on the quality oflife between the time one to six year and over six year The observed value was lowerover six year(5.0612) than one to six year(5.1864),the difference was not statisticallysignificant^t=-0.89，P〉0.05).After standardizing the sample compositions of theconfounding factors,the difference between two samples was statisticallysigniifcant^t=-2.11,P<0.05).Among all the confounding factors，self-efifcacy composition played a crucial role,the self-eiffcacy component effect was statisticallysigniifcantt=2.01,P <0.05).The percent distribution of effect of the self-efifcacycomponent is-105.2100%，reducing the difference of quality of life between two sample.The percent distribution of effect of depression is66.2256%, enlarging the difference.Conclusions:The total score of quality of life of the samples decreased gradually, as the time afterenterostomy goes on，and the influences of life quality in different times were not the same.However, in three periods, the total score of adjustment was the most important influence.After standardization and decomposition analysis, it was found that self-care compositionor self-eiffcacy composition played a crucial role with the differences of quality of life inthree periods. The ifndings provide reliable evidence to make individualized interventionsto improve the quality of life in patients with enterostomy in different post-surgery period. |
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