QUALITY OF LIFE IN EGYPTIAN STOMA PATIENTS

PURPOSE: Although it is widely believed that patients with permanent stoma generally have a worst quality of life 
compared to those without, little is known about the psychological and social influence of stoma on Egyptian patients. The effects of stoma on the religious rituals could pose problems and affect the social functioning in addition to self-image. The aim of this study was to document the long-term impact of permanent stoma on the quality of life of Egyptian patients with special emphasis on the religious aspects. 
METHODS: Over the period of data collection (three weeks) 35 patients were admitted to the study of them 7 patients 
were not eligible. There were 28 eligible patients (median age 55 years, min-max: 17-75 years) of them 10 were females (median age 58 years, min-max: 17-75 years) and 18 males (median age 54 years, min-max: 22-71years). A modified FIQL questionnaire was constructed to survey all possible areas of changes in quality of life after creation of stoma. The questionnaire included 39 questions were grouped under 5 types of questions according to the way of response. In addition to 3 direct questions about age, gender and the level of education. The questions were re-grouped into 5 scales: Life-style, Coping/Behavior, Depression/ Self perception, Embarrassment and Religious. Scale range from 1-5, with 1 indicating a lowest and 4 indicating a best functional status of QOL. Scale scores are the average (mean) response to all items in the scale. Not Apply (value 5) is coded as a missing value in analysis of questions. 
RESULTS: The mean score indicated lower functional status of QOL in each of the five scales. Analysis of variance 
using one-way ANOVA test revealed no significant difference in between the five scales (F=1.81, p = 0.13). There was strong correlation in-between the five scales. There was no correlation between changes in scales of QOL and the level of education, gender or age. Because of stoma, 61.5% of male patients lost their jobs or became unable to work. Muslim ostomate has significant problems in preparation and during the time of prayers; 58.33% of patients have had to repeat ablution several times for each prayer interval; another 37.5% have had to empty their pouches several times before ablution; and 61% of patients were not able to pray in the mosque because of their stoma. During praying, 34.78% of patients leak stool without even knowing that. Fasting Ramadan does not disturb the stoma care of 83% of patients while 17% patients suffer from changes in bowel habits that disturb their stoma care. A significant number of Muslim ostomates (54%) cannot do Hajj because stoma interferes with their ability to travel. 
CONCLUSION: Creation of stoma substantially diminishes the quality of life of Egyptian patients. There is a clear 
relation between the impact of stoma on the religious rituals and quality of life. 
Adding the religious aspects to the pre-operative counseling and to the informed consent of surgery can provide 
information that are necessary to make the patient's expectation more realistic and to put him in a better position to cope with the physical and psychological consequences of stoma.