Using advanced quantitative methods to explore quality of life in patients with a stoma from Bowel Cancer.

造口是肠内的一个人工开口，它将肠道带到腹部表面，以转移粪便的流动。有几种情况，作为治疗的一部分，可能需要形成一个造口，包括肠癌。在英国，每年约有12万例造口手术，约有13500例造口手术。与没有造口的肠癌患者相比，因肠癌而造口的患者报告的生活质量（QOL）较低。肠癌的诊断数量正在增加，更多的人幸存下来，所以我们确实需要关注改善这一不断增长的患者群体的生活质量。然而，到目前为止，对有造口的肠癌患者的研究还不够充分，确定改善生活质量的方法的研究也很少。最近一项关于心理教育干预的综述发现，只有6项研究测量了它们对生活质量的影响，而且结果是可变的。本博士的目标是：1)综合以往干预措施的证据，以确定迄今为止改善该患者组生活质量的有效技术。2)描述患者目前的生活质量以及他们对建议的经历和愿望。3)通过对患者行为和幸福感的密切监测，提高我们对影响该患者群体生活质量的因素的理解。4)探索以健康行为为目标的短期干预措施的潜力，以改善该患者群体的生活质量。本博士将包括以下研究：研究1-改善造口患者生活质量的干预措施的系统回顾和荟萃分析。研究1旨在探索迄今为止旨在改善该患者组生活质量的干预措施有效性的证据。拟议的研究将通过探索那些鼓励行为改变的干预措施来更新和扩展最近的一项有限的系统综述。这将有助于对以前干预措施的有效性进行严格评估，并确定已证明有效、相关和可行的工具。研究2-分析由卫生部“结直肠癌患者及术后生活”调查收集的二手数据。研究2旨在概述与无造口患者相比，有造口患者报告接受和希望接受的建议。本研究将调查是否接受不同主题的建议受到气孔存在的影响，以及这些建议如何与他们的生活质量相关联。这项研究的结果将有助于确定有造口的患者觉得没有得到建议的地方，以及他们希望得到更多支持和建议的地方。研究3-生态短期评估研究。研究3旨在通过密集的纵向数据收集方法来提高我们对这一人群生活质量的理解。EMA允许在几天内每天多个时间点收集数据，提供有关个人行为和环境的独特数据。本研究旨在了解个体10天内的生活质量及其影响因素，并将是首次对该患者群体使用EMA方法的研究。研究4-来自晚期癌症预后试验（ASCOT）的次要数据分析。研究4旨在探讨短期生活方式干预对改善这组患者健康行为和提高生活质量的有效性。ASCOT正在测试一个简短的、基于理论的干预对乳腺癌、肠癌和前列腺癌患者饮食和PA行为的影响。这项研究将使我们了解生活方式干预可能对这一群体的健康产生的潜在影响。该博士课程还有一个由患者、临床医生、学者、慈善机构和行业代表组成的利益相关者小组，他们将帮助指导整个博士课程的研究方向

A stoma is an artificial opening in the bowel that has been made to bring the bowel onto the surface of the abdomen in order to divert the flow of faeces. There are several conditions that as part of treatment may necessitate the formation of a stoma, including bowel cancer. In the UK there are ~120,000 ostomates and around 13,500 stoma formation surgeries are performed annually. Patients with a stoma due to bowel cancer report lower quality of life (QOL) compared to bowel cancer patients who do not have a stoma. The number of bowel cancer diagnoses is increasing, and more people are surviving, so there is a real need to focus on improving the QOL of this growing group of patients. However, to date bowel cancer patients with a stoma have been under-researched and studies to identify methods of improving QOL have been few. A recent review of psycho-educational interventions identified only 6 studies that measured their impact upon QOL, and results were variable.This PhD will aim to:1) Synthesise the evidence on previous interventions to identify effective techniques to improve QOL in this patient group to date.2) Describe patients' current QOL alongside their experiences of and desire for advice.3) Improve our understanding of factors that influence QOL in this patient group through intensive monitoring of patient behaviours and well-being.4) Explore the potential for a brief intervention targeting health behaviour to improve the QOL of this patient group.This PhD will comprise the following studies:Study 1- A systematic review and meta-analysis of interventions to improve QOL in patients with a stoma. Study 1 aims to explore evidence for the effectiveness of interventions designed to improve QOL within this patient group to date. The proposed study will update and extend a recent, limited, systematic review by also exploring those interventions that encourage behaviour change. This will enable a rigorous evaluation of the effectiveness of previous interventions and identification of tools with demonstrated effectiveness, relevance and feasibility.Study 2- Analysis of secondary data collected by the Department of Health's 'Living with and Beyond Colorectal Cancer' survey. Study 2 aims to outline the advice that patients with a stoma report receiving and want to receive compared to those without a stoma. This study will investigate whether receipt of advice on different topics is affected by the presence of a stoma, and how this advice is associated with their QOL. The findings from this study will help to pinpoint areas where patients with a stoma feel advice has not been given and where they would have liked to receive more support and advice. Study 3- An Ecological Momentary Assessment (EMA) study. Study 3 aims to improve our understanding of QOL in this population through an intensive method of longitudinal data collection. EMA permits data to be collected at multiple time points a day across several days, providing unique data on an individual's behaviour and surroundings. This study will seek to understand individuals QOL across 10 days and the factors that influence this, and will be the first study using EMA methods with this patient population. Study 4- Analysis of secondary data from the Advancing Survivorship Cancer Outcomes Trial (ASCOT). Study 4 aims to explore the effectiveness of a brief lifestyle intervention to improve health behaviour among this group of patients and increase QOL. ASCOT is testing the effect of a brief, theory-based intervention on diet and PA behaviours among patients with a diagnosis of breast, bowel and prostate cancer. This study will allow us to understand the potential impact a lifestyle intervention could have on well-being for this group.This PhD also has an engaged stakeholder group comprised of patients, clinicians, academics and charity and industry representatives, who will help to guide the direction of the research throughout the course of the PhD to en