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

造口是一个人造的肠道开口，它被用来将肠道带到腹部的表面，以转移粪便的流动。作为治疗的一部分，有几种情况可能需要形成造口，包括肠癌。在英国有~ 120，000造口，每年进行约13，500例造口形成手术。与没有造口的肠癌患者相比，患有肠癌造口的患者报告生活质量（QOL）较低。肠癌的诊断数量在增加，更多的人存活下来，因此有真实的需要关注改善这一不断增长的患者群体的生活质量。然而，迄今为止，对具有造口的肠癌患者的研究不足，并且确定改善生活质量的方法的研究很少。最近一项关于心理教育干预措施的综述仅确定了6项测量其对生活质量影响的研究，结果各不相同。该博士学位旨在：1）综合以往干预措施的证据，以确定迄今为止改善该患者群体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的经验和对建议的渴望。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）探索针对健康行为的简短干预的潜力，以改善这一患者群体的生活质量。这个博士学位将包括以下研究：研究1-干预措施的系统回顾和荟萃分析，以改善造口患者的生活质量。研究1的目的是探索证据的有效性，旨在改善生活质量的干预措施，在这一患者群体的日期。拟议的研究将通过探索鼓励行为改变的干预措施，更新和扩展最近的有限系统性审查。这将使以前的干预措施的有效性进行严格的评估和识别的工具，已证明的有效性，相关性和可行性。研究2-卫生署的“生活和超越结直肠癌”调查收集的二手数据分析。研究2的目的是概述与那些没有造口的患者相比，造口患者报告接受和希望接受的建议。本研究将调查是否收到不同主题的建议是由造口的存在，以及如何与他们的生活质量相关的建议。这项研究的结果将有助于查明造口患者认为没有得到建议的领域，以及他们希望获得更多支持和建议的领域。研究3-生态瞬时评估（EMA）研究。研究3旨在通过纵向数据收集的密集方法，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。本研究将试图了解10天内的个体QOL及其影响因素，并将是第一项使用EMA方法对该患者人群进行的研究。研究4-分析晚期癌症生存结局试验（阿斯科特）的次要数据。研究4旨在探讨简单的生活方式干预对改善这组患者的健康行为和提高生活质量的有效性。阿斯科特正在测试一种简短的、基于理论的干预对诊断为乳腺癌、肠癌和前列腺癌的患者的饮食和PA行为的影响。这项研究将使我们能够了解生活方式干预可能对这一群体的福祉产生的潜在影响。该博士学位还拥有一个由患者，临床医生，学者以及慈善机构和行业代表组成的参与利益相关者小组，他们将在整个博士课程中帮助指导研究方向，以确保他们的健康。

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