Construction and Evaluation of a Flipped Discharge Model for Stomates With Colorectal Cancer

This study aims to develop and test a "Flipped Discharge" model for colorectal cancer patients with an intestinal stoma (ostomy) based on the Response to Transition Theory. After stoma surgery, patients often face significant physical, psychological, and social challenges during the vulnerable early post-discharge period. Current care models, characterized by shorter hospital stays and limited follow-up support, may leave patients unprepared for self-care, potentially leading to complications, reduced quality of life, and increased hospital readmissions. The proposed "Flipped Discharge" model shifts essential post-discharge assessments and education from the hospital to the patient's home or via enhanced remote support, aiming to provide continuous, specialized care during this critical transition. In this multi-center study, approximately 200 eligible patients will be randomly assigned to either an intervention group receiving the "Flipped Discharge" protocol or a control group receiving standard care. The intervention includes early telephone follow-ups and a core intervention around the third day after discharge, delivered either through an in-home visit by a specialized stoma nurse within an established "Internet + Nursing Service" network or a standardized intensive video follow-up with mailed instructional materials for patients outside the service coverage area. The study will measure outcomes including stoma-related complications (primary outcome), patient quality of life, self-care ability, self-efficacy, adaptation to the stoma, readiness for discharge, healthcare costs, and satisfaction. The research also seeks to understand how factors like self-efficacy influence quality of life, with the ultimate goal of determining if this model is effective and feasible in improving care continuity and patient outcomes, thereby providing evidence for a new patient-centered care model suited to the current healthcare context.

• Level of adaptation to the stoma [Time frame: From the initiation of the intervention (post-discharge) up to 1 month postoperatively, or as defined by the primary study endpoint period.]
• Level of stoma-related self-efficacy [Time frame: From the initiation of the intervention (post-discharge) up to 1 month postoperatively, or as defined by the primary study endpoint period.]
• Readiness for hospital discharge [Time frame: Assessed at the core intervention point (approximately 3 days post-discharge).]
• Disease-specific quality of life [Time frame: From the initiation of the intervention (post-discharge) up to 1 month postoperatively, or as defined by the primary study endpoint period.]
• Self-care ability for stoma management [Time frame: From the initiation of the intervention (post-discharge) up to 1 month postoperatively, or as defined by the primary study endpoint period.]
• Length of Hospital Stay [Time frame: From hospital admission for the index surgery through the follow-up period (e.g., 1 month postoperatively).]
• Healthcare Costs [Time frame: From hospital admission for the index surgery through the follow-up period (e.g., 1 month postoperatively).]
• Intervention Implementation Costs [Time frame: From hospital admission for the index surgery through the follow-up period (e.g., 1 month postoperatively).]
• Hospital Readmission Rate [Time frame: From hospital admission for the index surgery through the follow-up period (e.g., 1 month postoperatively).]
• Patient Trust and Perceived Support [Time frame: From the initiation of the intervention (post-discharge) up to 1 month postoperatively, or as defined by the primary study endpoint period.]