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Parastomal Hernia Prevention, Assessment, and Management: A Scoping Review and Consensus-Based Best Practice
Madeline Lemke1,2,3,4,5, Kimberley LeBlanc1,2,3,4,5, Mary Hill1,2,3,4,5
1Madeline Lemke, MD, MSc, Department of Surgery, Western University, London, Ontario.
Purpose:
This purpose of this project was to generate best practice recommendations for health care providers caring to individuals at risk of or experiencing a parastomal hernia.
Methods:
This project was completed in 2 phases. A scoping literature review was conducted, and results were used to generate best practice statements guiding clinicians caring for persons undergoing or living with an abdominal ostomy. A modified Delphi method was used to generate consensus-based recommendations for care. Finally, these statements underwent external review.
Search Strategy:
A scoping review was conducted that focused on the definitions, etiology, epidemiology, pathophysiology, assessment, prevention, and management of parastomal hernias. Databases and resources searched were CINAHL; EMBASE; Google Scholar; MEDLINE via OVID, Nurses Specialized in Wound, Ostomy and Continence Canada; Nursing and Allied Health Source on ProQuest; Ordre des infirmiers et infirmières du Québec; PsycInfo; PubMed Registered Nurses' Association of Ontario (RNAO); and the Wound, Ostomy, Continence Nurses Society library.
Results:
Our search retrieved 187 records; 65 were read in full and included in the scoping literature review used to generate proposed consensus statements. Consensus was reached on 15 statements that achieved a 96% or higher agreement among expert panelists. Twenty-eight professionals participated in expert review, and 96% (n = 27) reported they would recommend these best practice recommendations to support parastomal hernia practices.
Conclusion:
This process generated 15 best practice recommendations that provide guidance to health care providers who care for patients with an ostomy to assess risk, prevent, assess, and manage parastomal hernias.
Implications:
These recommendations were generated from a structured literature review of current best evidence, supported by consensus among a panel of clinical experts, and supported by external review. While they represent best practice in the prevention and management of parastomal hernias, further research is required to establish evidence-based preventive and treatment recommendations.
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