Challenges in postoperative self-management for patients with bladder cancer and urinary stoma: a qualitative study

This study aims to explore common challenges in self-management among patients with bladder cancer stoma during the first year post-surgery, providing reference for developing postoperative management and follow-up strategies.

This was a descriptive qualitative study. Using purposive sampling, bladder cancer patients with urinary stomas from the Urology Departments of the Third Affiliated Hospital of Kunming Medical University and the Second Affiliated Hospital of Kunming Medical University were selected as participants between October 2024 and February 2025. Semi-structured interviews were conducted with patients at 1 month, 3 months, 6 months, and 12 months post-surgery. Thematic analysis was employed to identify themes.

A total of 52 patients with urinary ostomies following bladder cancer surgery at different postoperative stages were included: 11 at 1 month post-surgery, 15 at 3 months, 14 at 6 months, and 12 at twelve months. Four main themes and nine sub-themes were identified: (1) constraints of physical and mental conditions (limited physical function, the fear of managing stoma care independently); (2) limitations in educational practice applications (lack of adequate and personalized education, application challenges in daily and nursing practice, inadequate health assessment capabilities); (3) perceptual and coping biases (tolerance and neglect of discomfort); (4) imbalance in multifaceted support systems (loss of autonomy with reliance on others' assistance, lack of access to specialized resources, negative impact of economic and policy constraints on self-management behaviors).

Patients with urinary stomas face multiple postsurgical self-management challenges, including physical and psychological limitations, insufficient educational support, and constraints imposed by family, financial, and policy factors. These challenges hinder effective self-management to varying degrees. Therefore, enhancing pre- and post-discharge educational interventions is crucial to equip patients with the necessary skills and improve their health literacy. Concurrently, strengthening primary-level professional stoma care and reinforcing family and social support systems are essential. The comprehensive implementation of these measures may significantly improve self-management abilities and overall quality of life for patients with urinary ostomies, providing valuable implications for clinical practice and patient care strategies.