Report on ATMS PhD Scholarship Study
Teresa Mitchell-Paterson
Introduction
I have been fortunate to receive the inaugural ATMS PhD Scholarship , and I am genuinely grateful for this . The background to my research involves my experience of the intricate relationship between low-fibre diets , high-output stomas ( HOS ), and the perceived quality of life ( QoL ) from the perspective of stoma patients . The influence of a high-output stoma ( HOS ) affects both physical and psychological aspects of patient lives , impacting QoL .
What is a stoma ?
A stoma is an opening to the external surface of the stomach with the intestine pulled through and connected to a bag for faecal drainage . The clinical definition of a high faecal output stoma is an amount that extends beyond what is considered acceptable , a volume of liquid between 1.6 litres and 2 litres a day . This results in substantial amounts of faecal matter expulsion , multiple bag changes , possible leakage around the stoma ( pancaking ), odour , and psychosocial challenges for the stoma patient .
Stoma-related concerns
We can only imagine how the lack of sphincter control in the restriction of faecal matter in stomas is contrasted with the controlling aspects of two sphincters in a natural bowel . This underlines the unique challenges faced by stoma patients . The potential impact on daily life , fear of eating , and psychological repercussions are extensive for many people with a stoma . In a recent crosssectional Victorian study , 40 % of patients living with a stoma cited depressive symptoms , compared with only 6 % of the general population . Additionally , 9 % of respondents cited suicidal ideation , which is three times higher than the general Australian population .
Lack of consistent literature
While scoping the literature in this research area , I noted a need for more published articles . The nutritional guidelines published for managing HOSs display inconsistencies that merit attention . These inconsistencies lead to confusion and , conceivably , further stoma complications .
Current thinking and management of stoma output
While drug interventions exist to control output , they pose potential setbacks , including life-threatening bowel blockages . In contrast , a lowfibre dietary modification offers a simpler , more effective , and cost-saving approach in most cases , resulting in less bowel output and a more manageable condition . Addressing the common question of whether a low-fibre diet can still be healthy , I highlight the disparity in knowledge between general health recommendations of a high-fibre diet and the specific needs of stoma patients , an area that has so far been underresearched and under-represented .
Research approach
The study adopts an individualistic epistemology , integrating patients ' personal experiences and narratives to comprehend the meaning attached to the reduction of HOS and its implications for QoL . One of the many hats I wear apart from research , teaching , and private practice is as a Telehealth Nutritionist Advisor with over a decade of experience , providing insights into the challenges stoma patients face , emphasising the crucial role of dietary manipulation and education in enhancing their QoL .
For this research , I have both a personal and clinical history to draw upon , enabling me to highlight interactions with patients and a family member who encountered stoma dietary complications and QoL issues . The narrative approach I have chosen for the research aligns with social inquiry principles , emphasising the significance of storytelling in describing life experiences . This study provides mutual learning for all involved , where
30 | vol30 | no1 | JATMS