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

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