title: Symptom distress and self-care strategies of colorectal cancer patients with diarrhea up to 3 months after surgery.
abstract: BACKGROUND
  Diarrhea is common after colorectal surgery, but its severity and self-care methods have not been examined in depth.
  
  
  OBJECTIVE
  To understand changes in and factors influencing diarrhea distress and self-care strategies of patients 1 week and 1, 2, and 3 months after colorectal cancer surgery.
  
  
  METHODS
  For this descriptive, longitudinal study, 35 cancer patients were recruited from a teaching hospital in northern Taiwan. Data were collected in structured, one-on-one interviews at 1 week and 1, 2, and 3 months after surgery. Variance and effects of diarrhea distress and number of self-care strategies were analyzed by repeated-measures analysis of variance and generalized estimating equation. Effectiveness scores for self-care strategies were analyzed by Wilcoxon signed rank test.
  
  
  RESULTS
  Participants' overall level of diarrhea symptom distress was low. Distress level was highest 1 week after surgery, but gradually decreased thereafter. Over time after surgery, patients' frequency of using self-care strategies did not differ, but self-care strategies changed. Dietary modification and exercise were rated as the most effective strategies. Self-care information for hospitalized patients was primarily provided by medical personnel. The major factor affecting diarrhea distress was defecation frequency, and the major factors affecting self-care strategies were age, cancer stage, defecation frequency, and diarrhea distress.
  
  
  CONCLUSIONS
  Diarrhea distress level gradually decreased, and self-care strategies changed with time after colorectal cancer surgery.
  
  
  CONCLUSIONS
  Because health care personnel were the primary source of self-care information for hospitalized patients after colorectal cancer surgery, nurses should use these findings to provide supportive treatment and educate patients and their family members about the cause and severity of diarrhea. Such education should include treatment-induced adverse effects as the basis for treating diarrhea.
authors.affiliation: Department of Nursing, Chang Gung Memorial Hospital at Linkou, Taiwan.
authors.forename: Li-Hui
authors.initials: LH
authors.lastname: Pan
authors.forename: Yun-Fang
authors.initials: YF
authors.lastname: Tsai
authors.forename: Mei-Ling
authors.initials: ML
authors.lastname: Chen
authors.forename: Reiping
authors.initials: R
authors.lastname: Tang
authors.forename: Chee-Jen
authors.initials: CJ
authors.lastname: Chang
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000451:nursing* / Q000523:psychology*; D015897:Comorbidity; D003967:Diarrhea / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011788:Quality of Life / Q000523:psychology*; D012648:Self Care / Q000523:psychology* / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000453:epidemiology / Q000523:psychology*; D013624:Taiwan