Construction and Evaluation of a Flipped Discharge Model for Stomates With Colorectal Cancer

March 5, 2026 updated by: Luo BaoJia, Sun Yat-sen University

Construction and Empirical Study of a "Flipped" Discharge Model for Colorectal Cancer Patients With Stoma Based on Response Transformation Theory Research

This multicenter randomized controlled trial aims to develop and evaluate the effectiveness of a "Flipped Discharge" intervention for colorectal cancer patients with a new intestinal stoma. Guided by the Response to Transition Theory, the model addresses the care gap during the vulnerable post-discharge period by shifting critical support from the hospital to the patient's home. Approximately 200 eligible patients will be randomized into either the intervention or standard care control group. The core "Flipped Discharge" intervention occurs on the third day post-discharge, delivered either as an in-home visit by a specialist stoma nurse (via an "Internet + Nursing Service" platform) or as an intensive, standardized video follow-up with mailed instructional materials. The study's primary outcome is the incidence of stoma-related complications. Secondary outcomes include quality of life, self-care ability, self-efficacy, stoma adaptation, discharge readiness, healthcare costs, and satisfaction. The trial will also explore the mechanisms by which the intervention affects patient outcomes, ultimately seeking to provide evidence for a feasible, patient-centered model to improve care continuity.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Not yet recruiting

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

This study aims to develop and test a "Flipped Discharge" model for colorectal cancer patients with an intestinal stoma (ostomy) based on the Response to Transition Theory. After stoma surgery, patients often face significant physical, psychological, and social challenges during the vulnerable early post-discharge period. Current care models, characterized by shorter hospital stays and limited follow-up support, may leave patients unprepared for self-care, potentially leading to complications, reduced quality of life, and increased hospital readmissions. The proposed "Flipped Discharge" model shifts essential post-discharge assessments and education from the hospital to the patient's home or via enhanced remote support, aiming to provide continuous, specialized care during this critical transition. In this multi-center study, approximately 200 eligible patients will be randomly assigned to either an intervention group receiving the "Flipped Discharge" protocol or a control group receiving standard care. The intervention includes early telephone follow-ups and a core intervention around the third day after discharge, delivered either through an in-home visit by a specialized stoma nurse within an established "Internet + Nursing Service" network or a standardized intensive video follow-up with mailed instructional materials for patients outside the service coverage area. The study will measure outcomes including stoma-related complications (primary outcome), patient quality of life, self-care ability, self-efficacy, adaptation to the stoma, readiness for discharge, healthcare costs, and satisfaction. The research also seeks to understand how factors like self-efficacy influence quality of life, with the ultimate goal of determining if this model is effective and feasible in improving care continuity and patient outcomes, thereby providing evidence for a new patient-centered care model suited to the current healthcare context.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Estimated)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
200

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact

The name and contact information for the person who can answer enrollment questions for a clinical study. Each location where the study is being conducted may also have a specific contact, who may be better able to answer those questions.

Study Locations

  • China
    • Guangdong
      • Guangzhou, Guangdong, China
        • Sun Yat-sen University Cancer Center
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  1. Pathologically diagnosed colorectal cancer patients undergoing their first radical surgery with either abdominoperineal resection (Miles) plus permanent colostomy or sphincter-preserving anterior resection (Dixon) plus temporary ileostomy.
  2. Aged 18 years or older.
  3. Possess at least elementary school education and are able to read, communicate, and understand questionnaire content. Voluntarily participate and provide written informed consent.
  4. Postoperative condition is stable without major complications, and patient is conscious.
  5. Meets standard hospital discharge criteria with normally functioning stoma.

Exclusion Criteria:

  1. History of psychiatric disorders or severe cognitive impairment.
  2. Diagnosis with other concurrent malignancies.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Supportive Care
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Experimental: Flipped Discharge Model Group
Participants receive the "Flipped Discharge" intervention based on Response to Transition Theory. This includes standardized post-discharge telephone follow-ups on days 1-2. The core intervention occurs around day 3 (±1 day), delivered either via an in-home visit by a certified stoma nurse through the hospital's "Internet + Nursing Service" platform or, for eligible patients outside the service area, a standardized intensive video follow-up (≥30 min) with a mailed stoma care kit. Additional telephone support is provided at 1 week. All interventions follow a central protocol and are conducted by trained, certified stoma care specialists.
Behavioral: Response to Transition Theory-based Flipped Discharge Model
This is a structured, multi-component continuing care intervention initiated after hospital discharge for colorectal cancer patients with an intestinal stoma. Based on the Response to Transition Theory, it aims to support patients' adaptation during the critical early post-discharge period. The core intervention is a standardized assessment and education session conducted around the third day post-discharge. This is delivered flexibly based on patient location: either an in-home visit by a certified enterostomal therapist via a hospital-approved "Internet + Nursing Service" platform, or a standardized, intensive video follow-up (≥30 minutes) coupled with a mailed stoma care kit for those outside the service area. The intervention is complemented by protocol-driven telephone follow-ups on days 1-2 and at 1 week to reinforce education, provide psychological support, and address individual concerns.
No Intervention: Standard Care Group
Participants receive routine post-discharge care and follow-up as per the current standard practice at their respective hospital centers. This typically includes conventional discharge education and scheduled follow-up contacts (e.g., phone calls) conducted by hospital staff according to local protocols, without the structured, early in-home or intensive video intervention provided to the intervention group.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Incidence of stoma and peristomal skin complications
Time Frame: From the initiation of the intervention (post-discharge) up to 1 month postoperatively, or as defined by the primary study endpoint period.
The occurrence of complications related to the intestinal stoma and the surrounding skin will be assessed using a standardized Stoma Complication Assessment Form. This form evaluates six major items: changes in peristomal skin, degree of stoma prolapse, presence of parastomal hernia, degree of stoma stenosis, degree of stoma retraction, and degree of stoma mucocutaneous separation. Each item has specific criteria and a scoring system, with a higher total score indicating a greater number and severity of complications.
From the initiation of the intervention (post-discharge) up to 1 month postoperatively, or as defined by the primary study endpoint period.

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Level of adaptation to the stoma
Time Frame: From the initiation of the intervention (post-discharge) up to 1 month postoperatively, or as defined by the primary study endpoint period.
Measured using the Chinese version of the Ostomy Adjustment Scale (OAS) . The scale consists of 34 items rated on a 6-point Likert scale, with total scores ranging from 34 to 204. A higher total score indicates better psychological and social adaptation to living with a stoma.
From the initiation of the intervention (post-discharge) up to 1 month postoperatively, or as defined by the primary study endpoint period.
Level of stoma-related self-efficacy
Time Frame: From the initiation of the intervention (post-discharge) up to 1 month postoperatively, or as defined by the primary study endpoint period.
Measured using the Chinese version of the Stoma Self-Efficacy Scale (SSES) . This 22-item scale assesses patients' confidence in managing their stoma (stoma efficacy) and in social situations (social self-efficacy) using a 5-point Likert scale. Total scores range from 22 to 110. A higher score indicates greater self-efficacy.
From the initiation of the intervention (post-discharge) up to 1 month postoperatively, or as defined by the primary study endpoint period.
Readiness for hospital discharge
Time Frame: Assessed at the core intervention point (approximately 3 days post-discharge).
Measured using the Chinese version of the Readiness for Hospital Discharge Scale (RHDS) . This 12-item scale assesses a patient's self-perceived preparedness for discharge across three dimensions: personal status, coping ability, and expected support. Each item is scored on a 0-10 scale, with total scores ranging from 0 to 120. A higher total score indicates better readiness for discharge.
Assessed at the core intervention point (approximately 3 days post-discharge).
Disease-specific quality of life
Time Frame: From the initiation of the intervention (post-discharge) up to 1 month postoperatively, or as defined by the primary study endpoint period.
Measured using the Chinese version of the Stoma Quality of Life Scale (Stoma-QOL-C) . This 20-item scale evaluates the impact of the stoma on various life domains over the past month across four dimensions (e.g., sleep, social relationships). Each item is scored on a 4-point Likert scale (1 = always, 4 = never), with total scores ranging from 20 to 80. A higher total score indicates better stoma-specific quality of life.
From the initiation of the intervention (post-discharge) up to 1 month postoperatively, or as defined by the primary study endpoint period.
Self-care ability for stoma management
Time Frame: From the initiation of the intervention (post-discharge) up to 1 month postoperatively, or as defined by the primary study endpoint period.
Measured using the Chinese version of the Stoma Self-Care Scale - Early Stage version (SSCS-early) . This 10-item scale specifically assesses a patient's skill in independently changing the stoma appliance. Each item is scored on a 5-point Likert scale (1 = very unskilled, 5 = very skilled), with total scores ranging from 10 to 50. A higher score indicates greater self-care ability.
From the initiation of the intervention (post-discharge) up to 1 month postoperatively, or as defined by the primary study endpoint period.
Length of Hospital Stay
Time Frame: From hospital admission for the index surgery through the follow-up period (e.g., 1 month postoperatively).
Measured as the average length of the index hospital admission in days.
From hospital admission for the index surgery through the follow-up period (e.g., 1 month postoperatively).
Healthcare Costs
Time Frame: From hospital admission for the index surgery through the follow-up period (e.g., 1 month postoperatively).
Includes total medical costs during the study period, covering Western and traditional Chinese medicine, stoma center fees, and supplies. Measured in RMB.
From hospital admission for the index surgery through the follow-up period (e.g., 1 month postoperatively).
Intervention Implementation Costs
Time Frame: From hospital admission for the index surgery through the follow-up period (e.g., 1 month postoperatively).
The direct costs of implementing the "Flipped Discharge" intervention (e.g., provider travel expenses, personnel time) will be quantified separately. Measured in RMB.
From hospital admission for the index surgery through the follow-up period (e.g., 1 month postoperatively).
Hospital Readmission Rate
Time Frame: From hospital admission for the index surgery through the follow-up period (e.g., 1 month postoperatively).
The rate of hospital readmission during the follow-up period. Measured as a percentage (%) .
From hospital admission for the index surgery through the follow-up period (e.g., 1 month postoperatively).
Patient Trust and Perceived Support
Time Frame: From the initiation of the intervention (post-discharge) up to 1 month postoperatively, or as defined by the primary study endpoint period.
Assessed using a self-developed questionnaire evaluating the nurse-patient relationship. The tool includes two subscales: Trust subscale: Scores range from X to Y, with higher scores indicating greater patient trust in the nurse-patient relationship. Support subscale: Scores range from X to Y, with higher scores indicating greater perceived support from the stoma nurse. Each item is rated on a Likert scale (e.g., 1 = not at all to 5 = completely), and subscale scores are calculated by summing the individual item scores.
From the initiation of the intervention (post-discharge) up to 1 month postoperatively, or as defined by the primary study endpoint period.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Sun Yat-sen University

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
March 10, 2026

Primary Completion (Estimated)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
December 30, 2027

Study Completion (Estimated)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
December 30, 2027

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
December 29, 2025

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
March 5, 2026

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
March 11, 2026

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
March 11, 2026

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
March 5, 2026

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
December 1, 2025

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • G2025-208-01
  • A2025001 (Other Grant/Funding Number: Guangdong Provincial Health Commission)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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