Bladder cancer is a common malignancy of the urinary system, which occurs mostly in elderly men, and the incidence is increasing year by year (1). According, novel diagnosis tool has been developed to make better diagnosis and decision. For example, growing evidence has shown that liquid biopsy biomarkers, such as assays of DNA methylation and mutations, protein-based assays, specific mRNA, and even non-coding RNAs, are of great value for the diagnosis and choice of the urinary diversion (2). Also, novel imaging technologies, such as Vesical Imaging-Reporting and Data System, has been developed and exhibit excellent advantage in detection of muscle invasive bladder cancer and thus influence the clinical choice for surgery (3). To data, radical cystectomy following bilateral ureteral abdominal wall stoma has considered to be one of the main treatment options for patients with bladder cancer (4). These patients need to wear an ostomy bag for the rest of life, which not only changed the patient’s self-image, but also cause a serious burden on the patient’s psychology, physiology, and economy after the operation (5). For instance, in addition to changes in the urination method, the patient’s unfamiliar and difficult ways to replace the ostomy bag will cause great psychological pressure on the patient.

Readiness for discharge mainly refers to the ability of medical staff to provide patients with a comprehensive psychological, physical, and social assessment, and to further recover after the patient leaves the hospital and returns to the family and society (6). At this stage, the patient still faces a long recovery time after being discharged from the hospital and returning to the family and society. Many factors have been reported to affect readiness for hospital discharge in patients. For example, Qian et al. reported that total score of the QDTS, residence and educational level were the major influencing factors for readiness for hospital discharge in patients discharged with tubes (7). Similarly, another study showed that high education level, employment and the content-received dimension of QDTS favored participants’ readiness for hospital discharge (8).

Notably, another survey found that patients’ readiness for hospital discharge was lower in larger units and medical units but was greater in those with higher nurses’ experience, better patient self-reported health, higher patient ratings of self-care teaching and symptom management teaching in patients undergoing surgery (9). However, factors that affect discharge readiness of patients with bilateral ureteral stoma after radical cystectomy remain largely unknown.

This present study sought to explore the status of patients’ readiness for discharge and analyze relevant influencing factors. Our study will help to clarify the current problems and thereby grasp the requirements for treatment and rehabilitation after discharge.

The total RHDS score of patients with bilateral ureterostomy after radical resection of bladder cancer was (72.54 ± 18.37), which was at a medium level, and there was a large room for improvement. It may be related to the characteristics of the patient’s disease. Patients need to wear an ostomy bag for life after surgery, and the physiological structure changes cause great psychological pressure on patients. In addition, most patients have insufficient knowledge of the disease, surgery and stoma, and the long-term rehabilitation effect is poor, which will have a negative impact on the patient’s discharge readiness (13). Further analysis was made on the scores of all dimensions of patients’ discharge readiness, among which the score of personal state dimension after standardized score was the lowest (1.47 ± 1.53). The analysis may be attributed to the fact that under the concept of quick health, the length of hospital stay of patients was significantly shortened, and some patients met the discharge indicators but did not fully recover. Discharge at this time would increase the pressure of discharge of patients. Therefore, nursing staff should do a good job in the discharge evaluation of planned discharged patients, especially those with poor discharge readiness, to further reduce the readmission rate of patients and improve the discharge readiness of patients (14, 15).

QDTS are widely used to evaluate whether patients perceive the teaching ability of nursing and thereby verify the discharge education skills of the nurses, which was demonstrated to have high reliability with modification to Chinese version (16, 17). Herein, we adopted QDTS to evaluate the level of pre-discharge education. Interestingly, QDTS was positively associated with RHDS, indicating the important role of nursing skills and pre-discharge education in enhancing readiness of discharge.

Multiple linear regression analysis showed that discharge destination was the main factor influencing the discharge readiness of patients with bilateral ureterostomy after radical resection of bladder cancer (p < 0.05). Returning home directly after discharge indicates that patients have a good recovery condition and have family members or partners to take care of them, which can significantly improve patients’ sense of security and recovery confidence (8). However, patients transferred to rehabilitation institutions predict more complications, poor prognosis, relatively complex follow-up treatment for patients, prone to anxiety, tension, and other adverse emotions, reducing the patient’s discharge readiness. For such patients, palliative care services can be provided. Patients can first transition to rehabilitation centers or community hospitals and other institutions to improve the quality of care, and then realize the smooth transition from institutions to families, reducing the incidence of complications on the basis of reducing medical costs (9).

The results of multiple linear regression analysis showed that the way of care was the main factor affecting the readiness for discharge of patients with bilateral ureterostomy after radical bladder cancer surgery (p < 0.05). Patients living alone are relatively poorly prepared for discharge. Analysis of the reasons shows that because bladder cancer is high in the elderly, most of the spouses are retired, and they can provide life care and companionship for patients, and emergency situations can be dealt with and help in time, and patients have a relatively higher sense of safety when discharged from the hospital (18). Patients living alone have poor self-care ability, cannot fully grasp the method of ostomy bag replacement and stoma care methods in the short term, encounter emergencies or difficulties in life, cannot get help and support from family members, and the patient’s sense of security is relatively low. Some patients cared for by their children, due to their fast-paced life and busy work, are unable to provide patients with long-term companionship, and most patients are prone to guilt and are unwilling to trouble their children, leading to relatively poor readiness for discharge from the hospital (19).

Multiple linear regression analysis showed that age was the main factor influencing the discharge readiness of patients with bilateral ureterostomy after radical resection of bladder cancer (p < 0.05). With the increase of age, the body function of patients gradually decreases, hearing and vision are significantly reduced, more basic diseases are prone to occur, and the self-care ability of patients is relatively poor (20). Moreover, most elderly patients have relatively low acceptance of health knowledge and are difficult to master knowledge and skills such as pocket replacement operation and self-ostomy nursing in a short period of time, and do not recognize the self-care ability after discharge. In addition, older patients tend not to actively express their own needs and concerns, resulting in nursing staff unable to carry out specific discharge guidance according to the actual needs of patients, patients’ needs cannot be met, resulting in patients’ lack of coping skills and confidence for possible complications in the future, and relatively high discharge pressure. Nursing staff can ensure the continuity and coordination of care through effective nursing plans such as discharge education, health follow-up and drug guidance, and improve the patient’s discharge readiness (21).

However, certain limitations should be addressed, including single center team setting. Moreover, our analysis is based on retrospective data that could not be well-controlled.

Anyhow, our present study provides data for understanding the readiness status of patients with bilateral ureteral abdominal wall stoma after radical bladder cancer.

In summary, the readiness for discharge of patients with bilateral ureteral abdominal wall stoma after radical bladder cancer surgery is at a moderate level, and there is a lot of room for improvement. Nursing staff should strengthen the guidance and care of patients’ discharge preparations to reduce the incidence of postoperative complications and the rate of readmission.