OBJECTIVES: There is little research regarding the cost effectiveness of ostomy pouching systems. There is also limited evidence regarding the patient preferences of these devices. The aim was to investigate the patient preferences of individual characteristics of ostomy pouching systems. The aim was also to rank these characteristics based on patient preferences. METHODS: All ostomy pouching systems, within the Swedish reimbursement system, were documented and their individual characteristics (i.e. properties of the filter, base plate and pouch material etc) identified both for closed-end and open-end bags. The significance of the identified characteristics was validated by a group of stoma nurses and experts. A pilot test of the interview guide for the focus group interviews were also held, resulting in small changes of the guide. Stoma nurses at nine different clinics in in different areas of Sweden consecutively asked stoma patients to participate. Patients were included if they gave oral and written consent, had a colostomy or ileostomy for at least one year. The patients were requested, together with the other participants in the focus group, to rank these individual characteristics of the ostomy pouching systems. RESULTS: In total, 53 patients were included in the nine focus groups performed (one from each of the nine participating clinics). The top ranked patient preferences regarding closed-end bags were that the filter should reduce smell and should not leak but also that the base plate has good adhesive properties as well as being skin friendly. The top ranked patient preferences regarding open-end bags were also that the filter should reduce smell and should not leak. The bag should be easy to empty but also that the base plate has good adhesive properties as well as being skin friendly. CONCLUSIONS: The top-ranked patient preferences were mainly characteristics regarding the filter and base plate.