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Psychosocial adaptation to stoma surgery: A review

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Abstract

During the last decade strong improvements have been made in the medical care of patients with a digestive tract stoma, particularly with regard to nursing skills and to the quality of collecting material for faecal products. Scientific investigation into the psychosocial adjustment of patients after stoma surgery has intensified as well, giving us indications for quality of life. These developments induced a review of the actual state of affairs in psychological issues. After evaluating the results of psychosocial stoma research, it can be concluded that the technical improvements in stoma care during the past decade did not result in a decline in psychosocial problems after stoma surgery. However, there are some serious problems when interpreting the results of studies in this field of investigation. Stoma surgery is not per se solely responsible for the reported psychosocial problems, first, because many conclusions are based on research studies with poor design and, second, because these studies lack a theoretical framework within which the process of psychosocial adjustment has been measured and explained. This review assesses the most current developments and controversies in this field.

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References

  • Burnham, W. R., Lennard-Jones, J. E., and Brooke, B. N. (1977). Sexual problems among married ileostomists.Gut 18: 673–677.

    PubMed  Google Scholar 

  • Devlin, H. B., Plant, J. A., and Griffin, M. (1971). Aftermath of surgery for anorectal cancer.BMJ 3: 413–418.

    PubMed  Google Scholar 

  • Dlin, B. M., Perlman, A., and Ringold, E. (1969). Psychosexual response to ileostomy and colostomy.Am. J. Psychiatry 126: 374–381.

    PubMed  Google Scholar 

  • Druss, R. G., O'Connor, J. F., Prudden, J. F., and Stern, L. O. (1968). Psychological response to colectomy.Arch. Gen. Psychiatry 18: 53–59.

    PubMed  Google Scholar 

  • Druss, R. G., O'Connor, J. F., and Stern, L. O. (1969). Psychological response to colectomy. II. Adjustment to permanent colostomy.Arch. Gen. Psychiatry 20: 419–427.

    PubMed  Google Scholar 

  • Dukes, C. E. (1947). Management of permanent colostomy.Lancet 2: 12–14.

    Google Scholar 

  • Dyk, R. B., and Sutherland, A. M. (1956). Adaptation of the spouse and other family members to the colostomy patient.Cancer 9: 123–138.

    PubMed  Google Scholar 

  • Eyskens, E., Feenstra, L., Meinders, A. E., and Vandenbroucke, J. P. (1991).Codex Medicus, Elsevier Koninklijke PNBA, pp. 245–246.

  • Follick, M. J., Smith, T. W., and Turk, D. C. (1984). Psychosocial adjustment following ostomy.Health Psychol. 3: 505–517.

    PubMed  Google Scholar 

  • Foulis, W. F., and Mayberry, J. F. (1990). Elderly ileostomists and their social problems.J. Clin. Gastroenterol. 12, 276–278.

    PubMed  Google Scholar 

  • Gutman, H., and Reiss, R. (1985). Postoperative course and rehabilitation achievements of colostomates.Dis. Colon Rectum 28: 777–781.

    PubMed  Google Scholar 

  • Hengeveld, M. W. (1987). Stoma en seks: sexuele problemen na proctocolectomie of rectum-extirpatie.Ned. Tijdschr. Geneeskd. 131: 1254–1255.

    PubMed  Google Scholar 

  • Keltikangas-Järvinen, L. (1989). “Psychosomatic personality” — A personality constellation or an illness-related reaction?Br. J. Med. Psychol. 62: 325–331.

    PubMed  Google Scholar 

  • Keltikangas-Järvinen, L. and Järvinen, H. J. (1987). Psychosocial adaptation to ileostomy: A study after construction of conventional and continent stomies.Scand. J. Gastroenterol. 22: 202–206.

    PubMed  Google Scholar 

  • Keltikangas-Järvinen, L., Loven, E., and Möller, C. (1984). Psychic factors determining the long-term adaptation of colostomy and ileostomy patients.Psychother. Psychosom. 41: 153–159.

    PubMed  Google Scholar 

  • Köhler, L. W., Pemberton, J. H., Zinsmeister, A. R., and Kelly, K. A. (1991). Quality of life after proctocolectomy. A comparison of Brooke ileostomy, Kock-pouch and ileal pouch-anal anastomosis.Gastroenterology 101: 679–684.

    PubMed  Google Scholar 

  • La Monica, G., Audisio, R. A., Tamburine, M., Filberti, A., and Ventafridda, V. (1985). Incidence of sexual dysfunction in male patients treated surgically for rectal malignancy.Dis. Colon Rectum 28: 937–940.

    PubMed  Google Scholar 

  • MacDonald, L. D., and Anderson, H. R. (1984). Stigma in patients with rectal cancer: a community study.J. Epidemiol. Commun. Health 38: 284–290.

    Google Scholar 

  • MacDonald, L. D., and Anderson, H. R. (1985). The health of rectal cancer patients in the community.Eur. J. Surg. Oncol. 11: 235–241.

    PubMed  Google Scholar 

  • McLeod, R. S., Lavery, L. C., Leatherman, J. R., Maryland, P. A., Fazio, V. W., Jagelman, D. G., and Weakley, F. L. (1986). Factors affecting quality of life with a conventional ileostomy.World J. Surg. 10: 474–480.

    PubMed  Google Scholar 

  • McLeod, R. S., Churchill, D. N., Lock, A. M., Vanderburgh, S., and Cohen, Z. (1991). Quality of life of patients with ulcerative colitis preoperatively and postoperatively.Gastroenterology 101: 1307–1313.

    PubMed  Google Scholar 

  • Oades-Souther, D., and Olbrisch, M. E. (1984). Psychological adjustment to ostomy surgeryRehab. Psychol. 29: 221–237.

    Google Scholar 

  • Oberst, M. T., and Scott, D. W. (1988). Postdischarge distress in surgically treated cancer patients and their spouses.Res. Nurs. Health 11: 223–233.

    PubMed  Google Scholar 

  • O'Hara, M. W., Ghoneim, M. M., Hinrichs, J. V., Mehta, M. P., and Wright, E. J. (1989) Psychological consequences of surgery.Psychosom. Med. 51: 356–370.

    PubMed  Google Scholar 

  • Pemberton, J. H., Phillips, S. F., Ready, R. R., Zinsmeister, A. R., and Beahrs, O. H. (1989). Quality of life after Brooke ileostomy and ileal pouch-anal anastomosis.Ann. Surg. 209: 620–626.

    PubMed  Google Scholar 

  • Roy, P. H., Sauer, W. G., Beahrs, O. H., and Farrow, G. M. (1970). Experience with ileostomies: Evaluation of long-term rehabilitation in 497 patients.Am J. Surg. 119: 77–86.

    PubMed  Google Scholar 

  • Sjödahl, R., Lemon, E., Nyström, P., and Oleison, G. (1990). Complications, surgical revision and quality of life with conventional and continent ileostomy.Acta Chir. Scand. 156: 403–407.

    PubMed  Google Scholar 

  • Skarsgard, E. D., Atkinson, K. G., Bell, G. A., Pezim, M. E., Seal, A. M., and Sharp, F. R. (1989). Function and quality of life results for chronic ulcerative colitis and familial polyposis.Am. J. Surg. 157: 467–471.

    PubMed  Google Scholar 

  • Slors, J. F. M., Taat, C. W., and Brummelkamp, W. H. (1990). De ileo-anale anastomose met ileum-reservoir.Ned. Tijdschr. Geneeskd. 1334, 134:337.

    Google Scholar 

  • Sprangers, M. A. G. (1988).Response Shift and the Retrospective Test: On the Usefulness of Retrospective Pretest-Posttest Designs in Detecting Training Related Response Shifts, Instituut voor Onderzoek van het Onderwijs, SVO, 's-Gravenhage.

    Google Scholar 

  • Sutherland, A. M., Orbach, C. E., Dyk, R. B., and Bard, M. (1952). The psychological impact of cancer and cancer surgery. I. Adaptation to dry colostomy; preliminary report and summary of findings.Cancer 5: 857–872.

    PubMed  Google Scholar 

  • Thomas, C., Madden, F., and Jehu, D. (1984). Psychosocial morbidity in the first three months following stoma surgery.J. Psychosom. Res. 28: 251–257.

    PubMed  Google Scholar 

  • Thomas, C., Madden, F., and Jehu, D. (1987a). Psychological effects of stomas. I. Psychosocial morbidity one year after surgery.J. Psychosom. Res. 31: 311–316.

    PubMed  Google Scholar 

  • Thomas, C., Madden, F., and Jehu, D. (1987b). Psychological effects of stomas. II. Factors influencing outcome.J. Psychosom. Res. 31: 317–322.

    PubMed  Google Scholar 

  • Thomas, C., Turner, P., and Madden, F. (1988). Coping and outcome of stoma-surgery.J. Psychosom. Res. 32: 457–467.

    PubMed  Google Scholar 

  • United Ostomy Association (1985). Annual Report.

  • van der Wiel, H. B. M., Weijmar Schultz, W. C. M., Hengeveld, M. W., and Staneke, A. (1991). Sexual functioning after ostomy surgery.Sex. Mar. Ther. 6: 195–209.

    Google Scholar 

  • Wade, B. E. (1990). Colostomy patients: Psychological adjustment at 10 weeks and 1 year after surgery in districts which employed stoma-care nurses and districts which did not.J. Adv. Nurs. 15: 1297–1304.

    PubMed  Google Scholar 

  • Watts, J. M., de Dombal, F. T., and Goligher, J. C. (1966). Long-term complications and prognosis following major surgery for ulcerative colitis.Br. J. Surg. 53: 1014–1023.

    PubMed  Google Scholar 

  • Whates, P. D., and Irving, M. (1984). Return to work following ileostomy.Br. J. Surg. 71: 619–622.

    PubMed  Google Scholar 

  • Williams, N. S., and Johnston, D. (1983). The quality of life after rectal excision for low rectal cancer.Br. J. Surg. 70: 460–462.

    PubMed  Google Scholar 

  • Wirsching, M., Drüner, H. U., and Herrmann, G. (1975). Results of psychosocial adjustment to long-term colostomy.Psychother. 26: 245–256.

    Google Scholar 

  • Wyke, R. J., Edwards, F. C., and Allan, R. N. (1988). Employment problems and prospects for patients with inflammatory bowel disease.Gut 29: 1229–1235.

    PubMed  Google Scholar 

Download references

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This study was made possible by the financial support of Glaxo Nederlands, B. V., and Convatec-Squibb, B. V., The Netherlands.

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Bekkers, M.J.T.M., van Knippenberg, F.C.E., van den Borne, H.W. et al. Psychosocial adaptation to stoma surgery: A review. J Behav Med 18, 1–31 (1995). https://doi.org/10.1007/BF01857702

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