Psychological issues affecting patients living with a stoma
Stoma surgery is an intrusive operation, with outcomes that can impact seriously on daily life, not just in the immediate postoperative and recovery period, but for the rest of the patient's life. There are changes in bodily function, altered body image, physicality and personal care needs. These changes require acceptance and adaptation and can necessitate a re-ordering of daily life, socially, emotionally and in terms of work. Assessing the patient's needs through the trajectory of diagnosis, surgery and a stoma, is not just important during the treatment phase but needs to continue throughout the lifespan. Traditionally, patient outcome measures after bowel surgery have included overall self-efficacy, checking for stoma complications, clinical health status, function and psychological status. However, over the past three decades there has been increasing recognition that quality of life (QoL), which is now regarded as a key measurement, needs further consideration. Patients report difficulties when explaining to health professionals the challenges they face, and their reactions as they try to make the adjustments to their new normal of life with a stoma. This article examines stoma patients' perceptions of their outcomes from recent research. It discusses how more can be done by health professionals to support stoma patients through their initial transition to life with a stoma and for the rest of their life.
For all patients, regardless of diagnosis, treatment and outcomes, the impact of the changes and experiences that accompany the onset of illness can be frightening and challenging. Although treatment may address the original medical problems, the outcomes can include short-, medium- and long-term health issues. In addition, where major surgery such as stoma formation is needed, the physical changes can also be accompanied by psychological problems that are hard to resolve. Indeed, evidence suggests that more than 20% of stoma patients experience long-term significant psychological challenges and concerns that, unrecognised, can affect and impact not only the patient, but also their family, friends and work situation (Notter and Chalmers, 2012; Black 2018).
It is impossible to separate the psychological and physical self from who we are and what we do. Our daily activities of work, play, family and friends are perceived through our actions and interactions, with our bodies being integral elements in everything we do, including our relationships with others. Fundamentally implicated in all lived experiences, any action that impinges on or affects the mind and body affects individuals' lives. When medical help is sought and the diagnosis results in surgery, and individuals change their roles to become patients, they have to face the reality of the outcome of what may be radical and/or major surgery.
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