Psychological attitude to self-appraisal of stoma patients: prospective observation of stoma duration effect to self-appraisal

Caregiver Burden in Bladder Cancer Patients with Urinary Diversion Post-Radical Cystectomy and the Need for Comprehensive Nursing Education: A Narrative Literature

Background

Bladder cancer ranks seventh in global cancer prevalence. Radical cystectomy and urinary diversion are standard for muscle-invasive bladder cancer. Family caregivers shoulder a substantial care burden, affecting their own quality of life, with repercussions extending to patients' health-related quality of life (HRQOL).

Objective

This narrative review aims to highlight the major concerns perceived by the caregivers and efficacy of nurse-led interventions in alleviating their concerns and improving HRQOL.

Methods

A systematic search of the PubMed, CINAHL, and Science Direct databases was carried out to identify studies published in the last 5 years (from Jan 2018 to Aug 2023) that have evaluated the concerns and problems of caregivers attending bladder cancer patients with urinary diversion. Additionally, studies evaluating the efficacy of nurse-led interventions in alleviating these concerns were also searched.

Results

Overall, 6 studies involving 933 BC patients with UD and 1042 caregivers were identified as suitable for inclusion in this narrative literature review. Major concerns identified included psychological well-being, medical assistance needs, and peer support. Significant psychological impact was evident in the caregivers which operated in a dyadic manner. Nurse-led stoma education programs have demonstrated potential in enhancing caregivers' quality of life, although they remain restricted.

Conclusion

Emphasizing caregivers' role and program effectiveness is critical. Our review addresses these gaps, focusing on caregivers' concerns and the impact of nursing education for improved patient outcomes.

Implications for Practice

Holistic and collaborative approach could enhance the overall well-being and quality of life of bladder cancer patients and their caregivers.

Long-term incidence of depression in rectal cancer patients with or without stoma: a population-based cohort study

Purpose

Significant improvements have been made in the surgical treatment of rectal cancer with a higher sphincter-saving rate without compromising oncologic results. There have been studies about the quality of life of rectal cancer patients after surgery. However, no study has reported the long-term annual incidence of depression after rectal cancer surgery according to stoma status. The objective of this study was to determine the annual incidence of depression after rectal cancer surgery and the factors affecting it, especially the prevalence of depression according to the presence or duration of a stoma.

Methods

Using the Korea National Health Insurance Service database, patients who underwent radical surgery for rectal cancer from 2002 to 2019 were searched. We analyzed the incidence and risk factors of depression in patients who underwent radical surgery for rectal cancer according to stoma status.

Results

Annual incidence of depression in rectal cancer patients was decreasing annually for 15 years after surgery. There was no statistically significant difference in the incidence of depression according to the stoma status. However, the diagnosis of depression within 1 year after surgery was statistically significantly increased in the permanent stoma group.

Conclusion

There was no difference in the overall incidence of depressive disorders among patients with rectal cancer based on their stoma status. However, a permanent stoma seems to increase the incidence in the first year after surgery. Education and intensive assessments of depressive disorders in patients with permanent stoma within 1 year after surgery are needed, particularly for female patients who are under 50 years old.

Depression after stoma surgery: a systematic review and meta-analysis

BACKGROUND

Depression is the leading cause of global disability and can develop following the change in body image and functional capacity associated with stoma surgery. However, reported prevalence across the literature is unknown. Accordingly, we performed a systematic review and meta-analysis aiming to characterise depressive symptoms after stoma surgery and potential predictive factors.

METHODS

PubMed/MEDLINE, Embase, CINAHL and Cochrane Library were searched from respective database inception to 6 March 2023 for studies reporting rates of depressive symptoms after stoma surgery. Risk of bias was assessed using the Downs and Black checklist for non-randomised studies of interventions (NRSIs), and Cochrane RoB2 tool for randomised controlled trials (RCTs). Meta-analysis incorporated meta-regressions and a random-effects model.

REGISTRATION

PROSPERO, CRD42021262345.

RESULTS

From 5,742 records, 68 studies were included. According to Downs and Black checklist, the 65 NRSIs were of low to moderate methodological quality. According to Cochrane RoB2, the three RCTs ranged from low risk of bias to some concerns of bias. Thirty-eight studies reported rates of depressive symptoms after stoma surgery as a proportion of the respective study populations, and from these, the median rate across all timepoints was 42.9% 42.9% (IQR: 24.2-58.9%). Pooled scores for respective validated depression measures (Hospital Anxiety and Depression Score (HADS), Beck Depression Inventory (BDI), and Patient Health Questionnaire-9 (PHQ-9)) across studies reporting those scores were below clinical thresholds for major depressive disorder according to severity criteria of the respective scores. In the three studies that used the HADS to compare non-stoma versus stoma surgical populations, depressive symptoms were 58% less frequent in non-stoma populations. Region (Asia-Pacific; Europe; Middle East/Africa; North America) was significantly associated with postoperative depressive symptoms (p = 0.002), whereas age (p = 0.592) and sex (p = 0.069) were not.

CONCLUSIONS

Depressive symptoms occur in almost half of stoma surgery patients, which is higher than the general population, and many inflammatory bowel disease and colorectal cancer populations outlined in the literature. However, validated measures suggest this is mostly at a level of clinical severity below major depressive disorder. Stoma patient outcomes and postoperative psychosocial adjustment may be enhanced by increased psychological evaluation and care in the perioperative period.

The lived experience of colorectal cancer patients with a temporary ileostomy and the patient's perception of the ostomy nurses' educational interventions

PURPOSE

This study is aimed at exploring the lived experiences of colorectal cancer patients regarding temporary ileostomy and the educational interventions of ostomy nurses.

METHODS

This study is conducted using Heideggerian phenomenological focus group. Focus group interviews were conducted from November 2021 to February 2022 using a semi-structured guide with nine colorectal cancer patients having a temporary ileostomy. The interview data were analyzed using latent content analysis RESULTS: Four main categories and 13 sub-categories are identified as the result of data analysis. Main categories were "colorectal cancer and ileostomy: patient's adaptation," "supporting resources for the patient with ileostomy," "ileostomy closure: hope and concerns," and "ostomy nurse's professionalism." The main categories reflect the shared experiences and perceptions of colorectal cancer patients, across the timeline from colorectal cancer diagnosis to ileostomy closure.

CONCLUSION

This study provides a timely response to a pilot project for recognizing ostomy nurse's education for patients with stomas. Also, the findings of this study contribute to nursing knowledge by providing patients' perspectives on the education provided to them by the ostomy nurse. Lastly, this study inspires future studies to evaluate and recognize ostomy nurse's practice by using various methodological approaches.

Enhanced Nursing Care for Improving the Self-Efficacy & Health-Related Quality of Life in Patients with a Urostomy

Background

Bladder cancer is the most predominant cancer of the lower urinary tract and is the most common cause for urostomy or urinary diversion. Urostomy immensely affect the patient's everyday life from minor physical activity to social relations. Nurse-led interventions have been evaluated for improvement in quality of life in patients with urostomy.

Objective

The main objective of this study was to review the medical literature in a systematic way to evaluate the nursing role in improving the health-related quality of life of patients undergoing urostomy.

Methods

A systematic search of the PubMed, CINAHL, Embase, and Science Direct databases was carried out to identify studies that have evaluated the effect of nurse-led intervention on the self-efficacy and health-related quality of life in patients with urostomy. In addition, studies for factor affecting the quality of life were also investigated.

Results

Overall, 10 studies were identified as suitable for inclusion in this review. Health-related quality of life was lower in these patients as compared to population norms and several factors such as age, employment, and living status were identified as the contributing factors. Preoperative education was critical in meeting the psychological needs while postoperative intervention was instrumental in improving the self-efficacy and health-related quality of life particularly when a continued nursing-patient interaction was existent.

Conclusion

A comprehensive nurse-led intervention consisting of preoperative and postoperative components aimed at ostomy-related education, psychological counseling and compliant with patient factors is feasible and may result in greater improvement in self-efficacy and health-related quality of life in patients with urostomy. Larger clinical trials are warranted to validate these results.

The prevalence of anxiety and depression in patients with ostomy: A systematic review and meta-analysis

AIM

The prevalence of anxiety and depression in patients with ostomy is reported differently. The aim of this systematic review and meta-analysis is to estimate the global prevalence of anxiety and depression in patients with ostomy.

METHOD

A systematic search of Embase, Proquest, Scopus, PubMed and Web of Science (ISI) databases was conducted from January 1990 up to 5 May 2021. A total of 3392 records were retrieved and 18 studies were ultimately included. Two reviewers independently assessed full-text of articles according to predefined criteria. A random-effects model was used to estimate the prevalence of anxiety and depression and I² index was used to assess the heterogeneity of the studies. Subgroup analysis and mea-regression were conducted to explore potential sources of heterogeneity. The review protocol is registered in PROSPERO and is available online. Data analysis was performed using R software version 4.3.1.

RESULTS

In this study, the pooled prevalence of anxiety was 47.60% (95% CI, 29.94-65.26) and the pooled prevalence of depression was 38.86% (95% CI, 29.29-48.43). The subgroup analysis showed the prevalence of anxiety and depression in different regions was not significantly different (p = 0.854, p = 0.143 respectively). Nevertheless, the highest and lowest prevalence of anxiety were in Asia and the America 51.79% and 32.69%, respectively and the highest and lowest prevalence depression were in Asia with 49.80% and Europe with 26.77%, respectively.

CONCLUSION

The finding of this study showed the global prevalence of anxiety and depression in patients with ostomy is high. Therefore, all health care providers who deal with these patients should use appropriate psychological strategies, techniques and interventions to reduce anxiety and depression in these patients.

Urinary undiversion by conversion of the incontinent ileovesicostomy to augmentation ileocystoplasty in spinal cord injured patients

Context: Spinal cord injury (SCI) patients with neurogenic bladder and the inability to self-catheterize may require incontinent diversion to provide low-pressure drainage while avoiding the use of indwelling catheters. We demonstrate that in patients with significant functional improvement, the ileovesicostomy can be a reversible form of diversion, with simultaneous bladder augmentation using the same segment of ileum utilized for the ileovesicostomy. Multidisciplinary management should be utilized to assure mastery of intermittent catheterization before urinary undiversion. This technique allows for transition to a regimen of intermittent self-catheterization with excellent functional and urodynamic outcomes.Design: Case Series.Setting: Tertiary care hospital, Philadelphia, Pennsylvania.Participants: Three individuals with an SCI.Interventions: Conversion of bladder management from an incontinent ileovesicostomy to an augmentation ileocystoplasty, with intermittent catheterization.Outcome Measures: Ability to regain urinary continence with preservation of renal function as determined by serum creatinine and renal ultrasound.Results: Three SCI patients who had an incontinent ileovesicostomy developed sufficient functional improvement to intermittently self-catheterize reliably and underwent conversion of ileovesicostomy to ileocystoplasty. For each, the ileovesicostomy channel was taken down and detubularized, then used to create an ileal patch for augmentation ileocystoplasty. Intermittent catheterization was then used for periodic bladder drainage. All achieved large capacity, low-pressure bladders with complete continence and stable creatinine.Conclusion: In motivated SCI patients, it is possible to regain continence by converting the ileovesicostomy into augmentation ileocystoplasty, avoiding the disadvantages of a urostomy. A multidisciplinary collaborative approach facilitates the optimal rehabilitation of SCI individuals.

Clinical efficacy of nutritional diet therapy on gestational diabetes mellitus

OBJECTIVE

To analyze the clinical effect of nutritional diet therapy on gestational diabetes mellitus (GDM).

METHODS

One hundred pregnant women with GDM who were admitted to Ji'nan Central Hospital were enrolled in this study. The patients were divided into an observation group (received individualized nutrition nursing, n=50) and a control group (received routine nursing, n=50).

RESULTS

The total incidence of postpartum complications in the control group was 28.00%, which was significantly higher than 8.00% in the observation group (χ2=4.500, P=0.034). After nursing, the amniotic fluid index in the observation group increased significantly as compared with the control group (P<0.001). The nursing satisfaction rate of the observation group was higher than that of the control group. The difference was statistically significant (t=14.324, P<0.001). The health condition of newborns in the observation group was better than that in the control group (χ2=4.762, P=0.029). After intervention, the level of blood glucose of women in the observation group was better than that of the control group (P<0.05).

CONCLUSION

Nutritional diet therapy for pregnant women with GDM can help to reduce complications, control blood sugar, and improve the neonatal outcome. It is also conducive to the postpartum rehabilitation of pregnant women. It is worthy of clinical application and promotion.

Effect of high-quality nursing service in the delivery room on puerperae and newborns

OBJECTIVE

To analyze the effect of high-quality nursing service in the delivery room on puerperae and newborns.

METHODS

Clinical data of 100 puerperae who came to our hospital for delivery were analyzed in this retrospective study. The puerperae were divided into an observation group (50 cases) and a control group (50 cases) according to the nursing model they received. The observation group was given high-quality nursing, and the control group was given routine nursing. The levels of blood glucose and blood pressure, scores of Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS), delivery mode, nursing satisfaction and perinatal health status were recorded and compared.

RESULTS

After childbirth, the SAS and SDS scores in the observation group were significantly lower than those in the control group (both P<0.05). The amniotic fluid index of the observation group was increased significantly (P<0.001). The total nursing satisfaction of the observation group was higher than that of the control group (t=14.324, P<0.001). The health status of neonates in the observation group was better than that in the control group (χ2=4.762, P=0.029). After intervention, the levels of blood glucose and blood pressure in the observation group were lower than those in the control group (both P<0.05).

CONCLUSION

High-quality nursing for puerperae in the delivery room improves their negative psychological emotions, which is of significance for delivery and nursing work.

Disgust and Its Effect on Quality of Life and Adjustment to Stoma in Individuals with Ileostomy and Colostomy

AIM

This study aims to determine the effect of disgust sensitivity on the quality of life of patients with ileostomy and colostomy, and their adaptation to stoma.

METHODS

This study has a cross-sectional and correlational design. The sample consists of 167 patients being treated in a state hospital and a private foundation hospital, who meet the research inclusion criteria. The Patient Information Form, Disgust Sensitivity Scale, Ostomy Adjustment Inventory, and Ostomy Quality of Life Scale (OQLS) are used for data collection. Descriptive statistics, oneway analysis of variance (ANOVA), t-test, and correlation analysis are used in data analysis.

RESULTS

Of the 86% of the participants diagnosed with cancer, 60% had undergone ileostomy and 40% had undergone a colostomy; 46% of the patients declared that they were capable of handling their own stoma care and 53% stated that they felt self-efficient about care. Participants who were female (88.55 ± 23.17), single (88.40 ± 20.98), or university graduates (93.34 ± 22.92) had higher disgust sensitivity scores. The study found no significant correlation between disgust sensitivity, quality of life, and stoma adjustment scores (p > .05).

CONCLUSION

The findings proved believe that recognizing the disgust sensitivity will help meet the physical and psychological needs of stoma patients and understand their quality of life and adjustment to stoma. This will help in guiding both patients and healthcare workers, and lead clinical studies.

Physical activity interventions for disease-related physical and mental health during and following treatment in people with non-advanced colorectal cancer

BACKGROUND

Colorectal cancer is the third most commonly diagnosed cancer worldwide. A diagnosis of colorectal cancer and subsequent treatment can adversely affect an individuals physical and mental health. Benefits of physical activity interventions in alleviating treatment side effects have been demonstrated in other cancer populations. Given that regular physical activity can decrease the risk of colorectal cancer, and cardiovascular fitness is a strong predictor of all-cause and cancer mortality risk, physical activity interventions may have a role to play in the colorectal cancer control continuum. Evidence of the efficacy of physical activity interventions in this population remains unclear.

OBJECTIVES

To assess the effectiveness and safety of physical activity interventions on the disease-related physical and mental health of individuals diagnosed with non-advanced colorectal cancer, staged as T1-4 N0-2 M0, treated surgically or with neoadjuvant or adjuvant therapy (i.e. chemotherapy, radiotherapy or chemoradiotherapy), or both.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 6), along with OVID MEDLINE, six other databases and four trial registries with no language or date restrictions. We screened reference lists of relevant publications and handsearched meeting abstracts and conference proceedings of relevant organisations for additional relevant studies. All searches were completed between 6 June and 14 June 2019.

SELECTION CRITERIA

We included randomised control trials (RCTs) and cluster-RCTs comparing physical activity interventions, to usual care or no physical activity intervention in adults with non-advanced colorectal cancer.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected studies, performed the data extraction, assessed the risk of bias and rated the quality of the studies using GRADE criteria. We pooled data for meta-analyses by length of follow-up, reported as mean differences (MDs) or standardised mean differences (SMDs) using random-effects wherever possible, or the fixed-effect model, where appropriate. If a meta-analysis was not possible, we synthesised studies narratively.

MAIN RESULTS

We identified 16 RCTs, involving 992 participants; 524 were allocated to a physical activity intervention group and 468 to a usual care control group. The mean age of participants ranged between 51 and 69 years. Ten studies included participants who had finished active treatment, two studies included participants who were receiving active treatment, two studies included both those receiving and finished active treatment. It was unclear whether participants were receiving or finished treatment in two studies. Type, setting and duration of physical activity intervention varied between trials. Three studies opted for supervised interventions, five for home-based self-directed interventions and seven studies opted for a combination of supervised and self-directed programmes. One study did not report the intervention setting. The most common intervention duration was 12 weeks (7 studies). Type of physical activity included walking, cycling, resistance exercise, yoga and core stabilisation exercise. Most of the uncertainty in judging study bias came from a lack of clarity around allocation concealment and blinding of outcome assessors. Blinding of participants and personnel was not possible. The quality of the evidence ranged from very low to moderate overall. We did not pool physical function results at immediate-term follow-up due to considerable variation in results and inconsistency of direction of effect. We are uncertain whether physical activity interventions improve physical function compared with usual care. We found no evidence of effect of physical activity interventions compared to usual care on disease-related mental health (anxiety: SMD -0.11, 95% confidence interval (CI) -0.40 to 0.18; 4 studies, 198 participants; I2 = 0%; and depression: SMD -0.21, 95% CI -0.50 to 0.08; 4 studies, 198 participants; I2 = 0%; moderate-quality evidence) at short- or medium-term follow-up. Seven studies reported on adverse events. We did not pool adverse events due to inconsistency in reporting and measurement. We found no evidence of serious adverse events in the intervention or usual care groups. Minor adverse events, such as neck, back and muscle pain were most commonly reported. No studies reported on overall survival or recurrence-free survival and no studies assessed outcomes at long-term follow-up We found evidence of positive effects of physical activity interventions on the aerobic fitness component of physical fitness (SMD 0.82, 95% CI 0.34 to 1.29; 7 studies, 295; I2 = 68%; low-quality evidence), cancer-related fatigue (MD 2.16, 95% CI 0.18 to 4.15; 6 studies, 230 participants; I2 = 18%; low-quality evidence) and health-related quality of life (SMD 0.36, 95% CI 0.10 to 0.62; 6 studies, 230 participants; I2 = 0%; moderate-quality evidence) at immediate-term follow-up. These positive effects were also observed at short-term follow-up but not medium-term follow-up. Only three studies reported medium-term follow-up for cancer-related fatigue and health-related quality of life.

AUTHORS' CONCLUSIONS

The findings of this review should be interpreted with caution due to the low number of studies included and the quality of the evidence. We are uncertain whether physical activity interventions improve physical function. Physical activity interventions may have no effect on disease-related mental health. Physical activity interventions may be beneficial for aerobic fitness, cancer-related fatigue and health-related quality of life up to six months follow-up. Where reported, adverse events were generally minor. Adequately powered RCTs of high methodological quality with longer-term follow-up are required to assess the effect of physical activity interventions on the disease-related physical and mental health and on survival of people with non-advanced colorectal cancer. Adverse events should be adequately reported.

Processo de transição para vivência com estomias intestinais de eliminação: repercussões na imagem corporal

Objetivo: Conhecer o processo de transição e adaptação para a vivência com estomia intestinal de eliminação. Métodos: estudo misto, descritivo-exploratório, realizado entre maio e julho de 2018 por meio de entrevista semiestruturada e aplicação da escala de imagem corporal com 13 pessoas com estomia, no retorno pós-operatório em um hospital federal no sul do país. A análise dos dados deu-se por categorias temáticas e análise descritiva simples. Resultados: os dados apontaram paridade entre os sexos, idade média de 60,5 anos, maioria casada, com baixo grau de instrução e afastada das atividades laborais. Causas principais geradoras do estomia foram as neoplasias, as estomias com mais de seis meses e as temporárias. As complicações mais identificadas foram prolapso de alça intestinal e dermatites. As mudanças mais significativas ocorreram no padrão alimentar, vestuário, comportamento social e reflexos na imagem corporal. A subescala corpo pré-mórbido teve média de 22,23 pontos e a subescala corpo mórbido teve média de 15,15 pontos. Conclusão: A condição de ser uma pessoa com estomia acarreta impacto na maneira como o indivíduo vê seu corpo. Ressalta-se a importância de que os indivíduos com risco de má adaptação sejam identificados e abordados o mais precocemente possível.

Distúrbio na imagem corporal: diagnóstico de enfermagem e características definidoras em pessoas ostomizadas

Objetivo: identificar en la literatura las características definidoras del diagnóstico de enfermería disturbio en la imagen corporal en estudios desarrollados con personas ostomizadas. Métodos: se trata de una investigación bibliográfica, en la modalidad revisión integradora de la literatura, descriptiva y con enfoque cualitativo, realizada en noviembre del 2015, en las bases de datos Literatura Latinoamericana y del Caribe en Ciencias de la Salud, Medical Literature Analysis and Retrieval System Online, Índice Bibliográfico Español de Ciencias de la Salud, PubMed Central, Cumulative Index to Nursing and Allied Health Literature, Web of Science y SciVerse Scopus. El análisis se llevó a cabo por medio de consulta a la taxonomía NANDA-I, con la que se buscó identificar las características definidoras del diagnóstico en cuestión. Resultados: la muestra fue de 43 publicaciones, en las que se identificaron 14 de las 37 características definidoras que componen el diagnóstico estudiado. Conclusiones: los estudios señalan relaciones entre el disturbio en la imagen corporal y alteraciones en la sexualidad, restricciones sociales, cambios en el estilo de vida y calidad de vida.

The mediating role of resilience in the relationship between social support and posttraumatic growth among colorectal cancer survivors with permanent intestinal ostomies: A structural equation model analysis

PURPOSE

Information on posttraumatic growth (PTG) among colorectal cancer (CRC) survivors with permanent intestinal ostomies is limited. The aim of this cross-sectional study was to investigate the occurrence of PTG among CRC survivors with permanent intestinal ostomies and its association with perceived social support and resilience.

METHODS

This study was conducted with 164 CRC survivors with permanent intestinal ostomies at least one month after surgery. Participants completed questionnaires assessing socio-demographic and clinical characteristics, perceived social support, resilience and PTG.

RESULTS

The mean total score on the Post Traumatic Growth Inventory was 66.74 (SD = 13.99). Perceived social support (r = 0.450) and resilience (r = 0.545) were significantly positively correlated with PTG. Structural equation modeling analysis showed that resilience mediated the relationship between perceived social support and PTG in which the indirect effect of perceived social support on PTG through resilience was 0.203 (P < 0.001).

CONCLUSIONS

Moderate to high PTG was found in CRC survivors with permanent intestinal ostomies. The most important implication of this study was that improving social support and resilience might be scientific intervention strategies for promoting PTG among CRC survivors.

Psychological Adaptation to Alteration of Body Image among Stoma Patients: A Descriptive Study

BACKGROUND

Creation of an ostomy leads to significant change in the body image of the patient. However, adaptation to this alteration of body image is necessary for rehabilitation following surgery. The objective of this study was to identify the factors that influence adaptation to altered body image.

MATERIALS AND METHODS

An analytical cross-sectional study was conducted among 41 ostomy patients who were treated at a single tertiary care unit. Body image disturbance questionnaire (BIDQ) was used to assess the perception of body image. Data were analyzed using independent samples t-test (unpaired), Chi-square test, and Spearman's correlation.

RESULTS

In our study, the mean BIDQ score was 2.22 (standard deviation ± 0.88). The body image disturbance was significantly associated with younger age (P < 0.05). The prevalence of body image disturbance was significantly higher among overweight patients (P < 0.05). Males had a higher BIDQ score than females. Those who had temporary stoma had significantly higher BIDQ score (P < 0.05). Those who felt depressed or had thoughts of self-harm soon after surgery had significantly high body image disturbance score (P < 0.05). There was a significant negative correlation with the perception of self-efficacy and body image disturbance (P < 0.01). There was no significant association between body image disturbance and the diagnosis, type of surgery, or time duration after surgery.

CONCLUSIONS

Poor adaptation to alteration of body image was associated with younger age, overweight, and temporary stoma. Individuals at risk of poor adaptation should be identified before surgery and counseled before surgery, after surgery, and during follow-up visits.