Colostomy and Its Impact on Adults

Introduction

Colostomy can be described as a surgical procedure that results in the bringing out of one end of the large intestine through an incision called a stoma that allows for the attachments or the pouch for faecal collection (Yilmaz et al 2017). This procedure is often associated with performed on patients with colorectal cancer and advanced bowel movement to ensure that faecal discharge is effectively removed out of the body. The outcome of the colostomy surgical operations results in either a temporary colostomy or a permanent colostomy. A temporary colostomy is a procedure where faecal discharge collected in the porch for a particular defined timeline after which, corrective surgery will be conducted to replace the colon and the patient resumes their normal life (Dabirian et al 2010). On the other hand, permanent colostomy operation can’t b rectified once the surgery has been performed ant the patient will be required to spend their entire life with the faecal pouch attached. Colostomy surgical procedure is common among adult patients and may have associated impacts following the surgical procedure (Hansen et Al 2016). Colostomy condition affects people of all ages through the study focused on adult patients. The stoma is also utilized when treating patients with diverticulitis, Crohn’s disease or following trauma in the abdomen (Anaraki et al 2012). There are three types of stoma including colostomy, ileostomy, and urostomy (Yilmaz et Al 2017). A colostomy is generally an incision in the colon area, while urostomy entails incision on the urinary tract of the patients. Ileostomy, on the other hand, is the incision on the small intestine which can be performed depending on the type of illness of the patient (Swan 2011). This dissertation examines the quality of life issues experienced by adults following colostomy surgical operations. To achieve this, ten studies mostly focused on primary research will be critically appraised and discussed concerning four key themes that will be identified to be common among the studies. An integrative literature review adopted in this study is crucial since it allows for the presentation of the data from different research findings that are relevant to the study and form part of the results of this study. Secondary research studies adopting integrative literature review benefits from a comprehensive and comparative results section where the key themes identified in the results section s discussed concerning the reference to the findings of other studies, including considerations for those seeking healthcare dissertation help. This will be followed by a recommendation of one key approach to the management of the issues identified in the results section.

The literature review methodology informed by Aveyard (2014)

A research methodology serves to provide a design and the approach adopted in conducting the research. Various aspects are covered in the literature methodology that details how the researcher tailored their research and sought to answer the research questions. This study is based on the following research question: What quality issues do adult patients experience following colostomy operation? This research study is designed to answer this question

Search strategy

The literature review is an integral and crucial part of the research. This study, being an integrative research review sought literature through an established framework. In this case, the literature was sourced using google and google scholar search engines which listed a host of similar research studies from which the researcher accessed articles from common scholarly work databases such as PubMed, science direct, springer and academia.edu

Inclusion and exclusion criteria

This study was conducted by narrowing the literature search to 10 articles. This was guided by an exclusion and inclusion criteria that relied upon by the researcher. The table below documents the inclusion and exclusion criteria adopted in the literature search

A critical appraisal of the ten articles was conducted based on the CASP criteria. CASP criteria is an approach for appraising scientific literature through answering fundamental questions that allow for the selection of the best quality work. The critical appraisal was crucial since the 10 articles independently presented a wide range of information and thus required sieving in order to compress the data into the four main themes as discussed in the results section.

Strengths and weaknesses of the studies

The findings and discussions of this paper are premised on secondary studies that have been selected. Understanding the strengths and weaknesses of these studies is crucial. As pointed out in the table above, the study by Hansen et al (2016) substantially identified the improvement in the bowel movement following a colostomy, though the study didn’t address the psychological impacts of colostomy on the patients. The study by Ciorogar et al (2016) managed to address both positive and negative impacts of colostomy on the life of the patients’ studies, though the scale of 5 ratings limited the patients and could not capture explanations of the patients about their rating. Patients could select a number even if it is incorrect. The study by Yilmaz et al (2017) is more succinct since it was approved by the scientific ethics committee, though the reading of sensitive questions of the questionnaire by the research assistant limited the participant’s ability to disclose sensitive information. The study by Fortes et al (2012) is based on a wide range of topical areas, though the study only selected a sample of 39 participants, which is too low. Krouse et al (2007) study focused on the questionnaire as a data collection tool. This allowed them to reach a wide number of participants but the questionnaire failed to capture more data especially the one not listed in the series of the questions. The approach adopted by Elfeki et al (2018) focuses on the perspectives of the patients and doctors regarding colostomy and it points out key differences among the perceptions, though the p-value was based on the rating that was guided by the list of questions in the questions limiting the perspectives of the participants to the questions structured by the researchers. The study by Silva et al (2018) is only focused on 125 participants and thus such a sample is too small to be representative to the entire population. The study conducted by Susanty and Rangki (2015) provides a comprehensive literature review of some primary based research studies and compares and contrasts the results from the primary research findings. This provides a wide, reliable view of the topic. The study conducted by Fucini et al (2008) monitored participants for 5 years after treatment with colostomy and thus the findings are congruent and coherent enough for inferences to be made from them. Finally, Pachler and Wille-Jogernsen (2012) secondary research presents significantly different results from the other 9 studies analysed by explaining that only 2 out of 14 studies reviewed supported the positive impact of colostomy on quality of life of the patients making their findings questionable.

Results

Quality of life among patients who have undergone postoperative surgery following the formation of colostomy has been discussed and assessed academic researches that have been conducted on the topic. These studies have sought to evaluate different aspects of life to determine whether there is any effect in the quality of life of the patients having undergone the surgery. This study examines the findings from 10 selected studies through a thematic analysis approach where 4 key themes have been identified and form the basis of the critical appraisal of the findings from this researches. Having analysed the 10 studies, the results in respects to quality of life of patients following colostomy surgery can be categorised into four themes: physical activity, psychological functioning, social wellbeing, and sexual functioning impacts.

Physical activity

Surgical procedures mainly involve incisions through the human skin to access the internal organs and tissues affected by the disease. From the analysis, it is quite clear that colostomy is performed due to the presence of a medical condition causing pain and discomfort to the patient. For instance, in the study conducted by Ciorogar et al 2016), the patients who underwent colostomy operations were grappling with different medical conditions. They report that out of 56 patients examined, 10 patients undergone stoma surgery as a palliative care procedure due to the advanced tumour stage (Ciogar et al. 2016). On the other hand, the study conducted by Hansen et al (2016) focused on the bowel function of patients with spinal cord injury following colostomy surgery. All the 10 studies utilized focus on one or more physical aspect that is linked to colostomy with most focusing on bowel movement and colorectal parts of the body. This paints a picture that colostomy operation is largely a physical procedure and like all the surgeries, physical pain is evident. However, following the colostomy surgery, the quality of life of the patients has been examined to establish whether the patient’s perception of life following colostomy is the same, or even better than they were before the surgery. From the analysis, it is evident that studies reported different results with some being more precise than other studies. Fortes et al (2012) conducted a descriptive cross-sectional study of 39 patients with colorectal cancer and reported that following a colostomy surgery, 50% of the patients with definitive colostomy and 76.9% of those with temporary colostomy reported that physical pain didn’t hinder them from performing their physical activities. Additionally, 53.8% and 53.85 of the patients with definitive and temporary colostomy respectively reported having sufficient energy while 80% and 84.6% of the patients with definitive and temporary colostomy respectively reported excellent moving capability (Fortes et al 2012). However, the results from Fucini et al (2008) study which compared the experience of patients with a permanent abdominal stoma following a colostomy surgery with the patients without a permanent abdominal stoma found out that patients without a permanent stoma had better scores of physical functioning (p= 0.0036). Krouse et al (2007) study results show that the scores on the quality of life between the participants interviewed corresponded with the global health status index in the aspect of physical functioning of the patients with a colostomy.

In their study, Elfeki et al (2018) examined the perceptions of the patients, practitioners and medical students of the stoma related problems and they compared the scores from the colostomy impact scores. In their findings, the authors reported that there were differences between the responses of the practitioners compared to those of the patients. Regardless of the differences, Elfeki et al (2018) explained that the patient’s scores were more accurate. Specifically, the authors reported overestimation of hard and lumpy spot consistency was the most underestimated while the embarrassing smell was the most overestimated. However, in the study by Ciorogar et al (2016) results reported on the scale of 5, skin irritation resulting from colostomy operation was rated at 4 in 5-day testing as well as after 9 months. In yet another study by Susanty and Rangki (2016), 73% of the colostomy patients reported skin problems following the colostomy surgery with common manifestation being irritation, dermatitis, and eczema. Furthermore, Susanty and Rangki (2016) explain that in a study involving 48 patients, 35 of them reported that there was no skin problem while 13 of them were detected by stoma nurses to have skin erosion. This implies that most of the study identified that the quality of life of the adults following colostomy operation is manifested in the physical aspect (Liuo and Qin 2014). Physical pains, skin irritations, and erosions are the common physical problems that patients with colostomy have to grapple with (Anaraki et al 2012).

Psychological functioning

This is another theme that was identified in the results of the studies examined. According to the study conducted by Silva et al (2018), while there were similarities in the scores of the participants against the global indicators of the quality of life (p=0.678), there are differences in the functional scale. Comparing patients with definitive and temporary colostomy, the researcher presents that patients with definitive colostomy have higher emotional and cognitive effects following colostomy surgery (Silva et al 2018). This result is supported by the study conducted by Krouse et al (2007). Findings from the study by Susanty and Rangki (2016), a secondary literature review of other primary studies relevant to the topic establishes that colostomy patients reported psychological issues such as special stress through anticipation of isolation, issues of low self-esteem and body image disturbances. Susanty and Rangki (2016) further explain that 25% of colostomy patients experience anxiety, depression and lack of self-confidence following the surgery. However, primary research conducted by Fortes et al (2012) presents results that are quite contrasting from those of Susanty and Rangki (2016) as well as Silva et al (2018). Fortes et al (2012) identify that in their descriptive cross-sectional study of 39 participants, 46.28% and 53.8% of definitive and temporary colostomy respectively reported that they had a good quality of life while 84.6% and 46.2% of definitive and temporary colostomy patients respectively reporting not to have enjoyed life that much. It appears to be affirming with other researchers, Fortes et al (2012) report that 84.6% of both definitive and temporary colostomy patients experienced bad humour, anxiety, depression, and despair. The psychological impacts of colostomy on the patients are supported by more studies. According to the study undertaken by Ciorogar et al (2016) which involved 53 patients, the median score of patients who reported to have experienced fear regarding pouch coming off and leakages were at 2 on the scale of 5 at 5 days after surgery but interviewed 9 months after the surgery, the median score rose to 3.

Psychological impacts experienced by colostomy patients vary in severity. For instance, the anxiety experienced by patients regarding the pouch coming off and leakages may be heightened in the public when the patient is in the home alone, or a hospital. On the other hand, depression occasioning from colostomy can be a serious complication and may require further medical attention.

Social functioning

The manifestation of the impacts of colostomy among patients is also evident in their social sphere of life. The 10 studies reviewed exhibited mixed results regarding the impact of colostomy on the social life of the patients. To begin with, Fortes et al (2012) report that from their study, 65.4% of the patients with definitive colostomy and 61.55 of those with temporary colostomy expressed that following the surgical operations, the patients needed little medical care in daily life. Furthermore, the authors explain that 61.5% and 69.25 of definitive and temporary colostomy respectively reported having feelings of security in their daily life. However, Fortes et al. (2012) reported that 73.1% and 76.9% of definitive and temporary colostomy patients remarked that they didn't have enough money to fulfill their needs. In another study, Krouse et al (2007) explained that colostomy scores of the social functioning of the patients were equivalent to the global health status and specific scores. Silva et al (2018) express that while there were differences in the results of patients with definitive colostomy against those with a temporary colostomy, the study found no significant differences in the social scales between these two categories. In what appears to be a deviation from the findings of the other research explained above, the study by Hansen et al (2016) which was conducted to patients with bowel movement problems and resulted in the patients undergoing colostomy, reported some positive news in the social aspect of the patients. The study reports that 9 participants reported that colostomy caused a positive impact on the social life of the patients (Hansen et al 2016). They cited instances that the patients reported having improved following colostomy surgery to correct bowel movement. These instances include ease of traveling, seeing and socializing with more people and saving time on bowel management. These appear to be the only cited positive effects of colostomy on the social life of bowel movement patients. Ciorogar et al (2016) reported that on the scale of 5, participants rated patient comfort following colostomy at a median value of 3 when interviewed at 5 days from discharge and after 9 months. However, this was concomitant with family support the participant reported to have received to help them manage the colostomy condition. Examined on the scale of 1-5, the participants' median score was 4 both at 5 days after discharge or at 9 months following their discharge from the hospital (Ciorogar et al 2016). The social life quality of the patients is affected following colostomy surgery, both negatively and positively. The social environment of the patient also had an impact on the quality of life experienced by the patients. Fortes et al (2012) explain that 57.7% and 53.8% of the respondents with definitive and temporary colostomy explained that they lived in a healthy environment while 80% of the patients with definitive colostomy and 61.5% of those with temporary colostomy reported being satisfied with the place they live.

Sexual life

The studies have also sought to examine the impact of colostomy on the sexual life of the patients and presented some crucial findings. The study by Fortes et al (2012) identified reported that colostomy had an impact on the sexual life of the patients. In their findings, 69.2% of the patients with definitive colostomy and 46.25 with temporary colostomy reported having dissatisfaction in sexual relations. Furthermore, 79.5% of both definitive and temporary colostomy patients reported to lack a steady partner and were afraid of starting a new relationship due to their condition (Fortes et al 2012). In the study conducted by Fucini (2008), the authors reported that patients without a stoma exhibited a better trend for sexual functioning and body image compared to those with a stoma. However, compared between male and female patients, the Fucini (2008) identified that sexual functioning problem was worse in males and females and attributed this to the perceived greater difficulty in carrying out the operation in male patients. Krouse et al (2007) additionally support the findings of other researchers by explaining that colostomy patients had low sexual functioning ability compared to normal patients. A study conducted by Susanty and Rangky (2016) reports that patients depicted concerns of sexual functioning following a colostomy and were afraid of sexual activity. The study by Yilmaz et al (2018) further identified that patients with colostomy had low sex images with both male participants having low sexual desire and performance. However, a secondary review study conducted by Pachler and Wille-Jorgensen (2012) found that colostomy surgery had little impact on the Quality of life of the patients and this was supported by 14 studies they reviewed while only 2 found that a stoma slightly affected the patient’s quality of life.

Implementation of findings

The problem of colostomy has impacts on the patients ranging from physical, social, psychological as well as sexual. The results discussed above depict a picture of the wide range of the effect that colostomy has on the life of the patients. These aspects affect the quality of life of the patients and some may have serious medical complications. For instance, depression has been identified as one of the psychological impacts of the colostomy on the patient and thus the persistence of the condition may result in the need for seeking medical attention to manage the condition (Krouse et al 2009). Bearing in mind that, as the results above have established, some of the patients reported difficulties in financing their needs, the depression will be an additional financial burden on the patients. From the studies above, it is clear that the quality of life of adult patients with a colostomy is generally low compared to the normal and healthy counterparts, there social, physical, psychological and sexual impacts discussed above point to the need to effectively manage the condition. Therefore, patient-centred care is an ideal model for improving the quality of life of colostomy patients (Selby et al 2018). Patient-centred care, also known as person-centred care is an approach in healthcare delivery that emphasized value-based and individualized care of the patients depending on their needs (Delaney 2018). This approach in healthcare has been poised as an effective approach with promising results if we'll implement it. In this approach, nurses and medical practitioners are obliged to accord quality healthcare that integrates all the aspects of the patient's health and well-being. Additionally, the proponents of person-centred care are premised on core principles to enhance the effectiveness and quality service delivery. These principles are respect to human dignity, observance of the right of the patients and evidence-based healthcare (Delaney 2018).

Person-centred care can be applied to several colostomy management practices. For instance, through patient-centred care, patients will be assessed based on their manifested impacts which will equally be managed through the best available approach. Patients exhibiting psychological aspects such as anxiety and depression may be accorded counselling alongside the medications to manage and ease their colostomy postoperative pains (Selby et al 2018). Patient-based care emphasized that healthcare practitioners build a partnership with the family and the carers of the patients (Selby et al 2018). Adults experiencing postoperative colostomy often have their family members or are taken care of by carers hired to manage their condition and help them with performing chores at home. From the results above, the family support has been associated with improved quality of life of the patients with a colostomy. Equally, patient-centred care emphasized the collaboration between the healthcare providers, the family members and the patient to ensure that the patient's needs are effectively addressed (Faury et al 2017). The presence and role of the family motivate the patients to view life positively and their help will generally boost the quality of life of the patients (Faury et al 2017). However, to ensure that the family members are providing the necessary and tailored care, the health practitioners should be involved to educate the family on caring for the patient with a colostomy, since most of them do not have an idea of effectively caring for patients with this condition (Swan 2011). Postoperative care should be accorded to patients with a colostomy. Patient-centred care has been associated with positive impacts on the health of the patients (Delaney 2018). Pain is associated with surgeries with physical pain being more manifest. Skin rashes and irritations, for instance, have been pointed out to be common among the patients with colostomy following surgery. Patient-centred care seeks to enhance the quality of life of the patients by emphasizing on the continuous monitoring of the patients and tracking their response and any reactions to the medications accorded to the patients (Javarajah & Samarasekara 2017). This enhances the holistic wellbeing of the patients. Therefore, much as this approach may have limitations such as straining the healthcare providers in cases where one provider has to manage many patients, it presents promising outcomes and can be reliably used to enhance the quality of life of the patients (Selby et al 2018). Issues like the decline in the sexual activity among the patients with colostomy, patient-centred care will enhance the recovery of the patients by suggesting and integrating services from counselling practitioners who would also play a crucial role in the recovery of the patient (Badwin et al 2008). However, the main barriers to the implementation of patient-centred care are the strains on the healthcare resources since the model emphasized individualized care to the patients, the health providers may have difficulties offering care to many patients (Delaney 2018). Additionally, patient-centred care is more labour intensive emphasizing personal encounters and interactions between the patient and health practitioners (Jansen et al 2010). In the modern world where technology is increasingly being used, patient-centred seems to contradict with the trend.

The implementation of patient-centred care follows a model where colostomy patients are identified and accorded individualized care. The healthcare provider can establish communication with the family members of the patient to obtain regular updates of the performance of the patient to medication (Carlsson et al 2010). This will allow the healthcare provider to be in constant contact with the patients. The healthcare provider should then contact the needs assessment of the patient and accord care and medication depending on the needs of the patients. The family members, on the other hand, supports the healthcare providers in the implementation of patient-centred care. This is the ideal way of implementation of patient-centred care.

Conclusion

Colostomy condition has been evaluated by studies to arise from different illnesses such as cancer prompting incisions to be done on patients to aid them in effective excretion. Incisions made in the large intestines have been referred to as colostomy. In this study, it can be identified that there are mixed findings regarding the effect of colostomy on the quality of life of the patients. While some studies have pointed out that colostomy has some positive impacts, others have identified some negative impacts associated with a colostomy. In yet another, there are insignificant differences in the quality of life reported among patients following colostomy operations. By and large, the key aspects where the debate of the impacts of the quality of life issues can be focused are categorised under four themes which as physical, psychological, social and sexual functioning. More results analysed above found that following the colostomy surgery, patients generally have a low quality of life in all the four aspects, though the study conducted by Pachler and Wille-Jorgensen (2018) strongly disputes these findings. An effective care should be accorded to patients with colostomy, following their operations and this study has proposed the patient-centred care, one of the approaches considered to be effective in delivering quality healthcare to be applied in the care and management of these patients in order to resolve the quality of life issues that may be affecting them.

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