Exploration of health status, illness perceptions, coping strategies, and psychological morbidity in stoma patients. J Wound Ostomy Continence Nurs. 2014;41:573-580. [PMID: 25377108 DOI: 10.1097/WON.0000000000000073]

Living with and without an intestinal stoma: Factors that promote psychological well-being and self-care: A cross-sectional study

AIMS

This study compared those living with and without an intestinal stoma in relation to physical and psychological health, stress and coping, quality of life and resilience. Also, identifying factors that could be used to promote better self-care in stoma patients in the future.

DESIGN

A cross-sectional and comparative study design was employed.

METHODS

Participants were recruited via email and social media (Facebook and Twitter) between August 2018 and March 2019, to complete an online survey. The data were analysed using analysis of variance to examine group difference and a series of hierarchical linear regression analyses determining predictors of psychological well-being.

RESULTS

Of 278 participants aged 18-68 years who completed the survey, 129 (46%) had a stoma and reported significantly poorer physical health. Approximately one-fifth experienced problems with stoma management. Psychological well-being was mediated by the duration of living with a stoma (under 3 years) and frequency of leaks (weekly and monthly).

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 influence of stigma and disability acceptance on psychosocial adaptation in patients with stoma: A multicenter cross-sectional study

Background

The stoma can cause serious physical and psychological distress to the patient, leading to an inability to live a normal life; although it effectively improves the 5-year survival rate of patients.

Objective

The purpose of this study is to explore the status of stigma and disability acceptance of patients with stoma and their influences on psychosocial adaptation.

Design

A multicenter cross-sectional study.

Methods

A total of 259 patients with stoma in 6 hospitals from southeast China were enrolled. And this research adhered to the STROBE guideline and approved by the Ethics Committee of Fu Jian Provincial Hospital. The ostomy adjustment inventory-20、acceptance of disability scale and social impact scale were used to collect data. The hypothetical path model was tested using the SPSS version 22.0 software and AMOS version 26.0 software.

Results

Stigma, disability acceptance and psychosocial adaptation was associated. The sense of stigma was severe (72.76 ± 12.73), the acceptance of disability was medium (179.24 ± 32.29) and the psychosocial adaptation was poor (38.06 ± 8.76). Also, the hypothesis model of this study fitted the data well (AGFI = 0.967>0.08; χ ²/df = 1.723, p = 0.08 > 0.05), and the results showed that disability acceptance positively affected psychosocial adaptation; while stigma negatively affected psychosocial adaptation, and disability acceptance mediated between stigma and psychosocial adaptation (p < 0.01).

Conclusion

The stigma and disability acceptance of patients with stoma are serious problems that are closely related to their psychosocial adaptation. Medical staff should take some interventions based on different paths to reduce stoma patients' stigma and guide them to improve disability acceptance, thus to improve the level of psychosocial adaptation of patients with stoma.

Assessment of the Difficulties Experienced by Individuals with Intestinal Stomas: A Qualitative Study

OBJECTIVE

The aim of this study was to assess the difficulties faced by individuals with intestinal stomas.

METHODS

The authors used a qualitative descriptive phenomenologic design. The study population comprised individuals with intestinal stoma living in Eskişehir who were 18 years or older and did not have any mental, physical, and communication disorders. Criterion sampling and snowball sampling methods were used. Data were collected from June to September 2019 through a questionnaire of personal characteristics as well as a semistructured interview. Data on personal characteristics were analyzed in numbers and percentages, and qualitative data were analyzed using the MAXQDA 2020 program (VERBI Software, Berlin, Germany).

RESULTS

The study data were evaluated under two headings: (1) themes created using the Roy's Adaptation Model and (2) other themes. In the themes created using the Roy's Adaptation Model, difficulties related to the physiologic adaptation mode and interdependence adaptation mode were observed, whereas among other themes, difficulties due to lack of information and economic worries were commonly reported.

CONCLUSIONS

Most individuals experienced sleep pattern disturbances; faced issues in their relationships with family and friends due to physiologic and psychological distress; received no training for stoma care, diet, or sexual life; could not cope with issues related to the stoma; and faced financial difficulties in procuring stoma bags and care products.

Life with a stoma-coping with daily life: Experiences from focus group interviews

AIMS AND OBJECTIVES

To describe patients' experiences of coping with daily life practically and emotionally during the first years after stoma surgery.

BACKGROUND

For people with a stoma, a new life awaits with altered bowel function and body image. This means a profound change in a person's life.

DESIGN

A qualitative descriptive design using focus group interviews to gain an understanding of patients' experiences of coping with daily life. This study followed the COREQ checklist for reporting qualitative research.

METHOD

Six focus groups including 21 patients with a stoma experience of 1-3 years. Mean age was 65 (23-79) and comprised 9 men and 12 women. Thirteen participants had a colostomy, 8 had an ileostomy. The interviews were analysed with a qualitative content analysis.

RESULTS

Patients lived with uncertainty due to lost control over bowel function and did not feel comfortable with the new body. They had adjusted to the new life with a positive impact, by changing their attitude, enabling a social- and working life and tried to take control over the situation. Patients with a temporary stoma put life on hold.

CONCLUSION

Patients with a stoma lived with uncertainty, not trusting their body like before. They strived to regain control of their lives according to their own resources and conditions and with support from healthcare professionals. Interacting with others in similar situations and exchanging experiences, in demanding areas such as body image, sexuality and social activities could support patients in coping with their new life with a stoma.

RELEVANCE TO CLINICAL PRACTICE

The findings can help stoma care nurses and healthcare professionals plan themed lectures and group discussions for patients regarding coping with areas that are especially demanding. A themed evening would give patients the chance to share and exchange experiences and receive affirmation from others in the same situation.

Factors Associated With Quality of Life Among People Living With a Stoma in Nonmetropolitan Areas

Background

Interruption of gastrointestinal continuity through surgical formation of a stoma can be lifesaving. However, it is also typically associated with reduced quality of life (QoL). Although past research has investigated QoL among people living with a stoma, no known studies have investigated stoma-related QoL, specifically among nonmetropolitan residents who may experience distinct health issues compared with their metropolitan counterparts.

Objectives

The aim of the study was to investigate the level of and factors associated with QoL among people living with a stoma in nonmetropolitan Australia.

Methods

In a cross-sectional survey, 678 adults with colostomy, ileostomy, and/or urostomy and with membership in a regional Victorian stoma association were given the City of Hope Quality of Life Questionnaire for a Patient With an Ostomy (QOL-O). Total QoL score was calculated and described before categorization into quintiles. Patient factors associated with quintiles of QoL were assessed using univariable and multivariable proportional odds ordinal logistic regression, with a 95% confidence interval excluding 1.00 denoting statistical significance.

Results

Overall, 311 regional ostomy association members (46%) responded to any QOL-O questions; 285 members responded to >80% of QOL-O questions and contributed data to the study. Their median age was 73 years, and 60% were male. The median total QoL score was 6.9 on a scale of 0–10, where a higher number indicates better QoL. Factors independently associated with better QoL in the multivariable model were working full/part time, no poststoma clothing change, poststoma sexual activity, and older age. Factors independently associated with worse QoL were poststoma depression and a stoma location issue.

Discussion

People living with a stoma in nonmetropolitan Australia reported moderate-to-high QoL. Better QoL was identified in those who worked, had no poststoma clothing change, were sexually active poststoma, and were older. Worse QoL was seen in those who had poststoma depression and stoma location issues. Healthcare providers could influence stoma-related QoL by identifying risk factors and tailoring interventions toward individuals in nonmetropolitan settings.

Coping Processes of Patients with Ostomies in South Korea: A Focus Group Study

Despite the adverse effects of negative coping after receiving a stoma, there is a lack of information on how patients cope with ostomies and on their families' experiences throughout the coping process. We aimed to explore the coping experiences of individuals with ostomies throughout their illness, applying the Corbin and Strauss Chronic Illness Trajectory Framework, using exploratory qualitative methods involving focus group interviews. Purposive sampling was utilized to recruit 19 participants (split across three groups) through an ostomy association in South Korea. Two focus group interviews were separately conducted from March through to May 2017 until data saturation was achieved. Using qualitative content analysis, we analyzed the transcribed interviews and identified words and themes to interpret the results. The coping experiences of patients with ostomies were expressed through three interrelated themes: struggling and suffering, learning how to live with ostomy, and living with ostomy. We found gender differences in spousal support and a struggle among older patients regarding social coping. The themes identified suggest that gender should be considered when designing interventions to help patients cope with ostomies.

Systematic review: Pelvic floor muscle training for functional bowel symptoms in inflammatory bowel disease

BACKGROUND AND AIM

Large bowel functional symptoms are common in patients with inflammatory bowel disease (IBD) who are in disease remission. The efficacy of pelvic floor muscle training for symptoms of evacuation difficulty or fecal incontinence is well established in patients without organic bowel disease but is unknown in these patients. This study aimed to systematically evaluate the published evidence in this group of patients.

METHODS

A systematic review was conducted of articles evaluating pelvic floor muscle training, with or without biofeedback, to improve bowel function in patients with quiescent IBD, including those with an ileoanal pouch. The outcome of interest was improved bowel function measured by bowel diary, patient report, or validated questionnaire in randomized controlled studies, cohort studies, or case series.

RESULTS

Two randomized controlled trials, four retrospective case series, and one prospective study met eligibility criteria. Pelvic floor muscle training for patients with quiescent IBD improved symptoms in 51 of 76 (68%) patients with evacuation difficulty and 20 of 25 (80%) patients with fecal incontinence. Pelvic floor muscle training for patients with an ileoanal pouch, prior to stoma closure, did not appear to reduce the risk or severity of fecal incontinence following stoma closure. Studies were limited by small numbers, study design, methodological quality, and lack of long-term follow-up.

CONCLUSION

Pelvic floor muscle training appears to be of therapeutic value in some patients with quiescent IBD and evacuation difficulty or fecal incontinence. The effectiveness of this approach warrants further investigation.

Perceptions of illness as predictive factors for perceived stress in patients participating in a cardiac rehabilitation program

Psychosocial risk factors, such as perceived stress, not only increase the risk of cardiovascular disease, but also act as barriers for treatment adherence and cardiac rehabilitation. In this study, we examined the predictive role of perceptions for illness to perceived stress in Iranian patients participating in a cardiac rehabilitation program. A cross-sectional study was conducted in 2017 to determine correlations of demographic variables and domains of illness perception with perceived stress, and to develop a predictive model for perceived stress. In total, 150 patients with cardiovascular disease, who were admitted to a cardiac rehabilitation center, completed the questionnaires. (i) demographic and health-related characteristics; (ii) the Perceived Stress Scale-14; and (iii) the Brief Illness Perception Questionnaire. The mean perceived stress was 16.2 (8.4), and five illness perception subscales - timeline, personal control, treatment control, understanding and emotional response - were associated with increased perceived stress. Variables in the multi-variate predictive model accounted for 48% of the total variance in perceived stress. The results demonstrated the value of assessing and managing the patients' perceptions of illness to reduce their perceived stress, which could support adherence to cardiac rehabilitation programs.

Ileostomy versus fecal diversion device to protect anastomosis after rectal surgery: a randomized clinical trial

PURPOSE

Patients with rectal anastomosis commonly experience various ileostomy-related complications. This study aimed to elucidate the usefulness of a fecal diversion device (FDD) as an alternative to ileostomy for protecting rectal anastomosis.

METHODS

Patients with rectal anastomosis were randomly assigned to the ileostomy and FDD groups except in cases of emergency surgery. The primary endpoint was the clinical safety and effectiveness of FDD. The mean operation time, delay of diet advancement, length of hospital stay, FDD and stoma durations, and anastomotic leakage (AL) management methods were compared.

RESULTS

A total of 54 patients were enrolled in this study. No cases of mortality occurred. Overall morbidity was similar between groups (P = 0.551). Six patients (22.2%) in the FDD group and nine (29.0%) in the stoma group (P = 0.555) had AL. The mean total hospital stay was 16.4 ± 6.7 and 23.4 ± 8.7 days in the FDD and stoma groups, respectively (P = 0.002). The mean total hospital cost was 12,726.8 ± 3422.8 USD and 17,954.9 ± 9040.3 USD in the FDD and stoma groups, respectively (P = 0.008). The mean FDD and stoma durations were 21.6 ± 6.1 days and 114.9 ± 41.3 days, respectively (P < 0.0001).

CONCLUSIONS

This study demonstrated FDD safety and effectiveness. We identified the possibility of FDD as an alternative technique to conventional stoma procedures.

Application of discharge planning in rectal cancer patients with a stoma

BACKGROUND

Rectal cancer is a common malignant tumor of the digestive system. Surgery is the main method of treatment for rectal cancer. Enterostomy affects the patient's body structure, lifestyle, psychological adjustment, and social adaptability. Exploring ways to improve the stoma adaptability and quality of life in patients with rectal cancer can help patients return to their families and society smoothly.

AIM

To evaluate the effects of discharge planning in rectal cancer patients with a stoma.

METHODS

Using the convenience sampling method, 100 rectal cancer patients with a stoma were selected and randomly divided into a control group and an observation group, with 50 cases in each group. The control group received routine nursing intervention and telephone follow-up, while the observation group received planned nursing intervention at discharge and routine nursing intervention. The adaptation level to stoma, quality of life, and incidence of colostomy complications were compared between the two groups.

RESULTS

Three and six mo after discharge, the ostomy adjustment inventory (OAI) scores in the observation group were significantly higher than those of the control group (t = 2.136 and 6.713, P < 0.05). The scores of quality of life in the observation group were significantly higher than those in the control group (t = 22.52 and 24.87, P < 0.05). The incidence of colostomy complications in the observation group was significantly lower than that of the control group (χ² = 15.072, P < 0.05).

CONCLUSION

The application of discharge planning in rectal cancer patients with a stoma can help improve the adaptation level to stoma, effectively improve the quality of life, and reduce the incidence rate of colostomy complications.

Patient-Reported Outcomes and Readmission after Ileostomy Creation in Older Adults

Because of the concern about risk of poor outcome, ileostomy creation is sometimes avoided in older adults. We sought to evaluate the effect of a rigorous postoperative pathway and checklist on readmission and self-efficiacy in older surgical patients. After implementing a self-care checklist and standardized care pathway at our institution, we performed a retrospective review of patients between June 2013 and June 2016 and compared characteristics and outcomes for patients aged <65 and ≥65 years. Using logistic regression, we identified independent predictors of readmission. We also conducted a survey of patient self-efficacy after discharge to assess independence. There were 288 younger patients and 72 older patients. The older group had more patients with an American Society of Anesthesiologists >2 (53.0% vs 81.4%, P < 0.01) and were more likely to have had surgery for cancer (22.9% vs 48.5%, P < 0.01). In the multivariable analyses, age was not a predictor of readmission but American Society of Anesthesiologist and length of stay were. In the 57 patients surveyed after discharge, we found that older and younger patients reported similar self-efficacy scores. In our study, older and younger patients have similar rates of readmission and similar ability to independently care for their themselves after ileostomy creation.

Patient Decision-Making About Emergency and Planned Stoma Surgery for IBD: A Qualitative Exploration of Patient and Clinician Perspectives

BACKGROUND

Many inflammatory bowel disease (IBD) patients worry about stoma-forming surgery (SFS), sometimes enduring poor bowel-related quality of life to avoid it. Anticipation of SFS and whether expectations match experience is underreported. This qualitative study explored influences on patients' SFS decision-making and compared preoperative concerns with postoperative outcomes.

METHODS

We purposively recruited participants with IBD from UK hospital outpatient and community sources, and IBD clinicians from public hospitals. Four focus groups, 29 semistructured patient participant interviews, and 18 clinician interviews were audio recorded, transcribed, and analysed thematically. Participants had a current temporary, recently-reversed, or permanent stoma, or were stoma naive.

RESULTS

Four themes emerged: Preoperative concerns and expectations, Patient decision-making, Surgery and recovery, and Long-term outcomes. Participants and clinicians agreed about most preoperative concerns, that outcomes were often better than expected, and support from others with a stoma is beneficial. Patient decision-making involves multiple factors, including disease status. Some clinicians avoid discussing SFS, and the phrase 'last resort' can bias patient perceptions; others recommend early discussion, increasing dialogue when medical management becomes ineffective. The postoperative period is particularly challenging for patients. Stoma acceptance is influenced by personal perceptions and pre- and postoperative clinical and social support.

CONCLUSION

Patients need balanced information on all treatment options, including surgery, from an early stage. Early multidisciplinary team dialogue about SFS, and contact with others living well with a stoma, could enable informed decision-making. Life with a stoma is often better than anticipated, improving quality of life and control. Ongoing specialist nursing support aids recovery and adjustment.

Risks for depression among ostomates in South Korea

AIM

This study explored the factors that are associated with the depressive status among older adult ostomates in South Korea.

METHODS

The study was a secondary analysis of data from a cross-sectional study with 217 ostomates who were aged ≥55 years from September 2, 2013 to October 30, 2013. The general characteristics, daily routines, and depressive status were assessed in order to identify the factors that were contributing to a depressed mood among the older adult ostomates in South Korea. The general characteristics included their sex, age group, educational level, financial status, employment, outing hours, perceived social isolation, leisure activity, and perceived health status. The daily routines included living environment inconvenience, leisure activity satisfaction, body image satisfaction, sleep satisfaction, exercise involvement, intimacy with a spouse, sexual satisfaction, and satisfaction with quality of life.

RESULTS

The prevalence of depressive status in older adult ostomates was 50.7%, but 40.8% in the same-age population without an ostomy. The factors that were associated with a depressed mood among the older adult ostomates in South Korea were social isolation, perceived poor health status, perceived low quality of life, dissatisfaction with leisure activities, and poor financial status. The participants' sex, age, and educational level were not associated with depression.

CONCLUSION

Nurses need to encourage older adults with an ostomy to reduce their social isolation and to increase leisure activities by helping them to use resources, such as support groups and psychological support, in collaboration with interdisciplinary team members.

Psychological aspects of patients with intestinal stoma: integrative review

Objective:

to analyze evidences of psychological aspects of patients with intestinal stoma.

Method:

integrative review with search of primary studies in the PsycINFO, PubMed, CINAHL and WOS databases and in the SciELO periodicals portal. Inclusion criteria were: primary studies published in a ten-year period, in Portuguese, Spanish or English, available in full length and addressing the theme of the review.

Results:

after analytical reading, 27 primary studies were selected and results pointed out the need to approach patients before surgery to prevent the complications, anxieties and fears generated by the stoma. The national and international scientific production on the experience of stomized patients in the perioperative moments is scarce.

Conclusion:

it is recomendable that health professionals invest in research on interventions aimed at the main psychological demands of stomized patients in the perioperative period, respecting their autonomy on the decisions to be made regarding their health/illness state and treatments.

The role of coping strategies on health-related quality of life in adults with anorectal malformations

PURPOSE

Coping strategies have been acknowledged as crucial for the well-being and for health-related quality of life (HRQoL). The main aim of the present study is to determine whether different types of coping strategies predict HRQoL in patients born with ARM, above and beyond the variance explained by fecal and urinary continence.

METHODS

71 adult patients from the Italian Parents' and Patients' Organization for Anorectal Malformations (AIMAR) participated in the study. Participants completed measures of fecal and urinary continence of the Hirschsprung Disease/Anorectal Malformation Quality of Life (HAQL) (Hanneman et al. in Dis Col Rect 44:1650-1660, 2001), the Short Form Health Survey (SF-36) (Apolone and Mosconi in J Clin Epidemiol 51:1025-1036, 1998), and the Brief Coping Orientation to Problems Experienced (COPE) Inventory (Carver in Int J Behav Med 4:92-100, 1997), which measures different coping strategies: maladaptive, problem-focused and emotion-focused.

RESULTS

Hierarchical regression analyses showed that fecal continence (β = 0.53, p < 0.01) and urinary continence significantly predict (β = 0.23, p < 0.05) Physical HRQoL. Fecal continence (β = 0.36, p < 0.01) and maladaptive coping strategies significantly predict (β = -0.27, p < 0.05) Mental HRQoL.

CONCLUSION

Besides considering the importance of fecal and urinary continence for Physical HRQoL, these findings indicate that maladaptive coping strategies are associated with worse Mental HRQoL. Interventions aimed at enhancing the patients' HRQoL should target coping strategies by reducing denial, behavioral disengagement, substance abuse, and self-blame.

Relations between symptom severity, illness perceptions, visceral sensitivity, coping strategies and well-being in irritable bowel syndrome guided by the common sense model of illness

Irritable Bowel Syndrome (IBS) is a common condition affecting around 10-20% of the population and associated with poorer psychological well-being and quality of life. The aim of the current study was to explore the efficacy of the Common Sense Model (CSM) using Structural Equation Modelling (SEM) in an IBS cohort. One hundred and thirty-one IBS patients (29 males, 102 females, mean age 38 years) participating in the IBSclinic.org.au pre-intervention assessment were included. Measures included IBS severity (Irritable Bowel Syndrome Severity Scoring System), coping patterns (Carver Brief COPE), visceral sensitivity (Visceral Sensitivity Index), illness perceptions (Brief Illness Perceptions Questionnaire), psychological distress (Depression, Anxiety and Stress Scale), and quality of life (IBS Quality of Life scale; IBS-QoL). Using SEM, a final model with an excellent fit was identified (χ² (8) = 11.91, p = .16, χ²/N = 1.49, CFI > .98, TLI > .96, SRMR < .05). Consistent with the CSM, Illness perceptions were significantly and directly influenced by IBS severity (β = .90, p < .001). Illness perceptions in turn directly influenced maladaptive coping (β = .40, p < .001) and visceral sensitivity (β = .70, p < .001). Maladaptive coping and visceral sensitivity were significantly associated with psychological distress (β = .55, p < .001; β = .22, p < .01) and IBS-QoL (β = -.28, p < .001; β = -.62, p < .001). Based on these findings, we argue that to augment the adverse impact of IBS severity on IBS-QoL and psychological distress, psychological interventions will be best to target the mediating psychological processes including illness beliefs, visceral sensitivity and maladaptive coping.

Effect of group education in family members of rectal cancer patients undergoing enterostomy

AIM: To evaluate the effect of sequential group education in family members of rectal cancer patients undergoing enterostomy.

METHODS: One hundred and twenty family members of rectal cancer patients undergoing enterostomy were divided into either an observation group or a control group, with 60 cases in each group. The control group received traditional nursing education, and the observation group received sequential group education. Self-rating Anxiety Scale (SAS) score, qualification rate of colostomy related knowledge and qualification rate of changing ostomy bag were compared for the two groups of family members. SAS, the incidence of colostomy complications and Ostomy Adjustment Inventory (OAI) score were compared for the two groups of patients.

RESULTS: Compared with the control group, the observation group had a significantly lower SAS score and significantly higher qualification rates of colostomy related knowledge and changing ostomy bag; the patients had a significantly incidence rate of colostomy complications (41.38 ± 3.93 vs 46.54 ± 5.17, 43.02 ± 4.71 vs 47.15 ± 4.39, 16.67% vs 43.33%, P < 0.05) and a significantly higher OAI score (78.33% vs 60.00%, 70.00% vs 51.67%, 51.27 ± 6.92 vs 42.63 ± 5.87, P < 0.05).

CONCLUSION: Sequential group education in family members of rectal cancer patients undergoing enterostomy can reduce family members' anxiety and improve ostomy adjustment and recovery.