Pre-surgery information and psychological adjustment to enterostomy

The post-surgery psychological adjustment to enterostomy was examined in a longitudinal study of 120 patients. Subjects were representative of the general enterostomy patients population. All had undergone surgery in various hospitals located in Rome and its surroundings. Adjustment to enterostomy was longitudinally evaluated by interviewing patients at various intervals after enterostomy: soon after surgery; 1 year after surgery; more than 1 year after surgery. When patients were initially interviewed, information was requested on how they were informed of their clinical condition which led to surgery, as well as of enterostomy and its consequences. 42% reported a low level of understanding about enterostomy on the basis of information received during hospitalization. Patients were consequently divided into two groups, one including those judged as adequately informed (AI), and the other including those judged as not adequately informed (NAI). These groups were compared, for immediate adjustment to enterostomy (within 3-6 mos. since surgery), delayed adjustment (1 yr. since surgery), and prolonged adjustment (more than 1 yr. since surgery). Patients of NAI group demonstrated a consistently poorer pattern of adjustment in all parameters under study (emotional, cognitive, behavioral, social) and their adjustment to enterostomy did not show any spontaneous improvement over the time. AI patients, on the other hand, showed a more faborable level of adjustment since after surgery and a more positive pattern in the follow-up period. Adequate information before surgery and during hospitalization has been evidenced as a necessary component of patient care and a very important element in determining the optimal functional and psychological recovery of patients with enterostomy. The need for prompt and adequate information as well as for coping support from centers specialized in the rehabilitation of these patients is stressed.