The Trajectory of Adjustment Outcomes Among New Ostomy Patients: A Prospective Study.

Abstract

Purpose: The study aimed to describe a 9-month adjustment trajectory post ostomy surgery in a group of community dwelling persons with an ostomy and explore 9-month outcomes against personal and clinical characteristics.

Design: Questionnaire-based longitudinal survey.

Subjects and setting: Participants were enrolled by Enterostomal Therapy Nurses from 11 Australian hospitals (metropolitan and regional). Initial enrollment was 849 participants; 735 (86.6%) ultimately underwent ostomy surgery and 272 (32.0%) were followed to the 9-month end point. Participants were enrolled over a 2-year period from October 2017 to December 2019.

Methods: Respondents completed a questionnaire comprising the Ostomy Adjustment Inventory (OAI-23) and an inventory of demographics. Data were collected at 5 time points from discharge to 9 months post-discharge.

Results: Trend analyses suggested significant improvement in anger and worsening in anxious preoccupation domains by 9 months. No significant changes in acceptance and social engagement domains were identified. Multiple linear regression analysis suggested that younger age and not being culturally and linguistically diverse (CALD) background were the strongest predictors of adjustment at 9 months, with younger age retained by all 4 domain-based predictive models, and CALD status retained by 3 of 4 models. Elective (vs emergency) surgery was associated with improvement in both acceptance and anger, and the presence of incontinence on baseline was associated with improvement in anger. Self-reported peer support activity was associated with better social engagement.

Conclusions: Significant improvement by 9 months was noted in only 1 of the 4 OAI-23 domains (anger). This outcome highlights the time required for the adjustment process. Younger age and non-CALD background were both shown to be advantageous. The finding regarding involvement in peer support is encouraging. Further study about peer support as an assistive factor should be pursued.