StomieCare : un programme d’intervention psycho-éducationnelle individuelle à composantes cognitivo-comportementales pour des patients opérés d’un cancer du rectum avec stomie temporaire

Abstract

Notre recherche visait à développer et mettre en place un programme d’intervention psychosociale individuelle à l’attention des personnes opérées d’un cancer du rectum avec stomie temporaire. Cet article présente la structure et le contenu de ce programme d’intervention psycho-éducationnelle qui est une adaptation du programme développé et validé par Dolbeault et al. (2009) auprès de femmes atteintes d’un cancer du sein. Ce programme s’inspire largement des techniques cognitivo-comportementales et comprend des discussions thématiques autour de problèmes communs, d’apport d’informations et d’apprentissage de techniques (résolution de problème, restructuration cognitive). Il cible plus particulièrement les besoins psychosociaux des patients et vise à favoriser l’expression des émotions, à réguler la détresse émotionnelle et à restaurer l’image du corps et la qualité de vie de ces sujets. Ce programme, dont la validité a été mise à l’épreuve et sera présentée dans un article à venir, a suscité un vif intérêt chez les patients qui y ont participé et devrait pouvoir être généralisé à tout sujet volontaire opéré d’un cancer du rectum avec stomie temporaire.

Worldwide, colorectal cancer is one of the most commonly diagnosed cancers. For locally advanced rectal cancer, the standard treatment is rectal excision with or without preoperative chemoradiotherapy. Anastomotic leakage is one of the most important early complications and is associated with high morbidity and mortality rates. Temporary/protective stoma is recommended to prevent anastomotic leakage. Despite its clinical benefits, stomas unavoidably affect patients’ physically, psychologically and socially. In the context of cancer care, psychosocial interventions are valuable complements to physical treatments to help minimize stress, improve quality of life and reduce depression. The literature review performed by Hoon et al. (2013) revealed that very few studies (n = 11) focused on psychological interventions for colorectal cancer patients (with or without stoma). Educational interventions and cognitive-behavioral therapy were the two most commonly used psychosocial interventions. Regarding educational interventions, we performed a systematic review of the educational interventions on colorectal cancer patients with stoma. We noted that most interventions and evaluations were focused on stoma self-management and very few on psychosocial skills (Faury et al., 2017). Concerning the cognitive-behavioral therapies for colorectal cancer patients, their primary objectives are to implement lifestyle interventions to modify diet, exercise, smoking and alcohol consumption, to manage symptoms and fatigue, and to adjust weight control behaviors (Hoon et al., 2013). As part of our research project, we have developed an individual psychosocial intervention for people with rectal cancer and temporary stoma during and after their surgical treatment period. The main objective of our research was to study the effects of this type of intervention on variables such as psychological distress, quality of life, and body image through a randomized study comparing a treatment group to a control group. This article describes the structure and the content of this intervention, which is an adaption of the psycho-educational intervention developed by Dolbeault et al. (2009) for French women with breast cancer after the end of their treatment period. Largely based on cognitive-behavioral techniques, it consists of thematic discussions, information and education, and teaching problem solving and cognitive restructuring. It specifically targets emotional needs and body image. The program included three individual sessions with a psychologist (45 to 60 min): the first session was performed during the first hospitalization (rectal excision with temporary stoma); the second during the second hospitalization (stoma reversal operation) and the third, one month after the stoma reversal operation. The topics of these interventions were: the meaning of cancer and its treatments (session 1); the effects of cancer and its treatments on quality of life and self-esteem (session 2); the effects of a reversal stoma operation on patients’ life and uncertainty management (session 3). At the end of each session, a drawing of the person, which is a real clinical tool, was used in order to allow patients to discuss their perception of their body. The purpose of this article is to help other clinicians who want to help patients with rectal cancer and temporary stoma, since patient satisfaction appears to be very high.