An investigation into psychological morbidity and body image disturbances in adult colorectal resection patients

Literature Review : The prevalence of bowel disease is high in the UK with colorectal resection often a preferred intervention, creating temporary or permanent stomas. Whilst improvements in laparoscopic techniques and Enhanced Recovery Programmes, with standardised procedural developments, have improved biomedical outcomes, there has been little explicit consideration given to the psychological impacts of colorectal surgery and stoma formation. A systematic review of published research was undertaken providing analyses of findings and quality appraisals of research using standardised measures to investigate impacts of stoma status on body image and psychological well-being following colorectal resection. Eight papers reviewed revealed significant negative impacts of stoma presence for psychological disturbances and suggested this relationship is mediated by body image disturbances in stoma patients. The clinical implications of the findings are discussed and possible areas for research identified. Research Report : Limited past research has identified psychological difficulties and body image changes occurring in colorectal resection patients who require the formation of a stoma, however predictors of these constructs are relatively unknown. The Self-Regulatory Executive Function (S-REF) model advances an explanation for these findings with specific reference to cognitive schemas and intense self-focus. A mixed methodology, cross-sectional survey design was utilised, with questionnaires were returned by 84 participants. Data were examined using correlation analysis and multiple regression. Patients requiring permanent stomas demonstrated significantly higher levels of psychological morbidity and body image disturbance compared with non-stoma patients and community norms. Aspects of chronic self-focus and appearance schematisation were significantly associated with psychological morbidity and body image disturbance. Findings advanced the S-REF model, providing partial explanation for the prevalence of psychological morbidity in colorectal resection patients and suggesting possible markers for identifying individuals likely to struggle with adjusting to stoma formation with possible clinical relevance. Critical Appraisal : Reflections on the research process are summarised and critically appraised.