The Effect of a Multidisciplinary STOMA Team Approach on Distress, Anxiety, and Patient Satisfaction Among Patients Preparing for Colorectal Stoma Surgery

Background: The standard treatment for colorectal cancer, colorectal resection, may result in either a temporary or permanent ostomy. This surgery can negatively impact individuals’ body image, sexual functioning, relationships with others, and quality of life. As a result, these patients can experience considerable distress and anxiety.

Many cancer patients report distress and anxiety related to their disease. There is evidence to suggest that these feelings are best resolved in the preoperative period. Given the added stress and anxiety that can accompany stoma surgery, a multidisciplinary team approach was designed at this institution to support patients through this emotionally challenging time.

Objectives: To examine the effect of a multidisciplinary STOMA team approach on distress, anxiety, and satisfaction among patients preparing for colorectal stoma surgery.

Methods: The multidisciplinary team approach was evaluated using a quasi-experimental design. Team members included an oncology nurse navigator (ONN), ostomy nurses, a social worker, and a psychiatric nurse practitioner. Participants met with the ONN in preadmission testing before surgery and at discharge to assess their distress and anxiety. Patients were referred to the appropriate multidisciplinary team member depending on their needs.

The National Comprehensive Cancer Network’s Distress Thermometer (DT) and the Generalized Anxiety Disorder-7 (GAD-7) were used by an ONN to identify distress and anxiety and to develop a plan for psychosocial health services. An investigator-designed questionnaire was developed to assess patient satisfaction. Data from the DT and GAD-7 were collected pre- and postintervention. Patient satisfaction was assessed at discharge.

Results: Participants (N = 18) ranged in age from 40 to 79 years, with a mean of 60 years. Cancer staging among the sample was: stage I (n = 2), stage II (n = 7), stage III (n = 7), stage IV (n = 2). Five participants had a temporary ostomy, and 9 had a permanent ostomy. Neoadjuvant chemotherapy was administered to 13 participants, and 12 received neoadjuvant radiation. A dependent t test revealed a nonsignificant decrease in distress from presurgery (M = 4.43, SD 3.09) to postsurgery (M = 3.6, SD = 3.07), t (15) = 1.1, P = .285. Examination of items on the DT showed a decreased frequency in fear, nervousness, fatigue, and problems with sleep. A dependent t test comparing anxiety presurgery (M = 7.7, SD = 5.98) with postsurgery (M = 3.76, SD = 4.02) revealed a significant decrease in scores (t [20] = 2.7, P = .014). Participants were satisfied with stoma education, resources, attention to anxiety, involvement in decisions, and overall experience (M range = 3.1-3.7 of 4).

Conclusions: Results of this study support the initiation of a multidisciplinary stoma team approach. Anxiety and distress decreased presurgery and postsurgery. In identifying specific areas of distress, the ONN was able to refer patients to the appropriate resource for individualized care. Addressing specific areas of need early in the treatment process may have an association with decreasing patient distress and anxiety.