eP146 - What Is the Impact of Emotional Distress on Colorectal Patients After Fecal Ostomy Surgery?: A Qualitative Study of Clinician Perceptions

Purpose/Background: Patients who undergo colorectal surgery with a fecal ostomy can experience changes to quality of life and emotional distress. This study aims to 1) describe clinician’s perceived impact of emotional distress on patient recovery and 2) examine current solutions to address emotional distress in this patient population.Methods/Interventions: Purposive and snowball sampling methods were used to recruit a diverse sample of clinicians who frequently treat colorectal surgery patients requiring fecal ostomy from across the US. A semi-structured interview guide was used to identify and explore 1) challenges faced by patients, 2) the impact of emotional distress on patient recovery, and 3) potential solutions. Clinicians included colorectal surgeons, GI psychologists, colorectal surgery nurse practitioners, and ostomy nurses. Rapid thematic analysis was performed.Results/Outcomes: Flexible scheduling was used to perform 5 interviews (i.e., focus groups, dyads, and 1:1) between 7/13/23 and 7/28/23 including 6 colorectal surgeons, 1 GI psychologist, 2 ostomy nurses, and 2 nurse practitioners. The clinicians were 73% female, all white, and years in practice ranged from 2-40. All clinicians reported that emotional distress related to the ostomy impacts many of their patients. Some clinicians noted that emotional distress was mitigated when the ostomy improved bowel symptoms (i.e., urgency and incontinence) and that patients with chronic diseases like inflammatory bowel disease tended to be better informed about ostomies in general, leading to faster adaptation to life after surgery. Furthermore, clinicians perceived that those patients with permanent stomas tended to adapt more quickly, whereas those with temporary stomas had much more distress or never fully adapted. Participants agreed that distress appeared to impact patients’ ability to learn to care for the stoma and manage the ostomy prior to discharge. Many participants reported relying on caregivers to assist with stoma care and prolonged postoperative hospitalizations due to the need for ongoing patient teaching. Some participants also endorsed that distress could lead to problems with adhering to instructions for hydration or nutrition. Ostomy nurses interviewed noted that they spent significant time discussing and addressing patient distress.Only one of the clinicians reported currently using formal distress screening tools. However, most participants reported informal screening for distress during patient visits. Some clinicians noted that a distress screening tool provided to patients prior to clinic visits may help to focus the visit on patient concerns. A tool could be used to identify the most important issues for the patient and might provide reassurance that other patients experience similar problems. Clinicians reported lack of training, time, and resources needed to help patients manage and combat emotional distress when revealed during clinic visits.Conclusion/

Discussion: Clinicians treating colorectal patients requiring fecal ostomy frequently note clinically significant emotional distress among their patients. They report that emotional distress contributes to prolonged length of stay and longer visits. This distress hinders patients’ ability to adapt to managing the stoma, particularly when the stoma is temporary or in patients without underlying functional symptoms. There is a need to develop and implement an ostomy specific distress management intervention to improve the recovery and adaptation of this patient population.