Scandinavian Journal of Urology and Nephrology

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Psychosocial Adjustment and General State of Health In Patients With Ileal Conduit Urinary Diversion Gun Nordström, Claes R. Nyman & Töres Theorell To cite this article: Gun Nordström, Claes R. Nyman & Töres Theorell (1992) Psychosocial Adjustment and General State of Health In Patients With Ileal Conduit Urinary Diversion, Scandinavian Journal of Urology and Nephrology, 26:2, 139-147, DOI: 10.1080/00365599.1992.11690445 To link to this article:

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Date: 31 May 2016, At: 01:25

Scand J Urol Ncphrol 26: 139- 147, 1992


From the 1 Depanm ent of Urology, Suder~jukh uset and the 1 Na tionallnstitute of Psychosoc(al Factors and Health. Stockholm. Sweden

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(Submitted Augus t 5, 1990. Accep ted for publ ica! ion March 13, 199 1)

Abstract. Th e psychosocia l adj ust ment a nd ge nera l state of heal th were in ves ti ga ted in 66 pati ent s (40 males, 26 females) who had been subjected to an ilea l conduit urina ry diversion o n accou nt of bladder cancer (44 patients) or in co ntin ence o r bladder dysfuncti on (22 patients). Seve nt y per cent o f th e pati ent s reported un cha nged, overa ll , soc ia l activit y (OSA) a fte r th e o perati o n. Twenty pe r cent reported less a nd I 0 % more acti vit y. Bl adder-ca nce r patients we re more lik ely to curtai l th eir soc ial acti viti es compared with the patient s with inco ntin ence or bl adder dysfunction. Appliance-related prob lems were menti oned by half of the patients who reported dec reased OSA . One-third of th e pat ients co nsid ered acc identa l leakage or fea r of such leakage as th e most nega ti ve aspect of surgery. Factors related to a n alt ered body image we re the most com mon negati ve as pect reported by females. Despi te psychosoc ia l problem s, the majorit y of the patients (80%) co nsid ered thei r hea lth to be good. Ma les, individual s working full-tim e a nd patients with un cha nged OSA sco red higher on a Health Index, i.e. conside red themselves hea lthi er than the rest of the patients. Key words: urostomy, psychosoc ial adj ustm ent , socia l acti vit y, leisure, stoma related problems, ge nera l state of hea lth .

Early a nd late physical compli cations followin g il ea l conduit urinary di ve rsion h ave bee n ex t e ns ive ly studied (24 , 30, 31 , 41 ), but co ns id e rably less attention ha s been paid to th e p sychosocia l aspects and the q u a lity of life. In rece nt yea rs, howeve r, studi es on thi s subj ect have b ee n publi shed , showing th a t urinary dive rs ion and , whenever app li ca bl e, cystectomy affect most asp ects of life. R estrict ed social activit y, changed lei s ure pursuits, affected working ability and sex ua l function h ave b een repo rt ed (II , 12 , 2 1, 29, 32 , 33, 40). More over, e motional di sturbances and bodil y di sfi g urem e nt have furth e r impacts on life with a stoma (2, 6 , 34). Follick e t

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a l. (I 0) repo rt ed th at t ec hni ca l problems (for example, lea kage, odou r, c lothin g) were assoc ia ted with poorer emoti o na l, soc ia l an d m a rit a l or family adjust m e nt. Nevertheless , despite p sychosoc ia l problems, th e vast m ajo rit y of the urostom y patients consider th e m sclvc to b e in good o r excellent hea lth (29). Th e aim of the present st ud y was to explore th e impac t of th e uros tom y on psychosocial a d justment, to assess patients' s ubj ect ive h ea lth statu s and to e lu c id a t e the re la tion s b etwee n thi s and ge nd e r, di agnos is, stoma-re lat ed factors and soc ia l ac ti vit ies.


Patients The stud y comprised 66 pati ents (40 males, 26 fema les) with il eal condui t urinary diversions . The age di stributi o n at operati on was 20-76 years (mean 55 yea rs). The indi cation for surgery was ca rcinoma of the bladde r in 44 patients (m ea n age 58 yea rs; 33 ma les, II females) , whil e 22 (7 males, 15 females) were give n diversions because of incontinence a nd/or bladder dysfunction ofvarv ing etiology (mean age 44 years). The pat ients' age at follow-up was 26-82 yea rs (mean age 62 years) a nd the time that had elapsed since surge ry ranged from 3 to 14 years (mean 7 years). A detail ed description of th e patient selecti o n is present ed elsewhere (30). Interview Th e psychosocial aspects of life with a urosto my were in vesti ga ted by using an interview sched ul e with open e nded and closed quest io ns. The const ru cti o n of the questi on na ire was in spired by previously published studies (2 1. 40) a nd clinica l experience. The questions were specifically focused o n le isure pursuits, sociali zing with ot her people, post-surgical change in overall soc ial acti vit y (OSA) and the ove rall accepta nce o f the stom a. Questions abo ut app li ance co ncea lab ility. odour a nd self-ca re management were also asked. Th e Scand J Ural Nephrol 26

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G. No rdst rom et a/.

ove rall soc ial acti vity a nd the overall accep ta nce of the stoma we re measured o n a 5-po int scale o n whi ch I was the most pos iti ve direction and 5 the most negati ve directi on. For the remai ning closed q uesti ons the a nswe r was yes or no. All the pati ents we re also asked to state th e most nega ti ve aspect of the urin a ry diversion. These a nswe rs we re interpreted a nd d ivided into fi ve categories. In ord er to check the form at and unde rstanding of the questio ns, a pil ot stud y was ca rried out on 12 patients with ileal conduit urina ry di ve rsio ns treated at a hospital not in cl uded in the main stud y. Mino r alte ratio ns in the wo rd ing and o rga nization of the questio ns we re based on these interviews. All the interviews we re perfo rmed by the sa me enterostomalthera py nurse (G. N.), either at the Stoma Ca re Unit , Stidersj ukhuset (57 pati ents), or, when necessa ry due to old age or ph ys ical impairme nt ,. in the patients' own homes (9 pati ents).

Health index Afte r concluding the interviews, th e general state of health was measured by means of a I 0-item Hea lth Ind ex (HI) developed by Han agi & Rosenquist (1 4). The Nottingha m Health Profil e Pa rt l, measuring hea lth problems in the widest sense, was a source of inspirati on ( 18). For each of the I 0 items the follo wing descriptors we re used: I =ve ry poor, 2 = rather poor, 3 ::: rather good, 4::: ve ry good, with a max imum score of 40 (ve ry good health) and minimum score of 10 (ve ry poor hea lth). The Index includ ed q uesti ons rega rding (I ) energy, (2) te mper, (3) fatigue, (4) lo neliness, (5) sleep, (6) ve rtigo, (7) bowel fun cti on, (8) pa in, (9) mobility a nd (10) hea lth . Patients we re asked to rate their subjecti ve statements o n each item. T he hea lth status refers to effects in the past wee k. The HI was computed a nd analysed by ge nd er, di ag no is, age, work tat us a nd OSA. Work statu s was di vided into four groups: full -time work, part-time work, disability pension or sick leave a nd old-age pension , according to a recentl y published stud y (32). The HI was also a nalysed by toma-related factors, i.e. self-ca re in stoma ma nage ment , odour a nd stom arelated problems (for exa mple, skin probl ems a nd accident al leakage), a nd by o ve rall acce pta nce of th e stom a. Statistical calculations Statistica l ca lculations we re pe rform ed according to the SAS program package . Owing to the small number of subj ects in som e categories, th e Fisher Exact Probability Test was used aft er cond ensing the data into fo urfold tabl es. For analyses of two dependent groups, the Sign Test or the MacNe ma r Test for the significa nce of changes was used (19 , 39). All hypotheses we re tested by two-tailed tests a nd the p-l evels a re reported in the text as follo ws: p

Psychosocial adjustment and general state of health in patients with ileal conduit urinary diversion.

The psychosocial adjustment and general state of health were investigated in 66 patients (40 males, 26 females) who had been subjected to an ileal con...
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