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The Ostomy Files: Life is about Choice
Life is a series of decisions. We have a choice in life regarding almost every aspect, down to the smallest details. We make choices about our education, vocation, life partner, whether to have children, and other significant life-altering events.
We choose our friends, the model of the car we drive, the clothes we wear, the television programs we watch, and even the type of food we eat. Sickness and disease prevent us from having control over things we have traditionally taken for granted, often leading patients to say, “I have no choice in the matter,” when it comes to illness or surgery.
Ostomy surgery is no different. Elimination of body wastes is suddenly no longer “normal” or under the individual’s conscious control. In many instances, patients lose their ability to choose when elimination will take place. The way patients view their bodies and they way they believe others perceive them is often altered along the way. It has been suggested that a proportion of patients who are not satisfied with their pouching routine have a level of dissatisfaction that could be correlated with levels of psychological distress.1 White1 believes that most psychological problems associated with ostomy surgery are related in some way to a “lack of self-efficacy in the component parts of the stoma care routine” and that improving self-efficacy could improve psychological functioning.
The “right” pouching system is the one the patient says is “right.”2 In other words, the pouching system selected should be the pouching system the patient chooses. Based on several assessment criteria, it is the clinician’s responsibility to recommend an appropriate skin barrier, but the decision regarding the type of pouching system should be left to the patient.3 Today more than ever before, patients have a wide range of ostomy pouching systems from which to choose. However, they will not be aware of the fact that they have choices unless they are exposed to a variety of pouching system options. Responsibility for informing ostomy patients about newer technologies or various options falls directly on the shoulders of clinicians and retailers.
Clinicians should be cautious to refrain from assuming that simply because a patient is a Medicare beneficiary is he/she unable or unwilling to purchase additional quantities and types of ostomy supplies. Conversely, it cannot be assumed that individuals with higher incomes are willing to pay for ostomy supplies not covered under the Medicare benefit or their private health plan. If a particular product or care routine has an immensely positive impact on an individual’s self-esteem, sense of security, or the ability to conduct daily activities, additional out-of-pocket expenses may not be viewed as a negative.
The variety and choices available to people with a stoma have increased ten-fold from just a few decades ago. Pouching systems are available in one- and two-piece styles, closed-end, and drainable and urinary pouches are available with several types of outlets. Skin barriers are flexible, convex, and flat, with standard or extended wear. Pouches are shaped to body contours with both clip and “clipless” technologies. Newer “flangeless” pouching systems are also available. Wear time is now a choice the patient makes. Unlike pouching systems developed in the 1950s and 1960s, today’s pouching systems are odor-proof, comfortable, flexible, and disposable.
Clinicians cannot predict how a pouching system will positively or negatively impact a person’s life unless they conduct an in-depth comprehensive patient and abdominal assessment.2 It is important, however, to emphasize that something as simple as a pouching system can make an enormous difference in someone’s life. Consider this case.
A 65-year-old widow underwent the creation of a permanent end colostomy for rectal cancer. She managed the colostomy with daily irrigations for several years until she suffered a stroke. The subsequent hemiparalysis prohibited continuance of colostomy irrigation, so she was fitted with a drainable pouching system. The problem was that she was unable to empty the pouch using her “good” hand. Her daughter would come over two or three times each day to empty the pouch. After several weeks, the daughter felt she could no longer maintain this routine and suggested, reluctantly, that her mother be placed in a nursing home. After a consultation with the WOC Nurse, the patient was fitted with a two-piece, closed-end pouching system. She was taught how to remove the soiled closed-end pouch with one hand, dispose of it in a trashcan, and reapply a clean closed-end pouch. Both the patient and her daughter were delighted at her newfound ability to maintain her independence and remain in her own home. Her daughter changed the skin barrier once a week.
Caring for people who have undergone ostomy surgery without considering the psychological impact the surgery has had on their lives is impossible.1 People living the ostomy experience often struggle with anxiety and depression. Clinicians caring for them need to consider the impact of a pouching system. By understanding the features of today’s ostomy products and educating their patients, clinicians have the ability to change a life.
The Ostomy Files is made possible through the support of ConvaTec, a Bristol-Myers Squibb Company, Princeton, NJ.
1. White CA. Ostomy adjustment. In: Colwell JC, Goldberg MT, Carmel JE (eds). Fecal & Urinary Diversions: Management Principles. St. Louis, Mo.; Mosby, Inc.; 2004:326–336.
2. Turnbull GB. The ostomy assessment inventory: a data-gathering process to enhance appropriate pouching system selection. Ostomy Wound Manage. 1998;44(2):22–37.
3. Turnbull GB, Colwell JC, Erwin-Toth P. Quality of life: pre, post, and beyond ostomy surgery. Ostomy Wound Manage. 2004;50(7A Supple):2–12.
