How are our patients doing? Beverley Colton Member of the Ostomy Forum group

Participating countries Denmark England Netherlands Japan Norway Poland Scotland Sweden

Project timelines A History Taking Form was developed and tested A pilot on the Follow-up Form and Observation Index was undertaken The Follow-up Form, Observation Index and guidelines were revised, extended and retested

Revised Observation Index

Guidelines for use A. Is self-explanatory. B. All patients may experience pain on intercourse following major abdominal surgery. Low pelvic surgery and/or Removal of rectum: Male patients - retention of urine, inability to fully control their bladder function and urinary incontinence are all signs that nerve damage may have occurred at surgery. Erectile dysfunction and ejaculatory problems may be temporary or permanent. Urinary incontinence may have a severe impact on sexuality Female patients - Surgery may alter the position of the vagina. Nerve damage may cause vaginal dryness and altered sensation. Resection of the posterior vaginal wall will also cause significant changes. Urinary incontinence may have a severe impact on sexuality Removal of the bladder Male patients - There may be no penile sensation or erectile function following excision of the bladder. Female patients - there may be altered sensation in genitals. C. The stoma care nurse must discuss possible sexual and urinary implications pre-operatively, giving short explanations. She must follow this up post-operatively, ensuring that the patient is given opportunities to ask questions and discuss their fears. The patient may wish the stoma care nurse to talk with their partner, either with or without the patient being present. Guidelines for Sexuality observations

Revised Follow-up form

Methods of investigation Standardised Observation index Follow-up form Medical outcome study (SF 36) SAS Version A minimum of 10 consecutive patients Monitored for a maximum of 1 year

MOS Medical Outcomes: health and general well being

Commitment

Language and Culture

Normal = normal for patient based on HTF Colostomy Social Assessment: progression to ‘normal’ status

Normal = normal for patient based on HTF Colostomy Sexual Assessment: progression to ‘normal’ status

Normal = normal for patient based on HTF Ileostomy Psychological Assessment: progression to ‘normal’ status

Psychological Issues and Time from Surgery

A stoma means a change of body image

Sexuality

Pre and post-op sexual intimacy

Associations of sexual intimacy My spouse partner and I are sexually intimate I desire sexual intimacy Prior to ostomy surgery With 26 weeks post- operative Malesr=0.865r=0.521 Femalesr=0.791r=0.703

History Aug 1978 constipated, rectal atresia,recto/vaginalfistula.>Rectosigmoidectomy + colostomy Jan 1978 Colostomy closed June 1986 Repeat Duhamel for faecal incontinence : London Oct 1986 Psychiatric help Jan 1987 Formation of colostomy and taught to irrigate : Bristol 1993/4 8 month in patient stay at psychiatric unit June 1997 Gracillis procedure :London Aug 1997 Colostomy closed Sept 1997 ACE procedure Oct 1997 Stricture between ACE and rectum Formation Loop Ileostomy July 1998 Ileostomy > Colostomy. ACE and stimulator removed distal bowel oversewn July 2001 Cholecystectomy+ division of adhesions : Bristol Jan 2005 Colostomy refashioned Sept 2006 Colostomy refashioned

Listen – and you will make a difference Use of a History Taking Form, standardised Follow-up form and Observation index. Review of input and support at 3 months. Development of communication, counselling and listening skills.