A comprehensive educational intervention to reduce depression, anxiety and complications in Greek patients with ostomy

Abstract

Background and aims

The creation of an ostomy constitutes a profound surgical intervention, invariably introducing a multitude of potential difficulties and challenges into a patient’s life. The aim of the study was to assess the effectiveness of a structured educational intervention, combined with nursing follow-up for self-care, in reducing anxiety, depression, and peristomal complications among patients who have undergone intestinal or urinary ostomy surgery, compared to those receiving standard care (control group).

Methods

A randomized, prospective comparative study was conducted from June 2023-April 2024, involving 100 adult patients with recently formed ostomies residing in the capital of Greece. Participants were randomly assigned to either an Intervention Group (IG) (n=48) or a Control Group (CG) (n=52). The IG received a structured, in-home educational intervention with printed materials and systematic nursing monitoring. Both groups had reinforcement sessions at 45 and 90 days. The study featured dual outcome assessments at baseline, 45 and 90 days. Peristomal complications were measured using the Ostomy Skin Tool (OST), while anxiety and depression were assessed with the Hospital Anxiety and Depression Scale (HADS). For the study purposes, a structured educational tool was developed in three versions, each adapted to the specific needs and characteristics of colostomy, ileostomy and urostomy.

Results

The analysis of HADS scores indicated a statistically significant difference in the IG versus the CG at both 45 days for anxiety (p=0.002) and depression (p<0.0005), and at 90 days for anxiety (p=0.001) and depression (p<0.0005). Furthermore, analysis of OST scores identified a statistically significant difference in the complication index at 90 days (p<0.0005) for the IG compared to the CG. Regarding the change in the severity index, a statistically significant difference was also recorded in the IG versus the CG at both 45 days (p=0.001) and 90 days (p<0.0005).

Conclusions

A structured, educational intervention significantly improves ostomy patients’ psychological well-being (anxiety and depression) and reduces clinical complications. The practical success of this intervention is largely attributed to its accessible printed tool and dedicated nursing follow-up.