P341 Identification and management of psychological distress after stoma surgery: a qualitative study of patients and healthcare professionals

Abstract

Background: Evidence suggests that psychological distress is common among people with inflammatory bowel disease (IBD) following stoma surgery and is associated with adverse clinical and quality of life outcomes. Despite this, psychological problems are often underdetected and under-treated. The aim of this qualitative study was to identify the barriers and facilitators affecting access to psychological care among young adults with IBD following stoma surgery, from the perspective of both patients and relevant healthcare professionals (HCPs). This study was undertaken within the context of the National Health Service (NHS) in the UK (UK). Methods: Semi-structured interviews were conducted with 13 young adults with IBD and a stoma (aged 18-29), and 16 HCPs (including general practitioners, consultant gastroenterologists, colorectal surgeons, IBD nurses and stoma care nurses). Data were analysed using a grounded theory approach. Ethics approval was obtained from the NHS West Midlands Research Ethics Committee (REF: 17/WM/0236). Results: Psychological distress was commonly reported by young adults, particularly in the immediate period before and after stoma surgery, which in some cases persisted. Not all described having this distress recognised by their healthcare team and/or received psychological support. Various barriers and facilitators to accessing care were identified at patient, professional and healthcare system levels. Patients' attitudinal factors such as stigma on mental health and reluctance to seek help, as well as knowledge about available services influenced their decision to consult, or not, about psychological distress. HCP barriers included a lack of time during consultations to address psychological issues, as well as the perception that mental health problems go beyond their professional remit. System barriers included the complexity of care pathways which resulted in a lack of role clarity and coordination between primary and secondary care professionals, and funding constraints which limited the provision of specialised psychological services. HCPs emphasised the importance of developing a good-quality therapeutic relationship to facilitate disclosure of distress, as well as receiving appropriate training to further their skills and confidence in better addressing psychological problems. Conclusions: This study indicates the need for clinicians to support disclosure of psychological symptoms among young adults with IBD after undergoing stoma surgery. The development of more effective care pathways, which include psychological services for patients with an identified need, are required. Although this is an NHS-based study, these findings may nevertheless have broader applicability.