The psychological experience of body image change in adult stoma patients: A systematic review and qualitative meta-synthesis.

PURPOSE: Previous research demonstrates that body image concerns are highly prevalent in stoma patients and can significantly limit quality of life, yet the psychological processes underlying these changes remain under-theorized in the literature. This review aims to develop an understanding of the psychological experience of body image change in adult stoma patients.

METHODS

A systematic review and meta-ethnography was undertaken of primary, qualitative, English-language research focusing on the psychological experience of body image change in adult stoma patients. Eight hundred and forty-three studies were initially obtained from backwards citation chaining and three databases: Medline, CINAHL and PsychINFO. Methodological quality and risk of bias were evaluated using the Joanna Briggs Institute Qualitative Checklist.

RESULTS

After screening, 18 studies (n = 602) were included in the synthesis. Three third-order constructs were found across two time phases (immediately after surgery, and living with the stoma): all-consuming shock, visible 'otherness' and fluctuating acceptance. Findings map the trajectory of body image change following stoma formation and identify psychological, social and relational processes associated with continuing distress and adaptation.

CONCLUSIONS

This review moves beyond documenting body image distress in stoma patients to explain the psychological mechanisms through which it develops and fluctuates over time. Stoma formation can disrupt bodily integrity and identity, with distress maintained through self-scrutiny, shame and perceived social exposure. The mechanisms identified provide clear targets for tailored psychosocial support beginning pre-surgery and continuing through recovery to reduce long-term body image distress and improve health-related quality of life.