title: The relevance of lowered personal control for patients who have stoma surgery to treat cancer.
abstract: The objective of this study was to explore the experience of patients who had stoma surgery to treat cancer in order to explicate why problems associated with stoma surgery are not decreasing despite technical improvements in stoma care.
  
  
  
  A longitudinal design was used in order to capture the process of preparing for surgery and dealing with its aftermath. Participants were interviewed using a semi-structured protocol on three occasions; 1-2 weeks before surgery (eight participants), 1-2 weeks after surgery (seven participants), and 3 months after surgery (four participants).
  
  
  
  Transcripts were analysed guided by the procedures of grounded theory. This involved developing categories from the data and linking them together to form a conceptual understanding of our participants' experience.
  
  
  
  Lowered personal control was the most important concept to emerge from the analysis. We identified perceived causes of lowered control, its mitigating factors, the strategies used to manage this experience and the consequences of these processes.
  
  
  
  We make three recommendations based on the conclusion that improvements could be implemented in the psychological aspects of stoma care and, in particular, the enabling of patient perceived self-efficacy. First, improvements could be made in doctor-patient communication with doctors becoming more aware of their psychological impact on patients. Second, specialist stoma care nurses could be trained to recognize patients with dysfunctional self-efficacy beliefs and/or delayed psychological adaptation. Finally, we identify a need for more prolonged practical and emotional support for at least some stoma out-patients.
authors.affiliation: Department of Clinical and Health Psychology, St James' University Hospital, Beckett Street, Leeds LS9 7TF, UK.
authors.forename: J
authors.initials: J
authors.lastname: McVey
authors.forename: A
authors.initials: A
authors.lastname: Madill
authors.forename: D
authors.initials: D
authors.lastname: Fielding
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007389:Internal-External Control; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D009369:Neoplasms / Q000523:psychology* / Q000601:surgery; D010030:Ostomy / Q000523:psychology*; D019990:Perioperative Care / Q000523:psychology; D016896:Treatment Outcome