Should Support Group Intervention be Implemented for Individuals with Stoma?


  • Serap Sayar
  • Fatma Vural

Received Date: 25.12.2018 Accepted Date: 12.01.2019 Turk J Colorectal Dis 2019;29(1):1-5

The presence of stoma in individuals causes physical, psychological and social problems. For this reason, individuals with stoma need effective psychosocial interventions in order to adapt to the stoma. One of these effective psychosocial interventions is support groups. Support groups are defined as groups of individuals with the same problem that provide common support through interpersonal relationships. Individuals generally need to join these groups when natural social support networks are inadequate or if their psychosocial needs are not met. Sharing experiences with other group members in the support group intervention creates positive effects, and solutions are developed for problems with participation in the group. In many studies carried out with other patient groups, support group intervention has positive effects and individuals improve their quality of life. In our country, there is no ongoing support group intervention for individuals with stoma, but in order to help develop psychosocial adaptation to stoma and its effects, nurses should raise awareness about the need for support group intervention and implement these interventions.

Keywords: Stoma, support groups, nursing


According to Globocan 2012 data published by International Cancer Agency; colorectal cancer (CRC) is the second most common type of cancer in men in the world and the third most common form of cancer in women. According to the 2014 data of the Ministry of Health, CRCs are third in both women and men in our country. The prevalence is 22.8 per hundred thousand in men and 13.8 per hundred thousand in women.1 In the treatment of CRC, surgical treatment, chemotherapy or radiotherapy, alternatively adjuvant therapy can be applied, and most of the patients are exposed to stoma during surgery.2

Although stoma opening is a surgical procedure commonly used in the treatment of CRC, it is also used in the surgical treatment of inflammatory bowel diseases and traumas.3

Although stoma indications vary, stoma opening causes lifestyle changes due to loss of fecal control and dependence on bag, causing individuals to experience various physiological, social and psychological problems and adversely affect quality of life.4,5,6 Anxiety, change of body image, self-esteem and loss of self-esteem, loss of attractiveness, deterioration of sexual function, fecal leakage, fear of sound/smell and depression are frequently seen problems.5,7,8 Because of these problems, individuals tend to restrict themselves and abolish themselves from society. Family relations, work experiences, social and sexual life of individuals are affected negatively. They think that their family and their immediate surroundings are distancing themselves and restrict their interpersonal relations. In individuals, job drop and job efficiency after stoma opening is frequently observed.4,5,6 Individuals with stomata are ashamed of thinking that they are disturbing others in social environments with uncontrolled defecations. Accordingly, they isolate themselves from the society and are introverted.9,10 Studies have shown that the loss of control over gas and fecal output after stoma opening causes psychological and social isolation in individuals, and that stoma creates negative emotions affecting individuals, interpersonal relationships and body image. It is reported that it cannot carry out leisure activities such as sports and it affects the quality of life negatively.11,12

Since most individuals with stomata also fight with cancer, only medical treatment protocols such as chemotherapy, radiotherapy and surgical treatment are not sufficient on the way to recovery. The main treatment criteria are to ensure and maintain the psycho-social comfort of the individual during and after the treatment and recovery period. One of the most important means of providing this is social support. The scope of social support usually consists of family members, close relatives, friends and health care teams (physicians, nurses, social workers, psychologists, etc). Support groups are one of the most important tools that meet social support needs.13 These groups play an important role on the social cohesion of individuals.7 Social cohesion is that individuals learn to abide by the rules of the society they live in, and develop a behavior that is appropriate to these rules and value judgments. The stages of acquiring the values, behaviors and knowledge of the society in which individuals belong are the process of socialization. This socialization process can affect the family, heredity, whether the individual’s health status affects the activities of daily living and affect the peer group.14 Nursing interventions aimed at restoring the social cohesion of individuals; psychological support, psychotherapy, social support, inclusion of individuals in other stoma individuals and activating individuals.15 Creating support groups by bringing people with stoma together with other people with stoma, sharing feelings, thoughts and problems in these groups, realizing that individuals are not alone, sharing solution suggestions for problems and increasing social support facilitate the social cohesion of individuals.14
In this review, it is aimed to emphasize the effects of support group initiatives, one of the counseling roles of nurses, on stoma individuals.

Support Group Intervention

Definition, Purpose and Importance of Support Group Intervention

Support group initiative; is a planned and systematic aid process designed for individuals with similar problems or needs by a professional consultant to adapt to daily life and to deal with the problems they face.14 Support groups are the groups that provide individuals to share their knowledge, experience and problems in a safe environment and provide support from people with similar diseases.16,17 Support groups have five general objectives defined; the support group should empower individuals to cope with their coping skills, provide common points to talk, and share experience and situation sharing, to help the group members to overcome the current problem, to explore knowledge sharing, problem solving strategies, and to evaluate the advantages and disadvantages of various coping methods. The two aims of the support group are particularly important for stoma individuals; information sharing and encouraging individuals. Information sharing is very important because there are various and different skills that enable the successful management of the newly opened stoma within the group. It provides a rich resource for learning the experiences, ideas and attitudes of other individuals in the group.18 Support groups allow individuals to realize that they are not alone, to overcome illness and to confront, to provide stress relief to individuals. It gives basic knowledge and skills for social cohesion. With experience sharing, individuals share their feelings and thoughts, and suggestions for problem solving. Support groups provide individuals with the opportunity to assess their own behavior and the problems of others and to develop solutions for solutions, with the support of others, to participate in plans that lead to cognitive and behavioral change. Each member of the group forms a model for learning the appropriate behavior, and the individual learns to help others in the process of helping others.16

Structure and Operation of Support Group

Initiative support groups are classified into three groups16;

- Online,

- Guided by professional leaders such as nurses, psychologists, social workers,

- Peer leaders (self help). The most important element that provides support to the support groups is the leader.

It is important that the group leader is sensitive, flexible, and natural, so that the members can correctly identify their features and needs. The leader should ensure group harmony, provide accurate and consistent information, be effective in establishing sincerity as well as natural and open communication among group members. The leader takes part as a facilitator in the group. It sets the objectives of the group by evaluating the needs of the group members.13 When creating support groups, it is recommended to pay attention to the fact that the number of participating members is at least three and at most fifteen.16 It is important that the number of sessions, duration of the group, how many weeks the group will last, the number of members to be determined in advance and the status of the group members in determining these.13 In the studies, it is seen that the group sessions are done every week, biweekly and monthly.19,20,21 Group sessions can be performed during the diagnosis, treatment, recovery or palliative care.13 More than one person cannot speak at the same time within the group. For this reason, the group leader should remind the members that they must first listen to each other and promise to everyone. The group leader should pay attention to the fact that group meetings lasting more than two hours create a vicious cycle, are repetitive and ineffective, and the meetings are within an average 80-90 minutes period for an effective support group initiative.16

International Online Support Groups for Stoma Individuals

There are many online support group organizations in the world for people with stoma. The Australian Council of Stoma Association, the Federation of Nz Ostomy Societies, the United Ostomy Associations of America, the Ostomy Canada Society, and the Colostomy Association (Figure 1). These organizations allow individuals with stomata in the same situation to talk to each other, share their experiences and feelings, and guide each other through the Internet.

Support Group Intervention for Stoma Individuals in Turkey and in the World

It organizes many different support group meetings with individuals with stoma in many parts of the world. For example; stoma support group meetings are held every month at Northwest Community Hospital. In group meetings, speakers, company presentations, group support and stoma nurses provide answers to the questions of individuals.22 In support group meetings at Aga Khan University in Nairobi, individuals discuss issues such as group rules, information and acceptability. They distribute the stoma materials they pack together before the meeting. Some of the group members who have been trained and gained skills in a program help home users by opening a new stoma.23 Social meetings are held every two weeks in the form of morning coffee with the stoma support group called “inside out” at St Marks Hospital. Individuals attending the meeting meet with individuals with similar problems, share suggestions and have fun time.24 In our country, since 2000, patients who have opened stoma have been given care, training and consultancy services in nursing units by trained nurses. However, there are no support groups in our country where stoma individuals continue. In the literature, no support group work for stoma individuals could be reached. In a study conducted with individuals with stoma in our country, weekly meetings were organized using planned group interaction. The meetings continued for six weeks and each meeting lasted 90 minutes on average. In the meetings, methods such as presentation by using computer and projection, using stoma care materials, group discussion around the round table, letter writing about the participants’ stoma and reading the letters in group session were used. As a result of the study, it has been reported that planned group interaction increases the social cohesion of individuals with stoma.14

In the literature, there are other studies in which support group intervention is applied in other patient groups. As a result of a study in which support group intervention was applied to individuals with CRC, support group intervention was reported to increase the quality of life of individuals.25 In a study conducted with liver transplantation individuals, support group meetings were organized monthly and meetings were held on average for 90 minutes and a total of six meetings were held. In the meetings, information about the meeting subject was shared with the booklet prepared in advance. As a result of the research, it is reported that support group initiative is effective in increasing the level of knowledge of individuals and decreasing the symptoms of individuals, supporting the adaptation of individuals and improving the quality of life.19 In a randomized controlled trial, women with early stage breast cancer were divided into three groups. One hundred twenty-five women were given support group and training initiative based on Roy Adaptation Model. In the experimental group, 34 women received support group training in three stages and phone call for 13 months. In the first control group, 48 women received social support and training in three steps. In the second control group, 43 women received training only once by mail. As a result of the study, the experimental group and the first control group reported that they experienced less discomfort, less loneliness, and higher quality relationships than the second control group.21


In order to cope with the psychosocial problems experienced by individuals with stoma and to ensure the social cohesion of individuals, stoma care nurses have important responsibilities. The responsibilities of the nurses include; to provide psychosocial support to the patients as well as their physical and to increase their adaptation to the disease. The nursing roles of the stoma individual for social cohesion are; to provide individual training and consultancy services, to support the individual to realize and use his/her own social support factors in his/her environment and to strengthen the support by meeting with his/her family and his/her relatives. In this regard, it is important to create support groups by bringing together individuals with stoma with other people with stoma. In our country, there is no continuous stomaterapy program or support group initiative. For this reason, it is recommended to plan, implement and increase the support group meetings where stoma individuals can share their problems in order to ensure social cohesion, ask questions, get information and benefit from each other‘s experiences.


Peer-review: Internally peer-reviewed.

Authoring Contributions

Concept: S.S., F.V., Design: S.S., F.V., Data Collection or Processing: S.S., F.V., Analysis or Interpretation: S.S., F.V., Literature Search: S.S., F.V., Written by: S.S., F.V.

Conflict of Interest: There is no conflict of interest in this article.

Financial Support: No financial support was received from any institution or person for our study.


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