Prospective evaluation of psychosocial adaptation to stoma surgery: the role of self-efficacy.

Self-efficacy, one's expectations regarding the ability to perform some specific task, was studied prospectively in the adaptation process of stoma patients. One week after surgery, stoma-related self-efficacy was assessed in 59 patients (26 cancer patients and 33 patients with benign diseases) who had undergone intestinal stoma surgery. Twenty-nine items concerning self-efficacy were formulated. Factor analysis with oblique rotation resulted in two factors: a social functioning-related self-efficacy factor and a stoma care-related self-efficacy factor. Psychosocial adjustment was assessed by means of the Psychosocial Adjustment to Illness Scale (PAIS-SR) at 4 and 12 months after surgery. The PAIS-SR renders one global adjustment score and (in this study) five subscores for adjustment to specific life domains: vocational environment, domestic environment, sexual relationship, social environment, and psychological distress. In a multiple regression analysis, the relevance of self-efficacy for later adjustment was determined after partialing out the effects of relevant sociodemographic and medical factors. Strong evidence was found for the important role of self-efficacy in the process of adapting to a stoma; stronger feelings of self-efficacy shortly after the operation predicted fewer psychosocial problems in the course of the first postoperative year. Stoma care-related self-efficacy appears especially important in the first phase after surgery. Social functioning-related self-efficacy explains significant proportions of the variances in PAIS-SR total score and PAIS-SR subscores, in both the short (4 months after surgery) and long runs (12 months after surgery). If patients expect to be able to take care of their stoma, their postoperative adjustment is relatively good. By strengthening patients' self-efficacy, this adaptation process may be accelerated, and the psychological and social burden can be lightened.