Experiences of self-management behaviors during adaptation to permanent enterostomy among older patients: A qualitative study

OBJECT: This study aimed to explore the experiences and perceived changes in self-management behaviors among older patients with a permanent stoma during adaptation, providing insights for the development of targeted supportive interventions. METHODS: Semi-structured, in-depth interviews were conducted with 13 older colorectal cancer patients with a permanent stoma. All interviews were audio-recorded and transcribed verbatim. The data were analyzed and thematically refined using Colaizzi's seven-step method. RESULTS: Three overarching themes and several sub-themes were identified. Theme one, decision-making dilemmas and uncertainty, included insufficient and poorly tailored decision support resources and challenges in processing complex self-management information. Theme two, reconstructing daily life and identity after stoma formation, encompassed disruptions in body image and daily routines, emotional struggles between rejection and acceptance, and the development of a new normal in living with a stoma. Theme three, developing resilience through accumulated experience and self-management practice, involved learning through repeated self-adjustment, drawing on previous life experiences as coping resources, and redefining life priorities after illness. CONCLUSION: The findings suggest that older patients living with a permanent stoma experience self-management as an ongoing process involving decisional challenges, psychological adjustment, and the gradual reconstruction of resilience. Healthcare professionals should provide continuous decision support, psychological care, and family-inclusive interventions while adopting a strength-based approach that recognizes patients' existing abilities and lived experiences. Supporting patients in reflecting on their adaptation experiences and accumulated coping strategies may enhance self-efficacy and facilitate sustained self-management.