AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2578-8868/302
*Corresponding Author: Giulio Perrotta. Istituto per lo Studio delle Psicoterapie (ISP), Rome, Italy.
Citation: Giulio Perrotta, (2024), Clinical application of the “Perrotta-Guerrieri Psychological Care for Ostomy Patients” (PCOP) protocol and integrated questionnaire on adult ostomy patients, J. Neuroscience and Neurological Surgery, 14(2); DOI:10.31579/2578-8868/302
Copyright: © 2024, Giulio Perrotta. This is an open-access article distributed under the terms of The Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Received: 12 February 2024 | Accepted: 28 February 2024 | Published: 07 March 2024
Keywords: colostomy; quality of life; body image after surgery; ostomy; altered body image; impact of ostomy; Ileostomy; Urostomy; pcop; perrotta-guerrieri psychological care for ostomy patients
Background. Much attention is paid in the literature to the psychological profiles associated with ostomies, but until 2022 there was a lack of a psychoclinic instrument that was able to investigate all 9 individual subjective functions possibly impaired by the ostomate condition and the degree of impairment. For this reason, "Perrotta-Guerrieri Psychological Care for Ostomy Patients" (PCOP) was developed for all clinical phases, in 45 items with an L1-5 response scale, for the study of quality of life in the ostomized patient, which was also able to offer from the therapist a holistic understanding of the problem in all its phases (pre-operative, operative, postoperative, follow-up), integrating a patient-specific clinical intervention protocol. Materials and Methods. Clinical interview and battery of psychometric questionnaires. Results. Of 58 patients (M: 57.3 years), divided into two groups (CG and Cg) of equal distribution, the group in which the protocol was applied (CG) achieved quantifiable benefits to the extent of 50-75% individually and 97% in the total group. Conclusions. PCOP is a psychoclinical tool that can offer therapists the opportunity to explore the issue of patient quality of life and best focus on the most appropriate and targeted clinical intervention.
Perrotta-Guerrieri Psychological Care for Ostomy Patients (PCOP). Perrotta-Guerrieri Psychological Care for Ostomy Patients Model (PCOP-M). Perrotta-Guerrieri Psychological Care for Ostomy Patients Questionnaire (PCOP-Q1).
The term "ostomy" means "opening" and denotes the result of a surgical procedure that involves attaching a section of the intestines or urinary tract to the skin, thus allowing organic material (feces and urine) to leak outward. The placement involves a substantial change in the person's body plan and fecal and urinary elimination function, involving not only his or her physical integrity but also, more importantly, his or her psychological integrity; therefore, the role of the psychologist should be central in all phases of the health care intervention (preoperative, operative, postoperative, and follow-up). [1-4]
There are several criteria for classifying ostomies, based on packaging, duration, structure, and motivation [5-8]; based on the geographic region of location, for simplicity, they are distinguished into ileostomies [9-11], colostomies [9, 12], and urostomies [9, 13-14]
In the literature, special attention is given to psychological profiles, as ostomy can significantly impair all dimensions of quality of life (physical, psychological, social, economic, and spiritual) in individuals who have not been adequately prepared for the change or who suffer from one or more complications during the grafting and healing phase, or who do not reach a degree of maturity of acceptance of their health condition. Ostomy patients are subject to significant negative psychological impacts, affecting their quality of life in all aspects (physical, psychological, social, economic, and spiritual), especially if they are not properly constructed or if there are complications during the recovery phase. Placing the focus only on managing the physical dimension will hardly allow the person to integrate the ostomy into his or her life. [15-37]
The concept of "quality of life" is therefore central to applied psychology. According to the definition provided by WHO in 1998, it should be understood as "the total of the subjective perceptions that individuals have of their place in life about the cultural context and value system in which they live and about their own goals, standards and interests". Quality of life is thus seen as a multidimensional concept that includes positive and negative perceptions concerning physical, emotional, social, cognitive and spiritual dimensions. Because of this importance, clinical attention in the field of psychology is particularly focused on clinical intervention to restore the patient's quality of life if he or she perceives it to have deteriorated. [38-65] For this reason, there are questionnaires in the literature that address this profile, and among the most cited are the Health-Related Quality of Life Self-Assessment Test (HRQOL), the Short Form Health Survey (SF-36), the WHO Quality of Life (WHOQOL), and the Stoma-Qol, [66] but none of these are able to investigate in a single psychometric instrument all 9 individual subjective functions possibly impaired by the stoma condition as does the "Perrotta-Guerrieri Psychological Care for Ostomy Patients" (PCOP), developed in 2022. [67] Based on this publication, the experiment depicted here was developed.
The main objective of the research, based on the results of the literature and this study, is to demonstrate the clinical utility of PCOP, on the participants of the selected population sample and to try to answer the following profiles: 1) ontological, i.e., whether the reality under investigation exists objectively (and thus whether it is possible to determine the clinical utility of the protocol); 2) epistemological, i.e., whether the reality under investigation is knowable (and whether it is possible to determine the degree to which the patient's quality of life is impaired by applying the questionnaire attached to the protocol) 3) methodological, i.e., whether the reality under consideration is measurable (and whether it is possible to graduate the intervention based on the level of impairment); 4) axiological, i.e., whether the reality under consideration is worthy of study (and thus whether, through the protocol, the structured clinical intervention has greater effectiveness than other approaches).
With a specific search on Pubmed, using the terminological indicators of "ostomy" and "psychology," 56 useful results were selected. No limit was placed on the year of publication, until the completion date of the study (January 2024). [Figure 1]
Figure 1. PRISMA flow diagram template. Matthew J Page et al. BMJ 2021; 372:bmj.n71.
The protocol of integrated psychological intervention for ostomate patients (PCOP) provides a specific active procedure consisting of actions aimed at the patient's intake, management, and clinical care; based on the phase in which the intake takes place (preoperative, operative, postoperative or follow-up), the protocol establishes precise clinical actions using the strategic approach in patient care and establishes certain psychometric tools to support the therapist and a precise schedule of therapeutic sessions, with techniques and strategies that also draw from cognitive-behavioral, constructivist, psychodynamic and humanistic approaches. [67]
The method consists of applying the PCOP protocol, and using the PCOP-Q1 questionnaire, according to the patient's clinical stage, then comparing it with the group of patients who did not utilise the protocol. The phases of the research were divided as follows: 1) selection of the population sample, according to the parameters indicated in the following paragraph; 2) clinical interview, with each population group and protocol application; 3) administration of the psychometric tests; 4) PCOP-Q1 administration, 2 weeks after ostomy surgery and re-administration after the continuous cycle of psychotherapeutic sessions.; 5) data processing following administration and comparison of data obtained.
Inclusion criteria for the second clinical group (Cg) are: 1) age between 21 and 70 years; 2) defined sexual gender (male/female) and of Italian nationality; 3) need for definitive ostomy implantation, for clinical reasons; 4) declaration of non-submission to the PCOP protocol, following surgical pathway in a health care facility in the Italian System; and 5) absence of psychopathological diagnosis or known neurological and neurodegenerative disorders at the time of study participation. Exclusion criteria for the clinical group (Cg) are: 1) age less than 21 years and older than 70 years; 2) undefined sexual gender (transsexual and nonbinary) or nationality other than Italian; 3) need for non-definitive ostomy implantation, for clinical reasons; 4) declaration of non-submission to the PCOP protocol; 5) presence of psychopathological diagnoses or known neurological and neurodegenerative disorders at the time of study participation, of at least one of the two partners.
The selected setting, taking into account the protracted pandemic period, is the online platform via Skype and Video call WhatsApp, both for the clinical interview and for the administration. The present research work was carried out from September 2021 to January 2024.
The selected first population clinical sample (CG), which meets the requirements, is 29 partecipants, divided into 6 subgroups [Table 1]:
| Age | Male | Female | Total |
| 21-30 | 1 | 1 | 2 |
| 31-40 | 3 | 3 | 6 |
| 41-50 | 4 | 5 | 9 |
| 51-60 | 4 | 3 | 7 |
| 61-70 | 2 | 3 | 5 |
| Total | 14 (48%) | 15 (52%) | 29 (100%) |
Table 1: Population sample (numerousness) - CG.
The selected first population clinical sample (CG), which meets the requirements, is 29 partecipants, divided into 6 subgroups [Table 2]:
| Age | Male | Female | Total |
| 21-30 | 1 | 2 | 3 |
| 31-40 | 3 | 2 | 5 |
| 41-50 | 3 | 5 | 8 |
| 51-60 | 5 | 5 | 10 |
| 61-70 | 2 | 1 | 3 |
| Total | 14 (48%) | 15 (52%) | 29 (100%) |
The total population sample is 58 participants (M: 57.3 years).
Table 2: Population sample (numerousness) - Cg.
After the selection of the chosen population sample (first phase), we proceeded with the clinical interviews (second phase), from which the first significant data emerged:
The next phases of the research focused on the administration of PCOP-Q1 and the application of PCOP protocol steps. In particular [Tables 3-4]:
Test
|
CG |
Cg |
Δ CG/Cg |
M±DS |
P |
PCOP-Q1 (before) |
100% |
100% |
0% | CG = 177.6±21.1 Cg = 178.3±20.8 |
< 0> |
PCOP-Q1 (after) |
100% |
100% |
0% | CG = 83.1±16.3 Cg = 95.6±16.7 |
< 0> |
Table 3: S.P.S.S., T-test for tests and CG/Cg differential (descriptive)
Test
|
Groups |
CG (n/%) |
Cg (n/%) |
P |
PCOP-Q1 | 1 (21-30 y) | 2 (6.9%) | 3 (10.3%) | < 0> |
| 2 (31-40 y) | 6 (20.7%) | 5 (17.2%) | < 0> | |
| 3 (41-50 y) | 9 (31.1%) | 8 (27.7%) | < 0> | |
| 4 (51-60 y) | 7 (24.1%) | 10 (34.5%) | < 0> | |
| 5 (61-70 y) | 5 (17.2%) | 3 (10.3%) | < 0> |
Table 4: S.P.S.S., T-test for tests and groups.
The present study showed that with the use of the PCOP protocol and the PCOP-Q1 questionnaire, it is possible to improve the focus on the emotional and interpersonal problems of ostomate patients, centering therapeutic goals and fostering a more humanistic approach.
In the first clinical group (CG), those who scored greater than 50% of the total on the PCOP-Q1 in the first administration were 68/68 (100%); this figure is quite alarming, as it suggests that the psychological preparedness of these patients is severely inadequate and that an instructional plan needs to be put in place for patients before they can face the consequence of surgery. After the course of psychotherapeutic sessions, according to the protocol, data from the re-administration of the questionnaire showed a marked improvement in the psychological approach to ostomy persistence, but the data still show that early intervention could have brought greater benefits. The same argument should be made for the second clinical group (Cg), which has the same peculiarities, with markedly greater subjective data and therefore more alarming.
The use of the PCOP protocol and the PCOP-Q1 questionnaire is strongly recommended in the clinical setting, as their technical input concretely helps the therapist [71-72] in fostering the effectiveness of psychotherapeutic intervention and patients in improving their degree of acceptance by improving their quality of life.
The present study, however, has both structural and functional limitations that, in the opinion of the writer, do not affect the quality of the results obtained, but should be taken into consideration for future research to avoid analytical bias. Structurally, the design of the study involves the use of an unvalidated questionnaire, as there is no questionnaire in the literature capable of investigating all the areas (9 in total) studied by the PCOP-Q1; it was felt, therefore, that it could not be validated in the absence of a questionnaire capable of guaranteeing the correct comparisons, however, in the psychotherapeutic sessions provided by the protocol, as demonstrated in this study, it has demonstrated all its efficiency and effectiveness as a tool. Functionally, the study recruited 58 adult subjects who were permanently ostomized, and recruitment followed the inclusion and exclusion criteria, but there may be a selection bias related to the fact that the physical and mechanical characteristics of the ostomies were not taken into account; however, this bias was ruled out by the investigator who felt for this study not to consider these variables because the number of participants was too small to investigate this aspect in depth.
In the future, therefore, we will try to investigate the technical features even further, introducing in detail the issue of the validation process of the questionnaire used.
In conclusion, Perrotta-Guerrieri Psychological Care for Ostomy Patients" (PCOP) protocol and the integrated questionnaire (PCOP-Q1) can be considered tools that facilitate the process of acceptance of the adult ostomy patient on a definitive basis, helping the therapist to center the psychotherapeutic intervention strategically. However, these tools cannot be considered exclusive but rather must be complementary to the early educational and training intervention to be offered to the patient to help him or her in the difficult process of psychophysical healing.
This work received no external funding.
Ethics statement: All participants were assured of compliance with the ethical requirements of the Charter of Human Rights, the Declaration of Helsinki in its most up-to-date version, the Oviedo Convention, the guidelines of the National Bioethics Committee, the standards of "Good Clinical Practice" (GCP) in the most recent version, the national and international codes of ethics of reference, as well as the fundamental principles of state law and international laws according to the updated guidelines on observation studies and clinical trial studies.
Informed Consent Statement: Subjects who gave regular informed consent agreements were recruited; moreover, these subjects requested and obtained from GP, as the sole examiner and project manager, not to meet the other study collaborators, thus remaining completely anonymous.
Data Availability Statement: The subjects who participated in the study requested and obtained that GP be the sole examiner during the therapeutic sessions and that all other authors be aware of the participant's data in an exclusively anonymous form.
Acknowledgements: The author who contributed to the work is 1. The author has read and approved the final manuscript.
Conflicts of Interest: The authors declare no conflicts of interest.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
