The Effect of Online Solution- Focused Group Counseling On Adjustment, Psychological Well- Being and Resilience

Colorectal cancers are among the most frequently diagnosed cancer types both in our country and worldwide and constitute a major public health problem that leads to morbidity and mortality despite advanced diagnostic and treatment methods. Their high prevalence necessitates action to protect both individual and public health. The treatment of colorectal cancers includes radiotherapy (RT), chemotherapy (CT), antibody therapy, and surgical interventions. Surgical procedures for colon cancer vary depending on the location of the tumor. As a result of these surgical interventions, an ostomy may be created for reasons such as saving the patient's life, protecting the anastomosis line, or eliminating the necessity of the anus.

The term ostomy is derived from the Greek word stoma, meaning "mouth" or "opening." In medical terminology, a stoma/ostomy refers to a surgically created opening of a hollow organ onto the body surface to allow the elimination of waste products. Colostomy is one of the most common therapeutic interventions applied in pathological conditions of the colon, particularly colorectal cancer, and is defined as the exteriorization of the large intestine onto the skin.

Studies indicate that living with a colostomy affects individuals' overall quality of life. Patients with a stoma face not only physical and functional challenges but also psychological, emotional, and social losses. The presence of a colostomy has been associated with various complex problems, including psychological and sexual difficulties, dissatisfaction with altered body image, changes in daily routines, travel difficulties, and fatigue.

Changes occurring in the lives of individuals with a colostomy significantly affect their interpersonal and intimate relationships. Adopting a new lifestyle adapted to colostomy management may have an emotional impact on the patient as well as on close individuals such as family members and sexual partners. According to previous studies, married individuals experience major changes in their sexual lives, particularly immediately after surgery or during the early stages of the disease. Moreover, women have been found to have lower quality of life compared to men, a situation associated with body image changes, fear of rejection, and inability to perform household tasks. As having a colostomy may lead to partial or complete job loss, the professional lives of colostomy patients are also seriously affected.

Individuals with a colostomy encounter various physiological, psychological, and social challenges. Psychological resilience plays a crucial role in coping with these difficulties. Psychological resilience is defined as a dynamic process of positive adaptation in the face of significant adversity. Research has shown that individuals reporting higher levels of psychological resilience engage more frequently in health-promoting behaviors compared to those with lower resilience. Furthermore, individuals with higher psychological resilience demonstrate better adaptation to chronic illnesses than those with lower resilience. However, research on psychological resilience in individuals with permanent ostomies remains limited.

Studies have demonstrated that as psychological resilience increases in individuals with permanent ostomies, their adaptation to the ostomy also improves. Another study reported that decreases in psychological resilience among individuals with permanent ostomies were associated with reductions in health-related quality of life. In a study conducted by Dong X and colleagues (2017), a positive relationship was found between psychological resilience and post-traumatic growth.

Solution-focused counseling is a strengths-based approach that emphasizes the resources individuals already possess and how these resources can be applied in the process of change. This approach aims to facilitate change in individuals' lives in the shortest possible time. It is based on the belief that change originates from two main sources: encouraging individuals to define their preferred future (how their lives would look if therapy were successful) and detailing the skills and resources they have already demonstrated (examples of current and past successes).

A review of the literature revealed no studies investigating the effects of solution-focused group counseling in individuals with permanent colostomies. Therefore, understanding the effects of online solution-focused group counseling on adaptation, psychological well-being, and psychological resilience in individuals with permanent colostomies due to colorectal cancer is of great importance for the entire healthcare team, particularly for mental health and psychiatric nurses, who constitute a vital component of this team.

Inclusion criteria

• Being 18 years of age or older,

• Having a permanent colostomy due to colorectal cancer,
• At least 2 months having passed since the permanent colostomy was placed,
• Being able to use computers and online applications,
• Having no problems with verbal and written communication,
• Not having any physical or mental condition that would prevent cooperation.

Exclusion criteria

• Having previously had an ostomy • Having received psychotherapy in the last year or currently receiving it.