Objective:

To investigate the effects of integrating Acceptance and Commitment Therapy (ACT) with usual care on psychosocial outcomes, emphasizing the significance of these outcomes in improving patient quality of life and reducing complications in patients with permanent colostomies after colorectal cancer surgery.

Key Findings:

• ACT integration resulted in significant improvements in self-efficacy, resilience, and quality of life, indicating its potential as a valuable intervention.
• Large effect sizes (Cohen's d≈0.9) indicate a substantial association between ACT and psychosocial benefits, warranting further exploration.
• Reduction in complications was observed, although causality cannot be established due to the observational design.

Interpretation:

ACT's focus on acceptance and values-based actions may effectively address stoma-related distress, suggesting the need for formal psychological support in stoma care, which could enhance patient outcomes.

Limitations:

• Retrospective design limits causal inference and may include unmeasured confounders, such as baseline psychological flexibility or social support.
• Potential recruitment bias as participants may differ in motivation and other unmeasured factors, affecting the generalizability of results.
• Lack of detailed specification on intervention fidelity and usual care quality, which could impact the observed effect sizes.
• Single-center study with a small sample size (n = 120) limits generalizability and the applicability of findings to broader populations.

Conclusion:

The study provides preliminary evidence for ACT's benefits in stoma care, highlighting the need for further rigorous research, including RCTs and hybrid effectiveness-implementation designs to validate findings and explore mechanistic pathways, ultimately aiming to improve patient care.