Psychological Pain Tolerance and Its Associated Factors Among Hospitalized Patients With Enterostomy in China: A Cross-Sectional Quantitative Study

Hospitalized patients with enterostomy in China exhibit moderate psychological pain tolerance, necessitating targeted interventions to improve their quality of life, according to a comprehensive cross-sectional study. The research, published in Frontiers in Psychology, highlights that while patients can endure psychological distress, their capacity for active pain management is comparatively lower, suggesting a need for enhanced coping strategies. The study, which surveyed 506 patients across three tertiary grade-A hospitals, identified several key factors influencing psychological pain tolerance, including age, gender, living status, time since enterostomy, psychosocial adaptation, quality of life, and self-care abilities.

The Growing Challenge of Enterostomy Care

Enterostomy, a surgical procedure creating an opening for waste elimination, is a critical intervention for patients with severe gastrointestinal conditions, particularly colorectal cancer. Globally, colorectal cancer is a significant health concern, with the International Agency for Research on Cancer (IARC) reporting approximately 1.9 million new cases worldwide in 2020, making it the third most prevalent malignancy. This disease also accounts for a substantial number of deaths, ranking as the second leading cause of cancer-related mortality. Consequently, enterostomy remains a primary life-saving surgical approach.

The number of individuals requiring enterostomies is steadily increasing, with an estimated 100,000 new cases annually worldwide. Notably, a demographic shift indicates a growing proportion of younger patients undergoing this procedure. Post-enterostomy, patients face a myriad of challenges, including altered bodily functions, changes in body image, and the daily management of the stoma. These physical adjustments often trigger significant psychological distress. Data from China reveals a concerning prevalence of psychological distress among enterostomy patients, with one study reporting that 56.8% experience clinically significant distress, a rate considerably higher than in the general cancer population.

Understanding Psychological Pain Tolerance

Psychological pain, characterized by unpleasant emotional states such as anxiety, depression, and existential concerns, is increasingly recognized as a significant predictor of adverse outcomes, including suicidal behaviors. Emerging research emphasizes the importance of "psychological pain tolerance"—the ability to regulate emotions and cognitively reappraise distressing experiences—as a more robust indicator than traditional distress measures. Enhanced psychological pain tolerance acts as a protective factor, mitigating suicide risk and fostering adaptive coping mechanisms. However, prior research has indicated that this crucial aspect of psychological well-being remains underdeveloped among hospitalized enterostomy patients, with limited studies exploring its influencing factors within this specific population.

Study Methodology and Findings

To address this knowledge gap, the study employed a descriptive cross-sectional design, adhering to the STROBE checklist for quality reporting. Between March 2024 and May 2025, 506 hospitalized patients with enterostomies from three tertiary grade-A hospitals in China were recruited. Participants completed a series of validated questionnaires, including the Demographic Characteristics Questionnaire, Tolerance for Mental Pain Scale (TMPS), Ostomy Adjustment Inventory (OAI), Stoma Quality of Life (S-QOL), and Stoma Self-care Scale (SSCS).

The study revealed that the average psychological pain tolerance score among these patients was 32.18 (±10.42), suggesting a moderate level. Analysis of the TMPS dimensions indicated that patients scored higher on "pain tolerance" (3.35 ± 1.23) than on "pain management" (3.08 ± 1.27). This finding is particularly noteworthy, as it suggests that while patients may have a capacity to endure psychological discomfort, their active strategies for managing and alleviating this distress are less developed.

Furthermore, significant positive correlations were observed between psychological pain tolerance and psychosocial adaptation (r = 0.674, p < 0.01), quality of life (r = 0.542, p < 0.01), and self-care (r = 0.513, p < 0.01). These correlations extended across all dimensions of these measures, highlighting the interconnectedness of these factors.

Key Influencing Factors Identified

Multiple linear regression analysis identified several significant factors associated with psychological pain tolerance among hospitalized enterostomy patients. These include:

• Age: Older patients generally exhibited lower psychological pain tolerance. This may be attributed to a higher prevalence of comorbidities, chronic pain, and potentially diminished life expectations in older individuals.
• Gender: The study found gender to be a significant factor, though the precise nature of this association requires further nuanced investigation in future studies. The current sample had a substantial female predominance (77.87%).
• Living Status: Patients living alone demonstrated higher psychological pain tolerance compared to those living with others. This finding is somewhat counterintuitive and may suggest complex dynamics within family caregiving structures.
• Time After Enterostomy: A longer duration since the enterostomy surgery was associated with increased psychological pain tolerance. This suggests a process of adaptation and developing coping mechanisms over time.
• Psychosocial Adaptation: Patients who reported better psychosocial adaptation—including acceptance of their condition and a positive life attitude—showed higher psychological pain tolerance.
• Quality of Life: A higher perceived quality of life, encompassing social interaction, physical and psychological well-being, interpersonal relationships, and stoma appliance management, was strongly linked to greater psychological pain tolerance.
• Self-Care: Patients with higher levels of self-care competence in managing their enterostomy reported better psychological pain tolerance. This underscores the importance of patient empowerment and education in managing their condition.

These seven factors collectively explained 45.8% of the total variation in psychological pain tolerance, highlighting their substantial influence.

Implications for Nursing Practice and Future Research

The study’s findings carry significant implications for healthcare professionals, particularly nurses, involved in enterostomy care. The moderate level of psychological pain tolerance, coupled with the identified influencing factors, underscores the need for personalized nursing interventions.

Personalized Intervention Strategies: Nurses can leverage the study’s findings to develop tailored support programs. For instance, for older patients or those in the early stages post-enterostomy, interventions focusing on enhancing active pain management strategies and building self-efficacy in stoma care could be crucial. For individuals living alone, strategies to foster social support networks, even if non-familial, might be beneficial.

Enhancing Psychosocial Adaptation: Given the strong link between psychosocial adaptation and pain tolerance, interventions aimed at improving patients’ acceptance of their condition, fostering a positive outlook, and facilitating social integration are paramount. This could involve psychological counseling, support groups, and educational programs that address the emotional and social impact of enterostomy.

Promoting Quality of Life and Self-Care: The interconnectedness of quality of life, self-care, and psychological pain tolerance suggests that interventions should holistically address these domains. Empowering patients with comprehensive knowledge and practical skills for stoma management can boost their self-care abilities, leading to improved quality of life and, consequently, enhanced psychological resilience. This aligns with findings from other studies that have demonstrated the effectiveness of multimedia educational interventions in improving stoma care confidence and quality of life.

Addressing the Gender Disparity: While the study noted gender as a significant factor, the predominantly female sample necessitates further research with balanced gender representation to understand potential gender-specific needs and approaches in psychological pain management for enterostomy patients.

Limitations and Future Directions

The researchers acknowledge several limitations in their study. The use of convenience sampling from three hospitals may limit the generalizability of the findings to a broader population of enterostomy patients. The cross-sectional design also prevents the establishment of definitive causal relationships. Future research should employ random sampling across multiple centers and utilize longitudinal designs to explore the dynamic interplay between these factors over time. Additionally, further investigation into the specific mechanisms underlying the observed gender differences is warranted.

In conclusion, this study provides valuable insights into the psychological pain tolerance of hospitalized enterostomy patients in China. By identifying key demographic, psychosocial, and self-care-related factors, the research offers a critical foundation for developing evidence-based, individualized nursing interventions. The ultimate goal is to enhance patients’ psychological well-being and improve their overall quality of life as they navigate the challenges associated with enterostomy.