Family care and social alienation in patients with colorectal cancer and an ostomy: The sequential mediating effects of resilience and stigma

Objective: This study aimed to examine the association between family care and social alienation among patients with colorectal cancer (CRC) and an ostomy, and to explore the sequential mediating roles of resilience and stigma based on the ABC-X model. Methods: A cross-sectional study was conducted among 290 CRC patients with an ostomy in Fujian Province, China from October 2024 to August 2025. The participants completed questionnaires assessing family care, resilience, stigma, and social alienation. Serial multiple mediation analysis using the PROCESS macro tested the hypothesized pathways. Bootstrapping with 5000 resamples and bias-corrected 95% confidence intervals was used for testing the significance of indirect effects. Results: < 0.001). Using serial mediation analysis, resilience and stigma jointly and partially mediated the association between family care and social alienation. The total indirect effect accounted for 54.26% of the total effect, with three significant pathways via: resilience (25.25%), stigma (22.91%), and the chained path "resilience→stigma" (6.10%). Family care was associated with higher resilience, reduced perceived stigma, and consequently alleviated social alienation. Conclusions: Family care was associated with lower social alienation among CRC patients with an ostomy, potentially through higher resilience and lower stigma. These findings highlight the important role of family-based psychosocial resources in promoting adaptive adjustment following body-altering surgery. Nursing interventions should prioritize strengthening family care, cultivating resilience, and reducing illness-related stigma to promote social reintegration and overall well-being in CRC patients with an ostomy.