The effectiveness of health education based on the 5Ts for teach-back on oral nutritional supplements compliance of post-discharge patients after surgery for gastric cancer: a randomized controlled trial

Enhanced recovery after surgery continuity nursing in elderly gastric cancer patients

BACKGROUND

Gastric cancer predominantly affects the elderly, who face significant challenges due to high postoperative complications and stress. These challenges include comorbidities, reduced physiological reserves, and increased risks of infections and delayed healing. Traditional postoperative care often falls short in addressing these issues effectively. Enhanced recovery after surgery (ERAS) principles have revolutionized surgical care by reducing stress and promoting recovery through a holistic approach. ERAS emphasizes preoperative optimization, intraoperative care, and postoperative rehabilitation tailored to patient needs. Despite its recognized benefits, the impact of continuity nursing care within the ERAS framework on elderly gastric cancer patients remains underexplored. This study examines the influence of ERAS-based continuity nursing care on postoperative satisfaction, inflammation, stress, and quality of life in elderly patients undergoing gastric cancer resection.

AIM

To investigate the effects of ERAS-based continuity nursing care on postoperative satisfaction, inflammation, stress, and quality of life in elderly gastric cancer patients.

METHODS

A retrospective cohort analysis was conducted on 322 elderly patients who underwent gastric cancer resection between January 2020 and January 2022. Patients were assigned to a routine care group (n = 156) or an ERAS-control (ERAS-C) group (n = 166). Data collected included demographic information, inflammatory and stress markers, satisfaction scores using the patient satisfaction questionnaire-18, and quality of life measured using the European Organization for Research and Treatment of Cancer 22-item quality of life questionnaire specific to gastric cancer.

RESULTS

The ERAS-C group exhibited significantly lower postoperative interleukin-6 levels than the routine care group (12.97 ± 4.02 pg/mL vs 14.37 ± 3.86 pg/mL; P = 0.002). This finding indicates that the ERAS-C group experienced reduced inflammation. The ERAS-C group also had a higher cluster of differentiation (CD) 4:CD8 ratio than the routine care group (2.34 ± 0.35 vs 2.13 ± 0.61; P < 0.001), suggesting the former’s enhanced immune response. Postoperative stress markers, including norepinephrine, cortisol, and aldosterone, were significantly lower in the ERAS-C group than in the routine care group (P < 0.05 for all). Compared with the routine care group, the ERAS-C group showed increased nursing satisfaction scores (80.36 ± 7.24 vs 75.23 ± 7.03; P < 0.001) and improved quality of life indicators, such as reduced dysphagia and pain, (P < 0.05). The ERAS-C group also experienced fewer complications than the routine care group (5.42% vs 11.54%, P = 0.048).

CONCLUSION

Continuity nursing care within the ERAS framework significantly enhances postoperative outcomes for elderly gastric cancer patients by reducing inflammation, stress, and complications while improving satisfaction and quality of life.

Video discharge instructions increase patient understanding for office-based procedures: a randomized controlled study

Background

Health literacy significantly influences healthcare outcomes, with poor literacy leading to worse quality of life, increased mortality, and higher readmission rates. Recent efforts to improve post-encounter education include structured teach-back methods, patient preference assessments, and standardized discharge instructions. Studies in emergency departments have shown that incorporating video discharge instructions enhances patient understanding and retention of care information. To address the gap in urology, this study aims to evaluate patient comprehension and satisfaction with video discharge instructions following clinic-based vasectomy procedures.

Methods

We performed an Institutional Review Board approved (#H-51614) unblinded randomized controlled study with written consent from each participant. All men undergoing vasectomy from August to September 2022 in our outpatient clinic were included in our study. Patients were randomized to receive either video or written discharge instructions. A standardized questionnaire was administered containing objective comprehension questions regarding the discharge instructions they received. Patients were also queried on their preference of discharge instruction format and subjective Likert-scale of information usefulness and format understandability.

Results

Each cohort contained 11 men. There was no difference in age or educational level between the groups (P=0.91, 0.38, respectively). The video cohort exhibited increased comprehension scores (P<0.001). There was no difference between cohorts in ratings of information helpfulness and instruction understandability (P=0.48, 0.06, respectively). Approximately 73% of men in the video group preferred to receive both video and written instructions while 73% patients in the written cohort preferred to receive only written instructions (P<0.001).

Conclusions

Use of video discharge instructions significantly improved objective comprehension with similar perceptions of information helpfulness and understandability. Patients who received video discharge instructions were more likely to prefer receiving both written and video instructions than those who received written instructions. Overall, these findings support the utility of video discharge instructions in a urologic setting.

Perioperative Health Education for Patients With Daytime Anorectal Surgery: An Evidence-based Practice Change

PURPOSE

To develop and implement an evidence-based perioperative health education program for patients undergoing daytime anorectal surgery, and to enhance patients' knowledge scores pertaining to anorectal diseases.

DESIGN

An evidence-based quality improvement project.

METHODS

Adhering to the evidence-based practice model of the Joanna Briggs Institute, we developed 17 audit criteria grounded in the best available evidence. This evidence-based practice was subsequently applied to patients scheduled for daytime anorectal surgery between March 2023 and May 2024. The project progressed through three distinct phases: a baseline audit, implementation of practice changes, and a post evidence application audit. Specifically, we compared the execution rates of the audit criteria by the nursing staff, patients' scores on anorectal disease knowledge, patient satisfaction, and incidence of postoperative complications before and after implementation of the evidence-based practice.

FINDINGS

After implementation of the evidence-based practice, there was a statistically significant difference in the execution rates of audit indicators 1, 2, 5, 6, 8, and 10 to 17 (P < .05). After implementation, patients' average score on anorectal disease knowledge was 74.14 ± 14.40, higher than the average baseline audit phase score of 63.67 ± 12.31 (P = .004). Patients were likely to recommend the hospital's daytime anorectal surgery to others (P = .036). There were no statistically significant differences in patient satisfaction scores or complication incidence between the two groups.

CONCLUSIONS

Current evidence suggests that the program may regulate nurse behavior, enhance patients' health knowledge, and improve patients' overall medical experience. Continuous quality supervision and audit should be further conducted in the future.

Definition and assessment of adherence to oral nutritional supplements in patients with neoplasms: a scoping review

INTRODUCTION

Cancer remains a leading cause of death globally, with patients frequently experiencing malnutrition due to both the disease and its treatment, which negatively affects their quality of life and treatment outcomes. Oral nutritional supplements (ONS) provide a noninvasive solution to improve nutritional status, but poor patient adherence limits their effectiveness. Studies on ONS adherence vary in their definitions and assessment tools, creating inconsistencies. A scoping review is essential to synthesize these studies and establish a foundation for future research and clinical practice.

METHOD

We systematically searched six databases, including Web of Science, PubMed, and Scopus, up to August 2024. Our criteria focused on oncology patients, ONS interventions, and outcomes related to adherence definitions, assessment methods, and adherence rates.

RESULTS

37 studies from 2005 to 2024 met the inclusion criteria. Definitions of ONS adherence and assessment methods vary widely, with the most common definition being the ratio of actual intake to the recommended amount. The assessment tools included self-reported ONS diaries, and MMAS scores, among others. Adherence rates also vary significantly, with some studies reporting a decline in adherence over time.

CONCLUSION

The lack of standardized definitions and assessment methods for ONS adherence across studies hinders comparability. Future research should focus on developing standardized, comprehensive adherence assessment tools that incorporate both quantitative and qualitative data. This would allow for a better understanding of adherence factors and enable more targeted interventions to improve long-term adherence in cancer patients.

Health literacy friendly organizations - A scoping review about promoting health literacy in a surgical setting

OBJECTIVE

This review aims to describe interventions that promote health literacy in a surgical setting and identify knowledge gaps for future research.

METHODS

A scoping review with a systematic search was performed in Medline, CINAHL, Scopus, and Web of Science between January 1, 2012, and January 23, 2024. All screening was conducted using the Covidence software. In total, the search yielded 6 281 articles.

RESULTS

Eighteen articles were included in the results. Studies were heterogeneous regarding the type of health literacy measured, type of surgery, and type of intervention. Most interventions were educational to improve knowledge, decision making or health literacy through digital media, group sessions or consent forms. Most interventions had a positive impact on health literacy.

CONCLUSIONS

Patients with limited health literacy may benefit from a variety of interventions. However, research in this area is sparse. Further research is needed into interventions that may be beneficial for patients.

PRACTICE IMPLICATIONS

Measure, evaluate and implement health literacy-friendly options to ensure people can make safe and sound decisions for their care. Researchers need to consider the type of health literacy investigated and the type of instrument used in the research.