| Objectives:To describe the nutritional status,factors contributing to nutrition change in patients after gastrectomy,and oral nutrition problems and needs of patients at home after gastric cancer surgery,in order to construct an oral nutrition practice program for home cancer patients after gastrectomy using Knowledge,Attitude/Belief,Practice as a theory guide combined with H2H nutrition management model.Methods:A cross-sectional study and a longitudinal study design were made in this study.Using generalized estimation equations to explore the characteristics of high-risk populations that cause body weight loss within 3 months after gastric cancer surgery.A total of 160 patients with gastric cancer were tested through PG-SGA,food frequency questionnaire,digestive cancer patients nutrition knowledge,attitude and practice questionnaire by Zhang et al,and Quality of Life Questionnaire-Core 30 from European Organization for Research and Treatment.The nutritional status,oral nutritional intake,influencing factors of postoperative patients at home,the impact of nutritional status on quality of life and related factors that affect oral intake to meet standards were described and explained.Based on the analysis of Internet data,dietary problems and care needs were confirmed in home cancer patients after gastric cancer surgery.Then,leterature research and evidence summarization of relevant topic were performed,combined with Knowledge,Attitude/Belief,Practice theory,oral nutrition practice program for gastric cancer patients after gastrectomy at home was constructed.Results:1.There were 49 patients recruited in the study.Patient’s body weight decreased by 9.2%at T1(P<0.001),11.0%at T2(P<0.001),and 11.4%at T3 compared to baseline at T0(P<0.001).The results of GEE for multivariable analysis showed that total gastrectomy(Wald χ2=6.03,P=0.014)and preoperative BMI(Wald χ2=12.66,P=0.005)were contributing factors of body weight change.Compared with distal gastrectomy patients,total gastrectomy patients experienced greater body weight loss(β=2.8%,P=0.014).Compared with underweight patients,obesity patients(β=4.5%,P=0.026)experienced more body weight loss.2.Nutritional status of patients with gastric cancer after surgery.Among 160 patients with gastric cancer,the incidence of malnutrition was 70.6%.The percent of gastric cancer patients who did not meet the energy and protein intake was 21.9%and 32.5%,respectively.The energy(26.5%vs 10.6%,P=0.027)and protein(38.9%vs 14.9%,P=0.002)of malnourished group was significantly higher than that of the non-malnutrition group.The percent of non-compliance with protein intake in gastric cancer patients was in the order of 3 months(53.3%)after gastric cancer,before treatment(40.3%),chemotherapy(25.9%),and 3 months after gastric cancer(16.0%).There was a significant difference in protein intake(χ2=8.84,P=0.029),but there was no statistical difference in energy intake.Logistic regression analysis suggested that aged 65 or more(OR=3.62,P=0.005)and oral nutrient protein intake less than 2g/(kg*d)(OR=3.01,P=0.018)were independent influencing factors of malnutrition in patients with gastric cancer at home.Patients with malnutrition have significantly lower scores in physical function(Z=-3.33,P=0.001),role function(Z=-3.39,P=0.001),cognitive function(Z=-2.37,P=0.018),emotional function(Z=-3.28,P=0.001),and overall health status(Z=-4.88,P<0.001)than those with non-nutrition,and pain(Z=-2.32,P=0.021),nausea and vomiting(Z=-2.98,P=0.003)were significantly higher than those of non-nutrition patients.Logistic regression analysis of oral nutritional intake indicated that nutritional knowledge scores of patients with gastric cancer(Wald χ2=18.42,P<0.001)and ECOG score(Wald χ2=11.16,P=0.011)were independent factors affecting energy intake.Gastric cancer patients’ nutrition knowledge score(Wald χ2=15.766,P<0.001),and ECOG score(Wald χ2=10.392,P=0.015)were independent factors affecting protein intake.3.Based on the websites,1420 diet-related questions was asked by patients during the time before discharge and after gastrectomy several years.The patients asked about 83.87%of all questions about how to eat after gastric cancer,the cause and treatment of diet-related symptoms accounted for 12.04%,oral nutritional supplement problems accounted for 3.45%,diet and prognosis accounted for 0.56%,and diet and exercise problems accounted for 0.07%.Among the questions about how to eat,the percent of about regular diet after gastric cancer and whether a certain food can be eaten was 43.84%and 44.44%.The seven most common symptoms of gastric cancer patients during their postoperative diet were vomiting,difficulty swallowing,abdominal pain,bloating,snoring,reflux,and body weight loss,accounting for 81.13%of all symptoms.The oral nutritional requirement of gastric cancer patient included oral nutrition-related solutions provided by professional staff,diet-related knowledge after gastric cancer surgery and psychological support.The results of emotional orientation of oral nutrition problems in home patients after gastrectomy was generally positive(positive vs negative score:1758 VS-1531),but the emotional orientation of diet and symptom problems was generally negative(positive vs negative score:256.5 VS-410).4.Based on the research of oral nutrition practice,exercise management,and pyschological support for patients with gastric cancer after surgery,this section includes a total of 33 articles,including 22 experimental studies and 4 guidelines,1 literature expert consensus,and 6 manuals for oral nutrition education after gastric cancer.Evidence of oral nutrition implementation,exercise management and psychological support were systematically evaluated and synthesized,conbined with previous literature reviews and research results,oral nutrition practice program for gastric cancer patients after gastrectomy at home was formed.Conclusions:1.Gastric cancer patients experienced significant weight loss during 3 months after gastrectomy.Total gastrectomy and BMI≥25 kg/m2 were risk factors to postoperative body weight loss within 3 months of gastric cancer.2.Gastric cancer patients at home have a high incidence of malnutrition,and malnutrition reduces some patients’ quality of life.3.The highest rate of substandard protein intake was found in home patients who received chemotherapy within 3 months after gastric cancer resection.The mount of protein intake less than 2g/(kg*d)was independent factor contributing to malnutrition in gastric cancer patients.4.Patient nutrition knowledge,ECOG levels were independent factors that influence whether oral protein intake and energy intake meet the standard.And lack of nutrition knowledge may affect nutrition status by regulating oral nutrition intake.5.The dietary problems of patients with gastric cancer after surgery mainly involve how to eat,the causes of diet-related symptoms and treatment measures.Patients’ needs are mainly diet knowledge,nutritional support of professionals,and psychological support.6.Based on our quantitative research results of this study,Oral nutritional care practice program for patients with gastric cancer after surgery includes oral nutrition management module,exercise management module and psychological support module. |
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