Differences In Compliance Of Oral Nutritional Supplements In Postoperative Patients With Gastric Cancer

Patients with gastric cancer are prone to malnutrition after surgery,and it is very important to prevent malnutrition in patients after gastric cancer surgery.The European Society for Parenteral and Enteral Nutrition(ESPEN)recommends oral nutritional supplementation(ONS)as a first-line nutritional treatment to effectively prevent malnutrition in cancer patients,but patients’ compliance with ONS is generally low.Therefore,improving patient compliance is a key step in maintaining the nutritional status of gastric cancer patients.At present,an in-depth study is urgently needed to discover the factors that encourage patients to persist and stop taking ONS after gastric cancer surgery,and to provide references for the formulation of future ONS compliance management strategies.Objectives:1.Determine the level,trend and status of ONS compliance in patients with gastric cancer within 12 weeks after surgery;2.Determine the impact of ONS compliance of patients after gastric cancer surgery on the nutritional status of patients;3.Explore the hindering and promoting factors that affect the compliance of patients with gastric cancer on ONS;4.From the perspective of patients,explain the reasons for the differences in compliance of patients with gastric cancer on ONS.Method:In this study,an explanatory sequential mixed research method was used to take ONS patients after gastrointestinal surgery in a tertiary hospital from October 2019 to May 2020.In the quantitative phase,a 12-week longitudinal study was conducted on 122 patients with gastric cancer after surgery.Each week was a follow-up point.The ONS intake diary was used to record the intake,and the intake/doctor’s order amount*100% was used to calculate the compliance rate.At each point,the patients are divided into groups with the dual indicators of dose and the number of days to analyze the characteristics of the changes in the compliance status of patients after gastric cancer:(1)Dose and number of days meet the requirements(DT);(2)The daily dose meets the requirements,but the number of days not enough(Dt);(3)The number of days meets the requirement,but the daily dose does not meet the requirement(dT);(4)The dose and number of days fail to meet the requirement(dt).In addition,re-admission and complications were collected through follow-up at each point,and patient weight and BMI were collected at 12 weeks.At the end of the 12-week follow-up,the overall average compliance rate of all patients at 12 weeks is a node,and patients higher than this node are divided into the high compliance group,Otherwise,it is classified as low compliance group.Then analyze the differences between the factors between the two groups and the impact of compliance on nutritional status and clinical outcomes.To evaluate its compliance with oral nutritional supplements and the factors affecting its compliance.After the quantitative research,we based on the results of the quantitative research,selected the interviewees,formulated an outline for the interview,and designed the second phase of the qualitative research to explain the quantitative research.The survey tools include general information questionnaire,ONS taking diary,PG-SGA scale,concise diet self-evaluation tool,voice recorder.For quantitative research,Epidata was selected to enter the data,and SPSS25.0 was used to analyze the data.Wilcoxon signed rank test,Fisher’s exact test,Mann-Whitney U test andT-test were used for data analysis.For qualitative research data,NVivo 12.0 was used for data management,and Colaizzi seven-step data analysis method was used for data analysis.Result:1.ONS compliance of patients after gastric cancer surgery within 12 weeks: The average compliance rate of ONS in patients after gastric cancer surgery at 12 weeks was 30.59%.Patients with compliance rates higher than 30.59% were classified as high compliance group(N=51),and vice versa(N=71).The patient’s compliance rate to ONS decreased over time,from 60.5% in the first week to 16.9% in the 12 th week.However,at 5-6 weeks after the operation,some patients choose to retake ONS,and the patients’ compliance with ONS has A brief rebound.2.Characteristics of changes in compliance: Within 12 weeks after surgery,the dT group always accounted for the majority of all patients.As time changes,patients switch between the four compliance states.The number of patients in the DT group is gradually decreasing,but the number is basically stable after 9 weeks,and the patients in the Dt group have disappeared by 9 weeks.3.The effect of ONS compliance of postoperative gastric cancer patients on nutritional indicators,complications and 30-day readmission: The 12-week weight loss of patients in the high compliance group was significantly lower than that in the low compliance group.There were no statistically significant differences in body weight or BMI between patients in the high compliance group before and after surgery,while there were statistical differences in weight and BMI between patients in the low compliance group.There was no significant difference between the two groups in the number of patients re-admitted to hospital within 30 days,wound infections,respiratory infections and infectious diarrhea.4.Influencing factors of ONS compliance in patients with gastric cancer: univariate analysis showed that household monthly income,main caregivers,education level,baseline weight,baseline BMI,PG-SGA score and ONS adverse reactions(P=0.023)are the statistically significant factors affecting ONS compliance.Binary logistic regression analysis showed that the family’s per capita monthly income,main caregivers,and ONS adverse reactions were independent factors related to patients’ ONS compliance.5.Qualitative research results: Through the analysis of the interview content of 15 participants who took ONS after gastric cancer surgery,four themes were finally obtained: social support plays an important role in patients taking oral nutritional supplementation,adverse reactions discourage patients from continuing to take oral nutritional supplementation,patients’ attitudes towards diseases and nutritional support affect their motivation to take ONS,and the different needs of patients for oral nutritional supplementation affect patient compliance.Conclusion:1.The high compliance of ONS is related to the maintenance of body weight and BMI at 12 weeks postoperatively in patients with gastric cancer,but the compliance of patients with ONS is at a very low level.The influencing factors include multiple aspects,adverse reactions of ONS and the main caregiver of the patient and economic capacity are independent factors influencing ONS compliance.2.Health education should pay attention to the management of adverse reactions,the role of patients’ companions and family members,and guide patients to self-monitor their nutritional status.