Effect Of Health Education Based On The 5Ts For Teach Back On Compliance Of Oral Nutritional Supplements In Discharged Patients After Gastric Cancer Surgery

Background:The incidence of malnutrition in postoperative patients with gastric cancer was high.Oral nutritional supplements（ONS）could significantly improve the nutritional status of patients,which was recommended as the first-line treatment of nutritional therapy.However,the study found that the ONS compliance of postoperative patients with gastric cancer was generally low.Therefore,how to improve the ONS compliance of postoperative patients with gastric cancer had become the key to improve their nutritional status.Previous studies had pointed out that on health education for postoperative patients with gastric cancer was an important factor affecting their ONS compliance,but at present,the way of health education mostly adopts one-way information transmission,ignoring the patient’s understanding and feedback of the learned information;And the cancer patients with low level of health literacy seriously affected their understanding and application of input knowledge.As a teaching strategy of two-way transmission of information,teach back method has become an effective method of health education for cancer patients.The teach-back method,while inputting health education knowledge to patients,pays attention to patients’understanding,so that patients could describe what they had learned in their own language.Educators re-emphasize and circulate the education information that was misunderstood or not understood according to patients’feedback until patients correctly understand and master it.This method could effectively help medical staff quickly evaluate patients’acceptance of health education,timely correct their wrong understanding and cognition,and consolidate information.This study hopes to carry out health education for postoperative patients with gastric cancer based on teach back method,to improve the ONS compliance and provide reference for nutritional care of discharged patients after gastric cancer surgery in the future.Objective:This study aims to explore the impact of health education based on the 5Ts for teach back on the compliance of ONS for discharged patients with gastric cancer after surgery.Method:This study was a randomized controlled intervention study.Patients who underwent gastric cancer surgery in gastrointestinal surgery of a third-class hospital in Changchun,Jilin Province from December 2020 to October 2021 were selected as the research object.108 patients were randomly divided into experimental group and control group according to the order of admission.54 patients in the experimental group received health education program based on the 5Ts for teach back;54 patients in control group received routine health education.The intervention time of the two groups was from before discharge to 5 weeks（w）after discharge,with a total of 6times.Before and after the intervention,the knowledge level of ONS and the health literacy of patients with chronic diseases were measured in the two groups;In addition,the patients in the two groups were followed up to 12w after discharge.During the follow-up period,the patients or their families were required to fill in the ONS diet diary every week.Oral ONS compliance was calculated according to ONS diet diary,ONS dosage/doctor’s order*100%;The compliance of patients with ONS was evaluated by using the double indicators of ONS dose and days per week.The patients were divided into groups:（1）Full Dose and Full Time（DT）;（2）Full Dose and Insufficient time（Dt）;（3）Insufficient dose and Full Time（d T）;（4）Insufficient dose and Insufficient time（dt）,and then the change trend and characteristics of ONS compliance of discharged patients after gastric cancer surgery were analyzed.In addition,this study collected the nutritional indicators of patients,including body mass index（BMI）and health education compliance indicators by telephone or We Chat at 5w（at the end of intervention）and 12w（at the end of follow-up）;Patients’satisfaction with the overall health education was evaluated at the end of follow-up.This study uses SPSS 23.0 software for analysis.The measurement data of normal distribution is in the form of mean±standard（（?）±S）deviation,and the median（M）and interquartile spacing(P₂₅,P₇₅)are used in non-normal distribution;The changes of body weight and BMI of the two groups before and after 5 and 12weeks were compared by Wilcoxon signed rank test.The baseline characteristics and other outcome indexes of the two groups were compared byx~2test,t test and Mann Whitney U test.Bilateral P<0.05 was statistically significant.Result:By July 2021,160 patients had been recruited in this study.After inclusion and exclusion criteria,108 patients remained,54 in the experimental group and 54 in the control group;At the end of the intervention,there were 41 patients in the experimental group and 40 patients in the control group,and the loss of follow-up rates were 24.1%and 25.9%respectively;At the end of follow-up,that is,in October2021,there were 30 patients in the experimental group and 27 patients in the control group,and the loss of follow-up rates were 44.4%and 50%respectively.1.Demographic sociological and disease characteristic data:there was no significant difference between the two groups in demographic sociological data such as age,gender,weight,BMI and disease characteristic data such as operation mode,intraoperative blood loss and tumor type（P>0.05）.2.Primary endpoints:（1）ONS compliance:5w after discharge,the ONS compliance rate of patients in the experimental group and the control group was 55.69%vs 32.87%,and the difference in compliance was statistically significant（P=0.009）.The 5w average compliance rate of the experimental group and the control group was 65.70%and43.73%,respectively.The ONS compliance in the experimental group was significantly higher than that in the control group（P=0.005）.The 12w after discharge ONS compliance rate of patients in two groups was 25.95%vs 21.40%,but there was no statistically significant difference in compliance at this time（P=0.728）.The 12w average compliance rate of patients in the experimental group and the control group was 48.14%vs 32.77%.The ONS compliance in the experimental group was still higher than control group,with statistical significance（P=0.020）.Patients in both groups were consistently in the majority of d T groups within 12w after discharge.Over time,the number of patients in DT group of the experimental group decreased gradually,but the number was basically stable after 9w.The number of dt group increased gradually and stabilized at 10w.Within 12w of discharge from the control group,patients in the Dt group were still in the lowest proportion of patients,and disappeared at 9w.（2）ONS Knowledge level:Patients in the experimental group were significantly higher than those in the control group in terms of"nutrition and malnutrition","methods and precautions of taking ONS preparations","adverse reactions and treatment of taking ONS preparations"and"total score",with statistical significance（P<0.05）.However,there was no statistical difference in"definition and function of ONS"and"form and type of ONS preparation"（P>0.05）.（3）Health literacy level:At the end of intervention,there was"information acquisition ability","willingness to improve health","communication and interaction ability"and"total score"of patients in the experimental group were significantly higher than those in the control group（P<0.05）.However,in the dimension of"willingness to support",there was no statistical difference between the two groups（P=0.411）.3.Secondary endpoints:（1）Nutritional indicators:there were no statistical differences in body weight and BMI between the two groups after intervention（P>0.05）,but there were statistically significant differences in body weight and BMI between two groups（P<0.001）.At 5w after discharge,weight loss and BMI loss in the control group were higher than experimental group,but the difference was not statistically significant（P>0.05）.There was also no statistically significant difference in body weight and BMI between the two groups at 12w after discharge（P>0.05）,but the body weight and BMI of control group were significantly decreased（P=0.001;0.002）.The weight loss and BMI loss in the control group were significantly higher,with statistical significance（P=0.034;0.039）.（2）Patients’satisfaction with health education:The total score of patients in experimental group was significantly higher（P=0.009）.In terms of the scores of all dimensions,except"overall satisfaction","technical service quality"and"service economy",the scores of three dimensions had no statistical significance（P>0.05）,and the other dimensions were statistically significant（P<0.05）.（3）Health education compliance:the health education compliance between the experimental group and the control group was 75.92%vs 74.07%,with no statistically significant difference（P=0.780）.Conclusion:1.Health education based on the 5Ts for teach back can significantly improve the level of ONS related knowledge and health literacy of discharged patients with gastric cancer,and improve their short-term and long-term ONS compliance.2.Health education based on the 5Ts for teach back effectively reduced the weight loss and BMI loss at 12w after discharge of patients with gastric cancer,but had no significant effect on the weight loss and BMI loss at 5w after discharge.3.Health education based on the 5Ts for teach back effectively improves the health education satisfaction of discharged patients with gastric cancer.