We evaluated oral nutrition home nursing needs in Chinese gastric cancer patients after gastrectomy in this study. To this end, we collected and assessed the postoperative oral nutrition questions by GC patients or their caregivers from the Internet. Our data show that postoperative oral nutrition questions presented from pre-operation to several years after gastrectomy. Most of the questions were about what to eat and how to eat after gastrectomy. The cause and treatment of diet-related symptoms were also paid attention to by patients and their caregivers, including vomiting, difficulty swallowing, abdominal pain, bloating, snoring, reflux, et.al. In addition, symptoms often induced a negative emotional state for the patients and their caregivers. The oral nutritional home nursing needs of gastric cancer patient included oral nutrition-related solutions provided by professional staff, symptom support, ONS information, nutrition monitor, psychological support, dietary and prognosis information, and exercise information.
The results are similar to a previous study in which patients experienced temporal, uncovered, improved, and unchanged problems in quality of life after 3 and 12 months of gastrectomy, specifically, fatigue, digestive symptoms such as diarrhea, dysphagia, and eating restrictions were the representative unrecovered problems, persisting at 12 months after surgery[11]. Also in agreement with other studies, patients undergone consistently eating restrictions, nausea, vomiting, dysphagia, reflux, and dry mouth during the two or more postoperative years[12, 22, 23]. For long-term survivors, eating restrictions still existed in total gastrectomy GC patients[14]. The results underscore health care providers should initiate oral nutritional education earlier and make sure that patient have acquired relevant knowledge and skills, in order to deal with subsequent problems and save medical resources. On the other hand, healthcare givers should also pay attention to long-term survivor with oral nutrition question in patients after gastrectomy.
We found that most of the questions were about what to eat and how to eat after gastrectomy, accounted for 83.87%. This finding is in accordance with some study, which analyzed 3 unique cases studies using content analysis, and found that learn to eat again post-surgery was by far the largest theme in the interviews[8]. Ying et.al investigated 70 GC patients diet and nutritional status from 4 to 6 weeks after gastrectomy, also found that what to eat and how to eat after surgery was main questions presented by GC patients, including what is appropriate/unsuitable to eat, the amount of food intake per meal, the nature of diet, number of meals per day, and food cooking method [27]. In addition, similar to other studies[6, 23, 25], our data show that the more frequently questions presented also include the causes and treatment of oral nutrition related symptoms, as well as the choice of ONS. Symptoms mainly focus on vomiting, poor appetite, dysphagia, and abdominal pain. An article systematically reviewed the symptoms commonly experienced by gastric cancer patients, including abdominal pain, nausea, vomiting, diarrhea, constipation, reflux, dysphagia, loss of appetite, fatigue, body weight loss, depression and anxiety[18]. In our study, we found that patient usually do not know why these symptoms occur, and how to deal with them when they happen, which often induced a negative emotional state for the patients and their caregivers. This result is similar to the study of Tong et al., which confirmed that diet-related symptoms often lead to distress, poorer quality of life and physical condition[30]. The results suggest that healthcare givers should tell patients what to eat, how to eat, the causes and treatment of diet-related symptoms, and the use of ONS, when making home nutrition care plan for gastric cancer patients after surgery.
We concluded that the oral nutritional home nursing needs of gastric cancer patient included oral nutrition-related solutions provided by professional staff, dietary and prognosis information, food metabolism information, dietary information, ONS information, symptom support, nutrition monitor, psychological support, and exercise information. Some patients and their caregivers in our study clearly stated that they demand professional to answer their questions. GC patients after gastrectomy are unable to cope with problems outside the hospital, and are deeply troubled by physical, psychological, family and social problems. Therefore, they hope to obtain professional nursing, knowledge about disease, information on family and social support after discharge from the hospital, so do family care givers[4, 17, 19, 31]. A study in home found that 92.3%(72/78) of patient hope to receive transitional care from hospital they were discharged from or community institution guided by the hospital, and dietary information were one of the most prevalent demand[16]. Similarly, Li et.al. found that GC patient family caregivers they found that GC patient family caregivers were in heavy burden, especially in psychological burden, and they were in direly need of diet and nutrition knowledge, followed by knowledge of disease, rehabilitation, medicine, and psychological and social health support[17]. In addition, we found that although some patients or their family caregivers judge nutrition status by the amount of food, food form (liquid, semi-liquid, general food), body weight loss, weakness, or hemoglobin according to their questions, most of them were not aware of the concept of energy, protein, other nutrients goal attainment, or nutrient calculation tool. Both ESEPN and CSPEN guideline recommend energy requirement should be assumed to be similar to healthy subjects and generally ranging between 25-30 kCal/kg/day, if not measured individually, and protein intake should be above 1 g/kg/day, if possible up to 1.5 g/kg/day[2]. The results suggest that patients and their family caregivers should be informed of the concept of nutrient goal attainment and self-calculation tool.
The negative emotions of anxiety and depression in GC patients after gastrectomy are lower than before gastrectomy[20]. Similarly, the results of our study showed that the overall emotional propensity scores for oral nutrition problems in home GC patients after surgery are positive. However, we found that in the categories of diet-related symptoms questions and how to eat in patients with comorbidities questions, the emotional propensity scores were all negative. In addition, in the specific questions of the patients or their caregivers, it is semantically shown that in sufficient oral intake, diet-related symptoms, etc., can cause helplessness, anxiety, panic, and other psychology in patients and their families after GC surgery, especially when the problem can not be resolved for a long time. Similarly, some scholars found that new problems, such as nutrition problems will cause distress, not only on the physical symptoms, but also on social and emotional level, which will lead to negative emotion[19] and decrease quality of life[13]. Psychological support helps GC patients recover after surgery[21]. So, for GC patients with diet-related problems occurring after surgery, psychological support should be added while managing the symptoms.
Our study has several limitations. First, some of the oral nutrition questions from the internet cannot be determined whether they were presented by patients or their caregivers, so the needs of patient and their caregiver cannot be distinguished in this study. Secondly, as some questions may not be presented on the internet, there may be some oral dietary demands that have not been discovered, limited by research methods.
The dietary problems of patients with gastric cancer after surgery mainly involve how to eat and what to eat, followed by the causes of diet-related symptoms and treatment methods. Patients and their caregivers need professional person to support their nutrition need, and the nutrition need include dietary and prognosis information, food metabolism information, dietary information, ONS information, symptom support, nutrition monitor, psychological support, and exercise information. The study clarified the specific needs of oral nutrition for patients after gastric cancer surgery, laying a foundation for the formulation of intervention programs.