Junsheng Peng

Aim: To use network analysis to explore the relationships among distress, symptom burden, social support, and digital health literacy in older patients with gastric cancer following surgery. Background: Digital healthcare is gaining increasing prominence and represents a promising approach to improving long-term care and psychological support for older postoperative patients with gastric cancer. However, this population frequently experiences high distress, heavy symptom burden, limited social support, and low DHL, which together constitute major barriers to the effective use of digital health resources. To date, the mechanisms underlying the interactions among these factors remain poorly understood. Therefore, this study seeks to clarify these relationships and provide empirical evidence to support the integration of digital health into geriatric oncology care. Methods: A cross-sectional study was conducted involving 767 older postoperative patients with gastric cancer at a teaching hospital between August 2024 and June 2025. Participants completed validated questionnaires, including the Brief Symptom Inventory-18 (BSI-18), the M. D. Anderson Symptom Inventory Gastrointestinal Cancer Module (MDASI-GI), the Multidimensional Scale of Perceived Social Support (MSPSS), and the eHealth Literacy Scale (e-HEALS). R software version 4.2.1 was used. Network analysis assessed the structure, centrality, stability, and accuracy of these factors. Results: Network analysis revealed that “Blue” and “Tense” of the BSI-18, and “Evaluate” of the e-HEALS were the most central nodes. “Friends” and “Sleep” acted as key bridge nodes, linking distress, symptom burden, and social support domains. The network proved stable and accurate. Conclusions: This study highlighted the item “Blue” as a central node and “Sleep” as a key bridge node. These findings suggest the potential utility of network analysis in precision nursing. Furthermore, measures such as emotional counseling for low mood, sleep optimization, and peer-navigated digital empowerment may help address the interconnected symptom pattern observed in this population.

Purpose: To explore the stress adaptation experiences of young and middle-aged couples with colorectal cancer (CRC), specifically examining the interaction between illness cognitions and dyadic coping. Methods: Using purposive sampling, semi-structured interviews were conducted with eight pairs of young and middle-aged CRC couples, along with eight patients and five spouses, at a tertiary hospital in Guangzhou from October 2023 to February 2024. Data were analyzed following the six-stage process outlined in the interpretative phenomenological analysis research guidelines, with coding and organization supported by Nvivo 12.0 software to extract hierarchical themes reflecting the interaction process between illness cognitions and dyadic coping in CRC couples. Results: Three themes emerged: (1) Intrapersonal dynamics: positive illness cognitions facilitated adaptive coping strategies, whereas negative cognitions triggered maladaptive coping behaviors. (2) Dyadic mechanisms: a cross-partner influence was observed where one partner’s illness cognitions affected the other’s coping through specific pathways, including negative resonance, reverse activation, and compensatory adaptive coping. (3) Key moderators: relationship intimacy, communication quality, family resilience, social support, family role identity, and division of labor significantly moderated these interactions. Conclusions: The findings reveal complex bidirectional influences between CRC couples, including compensatory and reverse activation mechanisms. Relationship intimacy, communication quality, family role identity, resilience, and social support play crucial moderating roles in facilitating or hindering adaptive coping. These results underscore the necessity of psychosocial interventions adopting a family systems perspective, focusing on enhancing communication skills, clarifying role division, and strengthening support networks to improve psychological adjustment in cancer-affected families.

Objective: To explore the current status of patient involvement in neoadjuvant treatment decision‐making among individuals with locally advanced gastric cancer, and to further identify the factors influencing their level of participation. Methods: This cross‐sectional study included patients with locally advanced gastric cancer and was conducted between July 2023 and April 2024 at two hospitals in Guangzhou, China. Data were collected using the Questionnaire of Cancer Patients' Decision‐Making Regarding Treatment, the Decisional Conflict Scale, the Health Literacy Management Scale, the Fear of Progression Questionnaire–Short Form, and the Perceived Social Support Scale. Univariate analyzes and multivariable logistic regression were performed to identify factors associated with patient participation in neoadjuvant treatment decision‐making. Results: Patients with a positive attitude toward participating in neoadjuvant therapy decision‐making also demonstrated higher actual participation levels ( χ² = 47.05, p < 0.001). Binary logistic regression analysis identified several factors influencing decision‐making attitudes in patients with locally advanced gastric cancer, including being a worker or self‐employed, decisional conflict, health literacy (willingness to improve health), and fear of disease progression. Additionally, factors influencing the actual level of participation in decision‐making included having a college education, being employed in government or public institutions, a per capita monthly household income of 5,001–10,000 CNY (≈700–1,400 USD), decisional conflict, health literacy (willingness to improve health), and social support (family support). Conclusions: The decision‐making participation of patients with locally advanced gastric cancer is influenced by multiple factors, highlighting the need for comprehensive interventions tailored to these influences.

Peritoneal metastasis, the most common mode of dissemination in gastric cancer (GC), is characterized by resistance to treatment and a poor prognosis. Accu

Purpose This study aimed to develop an intelligent individualized nutrition management (iNutrition) applet for postdischarge gastric cancer patients following gastrectomy based on the Health Action Process Approach (HAPA) theory and using the design thinking method. Methods We developed the iNutrition applet using the design thinking method, including the following phases: (1) “empathize and define,” which focused on understanding patients’ needs and establishing the goals of the iNutrition applet through qualitative interviews; (2) “ideate and prototype,” during which literature reviews and multidisciplinary interactive workshops to conceptualize innovative solutions were conducted and a fully functional iNutrition applet was developed; and (3) “test,” during which the iNutrition applet was evaluated through usability testing. Results Based on qualitative interviews with 15 patients, we determined that the iNutrition applet would need to satisfy patients’ needs in the following areas: adjustment to postoperative anatomical changes, evidence-based knowledge, communication with peers, consultation with medical staff, tailored nutritional plans, coping plans, and needs for technology. Consequently, the applet was designed to have eight functions: gastrointestinal symptom management, nutrition knowledge, medical consultation, peer communication, nutrition goals, nutrition diary with calculator, weekly meal plan, and nutritional status score. During short-term usability testing, the patients’ task completion rate ranged from 88 to 100%. Long-term usability testing resulted in a System Usability Scale (SUS) score of 75.20 ± 10.63 and a net promoter score (NPS) of 32%. The participants were generally satisfied with the applet’s design and functionality, providing feedback that informed further refinements to the final version of the applet. Conclusion The iNutrition applet, which has received high ratings for usability and user satisfaction, is an acceptable and feasible method of postdischarge nutritional management for gastric cancer patients following gastrectomy.

BACKGROUND Patients with cancer experience complex physical, psychosocial, and behavioral challenges that require continuous support. This need has intensified with the rising cancer burden worldwide and the limited scalability of traditional care models. In response, conversational agents (CAs) have emerged as promising digital interventions for enhancing cancer care, but evidence regarding their feasibility and effectiveness remains limited. OBJECTIVE This study aimed to evaluate the feasibility and effectiveness of CAs in supporting care for patients with cancer and to summarize the key characteristics of CA interventions to inform future design and implementation. METHODS We systematically searched PubMed, Cochrane Library, Web of Science, and Embase databases from the index date through February 3, 2025, and screened reference lists and trial registries for gray literature. Eligible studies included randomized controlled trials (RCTs) and nonrandomized interventions (NRIs) evaluating CA-delivered interventions targeting health outcomes in patients with cancer. Two reviewers independently selected studies and extracted data. Study quality was then appraised using the Cochrane Risk of Bias 2.0 tool for RCTs and the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for NRIs. Extracted data included study characteristics, CA features, and implementation outcomes, including feasibility, acceptability, and usability. Meta-analyses were conducted on physical activity, pain, anxiety, depression, psychological distress, and quality of life. Narrative synthesis was used for outcomes with inconsistent reporting across studies, including health information acquisition and treatment-related side effects. RESULTS In total, 17 studies involving 1817 patients with cancer were included, with 10 (58.8%) studies being included in the meta-analysis. The meta-analysis showed significant improvements in physical activity (mean difference [MD]=1.44, 95% CI 0.36-2.52, P<.01), pain (MD=–0.91, 95% CI –1.44 to –0.38, P<.01), anxiety (SMD=–0.19, 95% CI –0.35 to –0.02, P=.02), and quality of life (SMD=0.35, 95% CI 0.03-0.67, P=.03). No significant effects were observed on depression (SMD=–0.07, 95% CI –0.42 to 0.27, P=.68) or psychological distress (SMD=–0.33, 95% CI –0.66 to 0.01, P=.06). Narrative synthesis suggested that CAs have the potential to improve patients’ acquisition of health information and help manage treatment-related side effects. Notably, CAs were generally found to be safe, feasible, acceptable, and usable among patients with cancer, particularly during the initial phase of use. However, user engagement tended to decline over time, underscoring the need for strategies to sustain long-term use. CONCLUSIONS This systematic review is the first comprehensive analysis to suggest that CAs are feasible, acceptable, usable, and effective interventions for patients with cancer. Nevertheless, the limited psychological benefits and suboptimal long-term user engagement indicate the need for further refinement. Future research should adopt theory-based designs and leverage emerging technologies to enhance personalization, empathy, and sustained engagement in CA interventions. Robust evidence from large-scale RCTs is needed to strengthen the evidence base. CLINICALTRIAL PROSPERO CRD42025645982; https://www.crd.york.ac.uk/PROSPERO/view/CRD42025645982

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