Effect of three-stage fusion nursing intervention the rehabilitation process and psychological stress in patients after gastric cancer surgery

Abstract

BACKGROUND

Patients with gastric cancer often experience slow postoperative recovery and psychological stress, necessitating enhanced nursing care to improve their prognosis.

AIM

To analyze the impact of a timing-theory-guided three-stage integrated nursing intervention (TSIN) on the postoperative recovery of patients undergoing gastric cancer surgery.

METHODS

Total 84 patients that underwent gastric cancer surgeries between June 2022 and June 2024 were selected and divided into a control group and an observation group based on perioperative nursing methods. The control group (n = 42) received routine nursing care, whereas the observation group (n = 42) received a timing-theory-guided TSIN. The psychological adjustment capabilities, psychological stress, cancer-related fatigue levels, postoperative recovery, and quality of life of the two groups were compared.

RESULTS

Compared to the control group, the observation group took lesser time to get out of bed, achieve gastrointestinal motility, have the first mealtime, along with a shorter hospital stay (P < 0.05). Before nursing, there were no significant differences between groups’ parameters or scores (P > 0.05). After nursing, the scores for psychological stress and cancer-related fatigue decreased. In contrast, the scores for psychological adjustment capabilities and quality of life increased, with more significant improvements observed in the observation group, showing significant differences within and between the groups (P < 0.05).

CONCLUSION

Timing theory-guided TSIN can improve the psychological adjustment capabilities of patients undergoing gastric cancer surgery, reduce psychological stress and cancer-related fatigue, accelerate postoperative recovery, and improve the quality of life.

Key Words: Timing theory; Three-stage integrated nursing; Gastric cancer surgery; Psychological adjustment; Psychological stress; Quality of life

Core Tip: This study explored the impact of a timing-theory-guided three-stage integrated nursing intervention (TSIN) on postoperative recovery in gastric cancer patients. Results showed that compared to routine nursing care, TSIN significantly reduced time to get out of bed, achieve gastrointestinal motility, and have the first mealtime, along with a shorter hospital stay. TSIN also improved psychological adjustment capabilities and quality of life while reducing psychological stress and cancer-related fatigue. Timing theory-guided TSIN is beneficial for the postoperative recovery of gastric cancer patients.

INTRODUCTION

Gastric cancer, a malignant tumor originating from the epithelial cells of the stomach, has an unclear etiology. The main contributing factors include Helicobacter pylori infection, poor diet, family history, and previous gastrointestinal diseases. It can cause digestive system symptoms such as upper abdominal discomfort, postprandial fullness, and nausea, and can also invade other tissues and organs, leading to complications and endangering life. However, prognosis is generally poor[1]. Surgical resection is the only curative method for this disease as it can remove the primary lesion and metastatic foci, alleviate symptoms, control disease progression, and extend survival. However, the disease itself and surgery are stressors, and when patients lack coping and psychological adjustment abilities, they may experience a state of tension known as psychological stress. Appropriate psychological stress can improve patients’ psychological resilience. Still, excessive stress often leads to negative symptoms such as emotional fluctuations, slow thinking, and decreased attention, which can affect postoperative recovery and reduce quality of life. Routine nursing care is often monotonous and lacks specificity, making it difficult to meet the individual needs of different patients and resulting in average treatment outcomes.

The timing theory is a novel nursing concept that emphasizes nursing work based on varying care needs at different stages of disease or patient condition, providing timely information and theoretical support for patients[2,3]. This theory divides nursing work into different stages. It formulates and implements nursing intervention strategies based on the changing characteristics of disease or patient needs, which can meet the dynamic nursing needs of patients and ensure the quality of nursing care. Therefore, this article focused on patients undergoing gastric cancer surgery and divided perioperative nursing into three stages: Pretreatment, treatment, and recovery. Furthermore, it analyzed the role of a timing-theory-guided, three-stage integrated nursing intervention (TSIN).

MATERIALS AND METHODS

General data

This study selected 84 patients who underwent gastric cancer surgery between June 2022 and June 2024 and grouped them based on perioperative nursing methods. The control group consisted of 42 cases, including 25 male and 17 female participants, with ages ranging from 32 years to 80 years, a mean age of 57.21 ± 7.18 years, a disease course of 6 months to 12 months with a mean of 9.18 ± 1.54 months, and a body mass index ranging from 18 kg/m² to 27 kg/m² with a mean of 21.72 ± 1.21 kg/m². Tumor staging included 27 cases with stage I and 15 cases with stage II cancer; the observation group consisted of 42 cases, including 22 male and 20 female participants, with ages ranging from 35 years to 75 years, mean age of 57.72 ± 7.32 years, a disease course ranging from 5 months to 14 months with a mean of 9.24 ± 1.52 months, and a body mass index ranging from 19 kg/m² to 26 kg/m² with a mean of 21.64 ± 1.27 kg/m². Tumor staging included 25 cases with stage I and 17 cases with stage II cancer; no significant differences were noted between both groups (P > 0.05), making them comparable. The inclusion criteria were as follows: (1) Patients with early-stage gastric cancer; (2) Those who underwent elective surgery; (3) Those in good condition and actively cooperating with the study; and (4) Those with complete information available to support the research. The exclusion criteria: (1) Patients with abnormal liver or kidney function; (2) Those with other malignant tumors; (3) Those with preoperative complications, such as bleeding, perforation, or other gastrointestinal complications; (4) Those undergoing emergency surgery; (5) Those with mental illnesses; and (6) Those who were planning to conceive, become pregnant, or breastfeed.

The inclusion criteria were as follows: (1) Patients with early-stage gastric cancer (stage I and II); (2) All patients who underwent elective surgery; (3) Patients in good physical and mental condition and actively cooperated with the study; and (4) Patients with complete medical records and information available to support the research. Exclusion criteria included: (1) Patients with abnormal liver function, defined as alanine aminotransferase or aspartate aminotransferase levels exceeding 1.5 times the upper limit of normal or albumin levels below the normal range; (2) Abnormal kidney function, defined as serum creatinine levels exceeding the normal range, blood urea nitrogen levels exceeding 1.5 times the upper limit of normal, or estimated glomerular filtration rate below the normal range; (3) A history of other malignant tumors, except for cured basal cell carcinoma or squamous cell carcinoma of the skin, or cervical carcinoma in situ; (4) Preoperative complications such as bleeding, perforation, or other severe gastrointestinal complications; (5) Patients undergoing emergency surgery; (6) Patients with mental illnesses that could affect their ability to participate in the study; and (7) Women who were planning to conceive, pregnant, or breastfeeding. These refined and clarified inclusion and exclusion criteria enhanced the accuracy and homogeneity of the research subject selection, ensuring the reliability and comparability of the study results.

Methods

The control group received conventional nursing care, including: (1) Preoperative care: Assess the patient’s condition and provide knowledge propaganda; introduce department personnel, rules and regulations, and facility layout; assist patients in completing examinations; take the initiative to comfort and encourage, and if necessary, administer sedative medication; perform bowel preparation 1 d before surgery; and fast for solids and liquids 8-10 hours before surgical treatment; (2) Intraoperative care: Adjust the temperature and humidity of the operating room (temperature 24-26 °C, humidity: 40%-60%), closely monitor the patient’s blood pressure, heart rate, and oxygen saturation, keep the non-surgical area warm, heat the infused fluids to 37 °C, and properly place the gastric tube and urinary catheter; and (3) Postoperative care: After surgery, monitor vital signs in real-time, administer analgesics as ordered by the physician, pay attention to the drainage status, replenish fluids promptly, provide dietary guidance, and inform patients of post-discharge home nursing precautions.

The observation group received timing theory-guided TSIN, including: Pretreatment period: This period is from the patient’s admission to the preoperative stage, where the nursing staff carry out nursing work under the guidance of enhanced recovery after surgery principles.

Cognitive intervention: Nursing staff conduct one-on-one knowledge propaganda and psychological intervention, explaining in detail preoperative exercise, nutritional support, postoperative functional exercise, and diet, as well as the type of surgery, anesthesia method, surgical process, precautions, and effects; take patients to visit the operating room before surgery to help them adapt to the environment; guide patients to ask questions and provide timely answers; for patients with severe negative emotions who cannot self-regulate, nursing staff can use language to comfort and encourage or inform patients to alleviate emotions through meditation, relaxation training, and emotional diversion.

Preoperative preparation: For patients in good condition, the fasting time is reduced to 6 hours and 4 hours for water, respiratory training and bed-toilet training are conducted 3 days before surgery, the nutritional status is assessed, and enteral nutritional agents are administered for those with malnutrition.

Treatment period

Intraoperative warming: The operating room temperature should not be lower than 24 °C; use heating blankets, temperature control blankets, and fluid heating devices for warming and preheating fluids, and the patient’s core body temperature should be above 36 °C.

Postoperative pain management: After surgery, the nursing staff assessed the patient’s pain level and used multimodal analgesia; for those with mild pain, pain relief was provided through position adjustment, verbal encouragement, muscle massage, and emotional diversion; for those with severe pain that could not be tolerated, opioids and non-steroidal anti-inflammatory drugs were administered through patient-controlled analgesia pumps, as ordered by the physician.

Postoperative diet and exercise: After 24 hours of surgery, patients were provided a moderate amount of warm water (3-5 mL), for those who can adapt, a small amount of liquid food was provided, after which it was gradually transitioned to semi-liquid food. Carbonated beverages, potatoes, sweet potatoes, radishes, and other gas-producing foods; and spicy and fiber-rich foods were to be avoided. Those with poor postoperative flatulence are to be assisted with abdominal massage, chewing gum, and other methods; 2 hours after surgery, bed exercises such as turning over and limb stretching are to be performed. They are supposed to try to get out of bed the next day, while controlling the intensity of activity. Activity has to be stopped if discomfort occurs.

Recovery period

Knowledge education: Nursing staff should compile a health education manual that fits the patient’s condition and surgical situation, propagating knowledge from different aspects, including postoperative psychological adjustment, lifestyle adjustment, standardized medication, and regular follow-ups, and, if necessary, share cases of gastric cancer surgery patients with a good prognosis to guide patients in learning from experience.

Dietary adjustment: Nursing staff should not only strengthen the routine dietary nursing but also assess the nutritional status and develop a dietary plan that fits the patient’s eating habits and taste, advise patients to correct bad habits such as overeating, preference for processed foods, smoking, and alcohol, and explain in clear and concise language the relationship between diet and gastrointestinal diseases. Staff should emphasize the dangers of poor eating habits to enhance patients’ awareness of regular meals. The use a combination of verbal explanations, PowerPoint presentations, and video playback is used to strengthen the dietary guidance, patients are advised to eat small and frequent meals, light diet, and increase the intake of high-quality protein and trace elements. Before discharge, nursing staff distribute a “diet diary” to patients, instructing them to record the time, type of food, cooking method, and post-meal gastrointestinal reactions of three meals. Staff follow up once a week after discharge, inquire about the patient’s diet from the previous week, assess the dietary situation, and guide those with poor eating habits, if necessary, supervise by family members. They understand other nursing issues that arise during the patient’s time at home and propose intervention strategies.

Observational indicators

Psychological adjustment: Capability: Assessed using the psychological adjustment scale for cancer patients developed by Huang et al[4], which contains 36 items scored from 1 to 5. The scale is divided into emotional/self-esteem (50 points), subjective feelings (40 points), interpersonal relationships/social life (30 points), daily life (25 points), and other (30 points), as well as self-evaluation of psychological adjustment (5 points), totaling 180 points. A higher final score indicated better psychological adjustment capabilities.

Psychological stress: Assessed based on the impact of event scale-revised[5], which consists of 22 items using a 0-4 point 5-level scoring method. The scale is divided into three dimensions: Avoidance, intrusion, and hyperarousal, with scores of 32 points, 32 points, and 24 points, respectively, totaling 88 points. A decrease in this score indicated a reduction in psychological stress.

Cancer-related fatigue: Assessed using the revised piper fatigue scale[6], which includes 22 items, with each item scored from 0 point to 10 points. The actual score is calculated as the total score of the items divided by the number of items. The scale corresponds to the dimensions of behavior (severity), emotion, sensation, and cognition (mood), each ranging from 0 point to 10 points, totaling 40 points. A higher score indicated a higher degree of fatigue.

Postoperative recovery time: Comparison of the time to get out of bed, gastrointestinal motility, first meal time, and hospital stay time between the control and observation groups.

Quality of life: Assessed using the functional living index-cancer developed by Raghunathet al[7], which consists of 22 items scored on a 1-7 point 7-level scale. The content included physical well-being and ability (63 points), psychological well-being (42 points), cancer-related hardships (21 points), social well-being (14 points), and nausea (14 points), with a maximum score of 154 points. A higher final score indicated a better quality of life.

Statistical analysis

Data are processed by SPSS 22.0, and the percentage (%) and χ² represent the count data. The measurement data are normally distributed and indicate the parameter is mean ± SD. Significant differences in contrast were confirmed at P < 0.05 by a parametric t-test.

RESULTS

Psychological adjustment ability

There was no difference between the two groups (P > 0.05). The scores increased, and the observation group was higher, with significant differences within and between groups (P < 0.05), as shown in Tables 1 and 2.

Table 1 Psychological adjustment ability, mean ± SD.

Group	Case	Emotional / self-esteem		Subjective sensation		Interpersonal relationships		Daily life; everyday life
		Before	After	Before	After	Before	After	Before	After
Control	42	22.16 ± 3.54	32.21 ± 2.96a	17.78 ± 2.56	23.96 ± 3.12a	14.16 ± 2.42	19.18 ± 1.80a	12.16 ± 1.78	16.18 ± 1.44a
Observation	42	22.12 ± 3.52	38.72 ± 3.28a	17.92 ± 2.44	30.18 ± 2.24a	14.21 ± 2.68	23.16 ± 1.64a	12.24 ± 1.72	19.27 ± 1.86a
t	-	0.052	9.549	0.257	10.495	0.090	10.592	0.209	8.513
P value	-	0.959	< 0.001	0.798	< 0.001	0.929	< 0.001	0.835	< 0.001

^aP < 0.05, compared with the same group before care.

Table 2 Psychological adjustment ability in other, psychological regulation of self-evaluation and total point, mean ± SD.

Group	Case	Other		Psychological regulation of self-evaluation		Total point
		Before	After	Before	After	Before	After
Control	42	15.24 ± 2.16	19.72 ± 1.96a	1.78 ± 0.32	2.56 ± 0.44a	83.38 ± 12.78	113.81 ± 11.72a
Observation	42	15.32 ± 2.21	23.64 ± 2.12a	1.72 ± 0.35	3.52 ± 0.38a	83.53 ± 12.92	138.49 ± 11.52a
t	-	0.168	8.799	0.820	10.701	0.053	9.733
P value	-	0.867	< 0.001	0.415	< 0.001	0.957	< 0.001

^aP < 0.05, compared with the same group before care.

Mental stress

There was no significant difference in the pre-nursing scores between the two groups (P > 0.05); all dimensions and total scores decreased, and the observation groups had lower scores within and between the groups (P < 0.05), as shown in Table 3.

Table 3 Psychological stress, mean ± SD.

Group	Case	Avoid		Crash into		High wake up		Total point
		Before	After	Before	After	Before	After	Before	After
Control	42	20.16 ± 2.44	24.18 ± 1.96a	19.78 ± 2.12	23.80 ± 2.08a	15.12 ± 1.56	18.21 ± 2.24a	55.06 ± 6.12	66.19 ± 6.28a
Observation	42	20.21 ± 2.48	27.72 ± 1.78a	19.92 ± 2.18	27.16 ± 1.84a	15.18 ± 1.52	21.12 ± 1.28a	55.31 ± 4.80	76.00 ± 4.90a
t	-	0.093	8.665	0.298	7.841	0.179	7.310	0.208	7.981
P value	-	0.926	< 0.001	0.766	< 0.001	0.859	< 0.001	0.836	< 0.001

^aP < 0.05, compared with the same group before care.

Cancer fatigue

The difference between the two groups was not significant (P > 0.05); however, the scores decreased in the observation group, with significant differences within and between the groups (P < 0.05), as shown in Tables 4 and 5.

Table 4 Sexual fatigue of cancer, mean ± SD.

Group	Case	Behavior (severity)		Sensibility		Felling
		Before	After	Before	After	Before	After
Control	42	6.78 ± 1.12	4.21 ± 0.72a	6.54 ± 1.18	4.32 ± 0.75a	6.18 ± 1.21	4.16 ± 0.54a
Observation	42	6.72 ± 1.15	2.56 ± 0.44a	6.48 ± 1.12	2.44 ± 0.36a	6.12 ± 1.27	2.27 ± 0.32a
t	-	0.242	12.673	0.239	14.645	0.222	19.514
P value	-	0.809	< 0.001	0.812	< 0.001	0.825	< 0.001

^aP < 0.05, compared with the same group before care.

Table 5 Cancer due to fatigue, mean ± SD.

Group	Case	Cognition (mood)		Total point
		Before	After	Before	After
Control	42	6.36 ± 1.18	4.12 ± 0.56a	25.86 ± 4.69	16.81 ± 2.57a
Observation	42	6.27 ± 1.21	2.35 ± 0.42a	25.59 ± 4.75	9.62 ± 1.54a
t	-	0.345	16.387	0.262	15.552
P value	-	0.731	< 0.001	0.794	< 0.001

^aP < 0.05, compared with the same group before care.

Postoperative recovery time

Ambulation time, gastrointestinal peristalsis time, first intake time, and hospital stay were shorter; the differences between the groups (P < 0.05) are shown in Table 6.

Table 6 Postoperative recovery time, mean ± SD.

Group	Case	Time to get out of bed (hour)	Gastrointestinal peristalsis time (hour)	Time of first feeding (day)	Length of stay (day)
Control	42	22.78 ± 3.16	27.56 ± 2.12	2.54 ± 0.36	6.68 ± 1.21
Observation	42	17.12 ± 2.44	19.56 ± 1.92	1.21 ± 0.27	4.56 ± 1.18
t	-	9.188	18.127	19.154	8.129
P value	-	< 0.001	< 0.001	< 0.001	< 0.001

^aP < 0.05, compared with the same group before care.

Quality of life

There was no significant difference in pre-nursing scores between the two groups (P > 0.05), and all dimensions and total scores were higher in the observed groups, with differences within and between groups (P < 0.05), as shown in Tables 7 and 8.

Table 7 Quality of life in physical good and ability, good psychology, the hardship caused by the cancer, mean ± SD.

Group	Case	Physical good and ability		Good psychology		The hardship caused by the cancer
		Before	After	Before	After	Before	After
Control	42	27.78 ± 3.12	40.21 ± 5.68a	19.16 ± 2.24	25.21 ± 3.36a	10.12 ± 1.44	12.45 ± 1.16a
Observation	42	27.72 ± 3.16	48.96 ± 5.54a	19.27 ± 2.18	31.42 ± 2.80a	10.18 ± 1.42	15.80 ± 1.72a
t	-	0.088	7.147	0.228	10.465	0.192	10.465
P value	-	0.930	< 0.001	0.820	< 0.001	0.848	< 0.001

^aP < 0.05, compared with the same group before care.

Table 8 Quality of life, mean ± SD.

Group	Case	Good society		Sicchasia		Total point
		Before	After	Before	After	Before	After
Control	42	6.18 ± 1.12	8.78 ± 0.92a	6.12 ± 1.16	8.72 ± 0.96a	69.36 ± 9.08	95.37 ± 12.08a
Observation	42	6.16 ± 1.15	10.21 ± 0.75a	6.15 ± 1.12	10.12 ± 0.72a	69.48 ± 9.03	116.51 ± 11.53a
t	-	0.081	7.808	0.121	7.561	0.061	8.204
P value	-	0.936	< 0.001	0.904	< 0.001	0.952	< 0.001

^aP < 0.05, compared with the same group before care.

DISCUSSION

Epidemiological survey results show that in 2022, the number of cancer cases in China was 4.8247 million, of which 358700 were gastric cancer cases, making the cancer rank fifth[8]. The number of deaths was 2.5742 million, with 260400 being gastric cancer deaths, with higher incidence and mortality rates among men. Although the trends for both gastric cancer incidence and mortality are declining, it remains a significant public health issue that severely affects the health of residents, and emphasis should be placed on disease screening, early diagnosis, and treatment. Surgical resection is the preferred method. It can remove the primary lesion or metastatic foci based on the patient’s condition, improving the condition and delaying its progression, thereby laying a solid foundation for subsequent treatment[9,10]. However, gastric cancer itself and surgical treatment are stressors that can lead to psychological stress in patients, prolonging the postoperative recovery time and reducing the quality of life. Therefore, it is essential to standardize treatment and focus on perioperative nursing to improve prognosis.

Traditional perioperative nursing, which divides care into the preoperative, intraoperative, and postoperative stages, is centered on the disease and lacks systematic and standardized approaches. It also fails to leverage the individual subjectivity of patients, resulting in poor nursing outcomes. The theory of timing, proposed by Canadian scholars in 2008, is based on the different nursing knowledge and practical skills required at various stages of the disease. This divides the disease process into different periods and implements nursing strategies according to the needs of each period. This concept can provide a framework for continuous nursing care for patients, maintaining their psychological health, and promoting recovery[11]. Nursing interventions based on the theory of timing not only provide patients with information about disease diagnosis and prognosis but also pay attention to emotional changes and daily life needs, provide timely emotional support, and provide life guidance to meet patients’ nursing needs and improve feasibility.

Emotional activities are the most influential components of psychological stimuli on health, providing emotional colors for mental activities. Mastering oneself and being good at regulating emotions can help maintain physical and mental health. Gastric cancer and surgery can lead to psychological reactions as stressors. It is important to pay attention to emotional outbreaks, correctly understand oneself, evaluate the environment to reduce the impact of negative events and irritants, better adapt to reality, maintain stable emotions, and protect physical and mental health[12]. This study showed that the observation group had higher psychological adjustment scores and lower psychological stress scores (P < 0.05), indicating that a TSIN based on the Theory of Timing could improve psychological adjustment capabilities and reduce psychological stress responses. The nursing staff divided nursing work for gastric cancer surgery patients into three periods: Pre-treatment, treatment, and post-treatment, focusing on the psychological state and emotional changes of patients at different stages. Pretreatment strengthens psychological guidance, actively answering patients’ questions; postoperatively, pain care is emphasized, and analgesic measures are taken according to pain assessment results; during the recovery period, systematic health education is conducted for patients, and psychological adjustment is made by sharing typical cases, which can improve patient experience, strengthen inner beliefs, and thereby reduce psychological stress responses.

Cancer-related fatigue is an unpleasant sensation and experience caused by cancer itself and its treatment, affecting cognition, leading to a sense of unease in patients and producing a sense of fatigue and exhaustion of energy, which affects patient recovery. Conventional rest is difficult to alleviate these symptoms. Therefore, it is necessary to accurately identify its influencing factors and intervene promptly[13]. The comparison in the text showed that the observation group had lower cancer-related fatigue scores (P < 0.05), suggesting that the TSIN, based on the theory of timing, can alleviate cancer-related fatigue. In this nursing model, nurses pay attention to the emotional changes in patients, reasonably use different types of psychological support and emotional regulation measures, pay attention to answer patients’ questions, help patients reconstruct cognition, and strengthen daily life guidance, which improves the discomfort of patients at the physiological, psychological, and spiritual levels, thereby reducing cancer-related fatigue[14,15].

Compared to the control group, the observation group had a shorter postoperative recovery time (P < 0.05), indicating that the TSIN based on the theory of timing can accelerate the postoperative recovery process of gastric cancer patients[16,17]. Nurses optimize nursing measures based on the rapid recovery nursing model, shorten the preoperative fasting and water deprivation time, eat as soon as possible after the operation, and get out of bed to move. At the same time, nurses use a series of pain intervention measures to help patients relieve pain, which can improve patient cooperation and shorten postoperative recovery time[18,19].

Quality of life is an assessment of an individual’s physiological, psychological, and social functions and is often used to measure the level and quality of medical services[20]. The comparison in the text showed that the observation group had higher quality of life scores (P < 0.05), indicating that the TSIN based on the theory of timing can improve patients’ quality of life. This nursing model emphasizes cognitive intervention for patients and takes the initiative to carry out health education, which can reduce or eliminate psychological pressure caused by incomplete cognition[21]; at the same time, it strengthens postoperative recovery period nursing, reduces uncomfortable experiences, improves patients’ physical and psychological feelings, reduces the impact of the disease on daily life and social interactions, and thus provides security for the quality of life.

Mechanism of the TSIN: The improvement in psychological adjustment capabilities observed in this study was closely linked to postoperative recovery[22]. Based on psychological theories, enhanced psychological adjustment can reduce the cortisol levels associated with stress, thereby mitigating systemic inflammation and promoting wound healing. Moreover, improved psychological states can enhance patient adherence to medical advice and rehabilitation protocols, further accelerating recovery[23-25]. However, there are potential limitations to these intervention measures. For example, individual differences in psychological resilience may affect the efficacy of an intervention. Additionally, the study’s reliance on self-reported psychological stress and fatigue measures may have introduced a subjective bias. Future studies should incorporate objective biomarkers to address these limitations and consider the long-term sustainability of psychological interventions.

CONCLUSION

In summary, the TSIN for gastric cancer surgery patients can promote the improvement of psychological adjustment ability and relieve both psychological stress and cancer fatigue, which can not only benefit the postoperative recovery of patients but also improve their quality of life.