The Relationship Between Quality of Discharge Teaching and Oral Nutritional Supplementation Adherence in Postoperative Patients With Gastric Cancer - A Chain Mediated Role of Readiness for Hospital Discharge and Medication Beliefs

Sep 30, 2026

Uploaded by McQueen

Aim: Develop a structural equation model to clarify mechanisms shaping oral nutritional supplementation (ONS) adherence in postoperative gastric cancer patients. Background: ONS is a cost-effective nutritional intervention whose effectiveness depends on sustained adherence, yet links among quality of discharge teaching, readiness for hospital discharge, medication beliefs, and adherence remain unclear. Methods: A convenience sample of 505 patients completed a cross-sectional survey (Jan 2023–Dec 2024) at a tertiary oncology hospital; analyses included descriptive statistics, Harman’s test, Pearson correlations, and mediation testing. Results: Variables were significantly interrelated; medication beliefs showed the strongest association with adherence, followed by readiness for discharge and discharge teaching. Structural equation modeling indicated good overall fit, with chain mediation via readiness for discharge and medication beliefs. Conclusion: Targeted strategies should prioritize enhancing discharge teaching, optimizing discharge readiness, and strengthening medication beliefs to improve adherence.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages13

Reading Time33 min

AccessFree to download

Introduction

Background and rationale

ONS adherence challenges

Methods

Study sample and design

Measures and reporting

Statistical analysis

Results

Correlation among key variables

Structural equation model fit

Chain mediation findings

Conclusion

Implications for targeted interventions

Journal of Clinical Nursing The Relationship Between Quality of Discharge Teaching and Oral Nutritional Supplementation Adherence in Postoperative Patients With Gastric Cancer: A Chain Mediated Role of Readiness for Hospital Discharge and Medication Beliefs Fang Shen | Xiaoxue Chen | Hong Yu | Fang Xiao | Xiuhong Yuan | Jia Li Department of Gastric Surgery, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, China Correspondence: Fang Xiao ([xiaofang@sysucc.org.cn](xiaofang@sysucc.org.cn)) | Xiuhong Yuan ([yuanxh@sysucc.org.cn](yuanxh@sysucc.org.cn)) | Jia Li ([lijia1@sysucc.org.cn](lijia1@sysucc.org.cn)) Received: 26 April 2025 | Revised: 19 June 2025 | Accepted: 23 June 2025 Funding: The authors received no specific funding for this work. Keywords: adherence | gastric cancer | medication beliefs | oral nutritional supplementation | quality of discharge teaching | readiness for hospital discharge ABSTRACT Aim: We aimed to elucidate the underlying mechanisms influencing Oral nutritional supplementation (ONS) adherence in postoperative patients with gastric cancer (GC) by developing a structural equation model. Background: ONS represents a cost-effective nutritional intervention for postoperative patients with GC, with its efficacy largely dependent on sustained patient adherence over time. However, the interrelationships among the quality of discharge teaching (QDT), readiness for hospital discharge (RHD), medication beliefs and adherence to ONS remain inadequately understood. Methods: A convenience sample of 505 postoperative patients with GC was recruited from January 1, 2023, to December 1, 2024, for a cross-sectional survey conducted at a tertiary-grade A specialised oncology hospital. The data of this study were subjected to descriptive analysis, Harman's one-way analysis of variance, Pearson correlation analysis and mediation effect analysis. Reporting Method: The STROBE checklist was employed for reporting in the study. Results: Pearson correlation analyses revealed that all four variables were significantly interrelated. Structural equation modelling showed that medication beliefs had the strongest correlation with ONS adherence (β = 0.589), followed by readiness for hospital discharge (RHD) (β = 0.557) and quality of discharge teaching (QDT) (β = 0.523) . The structural equation model demonstrated a robust overall fit. Conclusion: There was a significant chain mediation effect through RHD and medication beliefs. For the development of targeted intervention strategies to improve ONS adherence, future research should prioritise enhancing QDT, optimising RHD and strengthening patients' medication beliefs. | Abbreviations: BMQ, Beliefs about Medical Questionnaire; GC, gastric cancer; ONS, oral nutritional supplementation; ONSAS, Oral Nutritional Supplementation Adherence Scale; QDT, quality discharge teaching; QDTS, quality of Discharge Teaching Scale; RHD, readiness for Hospital Discharge; RHDS, readiness for Hospital Discharge Scale.
Fang Shen, Xiaoxue Chen and Hong Yu are contributed equally to this manuscript. | | --- | | This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
© 2025 The Author(s). Journal of Clinical Nursing published by John Wiley & Sons Ltd. | Journal of Clinical Nursing, 2026; 35:685–697 685 [https://doi.org/10.1111/jocn.70029](https://doi.org/10.1111/jocn.70029) Relevance to Clinical Practice: To help nurses and nursing managers formulate intervention measures to improve QDT, RHD, medication beliefs and ONS adherence in postoperative patients with GC. 1 | Introduction Gastric cancer (GC) is one of the most common malignant neoplasms in the digestive system, characterised by its high malignancy an

FAQs

What is the main aim of the study regarding ONS adherence?

To elucidate the underlying mechanisms influencing oral nutritional supplementation adherence in postoperative gastric cancer patients by developing a structural equation model.

Which factor shows the strongest relationship with ONS adherence?

Medication beliefs have the strongest correlation with ONS adherence, followed by readiness for hospital discharge and the quality of discharge teaching.

What mediation pathway did the structural equation model support?

A significant chain mediation effect was found through readiness for hospital discharge and medication beliefs.

Sep 30, 2026

Uploaded by McQueen