Effect of family synchronous empowerment education on postoperative esophageal cancer patients and their primary caregivers
Yu-ying Shi and Pan-yue Shu contributed equally to this work and should be considered joint first authors.
Abstract
The aim of this study was to evaluate the impact of family synchronous empowerment education on the caregiving ability and preparedness of primary caregivers, as well as the nutritional status and quality of life of patients who have undergone esophagectomy. A total of 102 patients who were treated with thoracoscopic radical resection for esophageal cancer and their primary caregivers from August 2023 to March 2024 were selected and evenly divided into a control group and an intervention group, with 51 cases in each group. The control group received standard nursing education, whereas the intervention group received additional family synchronous empowerment education. Both the preparedness and ability of the primary caregivers to provide care, as well as the nutritional status and quality of life of the patients, were assessed at admission and 1 month post-discharge. Post-intervention, the intervention group's primary caregivers demonstrated significantly improved caregiving ability and preparedness compared to the control group (p < .05). Similarly, patients in the intervention group exhibited significantly better nutritional status and quality of life than those in the control group (p < .05). The study concluded that the implementation of family synchronous empowerment education significantly enhances the caregiving ability and preparedness of primary caregivers and improves the nutritional status and quality of life in patients after esophagectomy.
1 INTRODUCTION
Esophageal cancer is a common malignant tumor of the digestive system, ranking as the eighth most common cancer worldwide and the sixth leading cause of cancer-related deaths.1 Despite a decline in incidence and mortality rates in China in recent years, it remains a region of high incidence globally, with a majority being the highly malignant and poor-prognosis esophageal squamous cell carcinoma (ESCC).2 Surgery is one of the essential treatment strategies for esophageal cancer, significantly improving disease prognosis and extending patients' survival time. However, as an invasive treatment method, it causes considerable damage to the body. Diarrhea, pain, dysphagia, sleep disturbances, and so on are common symptoms in postoperative patients with esophageal cancer.3 It has been reported that esophageal cancer is the first cancer with the incidence of malnutrition, and the incidence of postoperative malnutrition is up to 78.9%.4, 5 Malnutrition can reduce the sensitivity and accuracy of cancer cells to treatment, prolong hospital stay, delay physical recovery, and reduce the quality of life of patients.6 Besides, throughout the process of patients' disease diagnosis, the perioperative period, and postoperative home recovery, caregivers are always involved. Unlike formal caregivers who provide paid care services, primary caregivers, or informal caregivers, can be the patient's spouse, siblings, etc., providing unpaid care and medical assistance at various stages of the patient's disease trajectory.7
Studies have shown that the caregiving ability, psychological state, and problem-solving methods of primary caregivers can all affect patients' treatment and prognosis.8 Family synchronous empowerment education is based on empowerment theory, following the five steps of clarifying problems, expressing emotions, setting goals, making plans, and evaluating effects, to enhance the effectiveness of health education and stimulate individuals' potential to improve disease management capabilities. The literature points out that family synchronous empowerment education can help to reduce postoperative shame of young and middle-aged patients with cervical cancer, improve family function, and improve quality of life.9 Besides, in gestational diabetes management, the theory has been verified to strengthen caregiver preparedness and promote patient self-efficacy at the same time.10 However, the current research on this theory mainly focuses on patients after cervical cancer surgery and pregnant women with gestational diabetes mellitus, and the research population is small. Based on this, our study aims to explore the application effects of family synchronous empowerment education in postoperative esophageal cancer patients and their primary caregivers, and the report is as follows.
2 MATERIALS AND METHODS
2.1 Participants
A total of 109 patients with esophageal cancer who underwent treatment in the Department of Thoracic Surgery of our hospital from August 2023 to March 2024 participated in the study. The inclusion criteria for patients were: (1) patients who met the diagnostic criteria for primary esophageal cancer; (2) patients who underwent thoracoscopic radical resection for esophageal cancer; (3) patients who were conscious, able to communicate effectively, and without cognitive impairment; (4) patients with a fixed primary caregiver; (5) voluntarily joined the study. The primary caregivers' inclusion criteria were: (1) aged 18 or above, responsible for the care of the patient during hospitalization and after discharge; (2) an average daily care duration of at least 4 h, and an average weekly care duration of at least 5 days; (3) possessing normal communication and comprehension abilities; (4) voluntarily joined the study.
The exclusion criteria for patients were: (1) those engaged in other studies; (2) those who had received radiotherapy and/or chemotherapy and/or immunotherapy for esophageal cancer before surgery; (3) those with other malignant tumors and/or autoimmune diseases. The exclusion criteria for primary caregivers were: (1) those engaged in other studies; (2) primary caregivers in an employment relationship with the patient; (3) those with severe physical and/or psychological diseases; (4) those engaged in the nutrition and health industry.
This study was a randomized controlled trial and employed purposeful sampling, selecting 109 patients with esophageal cancer and their primary caregivers from August 2023 to March 2024 at our hospital's Department of Thoracic Surgery who underwent thoracoscopic radical resection for esophageal cancer. In this study, a computer-generated random number table (via SPSS 22.0) was utilized to ensure unbiased group allocation, and the participants were randomly assigned to the control group and the intervention group. The hospital's ethics committee has approved this study, and all participants have signed informed consent.
2.2 Intervention method in the control group
Provide routine nursing care. The responsible nurse is responsible for providing a series of nursing education, including but not limited to admission guidance, disease knowledge explanation, perioperative nursing matters, postoperative rehabilitation training, complication prevention knowledge, and discharge guidance.
2.3 Intervention method in the intervention group
Family synchronous empowerment education was adopted. A synchronous family empowerment education team was established, consisting of the head nurse of the ward, one oncology specialty nurse, one psychology group nurse, one nutrition specialty nurse, three responsible nurses, and one attending physician from the thoracic surgery department. All team members have received family synchronous empowerment education-related knowledge training, mastered the concept and educational program of family synchronous empowerment education, and developed intervention plans by searching the literature and combining nursing experience.
The stages of the family synchronous empowerment education were designed based on the distinct needs and challenges faced by patients and primary caregivers during different phases of the postoperative recovery process. The in-hospital stage focused on building foundational caregiving skills and addressing immediate postoperative care needs. This stage was critical for caregivers to learn essential skills under the guidance of healthcare professionals and to establish a strong base for subsequent caregiving. The home recovery stage, on the other hand, was designed to support caregivers as they took on increased responsibility for the patient's care at home. This stage emphasized the reinforcement of caregiving skills, problem-solving strategies, and emotional support to help caregivers adapt to the evolving needs of the patient during the recovery period. The specific plan is shown in Table 1.
| Step | Specific measures |
|---|---|
| Identify problems | Upon admission, establish a trusting relationship with the patient and their primary caregiver, and guide the patient to answer questions such as “Do you understand the disease and treatment?” “Do you have any doubts now?” “Do you understand postoperative care-related matters?” and “What are your doubts in the postoperative care process?” During the home recovery period, conduct open-ended questioning through phone follow-up, such as “How do you feel during the home recovery period?” “What other disease recovery information would you like to obtain?”; guide the caregiver to answer questions like “What preparations have you made during the home care process?” “Have you encountered any new care challenges?” |
| Express emotions | Encourage patients and their primary caregivers to express and vent, team members listen carefully to uncover the patient's physiological and psychological problems, guide the patient to face the existing problems positively and improve treatment confidence; understand the emotional changes and needs of the primary caregiver, guide them to express the confusion and difficulties in the care process boldly, provide psychological counseling and help when necessary, give full play to the supportive role of the caregiver in the care process; establish WeChat groups to encourage patients and caregivers to speak freely, enhance the experience sharing and communication between patients and patients, caregivers and caregivers. |
| Set goals | Team members analyze the problems existing in the patient's hospitalization and post-discharge home period on an individual basis, such as pain, nutritional status, activity, complications, emotions, etc., combined with the caregiver's care situation, emotional changes, existing confusion, etc., the three parties discuss and set stage goals and overall goals together. |
| Make plans | During hospitalization, the team closely monitors the patient, communicates with them and their caregiver daily for 15–20 min (longer if needed), and develops personalized nursing plans. Caregivers are encouraged to participate in care activities, and discharge and home care plans are formulated based on the patient's recovery. Three days prior to discharge, the caregiver is trained in essential nursing skills like enteral nutrition and tube care. A day before discharge, specific guidance and home care plans are prepared, covering activities, exercises, medication, re-checks, and tube maintenance. A WeChat group is used for prompt responses to patient and caregiver queries and to share rehabilitation materials. Daily monitoring and communication are maintained, with time extended as necessary. |
| Evaluate effects | During hospitalization, team members communicate with the patient and their primary caregiver for 10–20 min daily to understand and evaluate the implementation of stage goals, ask and solve problems in the process of plan implementation, and provide a basis and guidance for the next stage plan formulation. After discharge, make a phone follow-up once a week, increase the number of follow-ups if necessary, and dynamically grasp the actual situation of the patient and primary caregiver during the home recovery period. |
2.4 Observation indicators
2.4.1 Family Caregiver Task Inventory
The original Caregiver Task Inventory (CTI) was developed by Clark and Rakowski in 1983 and aimed at helping to improve the caregiving skills of family caregivers for the elderly.11 This inventory includes five dimensions, with 25 items, and the total score ranges from 0 to 50 points. The higher the score, the worse the caregiving ability. The internal consistency of the five subscales is between 0.67 and 0.86, and the overall Cronbach's α for the inventory is .93.
2.4.2 Caregivers Preparedness Scale
The concept of caregiver preparedness refers to caregivers' readiness to meet patients' physical and emotional needs. Archbold et al.12 developed the Caregivers Preparedness Scale (CPS) in 1990. The scale consists of one dimension with a total of eight items, using a 5-point Likert scale where “not at all” corresponds to 0 points and “very much” corresponds to 4 points. The total score is 32, with higher scores indicating better preparedness for caregiving.
2.4.3 Patient-Generated Subjective Global Assessment
The Patient-Generated Subjective Global Assessment (PG-SGA) was developed by Ottery in the 1990s13 and is recognized by the American Dietetic Association as a scale for assessing the nutritional status of cancer patients.14 The scale consists of two parts: one evaluated by medical personnel and the other by the patient, with a total of 23 items. The scale's validity has been confirmed by research, showing a sensitivity higher than 90% and a specificity higher than 80% for malnutrition in various cancer patients.15, 16 It can accurately identify patients at risk of malnutrition and guide nutritional therapy.
2.4.4 European Organization for Research and Treatment of Cancer Quality of Life questionnaire-core 30, V3.0
The European Organization for Research and Treatment of Cancer Quality of Life questionnaire-core 30, V3.0 (EORTC QLQ-C30) is the core questionnaire in the quality of life assessment scale system developed by the EORTC. This questionnaire consists of 30 items, including 1 global health status dimension, 5 functional dimensions (physical, cognitive, emotional, role, and social), 3 symptom dimensions (fatigue, pain, and nausea/vomiting), and 6 single symptom items (dyspnea, insomnia, appetite loss, constipation, diarrhea, and financial difficulties). Higher scores on the functional and global health status dimensions indicate better functioning and quality of life, while higher scores on the symptom dimensions indicate worse functioning and quality of life.
2.5 Data collection
Data acquisition included a total of three time points: The first postoperative day (T0), which serves as the baseline assessment. The day before discharge (T1), the short-term outcomes of the intervention during hospitalization were evaluated, providing the basis for targeted discharge guidance. One month after discharge (T2), this is the time for the patient to come to the hospital for review, so that the patient's condition can be collected and understood in detail.
Questionnaires were distributed to patients at T0, T1, and T2 time points. The PG-SGA scores at T0, T1, and T2 time points were compared. At the T2 time point, the QLQ-C30 scores of the two groups of patients were compared. Questionnaires were also conducted on the main caregivers of the patients at T0, T1, and T2 time points, and the Family Caregiver Task Inventory (FCTI) and CPS scores of the main caregivers in the two groups were compared.
2.6 Statistical methods
We utilized SPSS 22.0 software for data processing and analysis. Metric data conforming to a normal distribution were expressed as mean ± standard deviation (x̄ ± s), while enumeration data were described using frequency and percentage. For comparing scores between the two groups, we employed the independent samples t-test. Comparisons of frequency were conducted using chi-square tests, Kruskal–Wallis rank sum tests, or Fisher's exact probability method. The significance level was set at α = .05 for all two-tailed tests, with differences considered statistically significant at p < .05.
3 RESULTS
3.1 Comparison of general data between the two groups
There were five cases of loss to follow-up in the control group and two in the intervention group, ultimately including 51 cases in each group. The general data between the two groups were compared, and the differences were not statistically significant (p > .05) (Table 2).
| Variable | Intervention Group (n = 51) | Control group (n = 51) | Statistic | p-Value |
|---|---|---|---|---|
| Patients | ||||
| Age (years) | 65.76 ± 8.86 | 65.33 ± 9.25 | 0.24a | .81 |
| Gender, n (%) | 0.00a | 1.00 | ||
| Male | 42 (82.4%) | 42 (82.4%) | ||
| Female | 9 (17.6%) | 9 (17.6%) | ||
| Employment status, n (%) | 0.33a | .57 | ||
| Employed | 6 (11.8%) | 8 (15.7%) | ||
| Unemployed | 45 (88.2%) | 43 (84.3%) | ||
| Education level, n (%) | 0.46b | .65 | ||
| ≤Junior high school | 48 (94.1%) | 49 (96.1%) | ||
| ≥Senior high school | 3 (5.9%) | 2 (3.9%) | ||
| Clinical stage, n (%) | 0.15b | .88 | ||
| Stage I | 14 (27.5%) | 13 (25.5%) | ||
| Stage II | 17 (33.3%) | 20 (39.2%) | ||
| Stage III | 20 (39.2%) | 18 (35.3%) | ||
| Primary caregivers | ||||
| Age (years) | 49.94 ± 5.23 | 50.12 ± 5.02 | 0.17b | .87 |
| Gender, n (%) | 0.29a | .59 | ||
| Male | 7 (13.5%) | 9 (17.3%) | ||
| Female | 45 (86.5%) | 43 (82.7%) | ||
| Employment status, n (%) | 0.22a | .64 | ||
| Employed | 41 (78.8%) | 39 (75.0%) | ||
| Unemployed | 11 (21.1%) | 13 (25.0%) | ||
| Education level, n (%) | 0.87b | .39 | ||
| ≤Junior high school | 18 (34.6%) | 14 (26.9%) | ||
| ≥Senior high school | 8 (15.4%) | 8 (15.4%) | ||
| ≥College | 26 (50.0%) | 30 (57.7%) | ||
| Relationship to patient, n (%) | 0.99a | .61 | ||
| Parent | 33 (63.5%) | 29 (55.8%) | ||
| Spouse | 14 (26.9%) | 15 (28.8%) | ||
| Sibling | 5 (9.6%) | 5 (9.6%) | ||
| Prior caregiving experience, n (%) | 0.06a | .81 | ||
| Yes | 10 (19.2%) | 11 (21.2%) | ||
| No | 42 (80.8%) | 41 (78.8%) | ||
- a t-Value.
- b χ2-value.
3.2 Comparison of FCTI scores between the two groups of primary caregivers
The pre-intervention T0 time point showed no statistically significant difference (p > .05). At the T1 time, the intervention group had lower FCTI scores than the control group, but the difference was not statistically significant (p > .05). At the post-intervention T2 time point, the intervention group had lower FCTI scores than the control group, and the difference was statistically significant (p < .05). The effect size (Cohen's d) for the difference between the two groups at T2 was 0.72, indicating a large effect (Table 3).
| Time point | Intervention group (n = 51) | Control group (n = 51) | t-Value | p-Value | Cohen's d |
|---|---|---|---|---|---|
| T0 | 36.35 ± 9.61 | 36.47 ± 9.19 | 0.06 | .95 | 0.01 |
| T1 | 28.57 ± 7.84 | 31.65 ± 8.22 | 2.04 | .046 | 0.38 |
| T2 | 21.33 ± 7.54 | 26.71 ± 7.43 | 3.63 | <.01 | 0.72 |
3.3 Comparison of Caregivers Preparedness Scale (CPS) scores between two groups
At the T0 time point before intervention, there was no statistically significant difference in CPS scores between the two groups of primary caregivers (p > .05). At the T1 and T2 time points, the intervention group's CPS scores were significantly higher than those of the control group, with a statistically significant difference (p < .05). Cohen's d results show that the differences are of practical significance (Table 4).
| Item | Time point | Intervention group (n = 51) | Control group (n = 51) | t-Value | p-Value | Cohen's d |
|---|---|---|---|---|---|---|
| Physiological needs | T0 | 0.78 ± 0.42 | 0.78 ± 0.42 | <0.01 | 1.00 | 0.00 |
| T1 | 2.94 ± 0.54 | 1.59 ± 0.54 | 12.65 | <.01 | 2.52 | |
| T2 | 3.8 ± 0.40 | 2.69 ± 0.62 | 10.86 | <.01 | 2.03 | |
| Emotional preparedness | T0 | 1.24 ± 0.43 | 1.24 ± 0.47 | <0.01 | 1.00 | 0.00 |
| T1 | 2.96 ± 0.49 | 1.55 ± 0.50 | 14.39 | <.01 | 2.90 | |
| T2 | 3.78 ± 0.42 | 2.69 ± 0.58 | 10.96 | <.01 | 1.92 | |
| Service plan preparedness | T0 | 1.12 ± 0.55 | 1.18 ± 0.52 | 0.55 | .58 | 0.11 |
| T1 | 2.92 ± 0.56 | 1.51 ± 0.50 | 13.37 | <.01 | 2.63 | |
| T2 | 3.71 ± 0.46 | 2.65 ± 0.52 | 10.86 | <.01 | 1.95 | |
| Caregiver stress preparedness | T0 | 1.04 ± 0.53 | 1.12 ± 0.48 | 0.79 | .43 | 0.17 |
| T1 | 2.94 ± 0.54 | 1.55 ± 0.61 | 12.16 | <.01 | 2.09 | |
| T2 | 3.69 ± 0.47 | 2.73 ± 0.67 | 8.42 | <.01 | 0.71 | |
| Comfort care preparedness | T0 | 1.18 ± 0.39 | 1.12 ± 0.43 | 0.73 | .47 | 0.15 |
| T1 | 2.96 ± 0.53 | 1.51 ± 0.54 | 13.69 | <.01 | 2.70 | |
| T2 | 3.75 ± 0.44 | 2.69 ± 0.58 | 10.35 | <.01 | 1.09 | |
| Emergency preparedness | T0 | 1.08 ± 0.52 | 1.10 ± 0.54 | 0.19 | .85 | 0.04 |
| T1 | 2.90 ± 0.54 | 1.51 ± 0.50 | 13.47 | <.01 | 2.54 | |
| T2 | 3.73 ± 0.45 | 2.67 ± 0.59 | 10.20 | <.01 | 1.08 | |
| Resource preparedness | T0 | 1.18 ± 0.43 | 1.22 ± 0.42 | 0.47 | .64 | 0.10 |
| T1 | 2.98 ± 0.51 | 1.69 ± 0.65 | 11.21 | <.01 | 1.73 | |
| T2 | 3.73 ± 0.45 | 2.67 ± 0.59 | 10.20 | <.01 | 1.08 | |
| Overall preparedness | T0 | 1.18 ± 0.48 | 1.12 ± 0.43 | 0.65 | .52 | 0.13 |
| T1 | 2.98 ± 0.55 | 1.63 ± 0.60 | 11.91 | <.01 | 1.94 | |
| T2 | 3.67 ± 0.48 | 2.69 ± 0.62 | 8.99 | <.01 | 1.78 |
3.4 Comparison of patient-generated subjective global assessment scores in two groups of patients
At the T0 and T1 time points, there was no statistically significant difference in PG-SGA scores between the two groups of patients (p > .05); however, at the T3 time point, the comparison of subjective global assessment PG-SGA scores showed a statistically significant difference (p < .05). Cohen's d results show that the differences are of practical significance (Table 5).
| Time point | Intervention group (n = 51) | Control group (n = 51) | t-Value | p-Value | Cohen's d |
|---|---|---|---|---|---|
| T0 | 2.86 ± 1.55 | 2.80 ± 1.77 | 0.18 | .86 | 0.04 |
| T1 | 10.37 ± 2.52 | 10.71 ± 3.17 | 0.59 | .56 | 0.12 |
| T2 | 7.86 ± 2.07 | 10.90 ± 2.77 | 6.28 | <.01 | 1.28 |
3.5 Comparison of QLQ-C30 scores between two groups of patients
When comparing the quality of life scale scores of the two groups of patients during their 1-month postoperative follow-up, there was a statistically significant difference in all items (p < .05). Cohen's d results show that the differences are of practical significance (Table 6).
| Item | Intervention group (n = 51) | Control group (n = 51) | t-Value | p-Value | Cohen's d |
|---|---|---|---|---|---|
| Physical function | 1.88 ± 0.37 | 3.21 ± 0.40 | 17.35 | <.01 | 3.57 |
| Role function | 2.25 ± 0.52 | 3.55 ± 0.32 | 15.07 | <.01 | 2.78 |
| Emotional function | 5.83 ± 1.24 | 11.69 ± 2.01 | 17.75 | <.01 | 3.52 |
| Cognitive function | 1.84 ± 0.51 | 3.41 ± 0.43 | 16.85 | <.01 | 3.40 |
| Social function | 2.11 ± 0.39 | 3.41 ± 0.33 | 18.26 | <.01 | 3.58 |
| General health | 4.82 ± 0.47 | 2.37 ± 0.85 | 18.09 | <.01 | 3.76 |
| Fatigue | 1.89 ± 0.41 | 3.39 ± 0.38 | 19.27 | <.01 | 3.94 |
| Nausea and vomiting | 1.67 ± 0.50 | 2.87 ± 0.36 | 14.06 | <.01 | 2.85 |
| Pain | 1.50 ± 0.39 | 3.33 ± 0.24 | 28.80 | <.01 | 5.70 |
4 DISCUSSION
Esophageal cancer is a common malignant tumor of the digestive tract, with treatment primarily focused on surgery. However, the postoperative recovery challenges that accompany it cannot be ignored. Patients often face complications such as loss of appetite and dysphagia after esophagectomy, which severely affect their nutritional status and quality of life,17 and also pose a significant challenge for caregivers. With the development of medicine, the role of family-based synchronous empowerment education in postoperative recovery is gradually gaining attention.
The result indicates that at the initial time point (T1), the FCTI scores of the primary caregivers in the intervention group did not significantly differ from those in the control group, yet an increasing trend was noted. By the subsequent time point (T2), the FCTI scores of the intervention group markedly surpassed those of the control group, suggesting that family synchronous empowerment education significantly improves caregivers' caregiving capabilities. This enhancement may stem from the traditional medical care model, which often relegates patients and their primary caregivers to a passive role, thereby hindering the full expression of their proactivity and enthusiasm. In contrast, the family synchronous empowerment program addresses the challenges primary caregivers face at various stages post-surgery by offering tailored support through personalized guidance, regular follow-ups, and skill training, thereby mitigating the confusion and disorientation arising from the lack of caregiving experience and training. This finding is supported by the research of Mollica et al.,7 which highlighted that medical/nursing skills training can significantly improve caregivers' confidence and reduce their burden.
Additionally, at both T1 and T2 time points, the CPS scores of the intervention group were significantly higher than those of the control group, indicating a marked enhancement in the preparedness of caregivers. Through the implementation of the family synchronous empowerment education program, there was a deep understanding and grasp of each other's psychological states, which fully mobilized the enthusiasm of the primary caregivers and improved their self-management abilities. This approach is supported by the research18 that highlights the importance of family belief systems, organizational patterns, and communication/problem-solving. By improving these aspects, caregivers are better equipped to manage the complexities of care, leading to more personalized care plans that can reduce the incidence of complications and promote postoperative recovery. Furthermore, Edwards et al.19 demonstrated that personalized care planning can enhance caregivers' preparedness and improve patient outcomes, aligning with our findings.
Tables 3 and 4 also show that caregiving ability and preparedness complement each other. Caregivers with good caregiving ability tend to have higher preparedness, and highly prepared caregiver will continuously improve their caregiving skills to provide higher quality care, facilitating the patient's recovery, which is consistent with the results of the literature review.19
The rehabilitation of gastrointestinal function following esophageal cancer surgery is indeed a complex and lengthy process. Patients often need to continue with a liquid diet at the time of discharge and gradually transition to a normal diet. During this period, they may experience discomfort such as reflux and bloating, which underscores the critical role of postoperative nutritional support.20 While in-hospital care addresses immediate nutritional needs, it is the family-based support that sustains patients' long-term nutritional requirements and quality of life. Our research indicates that at the T1 time point, there is no significant difference in the PG-SGA scores between the two groups. However, at the T2 time point, the intervention group's PG-SGA scores are significantly lower, indicating better nutritional status. We analyze and believe that in-hospital nutritional support is primarily driven by healthcare professionals, which is why the PG-SGA scores at T1 do not significantly differ between the groups. Post-discharge, however, caregivers take the lead in nutritional support. Caregivers in the intervention group, having received family-based synchronized empowerment education, thoroughly assess patients' gastrointestinal tolerance and implement personalized nutrition strategies. They adjust the rate and dosage of nutritional solutions dynamically to ensure adequate nutrient intake and absorption, which gradually highlights the nutritional status difference between the two patient groups, and this is consistent with the research findings of Li et al.21
Quality of life is an essential indicator for evaluating the recovery outcomes of patients after surgery, as it directly reflects their physical and mental state during the disease process. Nutritional status, psychological factors, and social support can all affect the quality of life for patients post-surgery. Through the implementation of family synchronous empowerment education, patients and their primary caregivers are encouraged to actively participate in the postoperative recovery process. This not only improves the caregivers' knowledge of the disease and caregiving skills but also provides the patients with necessary social support, helping them better cope with postoperative discomfort and thereby enhancing the patients' quality of life. The influence of perceived family support on post-surgery recovery is undeniable. Research has demonstrated a clear relationship between family support and recovery, with patients who perceive higher levels of family support showing better postoperative recovery.22 This is particularly relevant as family support is a significant factor in providing quality care and improving patient outcomes. A study by Sagar et al.6 also found that patients with strong family support had fewer postoperative complications and better long-term quality of life, reinforcing the importance of our intervention.
In summary, the implementation of family synchronous empowerment education can have a profound impact on postoperative esophageal cancer patients and their primary caregivers. By carefully tailoring personalized rehabilitation plans, not only is essential postoperative recovery knowledge and skills systematically imparted, but also the communication between patients and their primary caregivers is enhanced, solidifying the foundation of the family as a support system, and significantly alleviating the psychological stress of patients during the disease recovery process. Furthermore, our study demonstrates the necessity of shifting from a patient-centric model to a family-integrated approach in oncology care. Future research and practice should prioritize the inclusion of caregivers as active participants in rehabilitation programs to optimize recovery outcomes.
5 STUDY LIMITATIONS
The subjects of this study were all from the thoracic surgery department of the same hospital, which limits the sampling range and the sample size. Future studies should expand the selection range and sample size of the study subjects to further verify the application value of synchronous family empowerment education. In addition, the intervention effects of the family synchronous empowerment education program were only followed up to 1 month after the patient's discharge, which is insufficient to evaluate the long-term sustainability of the intervention outcomes, and the long-term effects still need further tracking and investigation. Therefore, future research should expand the sample size and extend the observation period to more comprehensively evaluate the application effects of synchronous family empowerment in esophageal cancer patients and their primary caregivers after surgery.
6 CONCLUSION
Implementing family synchronous empowerment education for esophageal cancer patients and their primary caregivers can significantly enhance the caregivers' readiness and ability to provide care, improve the patients' postoperative nutritional status, and enhance the quality of life after surgery.
AUTHOR CONTRIBUTIONS
Yu-ying Shi: Writing original draft preparation. Pan-yue Shu: Writing review and editing. Mei-xiang Wang: Formal analysis. Rong Yu: Software. Liu-liu Zhang: Visualization. Li-li Feng: Methodology. Chang-min Mao: Conceptualization and methodology. Min Ding: Formal analysis and validation.
ACKNOWLEDGMENTS
We are particularly grateful to all the people who have given us help on our article.
CONFLICT OF INTEREST STATEMENT
The authors declare no conflicts of interest.
ETHICS STATEMENT
This study was conducted in accordance with the declaration of Helsinki. This study was conducted with approval from the Ethics Committee of Jiangsu Cancer Hospital (Approval No. 2022-006). All participants provided written informed consent.
