Content of this journal is licensed under a Abstract
Background:
To evaluate the clinical efficacy of integrating empowerment education and humanistic care in enhancing cognitive function, self-care ability, mood regulation, and quality of life among lung cancer (LC) patients undergoing chemotherapy.
Methods:
A total of 149 LC patients receiving chemotherapy from May 2022 to January 2024 were included in the study. They were divided into 2 groups: a control group (n = 63) receiving routine care and a joint group (n = 86) receiving empowerment education and humanistic care. Outcomes measured included cognitive function, self-care ability (using the Exercise of Self-Care Agency scale), mood (using the Hospital Anxiety and Depression Scale), cancer-related fatigue (using the Revised Piper Fatigue Scale), adverse reactions, and QoL (using the Functional Assessment of Cancer Therapy-Lung scale).
Results:
The joint group exhibited significant improvements in cognitive function, self-care ability, and QoL compared to the control group (P < .05). They also had lower scores in anxiety, depression, and cancer-related fatigue (P< .05). The incidence of adverse reactions was markedly lower in the joint group (10.47%) compared to the control group (39.68%).
Conclusion:
Combining empowerment education with humanistic care effectively improves cognitive function, reduces negative emotions and adverse reactions, enhances self-care ability, and improves the overall QoL of LC patients undergoing chemotherapy.
Main Points
Objective of the Study: The study evaluates the clinical efficacy of combining empowerment education with humanistic care to improve the cognitive function, self-care ability, mood, and quality of life of lung cancer patients undergoing chemotherapy.
Comparison of Groups: The study involved 149 lung cancer patients, split into a control group receiving routine care and a joint group receiving the empowerment education concept plus humanistic nursing care. The joint group demonstrated significant improvements across several measures, including disease knowledge, self-care abilities, and emotional well-being.
Key Findings: Patients in the joint group showed greater reductions in anxiety, depression, and cancer-related fatigue. They also had fewer adverse reactions to chemotherapy (10.47% in the joint group vs. 39.68% in the control group), as well as higher quality of life scores.
Conclusion: The combination of empowerment education and humanistic care offers clear clinical benefits for lung cancer patients undergoing chemotherapy, enhancing cognitive function, self-care abilities, reducing negative emotions and adverse reactions, and significantly improving overall quality of life.
Introduction
Lung cancer (LC) is the most common and lethal malignancy worldwide, with the majority of patients exhibiting no distinct clinical symptoms in the early stage. Consequently, as high as 80% of patients have entered the middle and late stages of the disease when typical symptoms emerge,1 with an unfavorable prognosis and a high mortality rate.2 Chemotherapy, as a widely applied and effective treatment modality, can effectively restrain the spread of cancer cells, thereby securing more survival time for patients.3 Nevertheless, chemotherapy also comes with the risk of a series of adverse effects, which not only impose an increased physical burden on patients but also exert significant psychological and mental stress on them, which in turn affects the sleep quality of patients and significantly reduces their quality of life (QoL).4 Hence, there is an urgent need to pay attention to the nursing quality of LC patients undergoing chemotherapy.
To ensure the smooth progress of chemotherapy, hospitals generally provide standard care for LC patients receiving chemotherapy, including guidance at admission, provision of health education brochures, specialized chemotherapy guidance, and education on discharge.5 These measures are intended to assist patients in better understanding their conditions, accepting the reality of being ill, and motivating them to actively cooperate and adhere to the doctor’s treatment plan.6 However, this conventional nursing model might lack targeted and personalized care as it mainly proceeds in accordance with the established nursing procedures and cannot fully meet the specific needs of each patient, resulting in suboptimal overall effectiveness.7 Research indicates that implementing professional, standardized, and humanized nursing measures for patients after LC chemotherapy can effectively improve their physical and mental health status, thereby enhancing the clinical efficacy of treatment.8 This nursing approach not only focuses on the disease itself but also attaches great significance to the holistic care of individuals.9 Humanistic care is the embodiment of this concept, emphasizing the concern for human dignity and survival status, and is committed to promoting the improvement of patients’ physical and mental health under living conditions that conform to human nature.10 Nevertheless, as an indispensable part of clinical nursing, the traditional model of health education often overlooks the physical and mental state of patients, thus affecting the educational outcomes.11 For this reason, the concept of empowerment education emerges. This new educational model endows patients with greater initiative and respects and trusts in their abilities and responsibilities.12 Through the joint efforts of patients and medical staff, better clinical outcomes can be achieved by stimulating patients’ willingness to actively participate in treatment.13
Previous studies have often focused on single-nursing models, such as either empowerment education or humanistic care alone. In contrast, this study innovatively combines the empowerment education concept with humanistic care. Moreover, most previous research has only evaluated one or two aspects of patients, like psychological state or self-care ability. However, this study comprehensively assesses multiple dimensions including cognitive function, self-care ability, mood, cancer-related fatigue, adverse reactions, and quality of life. This comprehensive approach provides a more in-depth and comprehensive understanding of the impact of the intervention on lung cancer patients undergoing chemotherapy, which is a novel contribution to the existing literature.
In this study, 149 patients undergoing chemotherapy for LC were included, and the influence of the empowerment education concept plus humanistic care intervention on their mood and QoL was comparatively analyzed.
Material and Methods
General Data
On the premise of obtaining approval from the Nanjing First Hospital's ethics committee and informed consent forms signed by all subjects (Approval Number: YW20221230-05), 149 LC chemotherapy patients who were admitted to the hospital from May 2022 to January 2024 were selected as the research subjects, including 63 cases in the control group who were given routine nursing intervention, and 86 cases in the joint group who were given empowerment education concept plus humanistic care intervention. The determination of the sample size of this study was based on the expected effect size, the efficacy of statistical tests, and the type of study design. Using G*Power software (ver. 3.1.9.7; Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany), combined with the independent sample t-test, chi-square test, and other statistical methods selected in this study, the significance level was set at 0.05, and the expected efficacy reached more than 80%. It was calculated that at least 149 patients needed to be included to meet the study requirements. The actual inclusion of 149 lung cancer chemotherapy patients (63 in the control group and 86 in the combined intervention group) helped to ensure the reliability and statistical validity of the study results. The comparison of general information revealed no marked inter-group differences (P > .05) and clinical comparability.
Criteria for Patient Selection
Inclusion criteria: LC diagnosed by pathological examination, with a clinical stage of II, III, or IV; receiving chemotherapy in the hospital; age > 18; expected survival > 6 months; normal communication and cognitive abilities; and willingness to cooperate with the study.
Exclusion criteria: Severe mental illness (affects patient cognition, compliance, and evaluation of research indicators); severe organ dysfunction (affects chemotherapy tolerance, recovery ability, and judgment of intervention effects); immune system diseases (affects chemotherapy efficacy, adverse reactions, and observation of intervention effects); inability to continue to complete this study due to disease progression (cannot ensure the integrity and effectiveness of research data).
Nursing Mode
Nursing methods for the control group: Routine nursing was provided. To stabilize moods and provide the necessary support for patients after admission, the nursing staff took the initiative to guide the patient in understanding and adapting to the hospital environment, including detailing various basic living facilities in the hospital, such as the location of the water dispenser and toilets, to facilitate the patient’s quicker integration into the new environment. To enable the patient to confront the upcoming chemotherapy treatment with a positive attitude, the nursing staff also disseminated relevant knowledge about chemotherapy to the patient. During chemotherapy, the nursing staff continuously and meticulously monitored the patient’s vital signs, including but not limited to key indicators such as body temperature, pulse, and respiration. Additionally, to reduce the risk of adverse reactions, the nursing staff regularly evaluated the likelihood of various possible adverse reactions and implemented timely prevention and intervention for potential risk factors. Regarding the patient’s diet, the nursing staff provided professional guidance to ensure that the patient could obtain balanced and sufficient nutrition during chemotherapy to maintain normal bodily functions. After chemotherapy concluded, the nursing staff still maintained close observation of patients, particularly paying attention to their clinical manifestations. Once any abnormal situation was detected, the attending physician was immediately notified for timely and effective symptomatic treatment. Before the patient’s discharge, the nursing staff also provided detailed discharge guidance to ensure that the patient understood how to conduct self-care and observation at home. Furthermore, the nursing staff emphasized the importance of regular outpatient follow-up in accordance with medical advice, so that the hospital can keep abreast of the patient’s recovery status and provide further medical advice and support.
The joint group received empowerment education concept plus humanistic care intervention: (1) During the patient’s treatment process, empowerment education concept nursing was implemented 3 times a week for 15-30 minutes each time, which included 5 core links: (a) Through in-depth understanding of patients’ physical and mental health status, underlying condition, and personality characteristics, a series of questions were put forward to patients, such as the specific steps, expected effects, and possible adverse reactions of chemotherapy, to gain insight into their level of awareness and attitude towards LC. (b) After establishing a trusting relationship, patients were encouraged to freely express their true feelings during the treatment and allowed to release their negative emotions without any judgment. This process aimed to guide patients in gradually transforming their originally negative expectations of the disease into a positive attitude. (c) Combining the patient’s personal situation, they were guided to independently set lifestyle and dietary adjustments, preventive measures for adverse reactions, and expected psychological states during treatment. In this process, special emphasis was placed on the practical feasibility of goal setting, aiming to help patients gradually achieve self-management and encourage them to enhance their self-implementation skills through peer-to-peer learning. (d) A customized nursing plan was jointly developed with the patient, integrating the previously established goals with the plan and documenting it in detail for subsequent follow-up and adjustment. (e) A problem-oriented assessment model was employed to conduct regular evaluations of the patient’s goal achievement, which included summarizing the disease, analyzing the reasons for uncompleted goals, and seeking solutions to enhance treatment confidence; (2) Humanistic care: Throughout the nursing process, particular emphasis was placed on humanistic care. Before commencing nursing, medical staff obtained the patient’s consent and maintained close communication with the patient’s family, encouraging them to give more care and support to the patient. Nurses paid attention to the patient’s psychological state, promptly channeled negative emotions, and ensured that patients could correctly face issues related to the disease, treatment, and the end of life through appropriate communication methods. Measures such as music therapy were also utilized to alleviate the patient’s pain during the treatment process.
Outcome Measures
1. Cognitive function: A questionnaire survey on LC-related knowledge and cognition, specifically formulated by the hospital, was employed for investigation. This questionnaire was filled out before and after patient care, respectively, to compare the enhancement of patients’ cognitive levels, including the understanding of basic knowledge of the disease, mastery of treatment methods, awareness of daily matters needing attention, and cognition of prevention and control of adverse reactions (the scoring range for each item is from 0 to 10 points). The higher the score, the greater the patient’s cognitive level of LC-related knowledge.
2. Self-care ability: The Exercise of Self-care Agency (ESCA) Scale was adopted. This scale was evaluated before and after patient care to compare changes in patients’ self-care ability. The ESCA scale comprises 4 assessment dimensions with a total of 43 assessment items. It adopts a scoring system ranging from 0 to 4 levels, with a total score of 172 points. The patient’s score is directly proportional to his/her self-care ability.14
3. Negative emotional state: The Hospital Anxiety and Depression Scale (HADS) was adopted for assessment. The scale specifically covers 2 evaluation dimensions, anxiety and depression, with a total of 14 assessment items. The scoring method employs the Likert 3-level scoring approach, which is judged by a cut-off score of 7 for each dimension. If the score of a certain dimension is higher than 7 points, it indicates that the patient has an emotional tendency towards anxiety or depression.15
4. Cancer-related fatigue (CRF) score: The Revised Piper Fatigue Scale (PFS-R) was used for assessment. This scale covers multiple dimensions such as cognitive/mood, sensory, behavior/severity, and affective. Each dimension is scored on a scale of 0-10, with higher scores indicating more severe fatigue.16
5. Adverse reactions: Adverse reactions were mainly evaluated by observing and recording the cases of nausea, vomiting, diarrhea, alopecia, headache, and myelosuppression in the 2 groups.
6. QoL: The Functional Assessment of Cancer Therapy-Lung (FACT-L) scale was used to assess patients’ QoL. This scale includes 5 assessment dimensions with a total of 36 assessment items, specifically subdivided into physiological status (containing 7 items), emotional state (containing 6 items), physiological function (containing 7 items), social function (containing 7 items), and a specific assessment module for LC (containing 9 items). Each assessment item is scored on a scale of 0 to 4 points, and the total score on the scale ranges from 0 to 144 points. The score is positively related to the QoL.17
Statistical Methods
For measurement data (represented as mean ± SEM), the independent sample t-test was used as it suits comparing 2 independent groups’ means, assuming normal distribution and variance homogeneity, applicable for variables like age and body mass index (BMI). A paired t-test for within-group (before and after nursing) comparisons as it controls for individual differences. For count data (in percentages), the chi-square test was chosen as it tests associations between categorical variables, like gender and Tumor Node Metastasis (TNM) staging. SPSS 22.0 (IBM SPSS Corp.; Armonk, NY, USA) was used, with P < .05 indicating significance. This selection is to ensure scientific data analysis and reliable results. These methods were chosen because they are standard and appropriate for the data types in this study, allowing for valid inferences and comparisons.
Results
Comparative Analysis of General Data
We did not identify any statistical significance in the general data (age, BMI, disease course, sex, TNM staging, and number of chemotherapy sessions) comparison between the control and observation groups (P > .05) (Table 1).
Table 1.
Comparative Analysis of the General Data of 2 Groups of Patients
| Indicators | Joint Group (n = 86) | Control Group (n = 63) | P |
|---|---|---|---|
| Age (years old, mean ± SEM) | 51.27 ± 4.58 | 51.38 ± 4.75 | .745 |
| Body mass index (kg/m2, mean ± SEM) | 22.05 ± 1.89 | 22.55 ± 2.48 | .664 |
| Disease course (months, mean ± SEM) | 8.62 ± 1.02 | 8.44 ± 0.73 | .546 |
| Gender (n, %) | .868 | ||
| Male | 49 (56.98) | 37 (58.73) | |
| Female | 37 (43.02) | 26 (41.27) | |
| TNM staging (n, %) | .872 | ||
| II | 28 (32.56) | 23 (36.51) | |
| III | 31 (36.05) | 22 (34.92) | |
| IV | 27 (31.40) | 18 (28.57) | |
| Number of chemotherapy sessions (n, %) | .669 | ||
| First time | 32 (37.21) | 28 (44.44) | |
| 2-4 | 30 (34.88) | 19 (30.16) | |
| > 4 | 24 (27.91) | 16 (25.40) |
Comparison of Cognitive Function Scores
Cognitive function indicators mainly determined the disease knowledge, therapeutic knowledge, matters needing attention, and prevention and control of adverse reactions before and after nursing. The data revealed no significant differences in any of these indicators between the 2 groups before nursing (P ≥ 05P); the scores of disease knowledge, therapeutic knowledge, matters needing attention, and prevention and control of adverse reactions in both groups increased statistically after care, with even more notable increases in the joint group compared to the control group (P< .05) (Figure 1).
Figure 1.
Detection of disease knowledge, therapeutic knowledge, matters needing attention, and adverse reaction prevention and control scores before and after nursing: A. Disease knowledge scores before and after nursing in 2 groups. B. Therapeutic knowledge scores of the 2 groups before and after nursing. C. Matters needing attention scores before and after nursing in 2 groups. D. Scores of prevention and control of adverse reactions before and after nursing in the 2 groups. Note: **P < .01 vs. before nursing; aP < .05 vs. control.
Comparison of Exercise of Self-care Agency Scores
The ESCA score mainly tested the self-concept, sense of responsibility, self-care skills, and health knowledge of the 2 groups of patients before and after nursing. The 2 groups showed similar scores before nursing (P > .05); a marked rise in the self-concept, sense of responsibility, self-care skills, and health knowledge scores was observed in both groups after care, with higher scores in all these dimensions in the joint group compared to the control group (P < .05) (Figure 2).
Figure 2.
Testing of self-concept, sense of responsibility, self-care skills, and health knowledge before and after nursing. A. Self-concept scores of both groups before and after nursing. B. Sense of responsibility scores before and after nursing in 2 groups. C. Self-care skill scores of 2 groups before and after nursing. D. Health knowledge scores of 2 groups before and after nursing. Note: **P < .01 vs. before nursing; aP < .05 vs. control.
Inter-Group Comparison of Hospital Anxiety and Depression Scale Scores
The psychological states of the 2 groups of patients were assessed using the HADS score (anxiety dimension and depression dimension). The 2 arms exhibited no marked differences in any of these indexes prior to care (P > .05); both groups showed an evident reduction in the scores of the anxiety and depression dimensions after nursing; moreover, the joint group exhibited a more remarkable decrease in the anxiety dimension and depression dimension than the control group (P < .05) Figure 3).
Figure 3.
Detection of anxiety dimension and depression dimension scores before and after nursing. A. Anxiety dimension scores of 2 groups before and after nursing. B. Depression dimension scores before and after nursing in 2 groups. Note: **P < .01 vs. before nursing; aP < .05 vs. control.
Comparison of Revised Piper Fatigue Scale Scores
The cognitive function indicators primarily examined the levels of behavior/severity, affective, sensory, and cognitive/mood of the 2 groups of patients prior to and after nursing. Statistical significance was absent in various indexes before care (P > .05); notable decreases in behavior/severity, affective, sensory, and cognitive/mood scores in both groups were observed after nursing, particularly in the joint group (P < .05) (Table 2).
Table 2.
Comparison of the Revised Piper Fatigue Scale (for Cancer-Related Fatigue Assessment) Scores (points, mean ± SEM)
| Items | Group (n) | Before | After | P | Difference |
|---|---|---|---|---|---|
| Behavior/severity | Joint group (n = 86) | 5.51 ± 1.09 | 2.41 ± 0.54 | <.001 | −3.13 ± 0.25 |
| Control Group (n = 63) | 5.32 ± 0.95 | 4.32 ± 0.88 | <.001 | −1.04 ± 0.12 | |
| P | <.001 | ||||
| Affective | Joint group (n = 86) | 5.33 ± 1.54 | 3.28 ± 0.76 | <.001 | −2.03 ± 0.18 |
| Control Group (n = 63) | 5.14 ± 1.18 | 4.84 ± 1.16 | .048 | −0.34 ± 0.05 | |
| P | <.001 | ||||
| Sensory | Joint group (n = 86) | 4.57 ± 1.32 | 1.84 ± 0.45 | <.001 | −2.83 ± 0.25 |
| Control Group (n = 63) | 4.89 ± 1.56 | 3.83 ± 1.65 | .012 | −1.04 ± 0.11 | |
| P | <.001 | ||||
| Cognitive/mood | Joint group (n = 86) | 4.02 ± 1.06 | 2.15 ± 0.49 | <.001 | −2.07 ± 0.18 |
| Control Group (n = 63) | 4.17 ± 1.21 | 3.49 ± 0.81 | .007 | −0.61 ± 0.05 | |
| P | <.001 |
Comparative Analysis of Adverse Reactions
By tallying the number and percentage of cases experiencing nausea, vomiting, diarrhea, alopecia, headache, and myelosuppression in the 2 groups, it was found that the total incidence of adverse reactions in the joint group was 10.47%, which was notably lower than 39.68% in the control group (P < .05) (Table 3).
Table 3.
Comparative Analysis of Adverse Reactions
| Indicators | Joint Group (n = 86) | Control Group (n = 63) | P |
|---|---|---|---|
| Nausea | 3 (3.49) | 7 (11.11) | |
| Vomiting | 2 (2.33) | 5 (7.94) | |
| Diarrhea | 2 (2.33) | 4 (6.35) | |
| Alopecia | 1 (1.16) | 3 (4.76) | |
| Headache | 1 (1.16) | 4 (6.35) | |
| Myelosuppression | 0 (0.00) | 2 (3.17) | |
| Total | 9 (10.47) | 25 (39.68) | <.001 |
Comparison of Functional Assessment of Cancer Therapy-Lung Scores Between 2 Patient Groups
The FACT-L score primarily evaluated the QoL from physiological, emotional, functional, and social dimensions, as well as the LC-specific module before and after nursing. No statistical inter-group difference was found in various domains before care (P > .05). After nursing, the levels of physiological, emotional, functional, social, and LC-specific modules in both groups increased significantly, with more pronounced improvements in the above dimensions in the joint group versus the other (P < .05) (Table 4).
Table 4.
Comparison of the Functional Assessment of Cancer Therapy-Lung Scores
| Items | Group (n) | Before | After | P | Difference |
|---|---|---|---|---|---|
| Physiological | Joint group (n = 86) | 14.79 ± 2.25 | 23.01 ± 2.31 | <.001 | 8.13 ± 0.85 |
| Control Group (n = 63) | 15.17 ± 1.61 | 17.98 ± 1.65 | <.001 | 2.84 ± 0.25 | |
| P | <.001 | ||||
| Emotional | Joint group (n = 86) | 15.33 ± 1.36 | 20.36 ± 2.23 | <.001 | 5.03 ± 0.48 |
| Control Group (n = 63) | 15.48 ± 0.91 | 17.81 ± 1.66 | .028 | 2.34 ± 0.25 | |
| P | <.001 | ||||
| Functional | Joint group (n = 86) | 13.98 ± 1.11 | 24.51 ± 2.08 | <.001 | 10.83 ± 1.25 |
| Control Group (n = 63) | 14.03 ± 1.15 | 19.83 ± 1.58 | .001 | 5.64 ± 0.51 | |
| P | <.001 | ||||
| Social | Joint group (n = 86) | 18.63 ± 1.99 | 24.37 ± 1.83 | <.001 | 5.83 ± 0.55 |
| Control Group (n = 63) | 18.46 ± 2.06 | 20.17 ± 1.00 | .032 | 1.74 ± 0.15 | |
| P | <.001 | ||||
| Lung cancer-specific module | Joint group (n = 86) | 20.42 ± 3.13 | 32.36 ± 2.80 | <.001 | 12.07 ± 1.18 |
| Control Group (n = 63) | 20.32 ± 3.48 | 27.83 ± 2.59 | <.001 | 7.61 ± 0.65 | |
| P | <.001 |
Discussion
Lung cancer ranks first in cancer incidence in China, and the adverse reactions brought about by chemotherapy often lead to a significant drop in the QoL of patients.18 Hence, 1 of the core tasks of clinical nursing is to explore and implement methods that can effectively enhance the QoL of patients during their survival.19 Currently, the routine health guidance for LC patients undergoing chemotherapy mostly adopts a one-way imparting approach, where healthcare workers instill health knowledge into patients.20 However, this approach often results in low patient compliance and limited effectiveness.21 Therefore, exploring and applying new nursing models has become the current research focus in an attempt to find a nursing method that better meets patients’ needs and significantly improves their QoL.
The conventional nursing scheme is undeniably comprehensive in nursing practice. However, its mechanized workflow may diminish the sense of care and importance perceived by patients, consequently impacting their cooperation in rehabilitation treatment and nursing.22 The intuitive feelings of patients are often directly linked to their compliance with treatment and nursing at hospitals.23 Many patients, after undergoing conventional nursing, do not experience the expected recovery of their conditions, suggesting the need for innovation in nursing strategies from the source to ensure that all nursing measures are patient-centered.24 Empowerment education is a nursing approach that emphasizes the patient’s dominant position. It encourages patients to participate in treatment decision-making and answers patients’ doubts through question-and-answer sessions, thereby maximizing patients’ subjective initiative.25 On the other hand, humanistic nursing intervention is dedicated to providing all-round care for patients and creating a warm and comfortable treatment environment.26 The declined cognitive function of LC patients receiving chemotherapy is mainly due to fatigue, affecting cognitive function and QoL, so effective intervention is needed.27 The cognitive function scoring results of this study showed that compared with the control group, the scores of disease knowledge, therapeutic knowledge, matters needing attention, and adverse reaction prevention and control of the joint group increased more statistically. It is suggested that the combined application of the empowerment education concept and humanistic care can effectively guide LC patients to have a deeper understanding of chemotherapy, thereby significantly improving the effectiveness of chemotherapy. The ESCA scale results revealed more evident increases in the self-concept, sense of responsibility, self-care skills, and health knowledge scores in the joint group. This implies that the combination of the empowerment education concept and humanistic nursing, through problem confirmation, emotional expression, goal setting, plan formulation, and effect evaluation, enhances the self-management of LC patients undergoing chemotherapy and augments their treatment participation, thereby improving therapeutic efficacy. Previous research has shown that empowerment education may enhance patients’ self-efficacy, which in turn could lead to better self-care behaviors and improved outcomes.28 Self-efficacy, as a psychological mechanism, might mediate the relationship between empowerment education and the observed improvements in self-care ability and quality of life. In this study, patients in the joint group were guided to set goals and make plans, which may have increased their sense of control and self-efficacy, thus contributing to the positive results observed. Additionally, humanistic care may have influenced patients’ perception of social support. When patients feel more cared for and supported by healthcare providers and their families, they may experience enhanced psychological well-being and be more motivated to engage in self-care and treatment. This perceived social support could be a social mechanism mediating the relationship between humanistic care and the observed outcomes such as reduced anxiety and depression, and improved quality of life.
Previous research has demonstrated that chemotherapy can give rise to a series of physical and psychological symptoms, including pain, sleep disorders, fatigue, and anxiety. Providing effective nursing interventions is an efficacious approach to alleviate post-chemotherapy pain and anxiety and improve sleep quality in cancer patients.29 In this study, the joint group showed more obvious reductions in the scores of the anxiety and depression dimensions than the control group, suggesting that the combination of empowerment education concept and humanistic nursing delves deeply into the root causes of patients’ negative emotions and guides them to rationally vent and stabilize their emotions. During chemotherapy, patients should be given recognition and encouragement to stimulate their positive mindset, and family members should be guided to participate in disease management and strengthen family support to mitigate negative emotions. Cancer-related fatigue is a persistent fatigue syndrome that emerges during cancer treatment, involving cognitive, emotional, and physical aspects.30 Unlike ordinary fatigue, it cannot be alleviated easily by rest and is characterized by a long duration, a profound degree, and rapid development.31 The majority of tumor patients will be afflicted by CRF during treatment and for months or even years afterward, which seriously impacts their social functioning and QoL.32 The results of this study on cancer-related fatigue indicate that compared with the control group, the joint group showed a more significant reduction in behavior/severity, affective, sensory, and cognitive/mood levels. This suggests that the combination of the empowerment education concept and humanistic nursing can guide patients to self-regulate their emotions, attention, and cognition to relieve physical and psychological discomfort, thereby better coping with various challenges brought by chemotherapy, the disease itself, and life stress. Yu et al33 indicated in the research that compared with conventional nursing, the combination of psychological intervention and health education for LC patients undergoing chemotherapy effectively relieved anxiety and depression, enhanced treatment confidence, reduced pain, and significantly improved sleep quality, respiratory function, QoL, and nursing satisfaction. The findings are consistent with Yu and colleagues’ study in that both highlight the positive impact of combined nursing interventions on the psychological well-being and quality of life of lung cancer patients undergoing chemotherapy. However, different from Yu and colleagues’ research, which did not focus on the role of empowerment education in enhancing patients’ self-management and knowledge acquisition, this study fills this gap. It was found that through empowerment education, patients had a more in-depth understanding of the disease and treatment, which was reflected in the significant increase in their cognitive function scores related to the disease and treatment. This new discovery enriches the understanding of the impact of combined nursing interventions on lung cancer patients undergoing chemotherapy.
Another study by Mannion E et al34 found that chemotherapy had a significant impact on the quality of life of patients with non-small cell lung cancer. In contrast, this study not only confirms the negative impact of chemotherapy on patients’ quality of life but also demonstrates that the combination of empowerment education and humanistic care can effectively improve patients’ quality of life, as evidenced by the significant increases in the physiological, emotional, functional, social, and LC-specific module levels in the joint group. This indicates that the intervention measures have a unique advantage in enhancing the overall well-being of patients.
This study demonstrated an evidently lower total incidence of adverse reactions in the joint group compared to the control group (10.47% vs. 39.68%), suggesting that the combination of empowerment education concept and humanistic nursing can, to a certain extent, help prevent the occurrence of adverse reactions such as nausea, vomiting, diarrhea, alopecia, headache, and myelosuppression. Research shows that chemotherapy can effectively improve patients’ QoL and ameliorate disease-specific symptoms. Hence, improving QoL should be regarded as the core objective of advanced cancer treatment. The results of this study showed that the levels of physiological, emotional, functional, social, and LC-specific modules in the joint group increased more significantly. This indicates that the combination of empowerment education concept and humanistic nursing can enhance patients’ understanding of the disease and strengthen their self-care ability, thus helping to reduce adverse reactions during chemotherapy and further improve patients’ QoL.
Educational philosophy and humanistic care not only have a positive impact on lung cancer chemotherapy patients in the short term but also have important significance in the long term. After the intervention, the improvement of patients’ cognitive function and self-care ability is expected to continue to play a role. Patients with a deeper understanding of the disease and treatment may be more likely to follow a healthy lifestyle in the subsequent recovery process, such as a reasonable diet, moderate exercise, and regular medical follow-ups, which can help reduce the risk of disease recurrence and improve long-term prognosis.
From a psychological perspective, the reduction of anxiety and depression during the intervention, as well as the strengthening of psychological adjustment ability, may enable patients to better cope with disease-related stress and life challenges in the future. The emotional management and coping strategies they learn will serve as a psychological resource to help them maintain a positive mindset and enhance mental resilience. At the same time, the strengthening of family support systems promoted by humanistic care will also provide patients with continuous emotional support so they will not feel isolated during the long-term recovery process.
In addition, improvements in various dimensions of quality of life may have a knock-on effect. Improvements in emotional and functional status help patients reintegrate into social activities, maintain social relationships, and pursue hobbies, which in turn enhances their sense of self-identity and meaning in life. This is critical for patients’ long-term quality of life and overall well-being. However, these long-term effects still need to be confirmed and further explored in longitudinal studies.
This study has several limitations. The sample was selected from a single hospital, which may limit the generalizability of the results. The measurement tools used may not capture all aspects of the constructs precisely. Additionally, there may be confounding factors that were not accounted for, such as patients’ social support networks outside the hospital, pre-existing mental health conditions, and genetic predispositions to certain reactions during chemotherapy.
The findings of this study have important practical implications for clinical nursing. The combination of empowerment education and humanistic care has been shown to be effective in improving various aspects of lung cancer patients’ well-being during chemotherapy. Healthcare providers should consider integrating these approaches into their routine care. Nurses should be trained to implement empowerment education strategies and focus on patients’ emotional and psychological needs. This integrated approach may lead to better patient outcomes, including improved cognitive function, self-care ability, mood regulation, and quality of life, as well as reduced adverse reactions.
There are several challenges in implementing the empowerment education concept and humanistic care. Staff training and time constraints in a busy clinical setting can be hurdles. Adequate resources need to be allocated for a comfortable treatment environment and materials for patient education. Additionally, ensuring patient acceptance and compliance with these interventions is crucial for their success.
To sum up, the combination of empowerment education concept and humanistic nursing intervention in LC chemotherapy shows significant clinical benefits, enhancing cognitive function, self-care ability, and QoL while reducing negative emotions and adverse reactions. Clinically, this suggests integrating both into routine care. Future research should validate these findings in larger, diverse groups, explore optimal implementation details, and investigate synergy with other therapies. Qualitative studies could also deepen the understanding of patient experiences.
Funding Statement
The authors declared that this study has received no financial support.
Footnotes
Ethics Committee Approval: This study was approved by the Ethics Committee of Nanjing First Hospital (Approval No.: YW20221230-05; Date: September 18, 2024).
Informed Consent: Informed consent was obtained from all participants and their parents who agreed to take part in the study.
Peer-review: Externally peer-reviewed.
Author Contributions: Concept – B.L.H., L.J.L., Q.W.Z.; Design – B.L.H., L.J.L., Q.W.Z.; Supervision – B.L.H., L.J.L., Q.W.Z.; Resources – L.J.L., Q.W.Z.; Materials – L.J.L., Q.W.Z.; Data Collection and/or Processing – B.L.H., L.J.L., Q.W.Z.; Analysis and/or Interpretation – B.L.H., L.J.L., Q.W.Z.; Literature Search – B.L.H., L.J.L., Q.W.Z.; Writing – B.L.H., L.J.L., Q.W.Z.; Critical Review – B.L.H., L.J.L., Q.W.Z.
Declaration of Interests: The authors have no conflict of interest to declare.
Data Availability Statement:
The data that support the findings of this study are available upon request from the corresponding author.
References
- 1. Bade BC Dela Cruz CS. . Lung Cancer 2020: Epidemiology, etiology, and prevention. Clin Chest Med. 2020;41(1):1 24. (doi: 10.1016/j.ccm.2019.10.001) [DOI] [PubMed] [Google Scholar]
- 2. Nasim F Sabath BF Eapen GA. . Lung cancer. Med Clin North Am. 2019;103(3):463 473. (doi: 10.1016/j.mcna.2018.12.006) [DOI] [PubMed] [Google Scholar]
- 3. Li Y Yan B He S. . Advances and challenges in the treatment of lung cancer. Biomed Pharmacother. 2023;169:115891. (doi: 10.1016/j.biopha.2023.115891) [DOI] [PubMed] [Google Scholar]
- 4. Du L Morgensztern D. . Chemotherapy for advanced-stage non-small cell lung cancer. Cancer J. 2015;21(5):366 370. (doi: 10.1097/PPO.0000000000000141) [DOI] [PubMed] [Google Scholar]
- 5. Naito T, Mitsunaga S, Miura S. Feasibility of early multimodal interventions for elderly patients with advanced pancreatic and non-small-cell lung cancer. J Cachexia Sarcopenia Muscle. 2019;10(1):73 83. (doi: 10.1002/jcsm.12351) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6. Xiao J, Chow KM, Choi KC. Effects of family-oriented dignity therapy on dignity, depression and spiritual well-being of patients with lung cancer undergoing chemotherapy: a randomised controlled trial. Int J Nurs Stud. 2022;129:104217. (doi: 10.1016/j.ijnurstu.2022.104217) [DOI] [PubMed] [Google Scholar]
- 7. Guo R Wang H. . Analysis of lung imaging intelligent diagnosis system for nursing intervention of lung cancer patients’ quality of life. Contrast Media Mol Imaging. 2021;2021:6750934. (doi: 10.1155/2021/6750934) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8. Zhu L Chen L Kan H Cai P. . Staged versus conventional nursing for patients receiving chemotherapy for advanced non-small cell lung cancer: a before and after study. Ann Palliat Med. 2021;10(1):250 257. (doi: 10.21037/apm-20-2240) [DOI] [PubMed] [Google Scholar]
- 9. Jin E. . Flexible nursing in patients with lung cancer who received chemotherapy. J Cancer Res Clin Oncol. 2023;149(12):9959 9963. (doi: 10.1007/s00432-023-04876-y) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10. Taghinezhad F Mohammadi E Khademi M Kazemnejad A. . Humanistic care in nursing: concept analysis using Rodgers’ evolutionary approach. Iran J Nurs Midwif Res. 2022;27(2):83 91. (doi: 10.4103/ijnmr.ijnmr_156_21) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11. FitzPatrick B. . Validity in qualitative health education research. Curr Pharm Teach Learn. 2019;11(2):211 217. (doi: 10.1016/j.cptl.2018.11.014) [DOI] [PubMed] [Google Scholar]
- 12. Damsgaard JB Overgaard CML Dürr DW Lunde A Thybo P Birkelund R. . Psychiatric care and education understood from a student perspective: enhancing competences empowering personal and social recovery. Scand J Caring Sci. 2022;36(4):1241 1250. (doi: 10.1111/scs.13097) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13. Mousavinasab ES Rostam Niakan Kalhori S Zarifsanaiey N Rakhshan M Ghazisaeedi M. . Nursing process education: a review of methods and characteristics. Nurse Educ Pract. 2020;48:102886. (doi: 10.1016/j.nepr.2020.102886) [DOI] [PubMed] [Google Scholar]
- 14. Cunha F Pinto MDR Riesch S Lucas P Almeida S Vieira M. . Translation, adaptation, and validation of the Portuguese version of the exercise of self-care agency Scale. Healthcare (Basel). 2024;12(2):159. (doi: 10.3390/healthcare12020159) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15. Garaiman A, Mihai C, Dobrota R. The Hospital Anxiety and Depression Scale in patients with systemic sclerosis: a psychometric and factor analysis in a monocentric cohort. Clin Exp Rheumatol. 2021;39(4 suppl 131):34 42. (doi: 10.55563/clinexprheumatol/qo1ehz) [DOI] [PubMed] [Google Scholar]
- 16. Cheng Z Johar A Nilsson M Schandl A Lagergren P. . Cancer-related fatigue trajectories up to 5 years after curative treatment for oesophageal cancer. Br J Cancer. 2024;130(4):628 637. (doi: 10.1038/s41416-023-02551-0) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17. Mohindra NA Peipert JD Blum SI Shaw JW Penrod JR Cella D. . General population reference values for the Functional Assessment of Cancer Therapy-Lung and PROMIS-29. Cancer Med. 2023;12(11):12765 12776. (doi: 10.1002/cam4.5920) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18. Chan CW Tsui SK Law BM So WK Tang FW Wong CL. . The utilization of the immune system in lung cancer treatment: beyond chemotherapy. Int J Mol Sci. 2016;17(3):286. (doi: 10.3390/ijms17030286) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19. Osoba D Rodrigues G Myles J Zee B Pater J. . Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol. 1998;16(1):139 144. (doi: 10.1200/JCO.1998.16.1.139) . Corrected and republished in: J Clin Oncol. 2023;41(35): 5345 5350. (doi: ) [DOI] [PubMed] [Google Scholar]
- 20. Ferrell B Koczywas M Grannis F Harrington A. . Palliative care in lung cancer. Surg Clin North Am. 2011;91(2):403 417, ix. (doi: 10.1016/j.suc.2010.12.003) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21. Miao J Ji S Wang S Wang H. . Effects of high quality nursing in patients with lung cancer undergoing chemotherapy and related influence on self-care ability and pulmonary function. Am J Transl Res. 2021;13(5):5476 5483. [PMC free article] [PubMed] [Google Scholar]
- 22. Mei C Zhang L Zhang Z. . Vomiting management and effect prediction after early chemotherapy of lung cancer with diffusion-weighted imaging under artificial intelligence algorithm and comfort care intervention. Comput Math Methods Med. 2022;2022:1056910. (doi: 10.1155/2022/1056910) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23. Zhang T Lu J Fan Y Wang L. . Evidence-based nursing intervention can improve the treatment compliance, quality of life and self-efficacy of patients with lung cancer undergoing radiotherapy and chemotherapy. Am J Transl Res. 2022;14(1):396 405. [PMC free article] [PubMed] [Google Scholar]
- 24. Yang S Zheng L Sun Y Li Z. . Effect of network-based positive psychological nursing model combined with elemene injection on negative emotions, immune function and quality of life in lung cancer patients undergoing chemotherapy in the era of big data. Front Public Health. 2022;10:897535. (doi: 10.3389/fpubh.2022.897535) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25. Ning L, Yuan C, Li Y. Effect of continuous nursing based on the Omaha System on cancer-related fatigue in patients with lung cancer undergoing chemotherapy: a randomized controlled trial. Ann Palliat Med. 2021;10(1):323 332. (doi: 10.21037/apm-20-2542) [DOI] [PubMed] [Google Scholar]
- 26. Sharifi N Adib-Hajbaghery M Najafi M. . Cultural competence in nursing: a concept analysis. Int J Nurs Stud. 2019;99:103386. (doi: 10.1016/j.ijnurstu.2019.103386) [DOI] [PubMed] [Google Scholar]
- 27. Kumano K, Oishi A, Matsuda N. Research of cognitive impairment in lung cancer patients undergoing chemotherapy]. Gan To Kagaku Ryoho. 2023;50(9):1013 1015. [PubMed] [Google Scholar]
- 28. Alzawahreh S Ozturk C. . Improving self-efficacy, quality of life, and glycemic control in adolescents with type 1 diabetes: randomized controlled trial for the evaluation of the family-centered empowerment model. JMIR Form Res. 2024;8:e64463. (doi: 10.2196/64463) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 29. Tang H Chen L Wang Y Zhang Y Yang N Yang N. . The efficacy of music therapy to relieve pain, anxiety, and promote sleep quality, in patients with small cell lung cancer receiving platinum-based chemotherapy. Support Care Cancer. 2021;29(12):7299 7306. (doi: 10.1007/s00520-021-06152-6) [DOI] [PubMed] [Google Scholar]
- 30. Thong MSY van Noorden CJF Steindorf K Arndt V. . Cancer-related fatigue: causes and current treatment options. Curr Treat Options Oncol. 2020;21(2):17. (doi: 10.1007/s11864-020-0707-5) . Erratum in: Curr Treat Options Oncol. 2022;23(3):450 451. (doi: ) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 31. Bower JE. . Cancer-related fatigue--mechanisms, risk factors, and treatments. Nat Rev Clin Oncol. 2014;11(10):597 609. (doi: 10.1038/nrclinonc.2014.127) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 32. Al Maqbali M. . Cancer-related fatigue: an overview. Br J Nurs. 2021;30(4):S36 S43. (doi: 10.12968/bjon.2021.30.4.S36) [DOI] [PubMed] [Google Scholar]
- 33. Yu J Huang T Xu J Xiao J Chen Q Zhang L. . Effect of nursing method of psychological intervention combined with health education on lung cancer patients undergoing chemotherapy. J Healthc Eng. 2022;2022:2438612. (doi: 10.1155/2022/2438612) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 34. Mannion E Gilmartin JJ Donnellan P Keane M Waldron D. . Effect of chemotherapy on quality of life in patients with non-small cell lung cancer. Support Care Cancer. 2014;22(5):1417 1428. (doi: 10.1007/s00520-014-2148-9) [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the findings of this study are available upon request from the corresponding author.