2.5.1. Intervention Details
Nutrition KnowledgeIn, gastrointestinal symptoms, postoperative cancer
Participants allocated to the intervention group were provided a 12-week individualized mHealth nutrition intervention (iNutrition intervention) aiming for optimal nutritional intake, using ordinary food and oral nutrition supplements (ONS), tailored to individual needs, preferences, and diet restriction. The intervention was led by a nutrition support team (NST) including administrative staff, nutritionists, surgeons, and nurses. An overview of the iNutrition intervention is provided in The iNutrition appletThe iNutrition applet consists of the following four modules (Gastrointestinal symptoms managementWe provide knowledge regarding the typical post-surgery gastrointestinal symptoms and symptom management guidelines after gastrectomy. Patients or caregivers could upload patients’ recent symptoms. The NST could give feedback according to patients’ recent symptoms in the biweekly nutrition consultation.Nutrition managementThere are four aspects: (1) nutritional status score, (2) nutritional requirement, (3) food diary with nutrition calculator, and (4) weekly meal plans along with recipes. Firstly, through the nutritional status score, participants can visually recognize their current nutritional status and changes in nutritional status through the Patient-Generated Subjective Global Assessment (PG-SGA). Secondly, the program could automatically calculate the nutritional requirements of participants after entering their weight and height. Additionally, if they modified weight in the program, the program would automatically update the nutritional requirement in real-time. Thirdly, patients or caregivers could keep a food diary through the program, and the nutrition calculator would calculate the energy and protein they took according to the Chinese Food Composition Tables in real-time [Nutrition KnowledgeIn the Nutrition Knowledge module, videos, texts, and images were used to display the latest nutritional knowledge regarding existing the guidelines, literature, and resources.Communication centerIn the communication center, participants were invited to share their experiences through texts, videos, and pictures as well as communicate with one another. Participants could also communicate with the NST and seek medical advice. The NST members read all messages every day and replied within 24 h.Telephone-delivered Nutrition ConsultationThe nutrition consultation was provided by a registered dietician (CJM) biweekly for 12 weeks. During each session of nutrition consultation, nutritional status and symptoms were recorded, and nutritional intake was assessed using tailored dietary interview strategies (incorporating 24 h recalls and qualitative information such as eating strategies and meal pattern). Then, the content of each patient’s iNutrition program was updated according to the participants’ nutritional status, nutritional intake, nutritional requirements, dietary challenges (such as gastrointestinal symptoms), recovery of intestinal function following gastrectomy, and dietary preferences through the telephone-delivered nutrition consultations. The target for participants was to optimize nutritional intake, ensuring adequate energy and protein intake, in accordance with the ESPEN guideline for postoperative cancer patients [