Principal Findings
esophageal cancer, redness, tumor, fever, swelling, shock, cancer, pain, infection, deterioration of wound infections
TUMOR, OESOPHAGEAL CANCER, SHOCK, CANCER, WOUND INFECTION, COMPLICATION, INFECTION, LEAKAGE, HEAT, COMPLICATIONS
The research findings demonstrated that using the PEG and Line apps can improve self-care behaviors, reduce complications, and enhance quality of life at the social level. The experimental group demonstrated significantly better self-care abilities than the control group. In terms of behavior change and habit formation, the experimental group utilized the app platform to proactively capture and report abnormal wound information, such as redness, swelling, heat, and pain, through daily wound photos, wound infection checks, and vital sign data feedback. Researchers received email notifications and were able to immediately observe changes in the patients' recent wound condition, particularly the quantity, color, and location of secretions, as well as slight fever symptoms indicated by body temperature, on the app platform. This early warning system enabled patients to increase the frequency of wound dressing changes and minimize further deterioration of wound infections. Both groups were knowledgeable about daily care and complication reporting, which is consistent with the findings by Ang et al [The experimental group experienced significantly fewer complications than the control group. Specifically, in the experimental group, there were 5 cases of complications (3 cases of infection and 2 cases of leakage) reported through daily wound checks and vital sign measurements. In comparison, the control group had 19 cases of complications (15 cases of leakage and 7 cases of infection, with 1 individual possibly experiencing 2 complications concurrently). The significant reduction in leakage complications in the experimental group can be attributed to the gastrostomy tube app platform, which primarily focused on medical care and allowed continuous uploading of daily data (wound symptoms, vital signs, complication reporting, and health care personnel's analysis of tube changes). In contrast, the control group relied on ad hoc communication to identify and report abnormalities, leading to intermittent photo uploads. The continuous uploading feature for the experimental group enabled a comparison of wound progression over time, facilitating timely detection of differences in care and adjustment of dressing change methods. Patients gained confidence in self-care through social support, changed their health behaviors, and developed a habit of daily reporting on their gastrostomy tube care. This early detection of leakage and prompt intervention helped reduce the risk of skin breakdown and physiological discomfort, such as pain. Furthermore, the lack of difference in wound infection rates between the 2 groups can be attributed to the small number of cases and the consistent use of antibiotics before and after surgery in both groups. Similarly, the lack of significant differences in emergency room visits and hospital readmissions in both groups can be attributed to the small number of cases, making it difficult to achieve statistically significant results. It is recommended that future research studies consider increasing the sample size to address this limitation.Regarding quality of life, there was no significant difference in total scores between the experimental and control groups. This is primarily because both groups had a comparable number of patients with esophageal cancer who underwent chemotherapy or radiotherapy, which has a significant physiological and psychological impact, as highlighted by Farrag et al [However, the experimental group had significantly higher scores in terms of quality of life at the social level than the control group. This could be attributed to the ”cost-benefit decision-making and self-efficacy in adopting healthy behaviors through the introduction of technologies such as health app usage, resulting in individual health and societal behavioral changes,” as indicated by Wong et al [When the tumor (cancer) was discovered, it was a sudden shock, with limited knowledge about health education and future treatment directions. Fortunately, the app helped record and take photos of the wound, etc. It helped me get through the toughest days. Recording on the app every day filled me with hope and confidence. With app management, we can discover overlooked steps and compare daily records.This implies that, with guidance from health care professionals and through recording and quality control, patients regain confidence and self-efficacy. This is consistent with the findings by Singh et al [This study confirms the behavior change theory of the PEG app, in which patients initially set the goal of wound healing and learn about gastric tube care knowledge through the app. On a daily basis, they self-report their gastric tube health, pay attention to complications, compare changes in their gastric tube, and make timely corrections for any oversights. The social resources of feedback, guidance, and clarification from health care providers facilitate changes in patients’ self-directed health behaviors.The lack of a significant difference in PEG knowledge between the experimental and control groups may be attributed to a couple of possible reasons. (1) Both groups had smartphones and could access PEG knowledge online and through patient support group chats, resulting in improved knowledge after intervention for both groups, and (2) both groups had instant messaging apps for immediate access to answers to questions, which could also be a contributing factor to the lack of a significant difference in knowledge. In terms of nursing application, the research findings demonstrate that the gastric tube action tracking system dynamically improved patients’ self-care knowledge, skills, and quality of life related to gastric tube management while reducing the incidence of complications and emergency department visits. Following the principle of a one-stop service, it is recommended to integrate the PEG app into the case management workflow of the hospital system, from inpatient to discharge, and expand it to cancer centers in parallel, achieving seamless integration of mHealth app information across hospital platforms, which brings substantial benefits to patients in terms of continuity of care, resulting in a win-win-win outcome. In terms of data collection, we suggest using big data approaches to collect wound evolution, vital signs, infection indicators, wound photos, and other features for early prediction of gastric tube wound infection through artificial intelligence algorithms.