OBJECTIVE:To examine longitudinal changes in health belief trajectories regarding colonoscopy screening across generations among first-degree relatives (FDRs) of colorectal cancer (CRC) patients and to inform tailored intervention strategies. METHODS:An explanatory sequential mixed-methods design was conducted. In the quantitative phase, 200 FDRs of CRC inpatients were recruited from a tertiary hospital in Wuhan (April-November 2025) using convenience sampling. Health beliefs were measured using the Chinese version of the Colorectal Cancer Screening Health Belief Scale at hospitalization, 3 months, and 6 months post-discharge. Of these, 184 participants completed all assessments. Generalized estimating equations were used to analyze temporal and intergenerational effects. In the qualitative phase, 17 participants were selected via maximum variation sampling and underwent semi-structured interviews. Thematic analysis was performed to explain and complement quantitative findings. RESULTS:Quantitative analysis revealed significant temporal changes in overall health beliefs (Wald χ² = 66.37, P < 0.001) and a significant group-by-time interaction (Wald χ² = 130.97, P < 0.001). Generation A (born 1950-1969, aged 56-75) exhibited a rise-then-fall pattern. Generation B (born 1970-1989, aged 36-55) remained relatively stable. Generation C (born 1990-2009, aged 16-35) showed a continuous decline. All groups demonstrated the lowest health belief scores at 6 months post-discharge. Qualitative analysis identified two major themes: dynamic evolution of screening health beliefs (three generational patterns) and intergenerational difference factors (role positioning, information access, emotional support, and health awareness). The perceived illness warning effect gradually weakened over time, with generation-specific influencing mechanisms. CONCLUSIONS:Intergenerational differences in health belief trajectories highlight the need for stage-specific and generation-tailored interventions to improve CRC screening adherence among FDRs. PRACTICE IMPLICATIONS:Healthcare providers should enhance risk perception and screening guidance during hospitalization. Post-discharge, personalized multi-channel reminders are recommended: emotional support for Generation A, practical assistance for Generation B, and new media-based risk communication for Generation C.

ObjectiveTo explore the screening decision-making dilemmas among intergenerational first⁃degree relatives of patients with colorectal cancer.MethodsA longitudinal qualitative research method was adopted.A total of 32 first⁃degree relatives of patients with colorectal cancer treated in the department of gastrointestinal surgery at a tertiary grade A hospital in Wuhan city were selected as the study subjects from September to December 2024.Three semi⁃structured interviews were conducted regarding their decision⁃making dilemmas about undergoing colonoscopy screening.The dilemmas at different time points were summarized and analyzed using the Colaizzi 7⁃step analysis method.ResultsBased on three time points,16 themes regarding the screening decision⁃making dilemmas among intergenerational first⁃degree relatives of patients with colorectal cancer were summarized from different generational perspectives.During the first week after surgery,three months after discharge,and six months after discharge,the screening decision⁃making dilemmas of first⁃degree relatives overall were,in turn,lack of knowledge,insufficient resources and conditions,and inadequate psychological preparation.For first⁃generation first⁃degree relatives,the screening decision⁃making dilemmas were,in turn,psychological concerns,insufficient improvement in screening awareness,and age bias.For second⁃generation first⁃degree relatives,the screening decision⁃making dilemmas were,in turn,role conflict,limited family support,and life conflicts.For third⁃generation first⁃degree relatives,the screening decision⁃making dilemmas were,in turn,focus on personal feelings,influence of life attitudes,and lack of encouragement.ConclusionsThe screening decision⁃making dilemmas among different generations' first⁃degree relatives of patients with colorectal cancer varied and changed over time.Healthcare providers could implement targeted interventions based on the characteristics of these dilemmas at different time points to help improve the rate of colonoscopy screening.

A family history of colorectal cancer among first-degree relatives is recognized as one of the most significant and prevalent risk factors for colorectal cancer in China. Colonoscopy remains the most crucial screening method, as early colonoscopy screening can effectively reduce the risk of advanced colorectal cancer. However, the factors influencing the decision-making behavior of first-degree relatives regarding colonoscopy screening have predominantly been examined through quantitative studies, while mixed-methods research remains scarce. This study aimed to evaluate the decision-making behaviors of first-degree relatives of patients with colorectal cancer and to identify the factors influencing these behaviors. An explanatory sequential design was adopted within a mixed-methods framework. For the quantitative phase, convenience sampling was used to select 272 first-degree relatives of colorectal cancer patients who were treated at a tertiary hospital’s gastrointestinal surgery department in Wuhan, China from March to December 2023, for a questionnaire survey. For the qualitative component, a maximum variation purposive sampling method, guided by the Protection Motivation Theory, was employed to select 16 participants from the initial survey group for semi-structured interviews. Our findings revealed that participants had a high health belief score. Key factors influencing their decision to undergo colonoscopy screening included marital status, average monthly household income, medical payment method, and perceived severity. The qualitative study identified six core themes: perceived susceptibility, perceived severity, internal and external rewards, response efficacy, response costs, and self-efficacy. Medical staff should focus on first-degree relatives of colorectal cancer who are unmarried or widowed, have lower family income, have lower reimbursement rate of medical insurance, and lack of disease severity perception. Through establishing social support system, issuing subsidies for colonoscopy screening, increasing reimbursement rate of medical insurance, emphasizing the severity of colorectal cancer, to enhance their health belief level and promote colonoscopy screening decision-making behavior. Not applicable.

The purpose of this study is to examine the validity, reliability and methodological quality of delirium scales that have been translated and adapted in China using quality assessment tools. A comprehensive search was conducted in PubMed, Embase, Web of Science, China Knowledge Network (CNKI), VIP database, Wanfang database, and China Biomedical Literature Database. The search covered the period from the establishment of the database until September 1, 2023. Two researchers independently screened the literature and extracted data. Studies were included if they focused on the translation of a delirium scale from English into simplified or traditional Chinese, with a study population aged ≥ 18 years and full text available. The risk of bias was assessed through the QUADAS-2 instrument. Level of evidence recommendation is completed with the GRADE and performed with GRADE GPT. Due to high heterogeneity across studies, a random-effects model was applied to calculate diagnostic accuracy indicators (sensitivity, specificity, and area under the curve index). This study has registered in the prospero. Thirteen studies were included, of which 2 were case–control studies and 11 were cross-sectional studies. These studies involved 13 adult delirium assessment tools, and were all translated following the Brislin or ISPOR principle. The results of the methodological quality assessment showed that 3D-CAM, 4AT, CAM-ICU, CAM-ICU-7, and S-PTD had higher quality ratings, with 4AT being the highest quality. 4AT, CAM, 3D-CAM, CAM-CR, CAM-ICU, CAM-ICU-7, and Nu-DESC were recommended at a level B. The Cronbach’s coefficient of most studies is over 0.8, and the inter-rater reliability of most studies is near or over 0.9, indicating good internal consistency and stability. Besides, a significant inverse correlation was found between these 13 Chinese-adapted delirium scales and their reference tests, with most studies were over 0.7, and especially 3 studies offered S-CVI and I-CVI value that were all larger than 0.9, indicating a good discriminate validity and content validity, though different cut-off points were recommended by different scales. Moreover, the sensitivity and specificity of these studies were mainly larger than 0.9, which proved the good diagnostic accuracy of these included scales. The pooled sensitivity of 7 Chinese delirium adaption scales that provided statistical data is 0.93 (95

Objective:The purpose of the study was to develop and validate the psychometric properties of the Colorectal Cancer and Colonoscopy Screening Health Beliefs Scale for First-Degree Relatives (CCHBS-FDR) instrument for the first-degree relatives (FDRs) of people with colorectal cancer (CRC) in China. Methods:This study was conducted in two phases: scale development and psychometric testing. In the scale development phase, a preliminary item pool was established based on a systematic review, qualitative interviews (n ​= ​42), and the Revised Colorectal Cancer Perception and Screening (RCRCPS) instrument. The scale was then refined through expert consultation and laymen review. Psychometric properties were tested by item analysis, validity assessment and reliability evaluation on a convenience sample of 258 Chinese FDRs of patients with CRC. Results:A preliminary 37-item scale with six dimensions, perceived severity, perceived susceptibility, perceived benefits, barriers-priority, barriers-concerns and barriers-knowledge, was developed in the first phase. The content validity index of the CCHBS-FDR was satisfactory (I-CVI ​= ​0.86-1, S-CVI/UA ​= ​0.89, S-CVI/Ave ​= ​0.98). Cronbach's α coefficient for overall scale was 0.863, and subscales ranged from 0.689 to 0.939. Confirmatory factor analysis results suggested that the CCHBS-FDR conformed to the six-factor model (χ 2/df ​= ​2.075, RMSEA ​= ​0.065, CFI ​= ​0.892, TLI ​= ​0.880, and SRMR ​= ​0.077). Conclusions:The CCHBS-FDR demonstrated acceptable reliability and validity as a culturally specific instrument for assessing health beliefs among FDRs with CRC. It can serve as a valuable tool for providing a more precise assessment of health beliefs and helping healthcare professionals develop and evaluate tailored communication interventions to promote colonoscopy screening among FDRs.

Background Research on achieving a good death for terminally delirious patients is scarce, with limited knowledge about the level of good death and influencing factors. This study investigates the level of good death among delirium patients, factors influencing it, and the correlation between distress, end-of-life care needs, and achieving a good death by surveying bereaved family members of deceased patients in Chinese hospitals. Methods This cross-sectional study from January 2022 to January 2024 was conducted among bereaved family members of patients using an online questionnaire. The questionnaires consisted of (1) participants' demographic and disease-related questionnaires; (2) the Good Death Inventory (GDI) - short form; (3) Terminal Delirium-Related Distress Scale (TTDS) China version; (4) the Care Evaluation Scale - short form (CES) China version. All data were analyzed using descriptive statistics, and the associated factors influencing good death were analyzed by multiple linear regression analyses. Result A total of 263 subjects were enrolled. More males (63.5%) participated than females (36.5%), the mean age was 75.35±13.90 years. Good quality of death was significantly and negatively related to the distress in patients with irreversible terminal delirium (r = -0.458, P＜0.01).The multiple linear regression model indicates that TDDS score, CES score, types of diseases, smoking history, nutritional deficiency are important factor affecting the good quality of death. Conclusions The good quality of death from the perspective of bereaved family, a negative correlation was found between the distress in patients with irreversible terminal delirium and good death. Medical staff should be more aware of good quality of death in patients, future research should expand sample sizes to include more demographic data, and explore the concept of a good death across different cultural contexts.

OBJECTIVE:This study evaluated the prevalence and perioperative risk factors for early high-output ileostomy (EHOI) and developed a precise nomogram model to predict the occurrence of EHOI. METHODS:140 patients who underwent ileostomy surgery at three hospitals in Wuhan, Hubei Province, between January 2022 and May 2022 were enrolled in this prospective cohort study. By using univariate and multifactorial logistic regression, independent risk variables for the development of EHOI were examined, and the nomogram model for predicting the risk of EHOI was created by using R software. The calibration curve and area under the receiver operating characteristic curve (ROC AUC) were used to evaluate the calibration and discrimination of the prediction model, Hosmer-Lemeshow to verify the fit of the model. Clinical impact curve (CIC) and decision curve analysis (DCA) were used to assess the model's clinical efficacy. RESULTS:A total of 132 patients participated in the study, and the incidence of EHOI was 25.8% (34/132). The nomogram model incorporated 3 risk factors hypertension, drinking habits, and high white blood cell (WBC) count after surgery. The AUC was 0.742, and the nomogram showed great calibration and clinical validity by comparing the calibration curve, DCA, and CIC. CONCLUSIONS:Hypertension, drinking, and high WBC was significantly correlated with EHOI. The nomogram model has great clinical value in predicting the EHOI.

Objective To investigate the pain catastrophising in patients with breast cancer during postoperative chemotherapy.Methods Objective sampling method was used to select patients with breast cancer who underwent breast surgery and received chemotherapy in a third-class hospital of Wuhan from October to December 2022 through semi-structured interview. The interview data were sorted out and analysed by content analysis method.Results A total of 11 patients were interviewed and five categories were summarised: (1) Physical memory of pain; (2) the special meaning of time; (3) disease treatment and prognosis; (4) interpersonal communication and coping; (5) personal behaviour and growth.Conclusion Patients with breast cancer have adverse pain experience during postoperative chemotherapy. The evaluation and screening of psychological variables such as pain catastrophising should be strengthened to provide new ideas for pain management.

Abstract Purposes The objective of this study was to assess the clinical significance and risk factors for postoperative diarrhea following primary colorectal cancer (CRC) surgery. Methods This prospective cohort study included patients with CRC who underwent radical non-stomy surgery between December 2021 and April 2022 at three tertiary care hospitals in Wuhan, Hubei Province. Assessment of risk factors and clinical impact of postoperative diarrhea after CRC surgeryby univariate and multifactorial logistic regression. Results The incidence of postoperative diarrhea was 20.3% (41/202). Multifactorial regression analysis showed that hypertension and diabetes mellitus were strongly associated with postoperative diarrhea (P=0.035 and P=0.037). Patients who after rectal resection were more likely to have postoperative diarrhea than patients after colectomy (P=0.030). Elevated postoperative C-reactive protein (CRP) was a strong predictor of postoperative diarrhea (P＜0.001). The probability of other complications was significantly higher in patients with diarrhea than in those without diarrhea (36.6% and 14.3%, P=0.001), with a significant impact on the development of late intestinal anastomotic fistula and abdominal infection in particular (P=0.001 and P=0.003). Conclusions Postoperative diarrhea in CRC is independently predicted by high postoperative CRP, hypertension, diabetes mellitus, and rectal resection. Early postoperative diarrhea can cause more serious problems to emerge.

Aim:Due to the changes of bowel physiological structure and functional disorders after rectal cancer surgery, patients will face many bowel dysfunction for a long time, which will greatly affect their quality of life. The purpose of this review is to integrate the qualitative research on the experience of bowel dysfunction and coping strategies in postoperative patients with rectal cancer.Methods:Systematic retrieval of PubMed, EMbase, Cochrane Library, CINAHL, Web of Sciences, PsycINFO, Willey and other databases was carried out by using the method of subject words and keywords. The Critical Appraisal Skill Programme (CASP) Qualitative Studies Checklist was used for Qualitative assessment. The findings were extracted from the included study and synthesized into the final themes, which was evaluated strictly in accordance with the ConQual process.Results:Nine studies involving 345 participants were included and two main themes were extracted: "Experience a series of changes caused by bowel dysfunction" and "nmet needs and coping strategies facing bowel dysfunction". The changes of rectal cancer patients who experience bowel dysfunction after operation mainly include three parts: bowel dysfunction is more than just a bowel reaction, which covers the bowel symptoms themselves and the subsequent body-related symptoms. The interruption of a normal life, mainly reflected in personal, family, and social life. Complex psychological reactions to bowel dysfunction, psychological changes have a dual nature, showing a positive and negative intertwined. There are two main aspects of unmet needs and coping strategies: the demand is mainly manifested in the need for information and support from medical professionals, while the coping strategy mainly includes diet, activity and drug management.Conclusion:Rectal cancer patient often experience persistent bowel dysfunction after operation, which has a certain physical and mental effects. A series of new needs of postoperative patients are often not fully met, and patients often rely on their own empirical attempts to seek balance, less can get professional support. Future studies need to focus on how to provide continuous information support for postoperative rectal cancer patients, especially professional care from health care staff.

Background:The living will provide patients at the end of life with the autonomy to choose medical care, so that the patients at the end of life can get dignified and die. In many countries such as Europe and the United States, this choice of people is guaranteed by the law. However, China is in its infancy in the field of living wills, lacking legal support, and the Chinese people have relatively low awareness of living wills and their acceptance is not optimism. China's aging population is developing rapidly, and death education is getting more and more attention, and the popularity of living wills will increase further in the future. Objective:The aim of this review is to find out the obstacles and facilitating factors in the decision-making of elderly patients in the Chinese context, and to propose countermeasures. Methods:By searching for relevant literature in databases such as Cnki, Wanfang date, Weipu, Pubmed, Springer, Elsevier, etc., we can understand the connotation of the living wills of elderly patients at home and abroad and the obstacles and promotion factors that affect the signing of the living wills of elderly patients in China. Results:In the Chinese context, obstacles and facilitating factors in the decision-making of elderly patients' living will can be summarized at the individual, social, and national levels. The obstacles are: low quality of hospice care, social ethics, and lack of legal support. Facilitating factors include: meeting people's psychological expectations, respecting personal autonomy, conducive to the mental health of dying patients and their caregivers, and patients' willingness to accept living will. Conclusion:Need to determine relevant specific influencing factors, formulate intervention measures, and promote the development of death education in China to ensure gradual progress.