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Symptom-System Complexity and Network-Informed Assessment Priorities in Patients With Colorectal Cancer and a Stoma:
Chao Guo1,2, Haichao Sun3, Fanghui Sun4
1Department of Nursing, Affiliated Hospital of Yanbian University (Yanbian Hospital), Yanji, China.
Aims And Objectives:
To characterise symptom-system heterogeneity and entropy-informed complexity and identify network-informed assessment priorities for clinical nursing in patients with colorectal cancer and a stoma.
Background:
Patients with colorectal cancer and a stoma frequently experience co-occurring physical, psychological and social adaptation symptoms. Severity scores may not show how broadly symptom activation is distributed across the symptom system.
Design:
A multicentre cross-sectional study.
Methods:
This multicentre cross-sectional study included 428 patients from three tertiary hospitals in China. After symptom screening, 29 indicators were analysed. Latent profile analysis and normalised symptom entropy characterised heterogeneity and dispersion; regularised Gaussian graphical modelling and association-rule analysis examined symptom roles; and in silico simulations with Borda-count convergence identified candidate assessment priorities.
Results:
Three symptom profiles were identified: low-burden (35.5%), moderate-burden psychological sensitisation (35.3%) and high-burden multidomain activation (29.2%). Symptom entropy was strongly related to total burden, yet 38 patients (8.9%) had discordant severity-complexity classifications, including 18 (4.2%) with lower burden but higher complexity. Decreased subjective well-being and insomnia occupied influential network positions. Multi-criteria convergence prioritised stoma hypervigilance, anxiety, insomnia, decreased subjective well-being and low self-esteem.
Conclusions:
Symptom severity and symptom-system complexity were closely related but not fully interchangeable. Entropy-informed assessment may complement severity screening by identifying a modest subgroup with diffuse symptom activation. The prioritised symptoms are hypothesis-generating assessment priorities and require prospective validation.
Relevance To Clinical Practice:
Symptom-severity scores alone may not fully identify patients with broadly distributed symptom activation after stoma formation. In this study, 18 patients (4.2%) had lower burden but higher complexity. For such patients, nurses could review item-level symptoms across domains, ask about functional impact and self-management concerns, and agree assessment priorities with the patient. Persistent concerns may warrant tailored education, specialist support and reassessment within existing care pathways. Stoma hypervigilance, anxiety, insomnia, decreased subjective well-being and low self-esteem were prioritised in the overall sample, not validated as targets specifically for this subgroup. These findings can inform prospective nurse-led assessment studies but should not yet be used as screening thresholds or a clinical decision algorithm.
Reporting Method:
This study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline.
Patient Or Public Contribution:
No patient or public contribution. Patients participated as research participants and provided self-reported symptom data.
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