Symptom‐System Complexity and Network‐Informed Assessment Priorities in Patients With Colorectal Cancer and a Stoma: A Multicentre Cross‐Sectional Study
Year: 2026
Type: article
Study design: Observational Study
Abstract: 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.
Source: Journal of Clinical Nursing
DOI: 10.1111/jocn.70580
Language: English
Topic: Stoma care and complications
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W7219698188