Abstract
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.