Multidisciplinary collaborative enhanced recovery after surgery nursing in patients with colorectal cancer: A comparative study

Abstract

BACKGROUND

Prolonged recovery following colorectal cancer (CRC) surgery can result in physiological discomfort and psychological stress, underscoring the importance of effective perioperative care to enhance patient outcomes.

AIM

To evaluate the impact of multidisciplinary collaborative enhanced recovery after surgery (ERAS) nursing on patients undergoing CRC surgery.

METHODS

This study included 100 patients who underwent CRC surgery between August 2022 and August 2024. Patients were divided into two groups based on the perioperative nursing approach. The control group (n = 50) received conventional nursing care, whereas the observation group (n = 50) received multidisciplinary collaborative ERAS nursing. Postoperative recovery time, disease perception, pain levels, coping strategies, self-management efficacy, and quality of life were compared between the two groups.

RESULTS

Compared with the control group, the observation group exhibited significantly shorter times to ambulation, gastrointestinal motility, first meal intake, and hospital stay (P < 0.05). No significant differences were observed in pre-nursing indicators between the two groups (P > 0.05). After nursing, both groups showed improvements in disease perception scores, self-management efficacy, and quality of life scores, along with reductions in pain levels and coping strategy scores, except for the confrontative and venting dimensions. The observation group demonstrated significantly greater improvements in these scores, with significant intergroup and intragroup differences (P < 0.05).

CONCLUSION

Multidisciplinary collaborative ERAS nursing can facilitate postoperative recovery in patients with CRC, enhance disease cognition, alleviate pain, and encourage active coping, thereby improving self-management efficacy and quality of life.

Key Words: Multidisciplinary collaboration; Enhanced recovery after surgery nursing; Colorectal cancer surgery; Disease perception; Coping strategies; Quality of life

Core Tip: This study highlights the benefits of multidisciplinary collaborative enhanced recovery after surgery (ERAS) nursing in patients undergoing colorectal cancer surgery. Compared with conventional care, ERAS nursing significantly reduced postoperative recovery times, improved disease perception, alleviated pain, and enhanced patients’ coping strategies, self-management efficacy, and quality of life. These findings support the integration of multidisciplinary ERAS protocols into perioperative nursing to promote better clinical outcomes and patient-centered recovery in colorectal cancer care.

INTRODUCTION

Colorectal cancer (CRC) is the third most common malignant tumor of the digestive system, following gastric and esophageal cancers, with a notable upward trend in incidence and a tendency toward older age of onset[1]. According to recent data, CRC accounted for 517100 new cases in China in 2022, ranking second overall after lung cancer, and second and fourth among males and females, respectively[2]. Although its precise clinical etiology remains unclear, major contributing factors include poor dietary habits, family genetic factors, rectal polyps, and previous inflammatory lesions, all of which are further influenced by age, mental state, immune function, and environmental adaptability[3]. Early-stage CRC is typically asymptomatic. As the tumor grows, it may lead to increased bowel movements, altered defecation patterns, and symptoms of hematochezia. In advanced stages, CRC may invade surrounding tissues and organs or develop distant metastasis, resulting in corresponding symptoms and posing serious risks to patient safety[4]. Surgical intervention remains the preferred curative approach; however, it inevitably causes tissue trauma during lesion removal, potentially affecting both physiological and psychological states and extending the postoperative recovery period[5]. Enhanced recovery after surgery (ERAS) nursing, first introduced by Danish scholar Kehlet in the 1990s, involves the application of perioperative nursing strategies supported by evidence-based practice to reduce trauma and promote patient recovery[6]. This concept emphasizes a patient-centered approach, focusing on preoperative assessment, intraoperative management, and postoperative rehabilitation through multidisciplinary collaboration. By integrating and utilizing resources across various disciplines, ERAS aims to address patients’ needs at multiple levels, thereby enhancing the feasibility and quality of nursing services[7]. In recent years, ERAS nursing has been widely implemented across various surgical fields, including CRC surgery, demonstrating significant advantages in reducing postoperative complications and accelerating patient recovery. However, most existing studies have focused on its application within a single discipline or have explored only limited nursing measures. However, the comprehensive application of multidisciplinary collaborative ERAS nursing remains insufficiently explored.

This study enrolled patients undergoing CRC surgery to evaluate the role of multidisciplinary collaborative ERAS nursing. The unique features of this study were the establishment of a multidisciplinary collaborative team and optimization of ERAS nursing measures. Under the supervision of the department head, the chief nurse of the surgical unit served as the team leader, responsible for coordinating and directing nursing operations. The team comprised specialized nursing staff, anesthesiologists, pain management nurses, dietitians, psychologists, and rehabilitation nurses. All team members received standardized training by colorectal nursing experts. The training curriculum covered disease causes, manifestations, surgical cooperation, nursing practices, and the connotation and specific implementation of the ERAS concept. This comprehensive team structure ensures that patients receive holistic care from multiple professional perspectives, representing a significant innovation compared with traditional nursing models. Additionally, the ERAS nursing measures in this study were optimized and innovated in several aspects, such as reduction of preoperative fasting duration, use of fast-acting anesthetics, implementation of warming interventions, and encouragement of early postoperative eating and ambulation. These measures were designed to reduce surgical stress and accelerate patient recovery, offering a more comprehensive and systematic application of multidisciplinary collaborative ERAS nursing in patients undergoing CRC surgery.

MATERIALS AND METHODS

Study design and patients

This study included 100 patients with CRC who underwent surgical treatment between August 2022 and August 2024. Patients were divided into the control and observation groups based on perioperative nursing methods. The control group comprised 50 patients (27 males and 23 females), aged 35 to 80 years, with a mean age of 57.21 ± 6.78 years. The duration of disease ranged from 6 to 15 months, with a mean of 10.72 ± 1.44 months. The body mass index ranged from 18 to 25 kg/m², with a mean of 21.16 ± 0.68 kg/m². Education duration ranged from 8 to 20 years, with a mean of 13.78 ± 1.92 years. Tumor staging included 22 cases of stage I and 28 cases of stage II CRC.

The observation group also consisted of 50 cases, including 24 males and 26 females, aged from 32 to 82 years, with a mean age of 57.16 ± 6.84 years. The duration of disease ranged from 8 to 14 months, with a mean of 10.68 ± 1.42 months. The body mass index ranged from 19 to 24 kg/m², with a mean of 21.18 ± 0.72 kg/m². Education duration ranged from 10 to 18 years, with a mean of 13.72 ± 1.96 years. Tumor staging included 26 cases of stage I and 24 cases of stage II CRC. No significant differences were found in the baseline characteristics between the two groups (P > 0.05), indicating comparability.

The inclusion criteria were as follows: (1) Patients diagnosed with stage I-II CRC; (2) Scheduled for elective surgery; (3) Normal auditory and visual functions with the ability to communicate effectively; and (4) Complete information available to support the study. The exclusion criteria were as follows: (1) Abnormal liver or kidney function; (2) Presence of malignant tumors at other sites; (3) Undergoing emergency surgery; (4) Recent receipt of other treatments; and (5) Women who were pregnant, breastfeeding, or planning to conceive.

Conventional nursing care protocol

The control group received conventional nursing care, including the following measures: (1) Preoperative care: Patients received enhanced preoperative education, including an introduction to the disease and surgical procedures. Emotional changes were monitored, and proactive guidance was provided to manage negative emotions. Patients underwent an enema the night before surgery, and gastric and urinary catheters were placed. Fasting was required for 12 hours before surgery, with water intake restricted for 8 hours prior; (2) Intraoperative care: Upon entering the operating room, the temperature and humidity were adjusted to 24-26 °C and 40%-60%, respectively. Blood pressure, heart rate, and oxygen saturation were monitored in real time. Intraoperative warming was prioritized, and all catheters were properly positioned and secured; and (3) Postoperative care: After surgery, vital signs were closely monitored, and attention was paid to drainage status. Patients received guidance on diet, medication, and exercise, along with detailed post-discharge nursing instructions.

Multidisciplinary collaborative ERAS nursing protocol

The observation group received multidisciplinary collaborative ERAS nursing, with specific measures including the following: (1) Formation of a multidisciplinary collaborative team: Under the leadership of the department head, the chief nurse of the surgical unit served as the team leader, responsible for coordinating and directing nursing operations. The team consisted of specialized nursing staff to implement specific nursing measures: One anesthesiologist, who selected the anesthesia method and drugs based on the patient’s surgical type and individual condition; one pain management nurse responsible for pain assessment and analgesic measures; one dietitian, who assessed nutritional status and proposed individualized nutritional interventions; one psychologist, who evaluated psychological status, analyzed causes, and proposed countermeasures; and one rehabilitation nurse, who assessed physical function and developed training programs. All team members received standardized training from colorectal nursing experts, covering topics such as disease causes, manifestations, surgical cooperation, nursing techniques, and the connotation and specific applications of the ERAS concept; (2) Preoperative care: Upon admission, specialized nursing staff conducted a comprehensive assessment of each patient’s physical condition to understand surgical risks and feasibility. Health education was delivered through various formats, including verbal introduction, brochures, PowerPoint presentations, and video playback, to enhance patient understanding of CRC and surgical procedure, emphasizing the advantages of minimally invasive surgery, and highlighting the purpose, significance, and importance of the ERAS concept. The specific operational process and cooperation methods of the ERAS concept were explained in detail, tailored to the patient’s condition, to clarify its role in promoting postoperative recovery. The psychologist maintained communication with patients, assessed their psychological state, and analyzed the causes of negative emotions. Guidance was provided through suggestion, comfort, motivation, or emotional diversion. Patients were encouraged to express their feelings, and the psychologist listened patiently, addressed misconceptions in a timely manner, and assisted in developing correct cognition. Cases of patients with good prognosis were shared to enhance motivation, strengthen patient conviction, and improve cooperation. On the night before surgery, patients were instructed to orally ingest 700 mL of polyethylene glycol electrolyte solution (diluted with glucose solution), followed by a fasting period of 6 hours and restriction of water intake beginning 2 hours before surgery; (3) Intraoperative care: All patients underwent minimally invasive surgery. Anesthesiologists selected fast-acting, short-acting anesthetics for general anesthesia via endotracheal intubation, and butorphanol tartrate was administered intravenously for preemptive analgesia. The operating room temperature was maintained at 24-26 °C, with humidity controlled at 40%-60%. Warming interventions, including the use of warming blankets and warm air blower, were applied to non-surgical areas to maintain a core temperature of at least 37 °C. Infusion or irrigation fluids were preheated to above 37 °C using a heating incubator before use. The infusion speed and volume were carefully regulated, with the infusion rate adjusted to 5-9 mL/kg·hour to meet the patient’s physiological needs; and (4) Postoperative care: After regaining consciousness, patient without nausea, vomiting, or other gastrointestinal reactions were permitted to sip small amounts of water (3-5 mL each time). At 12 hours post-surgery, a moderate concentration of 5% glucose solution was administered. After 24 hours, patients gradually transitioned from a liquid to semi-liquid diet, adhering to the principle of “small and frequent meals”, with each meal limited to 100 mL. If choking or other discomfort occurred, feeding was suspended and resumed only after symptom resolution. At 48 hours postoperatively, patients were allowed low-salt, high-protein liquid food, with the volume per meal increased to 300 mL, administered every 4 hours, for a total of 4-6 meals per day. For pain management, 50 mg of flurbiprofen ester was administered via intravenous infusion using a patient-controlled analgesia pump. The analgesic solution included sufentanil and ramosetron, diluted to 100 mL with physiological saline. The patient-controlled analgesia settings comprised an initial loading dose of 5 mL, a background infusion rate of 2 mL/hour, a single additional dose of 0.5 mL, and a lockout interval of 15 minutes. Pain management nursing staff assessed patients’ pain levels using a specialized scale and adjusted the dosage and infusion rate of analgesic drugs accordingly. After awakening, patients were encouraged to perform deep breathing and joint exercises while in bed. On the following day, with the guidance of rehabilitation nursing staff, patients were assisted in getting out of bed at the earliest opportunity, following the “gradual progression” principle for sitting and ambulation training.

Sample size and randomization

The difference in sample size between the control (n = 50) and observation (n = 50) groups resulted from the availability of eligible patients during the study period. Randomization was performed using a computer-generated random number table to ensure unbiased group allocation. To maintain a balance between the groups, the randomization process was stratified according to the tumor stage. The sample size was calculated based on previous studies to ensure adequate statistical power while accounting the feasibility of patient recruitment.

Observation index

(1) Illness perception: Illness perception was assessed using the Brief Illness Perception Questionnaire[8], comprising eight items scored on a 10-point scale. The dimensions include emotional representation (20 points), cognitive representation (50 points), and comprehension (10 points), with a total scale score of 80. Higher total scores indicate stronger illness perception; (2) Pain level: Pain level was evaluated using the Global Pain Scale[9], consisting of 20 items, each ranging from 0 to 10 points, divided into four dimensions: Pain, emotional response, clinical manifestation, and daily behavior, each contributing up to 50 points, with a total scale score of 200 points. A lower total score reflects greater pain relief; (3) Coping strategies: Coping strategies were measured using the Cancer Coping Modes Questionnaire[10], which includes 26 items, each scored from 1 to 4 points. The dimensions and score ranges are as follows: Confrontation (7-28 points), avoidance and suppression (6-24 points), submission (5-20 points), fantasy (4-16 points), and venting (4-16 points). Higher scores in a specific dimension indicate a greater tendency to adopt that particular coping strategy; (4) Self-management efficacy: Self-management efficacy was assessed using the strategies used by people to promote health[11], which includes 28 items, each scored from 1 to 5 points. The dimensions and score ranges are as follows: Self-stress reduction (10-50 points), positive attitude (15-75 points), and self-decision-making (3-15 points). The total scale score ranges from 28 to 140 points, with higher scores indicating stronger self-management efficacy; (5) Postoperative recovery time: Postoperative recovery indicators included time to ambulation after surgery, gastrointestinal motility duration, time to first food intake, and length of hospital stay; and (6) Quality of life: Quality of life was evaluated using the European Organization for Research and Treatment of Cancer CRC-specific quality of life questionnaire module[12], which consists of 38 items rated on a 4-point Likert scale. It includes functional dimensions (7-28 points) and symptom dimensions (31-124 points), with total scores ranging from 38 to 152 points. Higher final scores indicate a better quality of life.

Statistical analysis

Data were analyzed using SPSS 22.0 (IBM Corp., Armonk, NY, United States), and are expressed as percentages (%). The χ² test was applied for categorical data, whereas mean ± SD and t-tests were used for metric data to assess normal distribution characteristics. Statistical significance was set at P < 0.05.

RESULTS

Illness perception

No significant difference was observed in illness perception scores between the two groups before nursing care (P > 0.05). Following the intervention, scores in both groups increased, with the observation group exhibiting significantly higher scores compared with the control group, indicating both within-group and between-group differences (P < 0.05; Table 1).

Table 1 Illness perception.

Group	Cases	Emotion description		Cognitive characterization		Comprehensive understanding		Total score
		Before	After	Before	After	Before	After	Before	After
Control group	50	11.18 ± 1.44	13.24 ± 1.32	35.16 ± 4.92	40.18 ± 4.56	5.12 ± 0.78	7.16 ± 0.64	51.46 ± 7.14	60.58 ± 6.52
Observation group	50	11.21 ± 1.48	15.27 ± 1.52	35.24 ± 5.16	43.80 ± 4.12	5.15 ± 0.72	8.12 ± 0.56	51.60 ± 7.36	67.19 ± 6.20
t		0.103	7130	0.079	4.165	0.200	7.140	0.097	5.195
P value		0.918	< 0.001	0.937	< 0.001	0.842	< 0.001	0.923	< 0.001

Pain level

No significant differences were observed in pain scores between the two groups before nursing care (P > 0.05). Following the intervention, scores in both groups decreased, with the observation group exhibiting significantly lower scores than the control group, indicating both between-group and within-group differences (P < 0.05; Table 2).

Table 2 Pain level.

Group	Cases	Pain		Emotional perception		Clinical manifestations		Daily behavior		Total score
		Before	After	Before	After	Before	After	Before	After	Before	After
Control group	50	22.72 ± 4.18	15.16 ± 3.21	20.18 ± 3.27	14.24 ± 2.96	25.16 ± 3.12	17.18 ± 2.27	22.18 ± 3.16	16.54 ± 2.48	90.24 ± 13.73	63.12 ± 10.92
Observation group	50	22.96 ± 4.24	10.12 ± 2.15	20.12 ± 3.21	9.96 ± 2.54	25.42 ± 3.24	12.35 ± 1.78	90.74 ± 13.96	43.55 ± 8.39	90.74 ± 13.96	43.55 ± 8.39
t		0.285	9.224	0.093	7.759	0.409	11.840	0.093	12.220	0.181	10.049
P value		0.776	< 0.001	0.926	< 0.001	0.684	< 0.001	0.926	< 0.001	0.857	< 0.001

Coping strategies

Before nursing care, no significant differences were observed in scores between the two groups across all coping dimensions (P > 0.05). Following the intervention, scores for confrontation and venting increased, whereas scores for avoidance and suppression, submission, and fantasy decreased. The observation group exhibited more pronounced improvements (P < 0.05; Table 3).

Table 3 Coping strategies.

Group	Cases	Confrontation		Avoidance and suppression		Submission		Fantasy		Venting
		Before	After	Before	After	Before	After	Before	After	Before	After
Control group	50	12.16 ± 2.44	16.21 ± 1.78	14.72 ± 1.54	10.16 ± 1.21	12.27 ± 1.16	9.18 ± 1.32	11.12 ± 1.18	8.21 ± 0.72	11.18 ± 1.12	8.36 ± 0.78
Observation group	50	12.24 ± 2.48	20.24 ± 1.56	14.64 ± 1.52	7.18 ± 1.12	12.32 ± 1.24	6.96 ± 1.15	11.16 ± 1.15	6.12 ± 0.54	11.16 ± 1.18	6.24 ± 0.52
t		0.163	12.040	0.261	12.780	0.208	9.967	0.172	16.421	0.087	15.991
P value		0.871	< 0.001	0.794	< 0.001	0.835	< 0.001	0.864	< 0.001	0.931	< 0.001

Self-management efficacy

Prior to nursing care, no significant differences in self-management efficacy scores were observed between the two groups (P > 0.05). Following the intervention, scores increased in both groups, with the observation group demonstrating significantly higher improvements than the control group, indicating both within-group and between-group differences (P < 0.05; Table 4).

Table 4 Self-management efficacy.

Group	Cases	Self-stress reduction		Positive attitude		Self-decision making		Total score
		Before	After	Before	After	Before	After	Before	After
Control group	50	27.16 ± 3.72	35.24 ± 4.16	36.80 ± 6.54	51.82 ± 7.12	6.16 ± 1.24	9.32 ± 1.56	70.12 ± 11.50	96.38 ± 12.84
Observation group	50	27.24 ± 3.92	40.18 ± 3.56	37.12 ± 6.21	60.48 ± 6.36	6.32 ± 1.27	11.18 ± 0.96	70.68 ± 11.40	118.84 ± 10.88
t		0.105	6.380	0.251	6.414	0.637	7.180	0.245	9.437
P value		0.917	< 0.001	0.802	< 0.001	0.525	< 0.001	0.807	< 0.001

Postoperative recovery time

The observation group exhibited significantly shorter durations for postoperative bed-to-chair activity, gastrointestinal motility, first meal intake, and hospital stay compared with the control group, indicating between-group differences (P < 0.05; Table 5).

Table 5 Postoperative recovery time.

Group	Cases	Postoperative bed-to-chair time, hours	Gastrointestinal motility time, hours	First meal time, days	Hospital stay, days
Control group	50	22.78 ± 3.16	28.27 ± 2.92	2.12 ± 0.56	6.72 ± 1.18
Observation group	50	17.64 ± 2.32	20.18 ± 2.45	1.21 ± 0.44	4.48 ± 1.06
t		9.271	15.008	9.035	9.986
P value		< 0.001	< 0.001	< 0.001	< 0.001

Quality of life

No significant differences were observed between the two groups before nursing care (P > 0.05). Following treatment, quality of life scores increased in both groups, with the observation group reporting significantly higher scores. Both between-group and within-group differences were statistically significant (P < 0.05; Table 6).

Table 6 Quality of life.

Group	Cases	Functional dimension		Symptom dimension		Total score
		Before	After	Before	After	Before	After
Control group	50	13.12 ± 2.44	17.78 ± 2.12	66.54 ± 10.18	80.56 ± 9.21	79.66 ± 12.62	98.34 ± 11.33
Observation group	50	13.18 ± 2.42	20.27 ± 2.56	67.12 ± 11.24	95.32 ± 7.78	80.30 ± 13.66	115.59 ± 10.34
t		0.123	5.297	0.270	8.657	0.243	7.952
P value		0.902	< 0.001	0.787	< 0.001	0.808	< 0.001

DISCUSSION

CRC is a highly prevalent malignant tumor that affects the colon and rectum and may cause pathological changes in adjacent organs, thereby increasing the risk of mortality[13]. The development of minimally invasive techniques has led to a gradual adoption of laparoscopic surgery in CRC treatment. However, patients are often of advanced age and have poor tolerance, which can trigger surgical stress responses that affect postoperative recovery[14]. Therefore, standardizing surgical procedures and strengthening perioperative nursing care are essential to ensure the quality of nursing services.

The ERAS nursing philosophy aligns with the biopsychosocial medical model, integrating multiple disciplines such as psychology, anesthesia, nutrition, and pain management. By formulating nursing plans through multidisciplinary collaboration and implementing these plans in practice, the approach addresses the diverse nursing needs of patients and enhances the feasibility of nursing work[15,16]. Compared with the singular and one-sided characteristics of traditional nursing methods, this nursing approach is evidence-based, respects patient individuality, and optimally utilizes medical resources to provide more comprehensive, systematic, and targeted perioperative nursing services to patients[17,18].

The comparative results of this study showed that the observation group had significantly higher illness perception scores (P < 0.05), indicating that multidisciplinary collaborative ERAS nursing effectively improves patients’ illness perception. Nursing staff emphasized patient health education, proactively introducing knowledge about the disease, surgery, and ERAS nursing. By integrating various methods of knowledge dissemination, patients developed a better understanding of their condition and the advantages and necessity of laparoscopic surgery, fully recognizing the role of ERAS nursing in postoperative recovery, thereby promoting active cooperation and enhancing the quality of nursing services.

Surgical treatment can cause tissue trauma, and persistent pain may affect multiple physiological systems, leading to prolonged postoperative recovery and reduced postoperative quality of life. The results of this study showed that the observation group had significantly lower pain scores (P < 0.05), indicating that multidisciplinary collaborative ERAS nursing effectively alleviates postoperative pain. ERAS nursing emphasizes multimodal analgesia by combining different pain-relief methods and types of analgesic drugs to improve analgesic effects and reduce pain sensation. Butorphanol tartrate and sufentanil are opioid analgesics that act on central-specific receptors to exert analgesic effects; however, they may also cause adverse reactions such as excessive sedation and respiratory depression[19]. In contrast, flurbiprofen ester is a non-steroidal analgesic that inhibits cyclooxygenase, thereby reducing the synthesis and release of prostaglandins and alleviating pain associated with surgical tissue trauma, with a high affinity for inflammatory tissues and significant targeted analgesic effects. In addition, the combined use of preemptive and postoperative analgesic strategies during the perioperative period can provide significant pain relief, thereby reducing the impact of pain on patients’ emotions and daily life.

Surgery is an invasive procedure that can cause psychological stress in patients, leading to negative coping methods such as submission and avoidance, insufficient self-awareness, difficulty in consciously and purposefully changing thought patterns and behaviors, and limited self-management efficacy. The comparative results demonstrated that the observation group had lower scores for coping methods (except for the confrontation and venting dimensions) and higher self-management efficacy scores (P < 0.05), indicating that multidisciplinary collaborative ERAS nursing can regulate patients’ coping methods and improve personal self-management efficacy. Nursing staff pay attention to patients’ psychological states before surgery, analyze the causes of negative emotions, and use psychological theory knowledge and skills for guidance, encouraging patients to vent appropriately and motivating them with the experiences of others, which can strengthen patients’ inner beliefs, promote active coping, help relieve stress, and improve personal initiative and self-decision-making ability, thereby improving self-management efficacy[20].

Compared with the control group, the observation group had significantly shorter postoperative recovery times and higher quality of life scores (P < 0.05), indicating that multidisciplinary collaborative ERAS nursing can accelerate postoperative recovery and improve quality of life. Nursing staff optimized perioperative nursing measures, shortened the duration of preoperative fasting and water restriction, and encouraged patients to eat and ambulate as soon as possible after surgery, thereby further reducing postoperative recovery times and promoting faster recovery[20,21]. Quality of life reflects an individual’s physiological, psychological, and social functioning and serves as a direct indicator of the level and quality of medical services[22].

The present study has several limitations that should be considered when interpreting the results. First, the sample size was relatively small and limited to a single-center design, which may have affected the generalizability of the findings[23]. Second, this study employed a retrospective design, which may have introduced an information bias and limited the ability to establish causal relationships. Third, the study included only patients with stage I-II CRC, restricting the applicability of the findings to more advanced disease stages[24]. Additionally, although a multidisciplinary team structure was implemented, the specific communication and coordination mechanisms among team members were not thoroughly examined, which may have influenced the effectiveness of the implementation of nursing measures[25]. Future research should address these limitations by incorporating larger sample sizes, multicenter collaborations, and prospective study designs to validate the findings and enhance their generalizability.

CONCLUSION

Collaboration between different disciplines to address various aspects, including patients’ cognition, psychology, anesthesia, pain management, diet, and exercise, can not only reduce psychological stress in patients but also alleviate physiological stress responses. This comprehensive approach facilitates patients quicker return to normal life and social interactions, ultimately improving their quality of life.