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The 5Ts for Teach-Back method of health education can improve compliance with oral nutritional supplements in post-discharge patients after gastric cancer surgery.

Surgery for gastric cancer results in metabolic changes and absorption disorders, leading to worsening nutritional status after discharge. Oral nutritional supplements (ONS) are recommended for malnutrition after tumor surgery; however, studies show poor compliance, and it is thought that compliance could be improved with effective health education. 

In the teach-back method, healthcare personnel educate patients and then let the patients describe the information back to the instructor to gauge their understanding. A study published in the journal Supportive Care in Cancer evaluated the effectiveness of the 5Ts for Teach-Back (5Ts) for improving ONS compliance in gastric cancer surgery patients after discharge.

Study Population

Of 108 participants, 54 were randomized to the intervention group and 54 to the control group. The intervention group was educated with the 5Ts (Triage, Tools, Take responsibility, Tell me, and Try again). The control group received traditional health education. All patients were educated for 5 weeks (T1) and followed up for 12 weeks (T2) after discharge. During T1, 27 patients were lost. Data from 81 patients were analyzed at T1, and data from 57 patients were analyzed at T2.

Comparison of Oral Nutritional Support Compliance

The compliance rate of the intervention group was significantly higher compared to the control group at T1 (55.69 vs. 32.86%). At T2, the compliance rate of the intervention group patients was higher than that of the control group, but the difference was insignificant (25.95 vs. 21.40%). ONS compliance of all patients showed a decreasing trend from discharge to T2.

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Compliance was categorized by dose and days per week after discharge as DT (full dose, full time), Dt (full dose, insufficient time), dT (insufficient dose, full time), and dt (insufficient dose, insufficient time). The number of dT consistently predominated in both groups at T2.

Oral Nutritional Supplement Knowledge Level Before and After Intervention

At baseline, the groups showed no significant difference in all dimensions and total scores. At T1, scores for nutrition and malnutrition, ONS administration and precautions, adverse reactions, and ONS treatment measures, as well as the total scores of the intervention group, were significantly higher than those of the control group.

Significant Improvement in Information Acquisition and Communication Abilities

There was no significant difference between the groups in terms of information acquisition and communication abilities at baseline. At T1, the ability to acquire information, ability to communicate, willingness to improve health, and total scores of the intervention group were significantly higher than the control group.

Improved Health Education Satisfaction and Communication in the Intervention Group

Health education satisfaction, nurses’ interpersonal communication ability, nurse–patient communication level, service timeliness and accessibility, and total scores were significantly higher in the intervention group vs. the control group at T1. There was no significant difference between the groups in health education compliance.


Wang, J., Hu, H., Sun, J., Zhang, Q., Chen, Z., Wang, Q., Zhu, M., Yao, J., Yuan, H., & Zhang, X. (2023). The effectiveness of health education based on the 5Ts for teach-back on oral nutritional supplements compliance of post-discharge patients after surgery for gastric cancer: a randomized controlled trial. Supportive Care in Cancer, 31(3), 157. https://doi.org/10.1007/s00520-023-07581-1