{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T16:52:24Z","timestamp":1791132744581,"version":"4.1.0"},"reference-count":40,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T00:00:00Z","timestamp":1791072000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T00:00:00Z","timestamp":1791072000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Clinical Nursing"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims and Objectives<\/jats:title>\n                    <jats:p>To characterise symptom\u2010system heterogeneity and entropy\u2010informed complexity and identify network\u2010informed assessment priorities for clinical nursing in patients with colorectal cancer and a stoma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Patients with colorectal cancer and a stoma frequently experience co\u2010occurring physical, psychological and social adaptation symptoms. Severity scores may not show how broadly symptom activation is distributed across the symptom system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A multicentre cross\u2010sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This multicentre cross\u2010sectional 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\u2010rule analysis examined symptom roles; and in silico simulations with Borda\u2010count convergence identified candidate assessment priorities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Three symptom profiles were identified: low\u2010burden (35.5%), moderate\u2010burden psychological sensitisation (35.3%) and high\u2010burden multidomain activation (29.2%). Symptom entropy was strongly related to total burden, yet 38 patients (8.9%) had discordant severity\u2010complexity classifications, including 18 (4.2%) with lower burden but higher complexity. Decreased subjective well\u2010being and insomnia occupied influential network positions. Multi\u2010criteria convergence prioritised stoma hypervigilance, anxiety, insomnia, decreased subjective well\u2010being and low self\u2010esteem.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Symptom severity and symptom\u2010system complexity were closely related but not fully interchangeable. Entropy\u2010informed assessment may complement severity screening by identifying a modest subgroup with diffuse symptom activation. The prioritised symptoms are hypothesis\u2010generating assessment priorities and require prospective validation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Relevance to Clinical Practice<\/jats:title>\n                    <jats:p>Symptom\u2010severity 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\u2010level symptoms across domains, ask about functional impact and self\u2010management 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\u2010being and low self\u2010esteem were prioritised in the overall sample, not validated as targets specifically for this subgroup. These findings can inform prospective nurse\u2010led assessment studies but should not yet be used as screening thresholds or a clinical decision algorithm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Reporting Method<\/jats:title>\n                    <jats:p>This study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient or Public Contribution<\/jats:title>\n                    <jats:p>No patient or public contribution. Patients participated as research participants and provided self\u2010reported symptom data.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jocn.70580","type":"journal-article","created":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T16:12:27Z","timestamp":1791130347000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Symptom\u2010System Complexity and Network\u2010Informed Assessment Priorities in Patients With Colorectal Cancer and a Stoma: A Multicentre Cross\u2010Sectional Study"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-7876-4997","authenticated-orcid":false,"given":"Chao","family":"Guo","sequence":"first","affiliation":[{"name":"Department of Nursing Affiliated Hospital of Yanbian University (Yanbian Hospital)  Yanji China"},{"name":"School of Nursing Yanbian University  Yanji 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