{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T05:20:33Z","timestamp":1787721633674,"version":"build-2784847793"},"reference-count":43,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"\n Background<\/jats:title>\n Lung cancer patients frequently experience a reduced quality of life and psychological distress during treatment. Traditional Chinese Medicine (TCM) nursing shows promise, but substantial heterogeneity in the evidence base limits clinical interpretation.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A comprehensive literature search identified 15 randomized controlled trials (RCTs) involving 1,135 participants. A meta-analysis was conducted using RevMan 5.4 and Stata 17. Following the Donabedian framework, data were categorized into structure, process, and outcome dimensions to explore sources of heterogeneity.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n In the primary analysis, TCM nursing significantly improved all outcomes. For the Karnofsky Performance Status (KPS) score, the primary random-effects analysis showed a significant improvement (MD\u202f=\u202f7.18, 95%CI 4.29\u201310.08). The sensitivity analysis excluding one outlier yielded a consistent effect (MD\u202f=\u202f8.71, 95%CI 6.49\u201310.92). For the Self-Rating Depression Scale (SDS) score, the primary analysis showed a significant reduction (MD\u202f=\u202f\u22125.94, 95%CI \u22126.96 to \u22124.92). The sensitivity analysis excluding one outlier confirmed the robustness of these results (MD\u202f=\u202f\u22125.74, 95%CI \u22126.39 to \u22125.09). For the remaining outcomes with low heterogeneity, primary fixed-effects analysis revealed that TCM nursing significantly reduced Self-Rating Anxiety Scale (SAS) scores (MD\u202f=\u202f\u22124.65, 95%CI \u22125.28 to \u22124.03) and Visual Analog Scale (VAS) pain scores (MD\u202f=\u202f\u22121.46, 95%CI \u22121.56 to \u22121.36). Additionally, TCM nursing lowered the incidence of gastrointestinal reactions (RR\u202f=\u202f0.19, 95%CI 0.06\u20130.58) and improved nursing compliance (RR\u202f=\u202f1.24, 95%CI 1.10\u20131.39) (all\n p<\/jats:italic>\n \u202f&lt;\u202f0.01). The subgroup analysis confirmed that comprehensive TCM care was more effective than emotion regulation alone for treating depression (\n p<\/jats:italic>\n \u202f=\u202f0.01). Intervention timing was suggested as a potential hypothesis-generating source of heterogeneity via sensitivity analysis. Structural factors (staff training, equipment, and qualifications) were critically underreported across all studies included in the analysis.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n TCM nursing significantly improves multidimensional outcomes for lung cancer patients. The Donabedian model effectively identifies sources of process-related heterogeneity and highlights critical structural reporting gaps that require attention in future research.<\/jats:p>\n <\/jats:sec>\n \n Systematic review registered<\/jats:title>\n \n PROSPERO, ID\n https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420261339100<\/jats:ext-link>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1833561","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T04:44:23Z","timestamp":1787719463000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy of traditional Chinese medicine nursing for lung cancer: a systematic review and meta-analysis using the Donabedian model to investigate heterogeneity"],"prefix":"10.3389","volume":"14","author":[{"given":"Ting","family":"Duan","sequence":"first","affiliation":[{"name":"Affiliated Hospital of Jinggangshan University","place":["Ji'an, China"]},{"name":"School of Nursing, Jinggangshan University","place":["Ji'an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuxin","family":"Liu","sequence":"additional","affiliation":[{"name":"Affiliated Hospital of Jinggangshan University","place":["Ji'an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"209","DOI":"10.3322\/caac.21660","article-title":"Global Cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J Clin"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1016\/s0140-6736(21)00312-3","article-title":"Lung cancer","volume":"398","author":"Thai","year":"2021","journal-title":"Lancet"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"115","DOI":"10.3322\/caac.21338","article-title":"Cancer statistics in China, 2015","volume":"66","author":"Chen","year":"2016","journal-title":"CA Cancer J Clin"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"409","DOI":"10.3322\/caac.21731","article-title":"Cancer treatment and survivorship statistics, 2022","volume":"72","author":"Miller","year":"2022","journal-title":"CA Cancer J Clin"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1016\/s0140-6736(16)30958-8","article-title":"Lung cancer: current therapies and new targeted treatments","volume":"389","author":"Hirsch","year":"2017","journal-title":"Lancet"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"561","DOI":"10.1111\/1759-7714.12270","article-title":"Traditional Chinese medicine and cancer: history, present situation, and development","volume":"6","author":"Liu","year":"2015","journal-title":"Thorac Cancer"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"109","DOI":"10.3322\/canjclin.55.2.109","article-title":"Integrative oncology: complementary therapies for pain, anxiety, and mood disturbance","volume":"55","author":"Deng","year":"2005","journal-title":"CA Cancer J Clin"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"16","DOI":"10.5582\/bst.2015.01019","article-title":"The advantages of using traditional Chinese medicine as an adjunctive therapy in the whole course of cancer treatment instead of only terminal stage of cancer","volume":"9","author":"Qi","year":"2015","journal-title":"Biosci Trends"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"e60338","DOI":"10.1371\/journal.pone.0060338","article-title":"Traditional Chinese medicine in cancer care: a review of controlled clinical studies published in chinese","volume":"8","author":"Li","year":"2013","journal-title":"PLoS One"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1111\/j.1365-2354.2006.00685.x","article-title":"Traditional Chinese medicine in cancer care: perspectives and experiences of patients and professionals in China","volume":"15","author":"Xu","year":"2006","journal-title":"Eur J Cancer Care (Engl)"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e28696","DOI":"10.1371\/journal.pone.0028696","article-title":"Cochrane systematic reviews of Chinese herbal medicines: an overview","volume":"6","author":"Hu","year":"2011","journal-title":"PLoS One"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1743","DOI":"10.1001\/jama.260.12.1743","article-title":"The quality of care. 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