Post-Surgical Education Using 5Ts to Improve Oral Nutrition Compliance After Gastrectomy

By Dustin Samples - Last Updated: February 15, 2023

Gastrectomy and digestive tract reconstruction are the current gold standard treatments for gastric cancer. However, patients undergoing these procedures will experience worsened nutritional intake due to metabolic and absorption changes from surgery. Because of these changes, patients must follow an oral nutritional supplement (ONS) regimen to maintain adequate nutritional status.

ONS compliance has historically been low, perhaps because of inadequate education, with 1 study placing average compliance at 12 weeks post-gastric tumor removal at only 30.59%.

A team from Jilin University, People’s Republic of China, initiated a randomized controlled trial in which an intervention group was educated about ONS with a program called the 5Ts (5 themes) to address this low compliance. The program’s 5 themes related to ONS include:

  1. nutrition and malnutrition;
  2. the definition and function of ONS;
  3. forms and types of ONS;
  4. ONS administration and precautions; and
  5. adverse reactions and treatment measures of ONS.

The control group was given routine health education.

At the beginning of the study, each group had 54 participants. Participant-kept weekly ONS journals measured compliance. Key outcome measures were collected at baseline and 5 weeks after discharge. The measures included ONS knowledge, health literacy, and health education satisfaction.

At the end of the intervention, there were 41 patients in the intervention group and 40 in the control group. The authors reported that the “5Ts significantly improve ONS compliance, ONS knowledge level (P = 0.000), health literacy level (P = 0.011), and health education satisfaction (P = 0.009) of patients,” but they also noted that “At the end of follow-up, there were 30 and 27 patients in two groups, and no significant difference in ONS compliance (P = 0.728).”

Given these results, the authors concluded that ONS education based on the 5Ts could improve compliance, stating, “Our study showed that such health education can improve patients’ short-term and long-term ONS compliance, and their ONS knowledge level, HL level and health education satisfaction. Future health education should pay more attention to the functions and types of ONS, so as to further strengthen the motivation of patients to take ONS.”


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.