Psychological Experiences and Food Avoidance Behavior in Patients Following Esophageal Cancer Surgery: A Qualitative Study.

BACKGROUND

Nutritional rehabilitation is essential for recovery after esophagectomy. However, food avoidance behavior is common and may compromise nutritional intake, quality of life, and postoperative recovery. This study aimed to explore the factors influencing food avoidance behavior and the psychological and contextual processes underlying such behavior after esophagectomy, with the aim of informing targeted psychosocial and behavioral interventions and individualized dietary management.

METHODS

A descriptive qualitative design was used. Guided by the Roy Adaptation Model (RAM), a semi-structured interview guide was developed. Sixteen patients who had undergone esophagectomy were purposively recruited from a tertiary cancer hospital in central China. Directed content analysis was conducted, with NVivo 14.0 used to facilitate data organization and coding. The RAM guided the coding framework and category development.

RESULTS

Four main categories and ten subcategories were identified: physiological function factors (taste changes and swallowing discomfort; recurrent symptoms), self-concept factors (lack of nutritional knowledge; fear of disease recurrence; traumatic experiences of illness), role function factors (the patient role limiting social functioning; social role priorities overriding dietary management), and interdependence factors (passive dietary restriction in dependent relationships; lack of post-discharge follow-up; economic burden).

CONCLUSIONS

Food avoidance behavior after esophagectomy reflects the interaction of physiological symptoms, illness-related beliefs and experiences, role-related challenges, caregiver influences, and limitations in post-discharge support. RAM-informed care should integrate individualized nutritional support, psychological counseling, behavioral guidance, caregiver education, and continuous follow-up to reduce unnecessary food avoidance and promote nutritional and psychological adaptation.