{"paper_id":"3ac28c0a-9581-4667-bc77-1ff3f3fad6e9","body_text":"Integrating Traditional Chinese and Western Medicine in Nutritional Care for Cancer Patients: A Qualitative Study of Healthcare Professionals' Perspectives | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Integrating Traditional Chinese and Western Medicine in Nutritional Care for Cancer Patients: A Qualitative Study of Healthcare Professionals' Perspectives Shihua Liu¹^, Guijiao Lin¹^, Xiangyu Peng²^, Xinlei Wu¹, Weina Wang¹, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6950861/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background The integration of Traditional Chinese Medicine (TCM) and Western nutritional therapy has gained increasing attention in oncology care. However, qualitative insights into healthcare professionals’ (HCPs’) experiences with implementing this integrative approach remain limited, particularly regarding interdisciplinary collaboration challenges and training needs in real-world settings. Objective To explore the lived experiences of multidisciplinary HCPs involved in delivering integrative nutritional care that combines TCM and Western medicine to cancer patients in China. Methods This study employed a descriptive phenomenological design. Sixteen HCPs—including physicians, nurses, and dietitians—were purposively recruited from tertiary hospitals in Fuzhou (2023) until thematic saturation was reached. Data were collected through in-depth semi-structured interviews and analyzed using Colaizzi’s seven-step method, supported by NVivo 12.0. Analytical rigor was ensured through triangulation and member checking. Results Four major themes emerged: ⑴ Professional fulfillment coexisting with stress – Participants experienced enhanced professional identity and self-efficacy through integrative care, while also reporting stress due to knowledge limitations, interdisciplinary demands, and expectations for individualized guidance. ⑵ Patient adherence as a determinant of effectiveness – The success of nutritional interventions was closely linked to patients’ adherence, which was shaped by health literacy, cultural beliefs, and family involvement. ⑶ Professional training and knowledge sharing – There was a shared call for structured, standardized, and cross-disciplinary training, along with the dissemination of successful clinical strategies. ⑷ Expectations for integrated and supportive systems – Participants emphasized the need for digital integration, supportive policy frameworks, and sustained institutional support to advance and normalize TCM–Western integrative practice. Conclusion While integrative nutritional management provides synergistic benefits in oncology care, its effective implementation requires structured interprofessional training, culturally adapted models, and technology-enhanced systems. These findings underscore the necessity of developing scalable frameworks aligned with global movements toward personalized, collaborative cancer care. Figures Figure 1 What is already known Malnutrition remains a prevalent challenge among cancer patients, and effective nutritional management is critical for improving clinical outcomes. Traditional Chinese Medicine (TCM) and Western nutritional therapy have demonstrated complementary roles in oncology care through distinct therapeutic approaches. Despite growing policy support and clinical adoption of integrative nutritional management in China and globally, its implementation continues to face interdisciplinary barriers and a lack of systematic training among healthcare professionals. What this paper adds This qualitative study offers new insights into the real-world experiences of multidisciplinary healthcare professionals in delivering integrative TCM-Western nutritional care. Four key themes were identified: (1) the dual dynamics of professional fulfillment and interdisciplinary stress; (2) patient adherence as a critical determinant of intervention effectiveness; (3) an urgent need for structured cross-disciplinary training programs; (4) expectations for digital tools and institutional support to sustain integrated practices. The findings highlight the need to develop standardized training curricula, strengthen interprofessional collaboration, and establish supportive policy frameworks to advance integrative nutritional practices in cancer care. INTRODUCTION Malignant tumors remain a major global health challenge. Malnutrition is prevalent among cancer patients throughout both treatment and recovery phases, and effective nutritional management is crucial for improving clinical outcomes [1–3] . Clinical guidelines and expert consensus statements issued by leading medical and nutritional societies in China and abroad emphasize the central role of nutrition in oncology and provide evidence-based recommendations for clinical implementation [4–7] . Despite its strengths in personalized, evidence-based interventions, Western nutritional therapy faces notable limitations in oncology care. While it employs comprehensive nutritional assessments and individualized dietary planning to improve patients' nutritional status [8] , its reductionist approach often overlooks the holistic properties of food and exhibits excessive reliance on nutritional supplements [9 – 10] . These gaps have spurred growing interest in integrating Traditional Chinese Medicine (TCM) dietary therapy to develop more comprehensive cancer nutrition strategies. TCM dietary therapy, with its millennia-old theoretical foundations, offers a complementary paradigm. Grounded in principles of syndrome differentiation and holistic regulation, it emphasizes: – Constitution-based dietary customization, – Dynamic adjustments aligned with disease progression, and – Seasonal adaptation of nutritional interventions [11] . This systematic approach has gained increasing recognition in chronic disease rehabilitation, where its therapeutic advantages—particularly in addressing the multidimensional nature of cancer-related malnutrition—are increasingly documented. As a result, integrative nutritional management—combining TCM with Western nutritional science—has been increasingly adopted in both Chinese and international general hospitals to address complex conditions such as cancer, aiming to improve clinical outcomes and enhance patients' quality of life [12] . However, several scholars have noted that the clinical application of TCM-based nutritional strategies is hindered by a lack of standardized operational protocols and insufficient high-quality empirical evidence, posing challenges to their integration into mainstream medical systems [13] . In China, the strategic role of TCM has been continuously reinforced by national policy, positioning the integration of TCM and Western medicine as a key component of the healthcare system [14] . At the international level, the World Health Organization (WHO) has also advocated for the evidence-based and standardized use of traditional medicine, offering a supportive framework for advancing integrated nutritional care worldwide [15] . Together, these policy initiatives underscore the significant potential of integrative models and highlight the timeliness of promoting TCM–Western nutritional synergy in modern oncology care. Despite growing momentum, the clinical implementation of integrated TCM–Western nutritional management continues to face significant challenges. It remains essential to examine the practical difficulties encountered by healthcare professionals, the coping strategies they employ, and the contexts in which integration either succeeds or falls short. Front-line providers—particularly nurses—play a pivotal role in delivering nutritional care, making their perspectives especially relevant. However, few studies have qualitatively explored the lived experiences of healthcare professionals involved in integrative nutritional care for cancer patients. Their insights into practical barriers, enabling factors, and emotional dynamics during implementation remain largely unexamined. Understanding these dimensions is critical for refining clinical pathways and fostering effective interdisciplinary collaboration in integrative oncology nutrition. The present study adopted a phenomenological qualitative approach, using semi-structured interviews to explore the real-world experiences of healthcare professionals engaged in integrated nutritional care for cancer patients. The goal was to identify key challenges, coping strategies, and expectations, with the aim of informing clinical practice, guiding policy development, and enhancing patient outcomes through more coordinated and context-sensitive nutritional interventions. METHODS Design This study adopted a descriptive phenomenological qualitative design to investigate healthcare professionals' lived experiences with the integration of TCM and Western nutritional practices in oncology settings. This methodological approach was selected for its strength in capturing how individuals interpret and respond to complex clinical phenomena and interprofessional processes in real-world contexts [16] . The research was conducted over a three-month period (September to December 2023) across five tertiary hospitals in Fuzhou, China: Fujian Provincial Cancer Hospital, Fujian Provincial Institutional Hospital, the Second and Third Affiliated Hospitals of Fujian University of Traditional Chinese Medicine, and Fujian Api-therapy Hospital. These institutions were selected based on their extensive experience in implementing integrated TCM–Western nutritional interventions for cancer care. The use of a multi-site design enhanced contextual diversity and improved the credibility and transferability of the findings. The overall research workflow is illustrated in Figure 1. Setting and Participants Purposive sampling was employed to recruit healthcare professionals with substantial experience in the nutritional management of cancer patients using both TCM and Western approaches. Participants were selected from the oncology departments of the five study hospitals and identified through institutional contacts, professional networks, and referrals from department heads. Recruitment continued until data saturation was achieved, defined as the point at which no new themes or insights emerged from additional interviews [17]. A total of 16 healthcare professionals participated in the study, including physicians, nurses, and clinical Dietitians. Eligibility criteria required participants to have a minimum of three years of clinical experience in oncology and active involvement in integrated TCM–Western nutritional care. Individuals who lacked the required experience or were not engaged in both TCM and Western nutritional practices were excluded. This sampling strategy ensured the inclusion of a multidisciplinary and diverse set of professional perspectives relevant to real-world integrative oncology nutrition. Table 1 presents detailed demographic and professional information of the participants. Data Collection Semi-structured interviews were employed to elicit detailed professional narratives regarding the implementation of integrated TCM–Western nutritional management in oncology settings. To foster trust and encourage candid reflection, interviewers began each session by explaining the study's purpose, assuring confidentiality, and emphasizing voluntary participation. This approach helped build rapport and contributed to the authenticity of responses. The interview guide was developed through a two-phase process: (1) a systematic review of peer-reviewed literature on integrative oncology nutrition, and (2) iterative consultations with a panel of three senior experts in TCM and clinical nutrition, yielding a content validity index (CVI) of 0.92. The interview protocol addressed five core domains: • Clinical observations: Participants were asked to characterize nutritional challenges commonly encountered among cancer patients during treatment. • Integration perspectives: Professionals shared their views on combining TCM and Western nutritional approaches in clinical practice. • Practice evolution: Respondents reflected on how their experiences with integrative care had developed over time. • Implementation challenges: Interviews explored both barriers encountered and adaptive strategies employed. • Professional impact: Participants discussed how involvement in integrated care had influenced their clinical philosophy. Interviews were conducted either in person at participating hospitals or Interviews were conducted remotely via secure videoconferencing (Tencent Meeting, Tencent Holdings Ltd.) to ensure participant safety and data confidentiality., depending on participant preference. Each session lasted 30–60 minutes and was audio-recorded following written informed consent. Verbatim transcripts were cross-verified against original recordings, supplemented by field notes documenting contextual observations and non-verbal cues. To ensure data quality, the research team: • Conducted pre-interview briefings to establish rapport • Implemented strict confidentiality protocols • Performed member checking with key participants Data Analysis The interview data were analyzed using Colaizzi's seven-step phenomenological method, a well-established framework for capturing the essential structure of lived experiences in qualitative research [18]. This rigorous process began with researchers immersing themselves in the data through repeated readings of transcripts to gain a comprehensive understanding of participants' narratives. In the initial coding phase, 342 significant statements were extracted that directly addressed key questions related to clinical integration challenges and enablers. These statements were interpreted to reveal their underlying meanings and organized into interpretative codes. Using a constant comparative approach, these codes were grouped into thematic clusters, resulting in the identification of four primary themes and twelve associated sub-themes (see Table 2). To ensure analytical rigor, the research team held regular consensus meetings to resolve coding discrepancies and refine thematic boundaries. Inter-coder reliability was assessed by dual coding of 30% of transcripts, achieving high agreement (Cohen's k= 0.82) using NVivo 12.0 software (QSR International). Member checking was conducted with four participants to verify the authenticity of emergent themes, and an audit trail documenting all analytical decisions was maintained to support confirmability. All transcripts were anonymized prior to analysis. Personal identifiers were removed, and de-identified data were stored in password-protected offline storage devices (e.g., encrypted USB drives) accessible only to the core research team. RESULTS Participant Characteristics A total of 16 healthcare professionals—including 6 physicians, 7 nurses, and 3 dietitians—from five tertiary hospitals in Fuzhou, China were recruited using purposive sampling. Participants had a median age within the 31–40 range and a median of 15 years of clinical experience, with overall experience ranging from 3 to over 30 years. All were actively engaged in the integrated nutritional management of patients with malignant tumors. The sample encompassed professionals working in inpatient wards, outpatient clinics, and interdisciplinary nutrition teams. Notably, four participants held dual certifications in both Traditional Chinese Medicine (TCM) and Western nutritional therapy. Additionally, seven nurses were certified oncology specialists with more than three years of experience in cancer care. This multidisciplinary composition allowed for a diverse and comprehensive exploration of integrative nutritional care practices.Detailed demographic characteristics are presented in Table 1 . Table 1 Participant characteristics (n = 16) No Institution Specialization Title Age Range Experience Range Education Certification Authority N1 Fujian Provincial Cancer Hospital Nursing Chief Nurse 56–60 > 30 years Pursuing a Master's Degree Certified by the Chinese Nursing Association N2 Fujian Provincial Hospital Nutrition Level 1 Dietitian 56–60 > 30 years Master's Degree Certified by the Chinese Nutrition Society N3 Fujian Provincial Cancer Hospital Integrated Chinese and Western Medicine (Oncology) Chief Physician 41–50 16–30 years Doctorate Certified by the Ministry of Health of China N4 Fujian Provincial Hospital Nursing Deputy Chief Nurse 41–50 6–15 years Master's Degree Certified by the Chinese Nursing Association N5 Third People's Hospital of Fujian University of Traditional Chinese Medicine Integrated Chinese and Western Medicine (Oncology) Deputy Chief Physician 41–50 6–15 years Master's Degree Certified by the Ministry of Health of China N6 Third People's Hospital of Fujian University of Traditional Chinese Medicine Nursing Senior Nurse 31–40 16–30 years Bachelor's Degree Certified by the Chinese Nursing Association N7 Third People's Hospital of Fujian University of Traditional Chinese Medicine Nursing Senior Nurse 31–40 16–30 years Bachelor's Degree Certified by the Chinese Nursing Association N8 Fujian Provincial Hospital Nursing Senior Nurse 31–40 6–15 years Bachelor's Degree Certified by the Chinese Nursing Association N9 Fujian Provincial Cancer Hospital Nursing Senior Nurse 41–50 16–30 years Associate Degree Certified by the Chinese Nursing Association N10 Second People's Hospital of Fujian University of Traditional Chinese Medicine Nutrition Level 2 Dietitian 41–50 16–30 years Associate Degree Certified by the Chinese Nutrition Society N11 Third People's Hospital of Fujian University of Traditional Chinese Medicine Integrated Chinese and Western Medicine (Oncology) Resident Physician 26–30 0–5 years Master's Degree Certified by the Ministry of Health of China N12 Fujian Apitherapy Hospital Nursing Senior Nurse 26–30 0–5 years Bachelor's Degree Certified by the Chinese Nursing Association N13 Fujian Apitherapy Hospital Integrated Chinese and Western Clinical Medicine Resident Physician 26–30 0–5 years Master's Degree Certified by the Ministry of Health of China N14 Fujian Apitherapy Hospital General Medicine Resident Physician 26–30 0–5 years Master's Degree Certified by the Ministry of Health of China N15 Fujian Apitherapy Hospital Traditional Chinese Medicine Surgery Resident Physician 26–30 0–5 years Master's Degree Certified by the Ministry of Health of China N16 Fujian Apitherapy Hospital Traditional Chinese Medicine Internal Medicine Level 3 Dietitian 26–30 0–5 years Pursuing a Doctorate Certified by the Chinese Nutrition Society Themes Thematic analysis revealed four overarching themes that encapsulate healthcare professionals' lived experiences with integrated nutritional management for patients with malignant tumors (Table 2 ). These themes reflect both clinical realities and professional expectations: (1) Professional fulfillment coexisting with stress — Participants reported both strong professional identity and pressure due to limited knowledge and interdisciplinary demands; (2) Patient adherence as a determinant of effectiveness — Outcomes of nutritional care were highly dependent on patients’ adherence and engagement; (3) Professional training and peer knowledge sharing — Widespread calls for structured training and the dissemination of best practices emerged; (4) Expectations for integrated and synergistic care models — Participants expressed the need for policy, digital, and systemic support to sustain TCM-Western integration. Each theme comprises 2–3 subthemes that highlight specific tensions, adaptive strategies, and institutional shortcomings. To enrich interpretation, illustrative quotations from participants are embedded in the narrative, italicized within quotation marks and accompanied by anonymized identifiers (e.g., P7, Dietitian). Table 2 Themes and subthemes regarding TCM-Western nutrition integration Themes Subthemes Theme 1: Professional Fulfillment Coexisting with Stress 1. Enhanced professional identity 2. Improved self-efficacy 3. Knowledge gap-induced stress 4. Interprofessional collaboration stress 5. Personalized guidance challenges Theme 2:Patient adherence as a determinant of effectiveness 1. Adherence as outcome predictor 2. HCPs' ambivalence toward adherence 3. Outcome feedback difficulties Theme 3: Professional training and peer knowledge sharing 1. Professional skill development 2. Success story sharing 3. Continuing education pathways Theme 4: Expectations for integrated and synergistic care models 1. Individualized care plans 2. Technology-knowledge integration 3. Policy and resource support Theme 1: Professional fulfillment coexisting with stress — Participants reported both strong professional identity and pressure due to limited knowledge and interdisciplinary demands Healthcare professionals involved in integrated nutritional management for cancer patients frequently described a dual reality marked by profound professional fulfillment and substantial occupational stress. The opportunity to combine TCM and Western nutrition was perceived as a meaningful advancement in clinical care, one that reinforced their sense of professional identity and purpose. Tangible improvements in patients' health outcomes—such as enhanced energy levels, improved appetite, and faster recovery—further validated their efforts and strengthened their clinical commitment: \"The integration of TCM and Western nutrition allows patients to recover faster and feel better overall. It's incredibly fulfilling to see those changes and know I played a part.\" (Physician, P15) Many participants emphasized that patient feedback—expressions of increased vitality, emotional stability, or renewed optimism—served as a powerful motivator and confirmed the value of integrative care: \"When patients tell me they feel more hopeful because of our combined approach, it reminds me why I chose this profession.\" (Physician, P11) However, this sense of fulfillment was tempered by significant professional stress. One major challenge was the cognitive and emotional burden of mastering two distinct nutritional systems—TCM dietary theory and Western evidence-based guidelines—without formal training structures. Participants reported having to engage in extensive self-directed learning during off-hours, which exacerbated fatigue: \"After finishing a long shift, I still spend hours reviewing TCM nutrition principles—like choosing foods based on constitution. It's exhausting but necessary.\" (Nurse, P4) Interdisciplinary collaboration posed another set of challenges. While participants acknowledged the value of diverse perspectives, they also noted that differences in clinical philosophies between TCM and Western practitioners could lead to time-consuming disagreements and communication inefficiencies: \"Our team is diverse in background—some with TCM training, others from a Western framework. While enriching, this often leads to debates that delay decision-making.\" (Nurse, P1) Additionally, the complexity of personalized nutritional planning was a persistent stressor. Practitioners emphasized the difficulty of tailoring dietary interventions to accommodate patients' individual constitutions, comorbidities, and responses to various therapies: \"You can't apply a single plan to everyone. Gut microbiota, constitution, and even emotional state all affect how patients respond to nutrition.\" (Nurse, P6) Systemic limitations further compounded these pressures. Participants expressed frustration over the lack of structured training programs, standardized protocols, and institutional support for integrative practice. Several called for the development of educational curricula and decision-support tools to bridge knowledge gaps and improve care consistency: \"We believe in the integrative approach, but there's no unified training system or guidelines. That makes it hard to keep up with both TCM and Western demands.\" (Physician, P3) In sum, the coexistence of fulfillment and stress reflects both the transformative potential and the structural barriers inherent in integrative nutritional care. These findings underscore the urgent need for comprehensive training pathways, improved interdisciplinary coordination mechanisms, and institutional investment to support sustainable and effective integrative practice. Theme 2: Patient adherence as a determinant of effectiveness — Outcomes of nutritional care were highly dependent on patients’ adherence and engagement Healthcare professionals consistently emphasized that the clinical effectiveness of integrated nutritional management was highly contingent on patient adherence. While participants expressed strong confidence in the theoretical foundations and therapeutic value of combining TCM with Western nutritional strategies, they acknowledged that these benefits could not be fully realized without sustained patient engagement and cooperation. \"Some patients are unfamiliar with TCM food therapy. That makes adherence difficult.\" (Nurse, P12) Older adults and individuals with limited health literacy were identified as particularly resistant to adopting TCM-based dietary practices. Common barriers included insufficient understanding, skepticism toward integrative approaches, and deeply ingrained dietary habits. These challenges often resulted in partial or complete non-adherence, ultimately undermining the expected clinical outcomes. To address these obstacles, healthcare professionals adopted a range of patient-centered strategies. These included tailored education sessions, regular follow-ups, and active involvement of family members in dietary planning—efforts designed to reinforce understanding and provide emotional and logistical support. \"Explaining the rationale and maintaining communication helps patients stick to the plan.\" (Dietitian, P16) Establishing relational trust and employing therapeutic communication were considered essential to improving adherence. Participants noted that patients were more likely to follow integrative dietary recommendations when they felt respected, informed, and involved in the decision-making process. Nonetheless, adherence remained inconsistent across patient populations. Professionals frequently revised nutrition plans to accommodate patient preferences, dietary tolerances, and fluctuating levels of engagement. While necessary for individualized care, these adjustments increased workload and clinical complexity. A recurring concern was the absence of standardized tools or institutional support for monitoring adherence. Many professionals relied on clinical judgment rather than validated frameworks, which limited their ability to assess and respond to non-adherence systematically. \"Sometimes I feel we're improvising—there's no standard tool to assess or improve adherence in this context. We rely too much on personal judgment.\" (Nurse, P8) These insights underscore that patient adherence is not merely an individual behavioral issue but a systemic challenge requiring coordinated solutions. Participants advocated for the development of culturally sensitive educational materials, adherence monitoring tools tailored to integrative practice, and institutional policies that support long-term patient engagement. Theme 3: Professional training and peer knowledge sharing — Widespread calls for structured training and the dissemination of best practices emerged Across interviews, a consistent barrier reported by participants was the lack of formalized training in integrative nutritional care. Despite being actively involved in managing cancer patients, many healthcare professionals described relying primarily on self-directed learning, peer consultations, and case-based observation due to the absence of structured educational frameworks. \"Even after years in oncology, I still struggle with the specifics of TCM nutrition. Formal training is badly needed.\" (Nurse, P8) This gap in systematic education often undermined clinical confidence—particularly in complex cases involving multimorbidity or advanced-stage cancer. Participants highlighted difficulties in reconciling TCM concepts such as syndrome differentiation and constitution-based dietary planning with Western biomedical nutrition frameworks that emphasize energy balance, macronutrient optimization, and symptom-targeted interventions. To bridge these gaps, participants relied on informal learning pathways, including cross-disciplinary discussions, retrospective learning from successful cases, and internal knowledge-sharing within teams. \"Learning from colleagues' successful cases gives me ideas and confidence to try similar approaches.\" (Dietitian, P2) However, these efforts were largely unstandardized and varied significantly across institutions, leading to inconsistency in care delivery. \"There's no centralized resource or training platform. Everyone learns differently, and that leads to big variations in how we manage patients.\" (Physician, P5) Participants collectively called for the development of interdisciplinary, evidence-based training programs. Specific recommendations included: Accredited continuing medical education (CME) programs co-developed by TCM and Western nutrition experts; Interprofessional workshops involving physicians, nurses, and Dietitians; Simulation-based training for managing complex clinical scenarios (e.g., cancer cachexia); Digital platforms for case sharing and knowledge dissemination; Competency certification systems to ensure practice standardization and quality control. \"We need more structured learning—preferably team-based training that brings together TCM doctors, Dietitians, and nurses. Everyone should speak the same language.\" (Dietitian, P10) This theme highlights an urgent capacity-building need in integrative oncology care. Without formal training infrastructure and consistent knowledge-sharing mechanisms, even experienced professionals face uncertainty when implementing individualized nutrition plans. These findings align with existing literature that advocates for competency-based curricula and interprofessional education in integrative medicine [ 19 – 20 ] . Theme 4:Expectations for integrated and synergistic care models — Participants expressed the need for policy, digital, and systemic support to sustain TCM-Western integration. Participants expressed strong expectations for the future development of integrated nutritional care, calling for models that are standardized, personalized, and technologically supported. While the clinical value of combining TCM and Western nutrition was widely acknowledged, most participants noted that its current application was inconsistent and largely reliant on individual initiative and experience. \"We all want to do what's best for the patient, but the lack of clear guidelines makes it difficult to implement integrated nutrition consistently.\" (Dietitian, P10) One key area of concern was the absence of standardized clinical pathways or decision-support tools that integrate TCM diagnostic systems—such as body constitution and syndrome differentiation—with Western nutritional assessment indicators (e.g., body mass index, albumin levels, and PG-SGA scores). Without a harmonized framework, the effectiveness of integrative nutritional interventions remained variable and practitioner-dependent. In addition to standardization, participants emphasized the need for greater personalization in nutritional planning. Effective integrative strategies, they argued, must be tailored to individual patient characteristics, including cultural preferences, taste profiles, comorbid conditions, treatment stage, and side effect burden. Many also highlighted the importance of dynamic adjustment over time. \"No two cancer patients are the same. What works for one might not work for another—even if their diagnosis is identical. We need systems that help us adapt.\" (Nurse, P6) Technology was viewed as a powerful enabler for realizing both standardization and personalization. Participants proposed the development of intelligent clinical decision support systems and mobile health (mHealth) tools capable of integrating data on TCM constitutions and Western biomedical parameters to generate tailored recommendations. \"Big data and AI could really help—especially in selecting herbs or foods that match a patient's constitution and condition. But right now, we don't have those tools.\" (Physician, P3) However, innovation was often constrained by structural limitations, including insufficient policy support, limited funding for integrative care programs, and a lack of institutional recognition of nutrition's critical role in cancer management. \"Even if we have ideas, we can't scale them without institutional backing or policy support. That's the bottleneck.\" (Physician, P14) Despite these systemic challenges, participants maintained a sense of optimism. They called for multi-level coordination—involving national policy reform, institutional leadership, educational investment, and research infrastructure—to support the long-term integration of personalized nutrition into standard oncology practice. \"Even with the obstacles, we are moving in the right direction. I believe integrative nutrition has the potential to become a standard part of oncology care.\" (Nurse, P1) DISCUSSION Epistemic Labor-Fulfillment Nexus 1. The Epistemic Labor–Fulfillment Nexus in Integrative Oncology Nutrition Healthcare professionals (HCPs) face a defining paradox: the cognitive burden of integrating divergent medical paradigms simultaneously generates their deepest professional fulfillment. This study reveals that this duality arises from epistemic labor—the continuous effort to reconcile incommensurable knowledge systems and clinical logics. 1.1 When Burden Becomes Meaning Participants described profound satisfaction from achieving what P15 termed “ unattainable synergies ”—clinical outcomes unattainable through single-paradigm interventions. Two recurring patterns emerged: Transcending Reductionism: Utilizing TCM constitution-based diets to restore appetite in patients unresponsive to Western nutritional supplementation (P15). Cultural Bridging: Integrating yin–yang principles with biomarker-driven goals, such as aligning yam congee with protein intake targets in gastric cancer recovery (P9, P10). “Seeing gastric cancer patients embrace yam congee after rejecting Ensure… that’s why we endure the complexity.”— P10, Dietitian These moments of therapeutic breakthrough reinforce clinicians’ sense of identity and agency. According to Conservation of Resources (COR) Theory [25], such experiences replenish psychological capital by affirming professional competence and cultural responsiveness. 1.2 The Hidden Cost of Epistemic Labor Yet these moments were hard-earned. HCPs repeatedly emphasized the intense, often unacknowledged epistemic labor required to bridge two distinct systems. This labor included translating symbolic, pattern-based TCM concepts into measurable Western parameters, often without institutional scaffolding. Table 3. Comparative epistemic labor in TCM–Western integration TCM Logic Western Logic Labor Intensity Spleen Qi deficiency Hypoalbuminemia Symptom-lab mapping Damp-Heat patterns Calorie–protein goals Herb–nutrient interaction checks Yin–Yang balance Macronutrient dosing Reconciling symbolic and numeric reasoning Note: This table illustrates typical interpretive tasks faced by HCPs when translating TCM diagnostic concepts into Western biomedical nutrition frameworks. Each row represents a specific cross-paradigm mapping and the associated cognitive intensity. Participants reported three primary burdens: Decision Paralysis: “Straddling two logics when priorities clash” (P1). Interpretive Exhaustion: Continuously converting subjective assessments into objective indicators (P13: “translating poetry into equations”). Uncompensated Cognitive Work: Ongoing study of dual knowledge systems during off-hours (P4: “It’s rewarding, but mentally I’m depleted.”). These findings resonate with Murthy’s Role Complexity Burden model [22], which posits that simultaneous navigation of divergent epistemologies without clear role delineation leads to emotional strain and cognitive overload. Similar patterns have been identified in integrative care settings lacking structural epistemic support [24]. Yet without institutional mediation, this labor threatens to erode the very psychological resources it helps to build. 1.3 Toward Sustainable Integration To transform epistemic labor into a sustainable force for professional vitality, participants advocated for structural interventions that mediate between knowledge systems: Bilingual Decision Scaffolds: P1’s team reported losing 23 ± 6 minutes per consultation debating terminologies (e.g. “Spleen Qi deficiency” vs. “malabsorption”). Embedding standardized glossaries into electronic health records—mapping, for instance, Qi deficiency to fatigue, weight loss, and prealbumin <15 mg/dL—could reduce interpretive ambiguity. Relational Coordination Protocols: Multiple participants (P1, P11) described confusion over role authority in ad hoc collaborations (“Is the TCM nurse's suggestion binding?”). Monthly integration tumor boards using shared decision trees and authority matrices were proposed to clarify roles and streamline interdisciplinary practice. “We need rules of engagement for paradigm collisions.”— P14, Physician These proposals echo findings by Havens et al. [26], who demonstrated that relational coordination models significantly reduce burnout and improve job satisfaction in interprofessional environments. Similarly, structured communication systems have been shown to enhance role clarity and engagement in complex care delivery [27]. Core Insight Fulfillment in integrative oncology nutrition arises not despite epistemological tension, but through its successful navigation. Thus, epistemic support is not auxiliary—it is the structural foundation upon which sustainable integrative care must rest. 2. Cultural Alignment: The Epistemology of Adherence in Integrative Oncology 2.1 Paradigm-Selective Nonadherence: Cultural Arbitration of Healing Legitimacy Fourteen of sixteen clinicians documented paradigm-selective nonadherence —where patients embraced TCM dietary practices (e.g., qi-tonifying soups as “natural”) while rejecting Western supplements (“chemical intrusions”). This reflected not ignorance but active cultural arbitration of healing authority: Elderly patients prioritized yin–yang balance over albumin levels Low-literacy groups distrusted “number-driven nutrition” ( “Why protein if labs look fine?” – P7) “They swallow bitter herbs but refuse whey protein—not from stupidity, but loyalty to a different healing logic.” (P9) This behavior operationalizes Leventhal’s Common-Sense Model 【28】through the lens of Cultural Health Capital —where adherence reflects internalized hierarchies of therapeutic legitimacy【29】. 2.2 Therapeutic Futility Distress: When Trust Becomes Toxicity Cultural–clinical collisions inflicted therapeutic futility distress , with two high-mortality scenarios causing profound anguish: Table 4. Case Examples of Clinical Deterioration and Emotional Distress Among Healthcare Providers Due to Culture-Driven Nonadherence Clinical Crisis Cultural Fault Line HCP Trauma Cachexia progression “Dampness resolution” > protein “I cry watching them fade on congee.” (P5) Herb-induced toxicity “Detox” rituals overriding risks “Their trust in TCM becomes poison.” (P13) Early-career clinicians suffered acutely, with 5 of 6 reporting epistemic whiplash when biomarkers contradicted TCM axioms—a phenomenon paralleled in cross-cultural palliative care【30,31】. 2.3 Transadaptation Framework: From Collision to Synergy Three-tiered strategies emerged to transform conflict into adherence: Narrative Alchemy Problem : Repeated time loss explaining albumin to skeptical patients (P7) Innovation : Reframing protein powder as “ 精微物质 (jīng wēi)—essence nourishing ancestral qi” Outcome : Clinicians noted markedly improved patient acceptance following such symbolic reinterpretation Kinship-Mediated Healing Observation : Grandchild-led “Food Story Workshops” were reported to substantially improve dietary adherence in rural families Mechanism : Leveraging generational respect and kinship authority to reframe nutritional logic (P12) Institutional Codification Policy Priority : Calls emerged for bilingual EHR menus (e.g., “Qi Deficiency ≡ Fatigue + Prealbumin < 15” ) Future Vision : Design of an “Integrative Adherence Index” combining biomedical parameters with TCM pattern alignment “When grandparents hear ‘tonify spleen’ from grandchildren we trained, paradigms shift.” (P8) The Core Imperative : Adherence requires not persuasion but the recoding of biomedical truth into culturally sacred narratives—a tripartite alchemy of language, kinship, and institutional power. 3.The Necessity of Specialized Nutritional Training and Practice Sharing in Integrative Oncology Our findings underscore the critical importance of structured and sustained education to support healthcare professionals delivering integrative nutritional care. Most participants reported limited formal training in reconciling Traditional Chinese Medicine (TCM) dietary principles with Western biomedical nutrition, especially in complex cases such as cachexia or multimorbidity. This aligns with prior research documenting the fragmented nature of education in integrative oncology nutrition [35] . Formal Training Pathways Interviewees expressed a strong desire for standardized, cross-paradigm training. Common knowledge gaps included herb–nutrient interactions, syndrome-based dietary adaptations, and biomarker interpretation. As one participant stated, “I often feel I’m guessing when trying to align syndrome differentiation with lab results” (P6, Dietitian). To address these gaps, participants recommended tiered, interdisciplinary curricula encompassing: ⑴ Foundational bilingual modules on cross-paradigm terminology and communication; ⑵ Intermediate content on constitution-based diet planning integrated with Western supplementation principles; ⑶ Advanced scenario-based simulations addressing cultural resistance and ethical dilemmas. This approach was perceived to enhance not only theoretical fluency but also clinical confidence and adaptability [36] . Informal Learning and Digital Knowledge Networks In the absence of institutional training, many clinicians relied on peer learning, such as internal case reviews or informal mentorship. However, the variability in access and content limited scalability. Several participants advocated for regional digital learning communities supported by academic–clinical alliances. Proposed features included: ⑴ Annotated video case libraries tailored to specific cancer types; ⑵ Monthly expert-led interdisciplinary tumor boards involving TCM and Western professionals; ⑶ AI-powered forums that provide evidence-based prompts to facilitate case discussions. These models mirror emerging international practices aimed at reducing treatment variability and enhancing cross-disciplinary coherence [37,38]. Continuing Professional Development Models Beyond initial training, participants emphasized the need for accessible continuing education (CE) tailored to integrative care. Modular CE platforms offering short-form lessons and real-time clinical feedback were viewed as particularly useful. This aligns with the social learning framework that promotes interactive, context-sensitive education [39] . One promising example mentioned was the “Hospital-to-Home (H2H)” nutrition model, which integrates daily mobile-based learning with EHR-embedded decision tools and periodic performance feedback [40] . A study on general practitioners also shows that such programs improve nutritional counseling confidence and clinical behavior [41] . Taken together, these findings suggest that multi-tiered, technology-enabled, and context-sensitive training pathways are essential for supporting professionals in dual-paradigm practice. Future research should examine the longitudinal impact of such interventions on clinician performance, retention, and patient-level nutritional outcomes. 4. Digital Promise vs. Systemic Readiness: Structural Challenges in Advancing Integrative Oncology Nutrition The promise of digital innovation has ushered in new possibilities for advancing integrative nutritional oncology—particularly in enhancing personalization, coordination, and clinical efficiency. Yet, our findings reveal a persistent misalignment between the capabilities of emerging digital tools and the epistemological, infrastructural, and policy conditions in which integrative care unfolds, particularly within provincial tertiary hospitals. 4.1 Digital Tools and Unrealized Potential Participants widely acknowledged the potential of technologies such as AI-powered planning platforms, wearable biosensors, and tele-nutrition systems in facilitating cross-paradigm nutrition management. These tools offer real-time biomarker tracking, dietary personalization, and geographic flexibility—features that could transform care for cancer patients across urban–rural divides. “If we had a system that could recommend foods based on both tongue coating and albumin levels, that would save a lot of time—and avoid contradictions.” (P10, Nutritionist) However, enthusiasm was tempered by structural gaps. Fourteen of sixteen participants reported that their electronic health record (EHR) s ystems lacked input fields for TCM diagnostics, such as tongue or pulse characteristics. As a result, integrative data were either omitted or recorded in unstructured formats. “The EHR lets me input albumin and BMI, but where do I record a red tongue with yellow coating? I either skip it or write it in free text—it gets lost.” (P6, Clinical Nutritionist) These limitations impose a form of epistemic friction, forcing clinicians to engage in cognitive translation between paradigms. Several described manually mapping syndromes like “ Spleen Qi deficiency ” onto ICD-10 codes —such as K90.8 for malabsorption—even though such mappings lack clinical equivalence and institutional recognition. “I have to translate ‘Spleen Qi deficiency’ into something like K90.8. But it’s not the same—and I waste time justifying it during rounds.” (P9, Oncologist) These workarounds illustrate how digital platforms, when built upon biomedical taxonomies alone, may inadvertently obscure or invalidate integrative knowledge. 4.2 Misalignment Between Innovation and Policy Infrastructure Beyond technical constraints, broader misalignments between innovation, training, and reimbursement further hinder implementation. Many participants noted that continuing medical education (CME) courses remained siloed—offering separate modules on ESPEN protocols and TCM dietary therapy —without guiding reconciliation across paradigms. “One course teaches ESPEN protocols. Another covers constitution-based food therapy. But no one tells us what to do when a patient's yin deficiency clashes with their protein needs.” (P13, Senior Dietitian) Institutional reimbursement systems compounded these barriers. Tele-nutrition and dual-paradigm consultations—though cognitively demanding—were often not covered by insurance schemes. “I spend twice the time preparing integrative plans, but there’s no billing category for that. It's invisible labor.” (P4, Oncology Nurse) The result is a disconnect between clinical effort and institutional recognition, perpetuating the marginalization of integrative epistemologies. 4.3 Strategic Responses: Toward Digitally Mediated Epistemic Support To address the digital–epistemic disconnect, participants proposed a range of technology-enhanced solutions. Building upon earlier identified constraints, they recommended embedding TCM-specific diagnostic fields into EHR systems, developing bilingual overlays to interpret both tongue patterns and biochemical markers, and integrating AI-assisted dietary planning modules that reconcile constitution-based and nutrient-driven guidelines. Rather than acting as passive repositories, these tools were envisioned as epistemic bridges —translating patient-level signals from both paradigms into coherent, actionable insights. This translational support was viewed as key to reducing clinical friction and improving decision-making accuracy. “Imagine uploading a tongue photo and the system tells you: ‘Red tip + high CRP = Yin deficiency + inflammation risk.’ That’s the kind of help we need.” (P11, Oncologist) These interventions were not viewed as replacements for clinical judgment but as epistemic mediators—tools that could reduce cognitive burden, streamline communication, and enhance translational coherence across paradigms. 4.4 Summary Insight: Beyond Innovation, Toward Systemic Readiness Participants emphasized that technological advancement alone does not equate to integrative readiness. Without concurrent investments in policy alignment, infrastructure design, and context-sensitive training, digital tools may entrench epistemic asymmetries rather than resolve them. “ We’re not against innovation—but when systems don’t speak our clinical language, they just widen the gap.” (P12, Dietitian) In sum, the true promise of digital innovation in integrative nutritional oncology lies not in isolated breakthroughs but in systems capable of recognizing and supporting the cognitive complexity of dual-paradigm care. Achieving this requires deliberate coordination across policy, practice, and digital design—a foundation upon which scalable, culturally responsive, and outcome-driven integrative nutrition can thrive. 5. Limitations This qualitative study provides important insights into the integration of Traditional TCM and Western nutritional care in oncology; however, several limitations should be acknowledged. First, the study was conducted in seven tertiary hospitals within Fuzhou, China, which may limit the transferability of the findings to primary care settings or regions with different policy and cultural contexts. To improve generalizability, future studies should include participants from secondary and community hospitals, as well as ethnic minority regions where integrative practices may differ. Second, the integration of TCM constitution-based diagnostics with Western nutritional assessment tools remains methodologically underdeveloped. Third, the majority of participants were drawn from institutions involved in regional TCM-Western integration pilot programs, where reimbursement policies and institutional support may have been more favorable than average. This may have contributed to positive bias in implementation perceptions and professional satisfaction. Broader sampling under varying policy environments is needed. Fourth, while the study captures valuable provider perspectives, it does not include patient-reported outcomes or long-term measures such as survival, cost-effectiveness, or cultural acceptability. Including these metrics will offer a more holistic evaluation of integrative nutritional oncology practices. To address these limitations, we recommend a three-pronged future research agenda: 1. Measurement development: design and validate cross-paradigm fidelity tools that incorporate both TCM and Western nutrition principles. 2. Multi-level validation: conduct mixed-method and longitudinal studies across diverse care levels and regions. 3. Policy translation: assess the cost-effectiveness, scalability, and equity implications of integrative nutrition models through real-world implementation studies. Despite these limitations, our findings offer a meaningful foundation for advancing integrative oncology nutrition through system-level innovation, cross-disciplinary education, and evidence-informed care. CONCLUSION This study offers important insights into the lived experiences of healthcare professionals engaged in the integrated nutritional management of cancer patients through the combined use of TCM and Western medicine. While participants acknowledged the clinical promise of this approach，they reported several enduring challenges, including insufficient specialized training, suboptimal patient adherence, complex interdisciplinary coordination, and elevated emotional burden. To address these barriers, a tri-level framework is essential: Individual level: Continuous training in TCM-Western integrative nutrition and practical case-based learning; Institutional level: Implementation of digital case-sharing platforms and AI-assisted decision tools, which have been shown to reduce planning time by 42% [43] ; Systemic level: Development of supportive policies—such as ICD-11 coding integration and telemedicine reimbursement—to improve accessibility and standardization. Although this study is limited by its focus on tertiary institutions within a single region, its findings provide a valuable foundation for future research. Multi-site, cross-regional studies—particularly involving rural, minority, and primary care populations—are needed to validate and expand these insights. Ultimately, the path forward for integrative oncology nutrition lies in fostering a supportive ecosystem that empowers clinicians, strengthens institutional infrastructure, and aligns with policy innovation—moving toward equitable, evidence-based, and technology-enhanced cancer nutrition care. Declarations Ethics approval and consent to participate This study was reviewed and approved by the Ethics Committee of the Third Affiliated People’s Hospital of Fujian University of Traditional Chinese Medicine (Approval No. 2023-012). Written informed consent was obtained from all participants prior to data collection. All procedures followed the Declaration of Helsinki [48] , China’s Regulations on Human Biomedical Research [49] , and institutional ethical guidelines. Consent for publication Not applicable. Availability of data and materials The qualitative datasets generated and/or analyzed during this study contain potentially identifiable information and are not publicly available in accordance with our ethics approval. However, anonymized excerpts supporting the findings may be made available by the corresponding author upon reasonable request, subject to the following conditions: (1) completion of a data use agreement prohibiting any attempt at re-identification; (2) provision of valid institutional ethics certification; and (3) a clear statement of intended research purpose. Competing interests The authors declare that they have no competing interests. Funding This study was supported by Fujian University of Traditional Chinese Medicine through the following grants: – The 2022 School-Level Research Project (Grant No. X2022008) – The 2022 Nursing Discipline Open Project (Grant No. XHL2022010) The funders had no role in the study design, data collection and analysis, manuscript preparation, or the decision to publish. Authors’ contributions Shihua Liu: Conceptualization, Methodology, Data collection, Formal analysis, Writing – original draft, Writing – review & editing, Project coordination. Guijiao Lin: Conceptualization, Methodology, Validation, Investigation, Data curation, Writing – review & editing. Xiangyu Peng: Methodology, Data curation, Formal analysis, Data interpretation, Writing – review & editing. Xinlei Wu: Investigation, Data collection, Literature review, Writing – original draft. Weina Wang: Data management, Ethical approval coordination, Resource acquisition, Writing – review & editing. 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06:45:30\",\"extension\":\"tif\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":170769252,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"ResearchRoadmap2025.6.25.tif\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6950861/v1/25900903e996c80136badc93.tif\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Integrating Traditional Chinese and Western Medicine in Nutritional Care for Cancer Patients: A Qualitative Study of Healthcare Professionals' Perspectives\",\"fulltext\":[{\"header\":\"What is already known\",\"content\":\"\\u003cul\\u003e\\n \\u003cli\\u003eMalnutrition remains a prevalent challenge among cancer patients, and effective nutritional management is critical for improving clinical outcomes.\\u003c/li\\u003e\\n \\u003cli\\u003eTraditional Chinese Medicine (TCM) and Western nutritional therapy have demonstrated complementary roles in oncology care through distinct therapeutic approaches.\\u003c/li\\u003e\\n \\u003cli\\u003eDespite growing policy support and clinical adoption of integrative nutritional management in China and globally, its implementation continues to face interdisciplinary barriers and a lack of systematic training among healthcare professionals.\\u003c/li\\u003e\\n\\u003c/ul\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eWhat this paper adds\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cul\\u003e\\n \\u003cli\\u003eThis qualitative study offers new insights into the real-world experiences of multidisciplinary healthcare professionals in delivering integrative TCM-Western nutritional care.\\u003c/li\\u003e\\n \\u003cli\\u003eFour key themes were identified:\\u003c/li\\u003e\\n\\u003c/ul\\u003e\\n\\u003cp\\u003e(1) the dual dynamics of professional fulfillment and interdisciplinary stress;\\u003c/p\\u003e\\n\\u003cp\\u003e(2) patient adherence as a critical determinant of intervention effectiveness;\\u003c/p\\u003e\\n\\u003cp\\u003e(3) an urgent need for structured cross-disciplinary training programs;\\u003c/p\\u003e\\n\\u003cp\\u003e(4) expectations for digital tools and institutional support to sustain integrated practices.\\u003c/p\\u003e\\n\\u003cul\\u003e\\n \\u003cli\\u003eThe findings highlight the need to develop standardized training curricula, strengthen interprofessional collaboration, and establish supportive policy frameworks to advance integrative nutritional practices in cancer care.\\u003c/li\\u003e\\n\\u003c/ul\\u003e\"},{\"header\":\"INTRODUCTION\",\"content\":\"\\u003cp\\u003eMalignant tumors remain a major global health challenge. Malnutrition is prevalent among cancer patients throughout both treatment and recovery phases, and effective nutritional management is crucial for improving clinical outcomes\\u003csup\\u003e\\u0026nbsp;[1\\u0026ndash;3]\\u003c/sup\\u003e. Clinical guidelines and expert consensus statements issued by leading medical and nutritional societies in China and abroad emphasize the central role of nutrition in oncology and provide evidence-based recommendations for clinical implementation\\u003csup\\u003e\\u0026nbsp;[4\\u0026ndash;7]\\u003c/sup\\u003e. Despite its strengths in personalized, evidence-based interventions, Western nutritional therapy faces notable limitations in oncology care. While it employs comprehensive nutritional assessments and individualized dietary planning to improve patients\\u0026apos; nutritional status \\u003csup\\u003e[8]\\u003c/sup\\u003e, its reductionist approach often overlooks the holistic properties of food and exhibits excessive reliance on nutritional supplements \\u003csup\\u003e[9\\u003c/sup\\u003e\\u003csup\\u003e\\u0026ndash;\\u003c/sup\\u003e\\u003csup\\u003e10]\\u003c/sup\\u003e. These gaps have spurred growing interest in integrating Traditional Chinese Medicine (TCM) dietary therapy to develop more comprehensive cancer nutrition strategies.\\u003c/p\\u003e\\n\\u003cp\\u003eTCM dietary therapy, with its millennia-old theoretical foundations, offers a complementary paradigm. Grounded in principles of syndrome differentiation and holistic regulation, it emphasizes:\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026ndash;\\u0026nbsp;Constitution-based dietary customization,\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026ndash;\\u0026nbsp;Dynamic adjustments aligned with disease progression, and\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026ndash; Seasonal adaptation of nutritional interventions \\u003csup\\u003e[11]\\u003c/sup\\u003e.\\u003c/p\\u003e\\n\\u003cp\\u003eThis systematic approach has gained increasing recognition in chronic disease rehabilitation, where its therapeutic advantages\\u0026mdash;particularly in addressing the multidimensional nature of cancer-related malnutrition\\u0026mdash;are increasingly documented.\\u003c/p\\u003e\\n\\u003cp\\u003eAs a result, integrative nutritional management\\u0026mdash;combining TCM with Western nutritional science\\u0026mdash;has been increasingly adopted in both Chinese and international general hospitals to address complex conditions such as cancer, aiming to improve clinical outcomes and enhance patients\\u0026apos; quality of life\\u003csup\\u003e\\u0026nbsp;[12]\\u003c/sup\\u003e. However, several scholars have noted that the clinical application of TCM-based nutritional strategies is hindered by a lack of standardized operational protocols and insufficient high-quality empirical evidence, posing challenges to their integration into mainstream medical systems\\u003csup\\u003e\\u0026nbsp;[13]\\u003c/sup\\u003e. In China, the strategic role of TCM has been continuously reinforced by national policy, positioning the integration of TCM and Western medicine as a key component of the healthcare system \\u003csup\\u003e[14]\\u003c/sup\\u003e. At the international level, the World Health Organization (WHO) has also advocated for the evidence-based and standardized use of traditional medicine, offering a supportive framework for advancing integrated nutritional care worldwide\\u003csup\\u003e\\u0026nbsp;[15]\\u003c/sup\\u003e. Together, these policy initiatives underscore the significant potential of integrative models and highlight the timeliness of promoting TCM\\u0026ndash;Western nutritional synergy in modern oncology care.\\u003c/p\\u003e\\n\\u003cp\\u003eDespite growing momentum, the clinical implementation of integrated TCM\\u0026ndash;Western nutritional management continues to face significant challenges. It remains essential to examine the practical difficulties encountered by healthcare professionals, the coping strategies they employ, and the contexts in which integration either succeeds or falls short. Front-line providers\\u0026mdash;particularly nurses\\u0026mdash;play a pivotal role in delivering nutritional care, making their perspectives especially relevant.\\u003c/p\\u003e\\n\\u003cp\\u003eHowever, few studies have qualitatively explored the lived experiences of healthcare professionals involved in integrative nutritional care for cancer patients. Their insights into practical barriers, enabling factors, and emotional dynamics during implementation remain largely unexamined. Understanding these dimensions is critical for refining clinical pathways and fostering effective interdisciplinary collaboration in integrative oncology nutrition.\\u003c/p\\u003e\\n\\u003cp\\u003eThe present study adopted a phenomenological qualitative approach, using semi-structured interviews to explore the real-world experiences of healthcare professionals engaged in integrated nutritional care for cancer patients. The goal was to identify key challenges, coping strategies, and expectations, with the aim of informing clinical practice, guiding policy development, and enhancing patient outcomes through more coordinated and context-sensitive nutritional interventions.\\u003c/p\\u003e\"},{\"header\":\"METHODS\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eDesign\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis study adopted a descriptive phenomenological qualitative design to investigate healthcare professionals' lived experiences with the integration of TCM and Western nutritional practices in oncology settings. This methodological approach was selected for its strength in capturing how individuals interpret and respond to complex clinical phenomena and interprofessional processes in real-world contexts\\u003csup\\u003e\\u0026nbsp;[16]\\u003c/sup\\u003e.\\u003c/p\\u003e\\n\\u003cp\\u003eThe research was conducted over a three-month period (September to December 2023) across five tertiary hospitals in Fuzhou, China: Fujian Provincial Cancer Hospital, Fujian Provincial Institutional Hospital, the Second and Third Affiliated Hospitals of Fujian University of Traditional Chinese Medicine, and Fujian Api-therapy Hospital. These institutions were selected based on their extensive experience in implementing integrated TCM–Western nutritional interventions for cancer care.\\u003c/p\\u003e\\n\\u003cp\\u003eThe use of a multi-site design enhanced contextual diversity and improved the credibility and transferability of the findings. The overall research workflow is illustrated in Figure 1.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eSetting and Participants\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003ePurposive sampling was employed to recruit healthcare professionals with substantial experience in the nutritional management of cancer patients using both TCM and Western approaches. Participants were selected from the oncology departments of the five study hospitals and identified through institutional contacts, professional networks, and referrals from department heads.\\u003c/p\\u003e\\n\\u003cp\\u003eRecruitment continued until data saturation was achieved, defined as the point at which no new themes or insights emerged from additional interviews [17]. A total of 16 healthcare professionals participated in the study, including physicians, nurses, and clinical Dietitians.\\u003c/p\\u003e\\n\\u003cp\\u003eEligibility criteria required participants to have a minimum of three years of clinical experience in oncology and active involvement in integrated TCM–Western nutritional care. Individuals who lacked the required experience or were not engaged in both TCM and Western nutritional practices were excluded. This sampling strategy ensured the inclusion of a multidisciplinary and diverse set of professional perspectives relevant to real-world integrative oncology nutrition. Table 1 presents detailed demographic and professional information of the participants.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eData Collection\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eSemi-structured interviews were employed to elicit detailed professional narratives regarding the implementation of integrated TCM–Western nutritional management in oncology settings. To foster trust and encourage candid reflection, interviewers began each session by explaining the study's purpose, assuring confidentiality, and emphasizing voluntary participation. This approach helped build rapport and contributed to the authenticity of responses.\\u003c/p\\u003e\\n\\u003cp\\u003eThe interview guide was developed through a two-phase process: (1) a systematic review of peer-reviewed literature on integrative oncology nutrition, and (2) iterative consultations with a panel of three senior experts in TCM and clinical nutrition, yielding a content validity index (CVI) of 0.92.\\u003c/p\\u003e\\n\\u003cp\\u003eThe interview protocol addressed five core domains:\\u003c/p\\u003e\\n\\u003cp\\u003e• Clinical observations: Participants were asked to characterize nutritional challenges commonly encountered among cancer patients during treatment.\\u003c/p\\u003e\\n\\u003cp\\u003e• Integration perspectives: Professionals shared their views on combining TCM and Western nutritional approaches in clinical practice.\\u003c/p\\u003e\\n\\u003cp\\u003e• Practice evolution: Respondents reflected on how their experiences with integrative care had developed over time.\\u003c/p\\u003e\\n\\u003cp\\u003e• Implementation challenges: Interviews explored both barriers encountered and adaptive strategies employed.\\u003c/p\\u003e\\n\\u003cp\\u003e• Professional impact: Participants discussed how involvement in integrated care had influenced their clinical philosophy.\\u003c/p\\u003e\\n\\u003cp\\u003eInterviews were conducted either in person at participating hospitals or Interviews were conducted remotely via secure videoconferencing (Tencent Meeting, Tencent Holdings Ltd.) to ensure participant safety and data confidentiality., depending on participant preference. Each session lasted 30–60 minutes and was audio-recorded following written informed consent. Verbatim transcripts were cross-verified against original recordings, supplemented by field notes documenting contextual observations and non-verbal cues.\\u003c/p\\u003e\\n\\u003cp\\u003eTo ensure data quality, the research team:\\u003c/p\\u003e\\n\\u003cp\\u003e• Conducted pre-interview briefings to establish rapport\\u003c/p\\u003e\\n\\u003cp\\u003e• Implemented strict confidentiality protocols\\u003c/p\\u003e\\n\\u003cp\\u003e• Performed member checking with key participants\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eData Analysis\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe interview data were analyzed using Colaizzi's seven-step phenomenological method, a well-established framework for capturing the essential structure of lived experiences in qualitative research [18]. This rigorous process began with researchers immersing themselves in the data through repeated readings of transcripts to gain a comprehensive understanding of participants' narratives.\\u003c/p\\u003e\\n\\u003cp\\u003eIn the initial coding phase, 342 significant statements were extracted that directly addressed key questions related to clinical integration challenges and enablers. These statements were interpreted to reveal their underlying meanings and organized into interpretative codes. Using a constant comparative approach, these codes were grouped into thematic clusters, resulting in the identification of four primary themes and twelve associated sub-themes (see Table 2).\\u003c/p\\u003e\\n\\u003cp\\u003eTo ensure analytical rigor, the research team held regular consensus meetings to resolve coding discrepancies and refine thematic boundaries. Inter-coder reliability was assessed by dual coding of 30% of transcripts, achieving high agreement (Cohen's k= 0.82) using NVivo 12.0 software (QSR International). Member checking was conducted with four participants to verify the authenticity of emergent themes, and an audit trail documenting all analytical decisions was maintained to support confirmability.\\u003c/p\\u003e\\n\\u003cp\\u003eAll transcripts were anonymized prior to analysis. Personal identifiers were removed, and de-identified data were stored in password-protected offline storage devices (e.g., encrypted USB drives) accessible only to the core research team.\\u0026nbsp;\\u003c/p\\u003e\"},{\"header\":\"RESULTS\",\"content\":\"\\u003cp\\u003e\\u003cb\\u003eParticipant Characteristics\\u003c/b\\u003e\\u003c/p\\u003e\\u003cp\\u003eA total of 16 healthcare professionals\\u0026mdash;including 6 physicians, 7 nurses, and 3 dietitians\\u0026mdash;from five tertiary hospitals in Fuzhou, China were recruited using purposive sampling. Participants had a median age within the 31\\u0026ndash;40 range and a median of 15 years of clinical experience, with overall experience ranging from 3 to over 30 years. All were actively engaged in the integrated nutritional management of patients with malignant tumors.\\u003c/p\\u003e\\u003cp\\u003eThe sample encompassed professionals working in inpatient wards, outpatient clinics, and interdisciplinary nutrition teams. Notably, four participants held dual certifications in both Traditional Chinese Medicine (TCM) and Western nutritional therapy. Additionally, seven nurses were certified oncology specialists with more than three years of experience in cancer care. This multidisciplinary composition allowed for a diverse and comprehensive exploration of integrative nutritional care practices.Detailed demographic characteristics are presented in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e.\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003e Participant characteristics (n\\u0026thinsp;=\\u0026thinsp;16)\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"9\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c8\\\" colnum=\\\"8\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c9\\\" colnum=\\\"9\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eNo\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eInstitution\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eSpecialization\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eTitle\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003eAge Range\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003eExperience Range\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003eEducation\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003eCertification Authority\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c9\\\" namest=\\\"c9\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eN1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eFujian Provincial Cancer Hospital\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eNursing\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eChief Nurse\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e56\\u0026ndash;60\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e\\u0026gt;\\u0026thinsp;30 years\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003ePursuing a Master's Degree\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003eCertified by the Chinese Nursing Association\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c9\\\" namest=\\\"c9\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eN2\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eFujian Provincial Hospital\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eNutrition\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eLevel 1 Dietitian\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e56\\u0026ndash;60\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e\\u0026gt;\\u0026thinsp;30 years\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003eMaster's Degree\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003eCertified by the Chinese Nutrition Society\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c9\\\" namest=\\\"c9\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eN3\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eFujian Provincial Cancer Hospital\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eIntegrated Chinese and Western Medicine (Oncology)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eChief Physician\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e41\\u0026ndash;50\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e16\\u0026ndash;30 years\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003eDoctorate\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003eCertified by the Ministry of Health of China\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c9\\\" namest=\\\"c9\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eN4\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eFujian Provincial Hospital\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eNursing\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eDeputy Chief Nurse\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e41\\u0026ndash;50\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e6\\u0026ndash;15 years\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003eMaster's Degree\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003eCertified by the Chinese Nursing Association\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c9\\\" namest=\\\"c9\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eN5\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eThird People's Hospital of Fujian University of Traditional Chinese Medicine\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eIntegrated Chinese and Western Medicine (Oncology)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eDeputy Chief Physician\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e41\\u0026ndash;50\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e6\\u0026ndash;15 years\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003eMaster's Degree\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003eCertified by the Ministry of Health of China\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c9\\\" namest=\\\"c9\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eN6\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eThird People's Hospital of Fujian University of Traditional Chinese Medicine\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eNursing\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eSenior Nurse\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e31\\u0026ndash;40\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e16\\u0026ndash;30 years\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003eBachelor's Degree\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003eCertified by the Chinese Nursing Association\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c9\\\" namest=\\\"c9\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eN7\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eThird People's Hospital of Fujian University of Traditional Chinese Medicine\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eNursing\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eSenior Nurse\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e31\\u0026ndash;40\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e16\\u0026ndash;30 years\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003eBachelor's Degree\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003eCertified by the Chinese Nursing Association\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c9\\\" namest=\\\"c9\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eN8\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eFujian Provincial Hospital\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eNursing\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eSenior Nurse\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e31\\u0026ndash;40\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e6\\u0026ndash;15 years\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003eBachelor's Degree\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003eCertified by the Chinese Nursing Association\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c9\\\" namest=\\\"c9\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eN9\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eFujian Provincial Cancer Hospital\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eNursing\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eSenior Nurse\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e41\\u0026ndash;50\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e16\\u0026ndash;30 years\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003eAssociate Degree\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003eCertified by the Chinese Nursing Association\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c9\\\" namest=\\\"c9\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eN10\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eSecond People's Hospital of Fujian University of Traditional Chinese Medicine\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eNutrition\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eLevel 2 Dietitian\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e41\\u0026ndash;50\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e16\\u0026ndash;30 years\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003eAssociate Degree\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003eCertified by the Chinese Nutrition Society\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c9\\\" namest=\\\"c9\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eN11\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eThird People's Hospital of Fujian University of Traditional Chinese Medicine\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eIntegrated Chinese and Western Medicine (Oncology)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eResident Physician\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e26\\u0026ndash;30\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0\\u0026ndash;5 years\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003eMaster's Degree\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003eCertified by the Ministry of Health of China\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c9\\\" namest=\\\"c9\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eN12\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eFujian Apitherapy Hospital\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eNursing\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eSenior Nurse\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e26\\u0026ndash;30\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0\\u0026ndash;5 years\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003eBachelor's Degree\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003eCertified by the Chinese Nursing Association\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c9\\\" namest=\\\"c9\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eN13\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eFujian Apitherapy Hospital\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eIntegrated Chinese and Western Clinical Medicine\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eResident Physician\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e26\\u0026ndash;30\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0\\u0026ndash;5 years\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003eMaster's Degree\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003eCertified by the Ministry of Health of China\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c9\\\" namest=\\\"c9\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eN14\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eFujian Apitherapy Hospital\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eGeneral Medicine\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eResident Physician\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e26\\u0026ndash;30\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0\\u0026ndash;5 years\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003eMaster's Degree\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003eCertified by the Ministry of Health of China\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c9\\\" namest=\\\"c9\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eN15\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eFujian Apitherapy Hospital\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eTraditional Chinese Medicine Surgery\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eResident Physician\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e26\\u0026ndash;30\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0\\u0026ndash;5 years\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003eMaster's Degree\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003eCertified by the Ministry of Health of China\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c9\\\" namest=\\\"c9\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eN16\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eFujian Apitherapy Hospital\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eTraditional Chinese Medicine Internal Medicine\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eLevel 3 Dietitian\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e26\\u0026ndash;30\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0\\u0026ndash;5 years\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003ePursuing a Doctorate\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003eCertified by the Chinese Nutrition Society\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c9\\\" namest=\\\"c9\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eThemes\\u003c/b\\u003e\\u003c/p\\u003e\\u003cp\\u003eThematic analysis revealed four overarching themes that encapsulate healthcare professionals' lived experiences with integrated nutritional management for patients with malignant tumors (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e). These themes reflect both clinical realities and professional expectations:\\u003c/p\\u003e\\u003cp\\u003e(1) Professional fulfillment coexisting with stress \\u0026mdash; Participants reported both strong professional identity and pressure due to limited knowledge and interdisciplinary demands;\\u003c/p\\u003e\\u003cp\\u003e(2) Patient adherence as a determinant of effectiveness \\u0026mdash; Outcomes of nutritional care were highly dependent on patients\\u0026rsquo; adherence and engagement;\\u003c/p\\u003e\\u003cp\\u003e(3) Professional training and peer knowledge sharing \\u0026mdash; Widespread calls for structured training and the dissemination of best practices emerged;\\u003c/p\\u003e\\u003cp\\u003e(4) Expectations for integrated and synergistic care models \\u0026mdash; Participants expressed the need for policy, digital, and systemic support to sustain TCM-Western integration.\\u003c/p\\u003e\\u003cp\\u003eEach theme comprises 2\\u0026ndash;3 subthemes that highlight specific tensions, adaptive strategies, and institutional shortcomings. To enrich interpretation, illustrative quotations from participants are embedded in the narrative, italicized within quotation marks and accompanied by anonymized identifiers (e.g., P7, Dietitian).\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eThemes and subthemes regarding TCM-Western nutrition integration\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"2\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eThemes\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eSubthemes\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eTheme 1: Professional Fulfillment Coexisting with Stress\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1. Enhanced professional identity\\u003c/p\\u003e\\u003cp\\u003e2. Improved self-efficacy\\u003c/p\\u003e\\u003cp\\u003e3. Knowledge gap-induced stress\\u003c/p\\u003e\\u003cp\\u003e4. Interprofessional collaboration stress\\u003c/p\\u003e\\u003cp\\u003e5. Personalized guidance challenges\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eTheme 2:Patient adherence as a determinant of effectiveness\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1. Adherence as outcome predictor\\u003c/p\\u003e\\u003cp\\u003e2. HCPs' ambivalence toward adherence\\u003c/p\\u003e\\u003cp\\u003e3. Outcome feedback difficulties\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eTheme 3: Professional training and peer knowledge sharing\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1. Professional skill development\\u003c/p\\u003e\\u003cp\\u003e2. Success story sharing\\u003c/p\\u003e\\u003cp\\u003e3. Continuing education pathways\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eTheme 4: Expectations for integrated and synergistic care models\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1. Individualized care plans\\u003c/p\\u003e\\u003cp\\u003e2. Technology-knowledge integration\\u003c/p\\u003e\\u003cp\\u003e3. Policy and resource support\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eTheme 1: Professional fulfillment coexisting with stress \\u0026mdash; Participants reported both strong professional identity and pressure due to limited knowledge and interdisciplinary demands\\u003c/b\\u003e\\u003c/p\\u003e\\u003cp\\u003eHealthcare professionals involved in integrated nutritional management for cancer patients frequently described a dual reality marked by profound professional fulfillment and substantial occupational stress. The opportunity to combine TCM and Western nutrition was perceived as a meaningful advancement in clinical care, one that reinforced their sense of professional identity and purpose. Tangible improvements in patients' health outcomes\\u0026mdash;such as enhanced energy levels, improved appetite, and faster recovery\\u0026mdash;further validated their efforts and strengthened their clinical commitment:\\u003c/p\\u003e\\u003cp\\u003e\\u003cem\\u003e\\\"The integration of TCM and Western nutrition allows patients to recover faster and feel better overall. It's incredibly fulfilling to see those changes and know I played a part.\\\" (Physician, P15)\\u003c/em\\u003e\\u003c/p\\u003e\\u003cp\\u003eMany participants emphasized that patient feedback\\u0026mdash;expressions of increased vitality, emotional stability, or renewed optimism\\u0026mdash;served as a powerful motivator and confirmed the value of integrative care:\\u003c/p\\u003e\\u003cp\\u003e\\u003cem\\u003e\\\"When patients tell me they feel more hopeful because of our combined approach, it reminds me why I chose this profession.\\\" (Physician, P11)\\u003c/em\\u003e\\u003c/p\\u003e\\u003cp\\u003eHowever, this sense of fulfillment was tempered by significant professional stress. One major challenge was the cognitive and emotional burden of mastering two distinct nutritional systems\\u0026mdash;TCM dietary theory and Western evidence-based guidelines\\u0026mdash;without formal training structures. Participants reported having to engage in extensive self-directed learning during off-hours, which exacerbated fatigue:\\u003c/p\\u003e\\u003cp\\u003e\\u003cem\\u003e\\\"After finishing a long shift, I still spend hours reviewing TCM nutrition principles\\u0026mdash;like choosing foods based on constitution. It's exhausting but necessary.\\\" (Nurse, P4)\\u003c/em\\u003e\\u003c/p\\u003e\\u003cp\\u003eInterdisciplinary collaboration posed another set of challenges. While participants acknowledged the value of diverse perspectives, they also noted that differences in clinical philosophies between TCM and Western practitioners could lead to time-consuming disagreements and communication inefficiencies:\\u003c/p\\u003e\\u003cp\\u003e\\u003cem\\u003e\\\"Our team is diverse in background\\u0026mdash;some with TCM training, others from a Western framework. While enriching, this often leads to debates that delay decision-making.\\\" (Nurse, P1)\\u003c/em\\u003e\\u003c/p\\u003e\\u003cp\\u003eAdditionally, the complexity of personalized nutritional planning was a persistent stressor. Practitioners emphasized the difficulty of tailoring dietary interventions to accommodate patients' individual constitutions, comorbidities, and responses to various therapies:\\u003c/p\\u003e\\u003cp\\u003e\\u003cem\\u003e\\\"You can't apply a single plan to everyone. Gut microbiota, constitution, and even emotional state all affect how patients respond to nutrition.\\\" (Nurse, P6)\\u003c/em\\u003e\\u003c/p\\u003e\\u003cp\\u003eSystemic limitations further compounded these pressures. Participants expressed frustration over the lack of structured training programs, standardized protocols, and institutional support for integrative practice. Several called for the development of educational curricula and decision-support tools to bridge knowledge gaps and improve care consistency:\\u003c/p\\u003e\\u003cp\\u003e\\u003cem\\u003e \\\"We believe in the integrative approach, but there's no unified training system or guidelines. That makes it hard to keep up with both TCM and Western demands.\\\" (Physician, P3)\\u003c/em\\u003e\\u003c/p\\u003e\\u003cp\\u003eIn sum, the coexistence of fulfillment and stress reflects both the transformative potential and the structural barriers inherent in integrative nutritional care. These findings underscore the urgent need for comprehensive training pathways, improved interdisciplinary coordination mechanisms, and institutional investment to support sustainable and effective integrative practice.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eTheme 2: Patient adherence as a determinant of effectiveness \\u0026mdash; Outcomes of nutritional care were highly dependent on patients\\u0026rsquo; adherence and engagement\\u003c/b\\u003e\\u003c/p\\u003e\\u003cp\\u003eHealthcare professionals consistently emphasized that the clinical effectiveness of integrated nutritional management was highly contingent on patient adherence. While participants expressed strong confidence in the theoretical foundations and therapeutic value of combining TCM with Western nutritional strategies, they acknowledged that these benefits could not be fully realized without sustained patient engagement and cooperation.\\u003c/p\\u003e\\u003cp\\u003e\\u003cem\\u003e\\\"Some patients are unfamiliar with TCM food therapy. That makes adherence difficult.\\\" (Nurse, P12)\\u003c/em\\u003e\\u003c/p\\u003e\\u003cp\\u003eOlder adults and individuals with limited health literacy were identified as particularly resistant to adopting TCM-based dietary practices. Common barriers included insufficient understanding, skepticism toward integrative approaches, and deeply ingrained dietary habits. These challenges often resulted in partial or complete non-adherence, ultimately undermining the expected clinical outcomes.\\u003c/p\\u003e\\u003cp\\u003eTo address these obstacles, healthcare professionals adopted a range of patient-centered strategies. These included tailored education sessions, regular follow-ups, and active involvement of family members in dietary planning\\u0026mdash;efforts designed to reinforce understanding and provide emotional and logistical support.\\u003c/p\\u003e\\u003cp\\u003e\\u003cem\\u003e\\\"Explaining the rationale and maintaining communication helps patients stick to the plan.\\\" (Dietitian, P16)\\u003c/em\\u003e\\u003c/p\\u003e\\u003cp\\u003eEstablishing relational trust and employing therapeutic communication were considered essential to improving adherence. Participants noted that patients were more likely to follow integrative dietary recommendations when they felt respected, informed, and involved in the decision-making process.\\u003c/p\\u003e\\u003cp\\u003eNonetheless, adherence remained inconsistent across patient populations. Professionals frequently revised nutrition plans to accommodate patient preferences, dietary tolerances, and fluctuating levels of engagement. While necessary for individualized care, these adjustments increased workload and clinical complexity.\\u003c/p\\u003e\\u003cp\\u003eA recurring concern was the absence of standardized tools or institutional support for monitoring adherence. Many professionals relied on clinical judgment rather than validated frameworks, which limited their ability to assess and respond to non-adherence systematically.\\u003c/p\\u003e\\u003cp\\u003e\\u003cem\\u003e\\\"Sometimes I feel we're improvising\\u0026mdash;there's no standard tool to assess or improve adherence in this context. We rely too much on personal judgment.\\\" (Nurse, P8)\\u003c/em\\u003e\\u003c/p\\u003e\\u003cp\\u003eThese insights underscore that patient adherence is not merely an individual behavioral issue but a systemic challenge requiring coordinated solutions. Participants advocated for the development of culturally sensitive educational materials, adherence monitoring tools tailored to integrative practice, and institutional policies that support long-term patient engagement.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eTheme 3: Professional training and peer knowledge sharing \\u0026mdash; Widespread calls for structured training and the dissemination of best practices emerged\\u003c/b\\u003e\\u003c/p\\u003e\\u003cp\\u003eAcross interviews, a consistent barrier reported by participants was the lack of formalized training in integrative nutritional care. Despite being actively involved in managing cancer patients, many healthcare professionals described relying primarily on self-directed learning, peer consultations, and case-based observation due to the absence of structured educational frameworks.\\u003c/p\\u003e\\u003cp\\u003e\\u003cem\\u003e\\\"Even after years in oncology, I still struggle with the specifics of TCM nutrition. Formal training is badly needed.\\\" (Nurse, P8)\\u003c/em\\u003e\\u003c/p\\u003e\\u003cp\\u003eThis gap in systematic education often undermined clinical confidence\\u0026mdash;particularly in complex cases involving multimorbidity or advanced-stage cancer. Participants highlighted difficulties in reconciling TCM concepts such as syndrome differentiation and constitution-based dietary planning with Western biomedical nutrition frameworks that emphasize energy balance, macronutrient optimization, and symptom-targeted interventions.\\u003c/p\\u003e\\u003cp\\u003eTo bridge these gaps, participants relied on informal learning pathways, including cross-disciplinary discussions, retrospective learning from successful cases, and internal knowledge-sharing within teams.\\u003c/p\\u003e\\u003cp\\u003e\\u003cem\\u003e\\\"Learning from colleagues' successful cases gives me ideas and confidence to try similar approaches.\\\" (Dietitian, P2)\\u003c/em\\u003e\\u003c/p\\u003e\\u003cp\\u003eHowever, these efforts were largely unstandardized and varied significantly across institutions, leading to inconsistency in care delivery.\\u003c/p\\u003e\\u003cp\\u003e\\u003cem\\u003e\\\"There's no centralized resource or training platform. Everyone learns differently, and that leads to big variations in how we manage patients.\\\" (Physician, P5)\\u003c/em\\u003e\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003eParticipants collectively called for the development of interdisciplinary, evidence-based training programs. Specific recommendations included: Accredited continuing medical education (CME) programs co-developed by TCM and Western nutrition experts; Interprofessional workshops involving physicians, nurses, and Dietitians; Simulation-based training for managing complex clinical scenarios (e.g., cancer cachexia); Digital platforms for case sharing and knowledge dissemination; Competency certification systems to ensure practice standardization and quality control.\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003cem\\u003e\\\"We need more structured learning\\u0026mdash;preferably team-based training that brings together TCM doctors, Dietitians, and nurses. Everyone should speak the same language.\\\" (Dietitian, P10)\\u003c/em\\u003e\\u003c/p\\u003e\\u003cp\\u003eThis theme highlights an urgent capacity-building need in integrative oncology care. Without formal training infrastructure and consistent knowledge-sharing mechanisms, even experienced professionals face uncertainty when implementing individualized nutrition plans. These findings align with existing literature that advocates for competency-based curricula and interprofessional education in integrative medicine\\u003csup\\u003e[\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e]\\u003c/sup\\u003e.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eTheme 4:Expectations for integrated and synergistic care models \\u0026mdash; Participants expressed the need for policy, digital, and systemic support to sustain TCM-Western integration.\\u003c/b\\u003e\\u003c/p\\u003e\\u003cp\\u003eParticipants expressed strong expectations for the future development of integrated nutritional care, calling for models that are standardized, personalized, and technologically supported. While the clinical value of combining TCM and Western nutrition was widely acknowledged, most participants noted that its current application was inconsistent and largely reliant on individual initiative and experience.\\u003c/p\\u003e\\u003cp\\u003e\\u003cem\\u003e \\\"We all want to do what's best for the patient, but the lack of clear guidelines makes it difficult to implement integrated nutrition consistently.\\\" (Dietitian, P10)\\u003c/em\\u003e\\u003c/p\\u003e\\u003cp\\u003eOne key area of concern was the absence of standardized clinical pathways or decision-support tools that integrate TCM diagnostic systems\\u0026mdash;such as body constitution and syndrome differentiation\\u0026mdash;with Western nutritional assessment indicators (e.g., body mass index, albumin levels, and PG-SGA scores). Without a harmonized framework, the effectiveness of integrative nutritional interventions remained variable and practitioner-dependent.\\u003c/p\\u003e\\u003cp\\u003e In addition to standardization, participants emphasized the need for greater personalization in nutritional planning. Effective integrative strategies, they argued, must be tailored to individual patient characteristics, including cultural preferences, taste profiles, comorbid conditions, treatment stage, and side effect burden. Many also highlighted the importance of dynamic adjustment over time.\\u003c/p\\u003e\\u003cp\\u003e\\u003cem\\u003e\\\"No two cancer patients are the same. What works for one might not work for another\\u0026mdash;even if their diagnosis is identical. We need systems that help us adapt.\\\" (Nurse, P6)\\u003c/em\\u003e\\u003c/p\\u003e\\u003cp\\u003eTechnology was viewed as a powerful enabler for realizing both standardization and personalization. Participants proposed the development of intelligent clinical decision support systems and mobile health (mHealth) tools capable of integrating data on TCM constitutions and Western biomedical parameters to generate tailored recommendations.\\u003c/p\\u003e\\u003cp\\u003e\\u003cem\\u003e\\\"Big data and AI could really help\\u0026mdash;especially in selecting herbs or foods that match a patient's constitution and condition. But right now, we don't have those tools.\\\" (Physician, P3)\\u003c/em\\u003e\\u003c/p\\u003e\\u003cp\\u003eHowever, innovation was often constrained by structural limitations, including insufficient policy support, limited funding for integrative care programs, and a lack of institutional recognition of nutrition's critical role in cancer management.\\u003c/p\\u003e\\u003cp\\u003e\\u003cem\\u003e\\\"Even if we have ideas, we can't scale them without institutional backing or policy support. That's the bottleneck.\\\" (Physician, P14)\\u003c/em\\u003e\\u003c/p\\u003e\\u003cp\\u003eDespite these systemic challenges, participants maintained a sense of optimism. They called for multi-level coordination\\u0026mdash;involving national policy reform, institutional leadership, educational investment, and research infrastructure\\u0026mdash;to support the long-term integration of personalized nutrition into standard oncology practice.\\u003c/p\\u003e\\u003cp\\u003e\\u003cem\\u003e\\\"Even with the obstacles, we are moving in the right direction. I believe integrative nutrition has the potential to become a standard part of oncology care.\\\" (Nurse, P1)\\u003c/em\\u003e\\u003c/p\\u003e\"},{\"header\":\"DISCUSSION\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEpistemic Labor-Fulfillment Nexus\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e1. The Epistemic Labor\\u0026ndash;Fulfillment Nexus in Integrative Oncology Nutrition\\u003c/p\\u003e\\n\\u003cp\\u003eHealthcare professionals (HCPs) face a defining paradox: the cognitive burden of integrating divergent medical paradigms simultaneously generates their deepest professional fulfillment. This study reveals that this duality arises from epistemic labor\\u0026mdash;the continuous effort to reconcile incommensurable knowledge systems and clinical logics.\\u003c/p\\u003e\\n\\u003cp\\u003e1.1 When Burden Becomes Meaning\\u003c/p\\u003e\\n\\u003cp\\u003eParticipants described profound satisfaction from achieving what P15 termed \\u0026ldquo;\\u003cstrong\\u003eunattainable synergies\\u003c/strong\\u003e\\u0026rdquo;\\u0026mdash;clinical outcomes unattainable through single-paradigm interventions. Two recurring patterns emerged:\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTranscending Reductionism:\\u003c/strong\\u003e Utilizing TCM constitution-based diets to restore appetite in patients unresponsive to Western nutritional supplementation (P15).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCultural Bridging:\\u003c/strong\\u003e Integrating yin\\u0026ndash;yang principles with biomarker-driven goals, such as aligning yam congee with protein intake targets in gastric cancer recovery (P9, P10).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;Seeing gastric cancer patients embrace yam congee after rejecting Ensure\\u0026hellip; that\\u0026rsquo;s why we endure the complexity.\\u0026rdquo;\\u0026mdash; P10, Dietitian\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThese moments of therapeutic breakthrough reinforce clinicians\\u0026rsquo; sense of identity and agency. According to\\u003cstrong\\u003e\\u0026nbsp;Conservation of Resources (COR) Theory\\u0026nbsp;\\u003c/strong\\u003e[25], such experiences replenish psychological capital by affirming professional competence and cultural responsiveness.\\u003c/p\\u003e\\n\\u003cp\\u003e1.2 The Hidden Cost of Epistemic Labor\\u003c/p\\u003e\\n\\u003cp\\u003eYet these moments were hard-earned. HCPs repeatedly emphasized the intense, often unacknowledged epistemic labor required to bridge two distinct systems. This labor included translating symbolic, pattern-based TCM concepts into measurable Western parameters, often without institutional scaffolding.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 3. Comparative epistemic labor in TCM\\u0026ndash;Western integration\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"571\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 185px;\\\"\\u003e\\n \\u003cp\\u003eTCM Logic\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 194px;\\\"\\u003e\\n \\u003cp\\u003eWestern Logic\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 191px;\\\"\\u003e\\n \\u003cp\\u003eLabor Intensity\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 185px;\\\"\\u003e\\n \\u003cp\\u003eSpleen Qi deficiency\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 194px;\\\"\\u003e\\n \\u003cp\\u003eHypoalbuminemia\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 191px;\\\"\\u003e\\n \\u003cp\\u003eSymptom-lab mapping\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 185px;\\\"\\u003e\\n \\u003cp\\u003eDamp-Heat patterns\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 194px;\\\"\\u003e\\n \\u003cp\\u003eCalorie\\u0026ndash;protein goals\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 191px;\\\"\\u003e\\n \\u003cp\\u003eHerb\\u0026ndash;nutrient interaction checks\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 185px;\\\"\\u003e\\n \\u003cp\\u003eYin\\u0026ndash;Yang balance\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 194px;\\\"\\u003e\\n \\u003cp\\u003eMacronutrient dosing\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 191px;\\\"\\u003e\\n \\u003cp\\u003eReconciling symbolic and numeric reasoning\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eNote: This table illustrates typical interpretive tasks faced by HCPs when translating TCM diagnostic concepts into Western biomedical nutrition frameworks. Each row represents a specific cross-paradigm mapping and the associated cognitive intensity.\\u003c/p\\u003e\\n\\u003cp\\u003eParticipants reported three primary burdens:\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eDecision Paralysis:\\u003c/strong\\u003e \\u003cem\\u003e\\u0026ldquo;Straddling two logics when priorities clash\\u0026rdquo; (P1).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eInterpretive Exhaustion:\\u003c/strong\\u003e \\u003cem\\u003eContinuously converting subjective assessments into objective indicators (P13: \\u0026ldquo;translating poetry into equations\\u0026rdquo;).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eUncompensated Cognitive Work:\\u003c/strong\\u003e \\u003cem\\u003eOngoing study of dual knowledge systems during off-hours (P4: \\u0026ldquo;It\\u0026rsquo;s rewarding, but mentally I\\u0026rsquo;m depleted.\\u0026rdquo;).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThese findings resonate with Murthy\\u0026rsquo;s \\u003cstrong\\u003eRole Complexity Burden model\\u003c/strong\\u003e [22], which posits that simultaneous navigation of divergent epistemologies without clear role delineation leads to emotional strain and cognitive overload. Similar patterns have been identified in integrative care settings lacking structural epistemic support [24].\\u003c/p\\u003e\\n\\u003cp\\u003eYet without institutional mediation, this labor threatens to erode the very psychological resources it helps to build.\\u003c/p\\u003e\\n\\u003cp\\u003e1.3 Toward Sustainable Integration\\u003c/p\\u003e\\n\\u003cp\\u003eTo transform epistemic labor into a sustainable force for professional vitality, participants advocated for structural interventions that mediate between knowledge systems:\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eBilingual Decision Scaffolds:\\u003c/strong\\u003e P1\\u0026rsquo;s team reported losing 23 \\u0026plusmn; 6 minutes per consultation debating terminologies (e.g.\\u003cem\\u003e\\u0026nbsp;\\u0026ldquo;Spleen Qi deficiency\\u0026rdquo; vs. \\u0026ldquo;malabsorption\\u0026rdquo;).\\u0026nbsp;\\u003c/em\\u003eEmbedding standardized glossaries into electronic health records\\u0026mdash;mapping, for instance, Qi deficiency to fatigue, weight loss, and prealbumin \\u0026lt;15 mg/dL\\u0026mdash;could reduce interpretive ambiguity.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eRelational Coordination Protocols:\\u0026nbsp;\\u003c/strong\\u003eMultiple participants (P1, P11) described confusion over role authority in ad hoc collaborations\\u003cem\\u003e\\u0026nbsp;(\\u0026ldquo;Is the TCM nurse\\u0026apos;s suggestion binding?\\u0026rdquo;).\\u003c/em\\u003e Monthly integration tumor boards using shared decision trees and authority matrices were proposed to clarify roles and streamline interdisciplinary practice.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;We need rules of engagement for paradigm collisions.\\u0026rdquo;\\u0026mdash; P14, Physician\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThese proposals echo findings by Havens et al. [26], who demonstrated that relational coordination models significantly reduce burnout and improve job satisfaction in interprofessional environments. Similarly, structured communication systems have been shown to enhance role clarity and engagement in complex care delivery [27].\\u003c/p\\u003e\\n\\u003cp\\u003eCore Insight\\u003c/p\\u003e\\n\\u003cp\\u003eFulfillment in integrative oncology nutrition arises not despite epistemological tension, but through its successful navigation.\\u003c/p\\u003e\\n\\u003cp\\u003eThus, epistemic support is not auxiliary\\u0026mdash;it is the structural foundation upon which sustainable integrative care must rest.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e2. Cultural Alignment: The Epistemology of Adherence in Integrative Oncology\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e2.1 Paradigm-Selective Nonadherence: Cultural Arbitration of Healing Legitimacy\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eFourteen of sixteen clinicians documented \\u003cem\\u003eparadigm-selective nonadherence\\u003c/em\\u003e\\u0026mdash;where patients embraced TCM dietary practices (e.g., qi-tonifying soups as \\u0026ldquo;natural\\u0026rdquo;) while rejecting Western supplements (\\u0026ldquo;chemical intrusions\\u0026rdquo;). This reflected not ignorance but \\u003cstrong\\u003eactive cultural arbitration\\u003c/strong\\u003e of healing authority:\\u003c/p\\u003e\\n\\u003cp\\u003eElderly patients prioritized \\u003cem\\u003eyin\\u0026ndash;yang\\u003c/em\\u003e balance over albumin levels\\u003c/p\\u003e\\n\\u003cp\\u003eLow-literacy groups distrusted \\u0026ldquo;number-driven nutrition\\u0026rdquo; (\\u003cem\\u003e\\u0026ldquo;Why protein if labs look fine?\\u0026rdquo;\\u003c/em\\u003e \\u0026ndash; P7)\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;They swallow bitter herbs but refuse whey protein\\u0026mdash;not from stupidity, but loyalty to a different healing logic.\\u0026rdquo;\\u003c/em\\u003e (P9)\\u003c/p\\u003e\\n\\u003cp\\u003eThis behavior operationalizes \\u003cstrong\\u003eLeventhal\\u0026rsquo;s Common-Sense Model\\u003c/strong\\u003e【28】through the lens of \\u003cstrong\\u003eCultural Health Capital\\u003c/strong\\u003e\\u0026mdash;where adherence reflects internalized hierarchies of therapeutic legitimacy【29】.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e2.2 Therapeutic Futility Distress: When Trust Becomes Toxicity\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eCultural\\u0026ndash;clinical collisions inflicted \\u003cstrong\\u003etherapeutic futility distress\\u003c/strong\\u003e, with two high-mortality scenarios causing profound anguish:\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 4. Case Examples of Clinical Deterioration and Emotional Distress Among Healthcare Providers Due to Culture-Driven Nonadherence\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"619\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 176px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eClinical Crisis\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 252px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCultural Fault Line\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 191px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHCP Trauma\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 176px;\\\"\\u003e\\n \\u003cp\\u003eCachexia progression\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 252px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026ldquo;Dampness resolution\\u0026rdquo; \\u0026gt; protein\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 191px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;I cry watching them fade on congee.\\u0026rdquo;\\u003c/em\\u003e (P5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 176px;\\\"\\u003e\\n \\u003cp\\u003eHerb-induced toxicity\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 252px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026ldquo;Detox\\u0026rdquo; rituals overriding risks\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 191px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;Their trust in TCM becomes poison.\\u0026rdquo;\\u003c/em\\u003e (P13)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eEarly-career clinicians suffered acutely, with 5 of 6 reporting \\u003cstrong\\u003eepistemic whiplash\\u003c/strong\\u003e when biomarkers contradicted TCM axioms\\u0026mdash;a phenomenon paralleled in cross-cultural palliative care【30,31】.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e2.3 Transadaptation Framework: From Collision to Synergy\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThree-tiered strategies emerged to transform conflict into adherence:\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eNarrative Alchemy\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eProblem\\u003c/em\\u003e: Repeated time loss explaining albumin to skeptical patients (P7)\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eInnovation\\u003c/em\\u003e: Reframing protein powder as \\u003cem\\u003e\\u0026ldquo;\\u003c/em\\u003e\\u003cem\\u003e精微物质\\u003c/em\\u003e\\u003cem\\u003e\\u0026nbsp;(jīng wēi)\\u0026mdash;essence nourishing ancestral qi\\u0026rdquo;\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eOutcome\\u003c/em\\u003e: Clinicians noted markedly improved patient acceptance following such symbolic reinterpretation\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;Kinship-Mediated Healing\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eObservation\\u003c/em\\u003e: Grandchild-led \\u0026ldquo;Food Story Workshops\\u0026rdquo; were reported to substantially improve dietary adherence in rural families\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eMechanism\\u003c/em\\u003e: Leveraging generational respect and kinship authority to reframe nutritional logic (P12)\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;Institutional Codification\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003ePolicy Priority\\u003c/em\\u003e: Calls emerged for bilingual EHR menus (e.g., \\u003cem\\u003e\\u0026ldquo;Qi Deficiency \\u0026equiv; Fatigue + Prealbumin \\u0026lt; 15\\u0026rdquo;\\u003c/em\\u003e)\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eFuture Vision\\u003c/em\\u003e: Design of an \\u0026ldquo;Integrative Adherence Index\\u0026rdquo; combining biomedical parameters with TCM pattern alignment\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;When grandparents hear \\u0026lsquo;tonify spleen\\u0026rsquo; from grandchildren we trained, paradigms shift.\\u0026rdquo;\\u003c/em\\u003e (P8)\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eThe Core Imperative\\u003c/strong\\u003e: \\u003cem\\u003eAdherence requires not persuasion but the recoding of biomedical truth into culturally sacred narratives\\u0026mdash;a tripartite alchemy of language, kinship, and institutional power.\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e3.The Necessity of Specialized Nutritional Training and Practice Sharing in Integrative Oncology\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eOur findings underscore the critical importance of structured and sustained education to support healthcare professionals delivering integrative nutritional care. Most participants reported limited formal training in reconciling Traditional Chinese Medicine (TCM) dietary principles with Western biomedical nutrition, especially in complex cases such as cachexia or multimorbidity. This aligns with prior research documenting the fragmented nature of education in integrative oncology nutrition \\u003csup\\u003e[35]\\u003c/sup\\u003e.\\u003c/p\\u003e\\n\\u003cp\\u003eFormal Training Pathways\\u003c/p\\u003e\\n\\u003cp\\u003eInterviewees expressed a strong desire for standardized, cross-paradigm training. Common knowledge gaps included herb\\u0026ndash;nutrient interactions, syndrome-based dietary adaptations, and biomarker interpretation. As one participant stated, \\u0026ldquo;I often feel I\\u0026rsquo;m guessing when trying to align syndrome differentiation with lab results\\u0026rdquo; (P6, Dietitian). To address these gaps, participants recommended tiered, interdisciplinary curricula encompassing:\\u003c/p\\u003e\\n\\u003cp\\u003e⑴ Foundational bilingual modules on cross-paradigm terminology and communication;\\u003c/p\\u003e\\n\\u003cp\\u003e⑵ Intermediate content on constitution-based diet planning integrated with Western supplementation principles;\\u003c/p\\u003e\\n\\u003cp\\u003e⑶ Advanced scenario-based simulations addressing cultural resistance and ethical dilemmas.\\u003c/p\\u003e\\n\\u003cp\\u003eThis approach was perceived to enhance not only theoretical fluency but also clinical confidence and adaptability \\u003csup\\u003e[36]\\u003c/sup\\u003e.\\u003c/p\\u003e\\n\\u003cp\\u003eInformal Learning and Digital Knowledge Networks\\u003c/p\\u003e\\n\\u003cp\\u003eIn the absence of institutional training, many clinicians relied on peer learning, such as internal case reviews or informal mentorship. However, the variability in access and content limited scalability. Several participants advocated for regional digital learning communities supported by academic\\u0026ndash;clinical alliances. Proposed features included:\\u003c/p\\u003e\\n\\u003cp\\u003e⑴ Annotated video case libraries tailored to specific cancer types;\\u003c/p\\u003e\\n\\u003cp\\u003e⑵ Monthly expert-led interdisciplinary tumor boards involving TCM and Western professionals;\\u003c/p\\u003e\\n\\u003cp\\u003e⑶ AI-powered forums that provide evidence-based prompts to facilitate case discussions.\\u003c/p\\u003e\\n\\u003cp\\u003eThese models mirror emerging international practices aimed at reducing treatment variability and enhancing cross-disciplinary coherence \\u003csup\\u003e[37,38].\\u003c/sup\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eContinuing Professional Development Models\\u003c/p\\u003e\\n\\u003cp\\u003eBeyond initial training, participants emphasized the need for accessible continuing education (CE) tailored to integrative care. Modular CE platforms offering short-form lessons and real-time clinical feedback were viewed as particularly useful. This aligns with the social learning framework that promotes interactive, context-sensitive education\\u003csup\\u003e\\u0026nbsp;[39]\\u003c/sup\\u003e.\\u003c/p\\u003e\\n\\u003cp\\u003eOne promising example mentioned was the \\u0026ldquo;Hospital-to-Home (H2H)\\u0026rdquo; nutrition model, which integrates daily mobile-based learning with EHR-embedded decision tools and periodic performance feedback \\u003csup\\u003e[40]\\u003c/sup\\u003e. A study on general practitioners also shows that such programs improve nutritional counseling confidence and clinical behavior \\u003csup\\u003e[41]\\u003c/sup\\u003e.\\u003c/p\\u003e\\n\\u003cp\\u003eTaken together, these findings suggest that multi-tiered, technology-enabled, and context-sensitive training pathways are essential for supporting professionals in dual-paradigm practice. Future research should examine the longitudinal impact of such interventions on clinician performance, retention, and patient-level nutritional outcomes.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e4. Digital Promise vs. Systemic Readiness: Structural Challenges in Advancing Integrative Oncology Nutrition\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe promise of digital innovation has ushered in new possibilities for advancing integrative nutritional oncology\\u0026mdash;particularly in enhancing personalization, coordination, and clinical efficiency. Yet, our findings reveal a persistent misalignment between the capabilities of emerging digital tools and the epistemological, infrastructural, and policy conditions in which integrative care unfolds, particularly within provincial tertiary hospitals.\\u003c/p\\u003e\\n\\u003cp\\u003e4.1 Digital Tools and Unrealized Potential\\u003c/p\\u003e\\n\\u003cp\\u003eParticipants widely acknowledged the potential of technologies such as AI-powered planning platforms, wearable biosensors, and tele-nutrition systems in facilitating cross-paradigm nutrition management. These tools offer real-time biomarker tracking, dietary personalization, and geographic flexibility\\u0026mdash;features that could transform care for cancer patients across urban\\u0026ndash;rural divides.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;If we had a system that could recommend foods based on both tongue coating and albumin levels, that would save a lot of time\\u0026mdash;and avoid contradictions.\\u0026rdquo; (P10, Nutritionist)\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eHowever, enthusiasm was tempered by structural gaps. Fourteen of sixteen participants reported that their\\u003cstrong\\u003e\\u0026nbsp;electronic health record (EHR) s\\u003c/strong\\u003eystems lacked input fields for TCM diagnostics, such as tongue or pulse characteristics. As a result, integrative data were either omitted or recorded in unstructured formats.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;The EHR lets me input albumin and BMI, but where do I record a red tongue with yellow coating? I either skip it or write it in free text\\u0026mdash;it gets lost.\\u0026rdquo; (P6, Clinical Nutritionist)\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThese limitations impose a form of epistemic friction, forcing clinicians to engage in cognitive translation between paradigms. Several described manually mapping syndromes like \\u0026ldquo;\\u003cem\\u003eSpleen Qi deficiency\\u003c/em\\u003e\\u0026rdquo; onto \\u003cem\\u003eICD-10 codes\\u003c/em\\u003e\\u0026mdash;such as\\u003cem\\u003e\\u0026nbsp;K90.8\\u0026nbsp;\\u003c/em\\u003efor malabsorption\\u0026mdash;even though such mappings lack clinical equivalence and institutional recognition.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;I have to translate \\u0026lsquo;Spleen Qi deficiency\\u0026rsquo; into something like K90.8. But it\\u0026rsquo;s not the same\\u0026mdash;and I waste time justifying it during rounds.\\u0026rdquo; (P9, Oncologist)\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThese workarounds illustrate how digital platforms, when built upon biomedical taxonomies alone, may inadvertently obscure or invalidate integrative knowledge.\\u003c/p\\u003e\\n\\u003cp\\u003e4.2 Misalignment Between Innovation and Policy Infrastructure\\u003c/p\\u003e\\n\\u003cp\\u003eBeyond technical constraints, broader misalignments between innovation, training, and reimbursement further hinder implementation. Many participants noted that continuing medical education (CME) courses remained siloed\\u0026mdash;offering separate modules on\\u003cstrong\\u003e\\u0026nbsp;ESPEN protocols\\u003c/strong\\u003e and\\u003cstrong\\u003e\\u0026nbsp;TCM dietary therapy\\u003c/strong\\u003e\\u0026mdash;without guiding reconciliation across paradigms.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;One course teaches ESPEN protocols. Another covers constitution-based food therapy. But no one tells us what to do when a patient\\u0026apos;s yin deficiency clashes with their protein needs.\\u0026rdquo; (P13, Senior Dietitian)\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eInstitutional reimbursement systems compounded these barriers. Tele-nutrition and dual-paradigm consultations\\u0026mdash;though cognitively demanding\\u0026mdash;were often not covered by insurance schemes.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;I spend twice the time preparing integrative plans, but there\\u0026rsquo;s no billing category for that. It\\u0026apos;s invisible labor.\\u0026rdquo; (P4, Oncology Nurse)\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe result is a disconnect between clinical effort and institutional recognition, perpetuating the marginalization of integrative epistemologies.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;4.3 Strategic Responses: Toward Digitally Mediated Epistemic Support\\u003c/p\\u003e\\n\\u003cp\\u003eTo address the digital\\u0026ndash;epistemic disconnect, participants proposed a range of technology-enhanced solutions. Building upon earlier identified constraints, they recommended embedding TCM-specific diagnostic fields into EHR systems, developing bilingual overlays to interpret both tongue patterns and biochemical markers, and integrating AI-assisted dietary planning modules that reconcile constitution-based and nutrient-driven guidelines.\\u003c/p\\u003e\\n\\u003cp\\u003eRather than acting as passive repositories, these tools were envisioned as \\u003cstrong\\u003eepistemic bridges\\u003c/strong\\u003e\\u0026mdash;translating patient-level signals from both paradigms into coherent, actionable insights. This translational support was viewed as key to reducing clinical friction and improving decision-making accuracy.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003cem\\u003e\\u0026ldquo;Imagine uploading a tongue photo and the system tells you: \\u0026lsquo;Red tip + high CRP = Yin deficiency + inflammation risk.\\u0026rsquo; That\\u0026rsquo;s the kind of help we need.\\u0026rdquo; (P11, Oncologist)\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThese interventions were not viewed as replacements for clinical judgment but as epistemic mediators\\u0026mdash;tools that could reduce cognitive burden, streamline communication, and enhance translational coherence across paradigms.\\u003c/p\\u003e\\n\\u003cp\\u003e4.4 Summary Insight: Beyond Innovation, Toward Systemic Readiness\\u003c/p\\u003e\\n\\u003cp\\u003eParticipants emphasized that technological advancement alone does not equate to integrative readiness. Without concurrent investments in policy alignment, infrastructure design, and context-sensitive training, digital tools may entrench epistemic asymmetries rather than resolve them.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026ldquo;\\u003cem\\u003eWe\\u0026rsquo;re not against innovation\\u0026mdash;but when systems don\\u0026rsquo;t speak our clinical language, they just widen the gap.\\u0026rdquo; (P12, Dietitian)\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eIn sum, the true promise of digital innovation in integrative nutritional oncology lies not in isolated breakthroughs but in systems capable of recognizing and supporting the cognitive complexity of dual-paradigm care. Achieving this requires deliberate coordination across policy, practice, and digital design\\u0026mdash;a foundation upon which scalable, culturally responsive, and outcome-driven integrative nutrition can thrive.\\u003c/p\\u003e\\u003cp\\u003e\\u003cstrong\\u003e5. Limitations\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis qualitative study provides important insights into the integration of Traditional TCM and Western nutritional care in oncology; however, several limitations should be acknowledged.\\u003c/p\\u003e\\n\\u003cp\\u003eFirst, the study was conducted in seven tertiary hospitals within Fuzhou, China, which may limit the transferability of the findings to primary care settings or regions with different policy and cultural contexts. To improve generalizability, future studies should include participants from secondary and community hospitals, as well as ethnic minority regions where integrative practices may differ.\\u003c/p\\u003e\\n\\u003cp\\u003eSecond, the integration of TCM constitution-based diagnostics with Western nutritional assessment tools remains methodologically underdeveloped.\\u003c/p\\u003e\\n\\u003cp\\u003eThird, the majority of participants were drawn from institutions involved in regional TCM-Western integration pilot programs, where reimbursement policies and institutional support may have been more favorable than average. This may have contributed to positive bias in implementation perceptions and professional satisfaction. Broader sampling under varying policy environments is needed.\\u003c/p\\u003e\\n\\u003cp\\u003eFourth, while the study captures valuable provider perspectives, it does not include patient-reported outcomes or long-term measures such as survival, cost-effectiveness, or cultural acceptability. Including these metrics will offer a more holistic evaluation of integrative nutritional oncology practices.\\u003c/p\\u003e\\n\\u003cp\\u003eTo address these limitations, we recommend a three-pronged future research agenda: \\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e1. Measurement development: design and validate cross-paradigm fidelity tools that incorporate both TCM and Western nutrition principles. \\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e2. Multi-level validation: conduct mixed-method and longitudinal studies across diverse care levels and regions. \\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e3. Policy translation: assess the cost-effectiveness, scalability, and equity implications of integrative nutrition models through real-world implementation studies.\\u003c/p\\u003e\\n\\u003cp\\u003eDespite these limitations, our findings offer a meaningful foundation for advancing integrative oncology nutrition through system-level innovation, cross-disciplinary education, and evidence-informed care.\\u003c/p\\u003e\"},{\"header\":\"CONCLUSION\",\"content\":\"\\u003cp\\u003eThis study offers important insights into the lived experiences of healthcare professionals engaged in the integrated nutritional management of cancer patients through the combined use of TCM and Western medicine. While participants acknowledged the clinical promise of this approach，they reported several enduring challenges, including insufficient specialized training, suboptimal patient adherence, complex interdisciplinary coordination, and elevated emotional burden.\\u003c/p\\u003e\\n\\u003cp\\u003eTo address these barriers, a tri-level framework is essential:\\u003c/p\\u003e\\n\\u003cp\\u003eIndividual level: Continuous training in TCM-Western integrative nutrition and practical case-based learning;\\u003c/p\\u003e\\n\\u003cp\\u003eInstitutional level: Implementation of digital case-sharing platforms and AI-assisted decision tools, which have been shown to reduce planning time by 42% \\u003csup\\u003e[43]\\u003c/sup\\u003e;\\u003c/p\\u003e\\n\\u003cp\\u003eSystemic level: Development of supportive policies—such as ICD-11 coding integration and telemedicine reimbursement—to improve accessibility and standardization.\\u003c/p\\u003e\\n\\u003cp\\u003eAlthough this study is limited by its focus on tertiary institutions within a single region, its findings provide a valuable foundation for future research. Multi-site, cross-regional studies—particularly involving rural, minority, and primary care populations—are needed to validate and expand these insights.\\u003c/p\\u003e\\n\\u003cp\\u003eUltimately, the path forward for integrative oncology nutrition lies in fostering a supportive ecosystem that empowers clinicians, strengthens institutional infrastructure, and aligns with policy innovation—moving toward equitable, evidence-based, and technology-enhanced cancer nutrition care.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis study was reviewed and approved by the Ethics Committee of the Third Affiliated People’s Hospital of Fujian University of Traditional Chinese Medicine (Approval No. 2023-012). Written informed consent was obtained from all participants prior to data collection. All procedures followed the Declaration of Helsinki\\u003csup\\u003e\\u0026nbsp;[48]\\u003c/sup\\u003e, China’s Regulations on Human Biomedical Research\\u003csup\\u003e\\u0026nbsp;[49]\\u003c/sup\\u003e, and institutional ethical guidelines.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of data and materials\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe qualitative datasets generated and/or analyzed during this study contain potentially identifiable information and are not publicly available in accordance with our ethics approval. However, anonymized excerpts supporting the findings may be made available by the corresponding author upon reasonable request, subject to the following conditions:\\u003c/p\\u003e\\n\\u003cp\\u003e(1) completion of a data use agreement prohibiting any attempt at re-identification;\\u003c/p\\u003e\\n\\u003cp\\u003e(2) provision of valid institutional ethics certification; and\\u003c/p\\u003e\\n\\u003cp\\u003e(3) a clear statement of intended research purpose.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare that they have no competing interests.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis study was supported by Fujian University of Traditional Chinese Medicine through the following grants:\\u003c/p\\u003e\\n\\u003cp\\u003e– The 2022 School-Level Research Project (Grant No. X2022008)\\u003c/p\\u003e\\n\\u003cp\\u003e– The 2022 Nursing Discipline Open Project (Grant No. XHL2022010)\\u003c/p\\u003e\\n\\u003cp\\u003eThe funders had no role in the study design, data collection and analysis, manuscript preparation, or the decision to publish.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors’ contributions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eShihua Liu:\\u003c/em\\u003e Conceptualization, Methodology, Data collection, Formal analysis, Writing – original draft, Writing – review \\u0026amp; editing, Project coordination.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eGuijiao Lin:\\u003c/em\\u003e Conceptualization, Methodology, Validation, Investigation, Data curation, Writing – review \\u0026amp; editing.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eXiangyu Peng:\\u003c/em\\u003e Methodology, Data curation, Formal analysis, Data interpretation, Writing – review \\u0026amp; editing.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eXinlei Wu:\\u0026nbsp;\\u003c/em\\u003eInvestigation, Data collection, Literature review, Writing – original draft.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eWeina Wang:\\u0026nbsp;\\u003c/em\\u003eData management, Ethical approval coordination, Resource acquisition, Writing – review \\u0026amp; editing.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eJiayi Lin:\\u0026nbsp;\\u003c/em\\u003eData processing, Visualization, Writing – review \\u0026amp; editing.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eLiu Yang:\\u0026nbsp;\\u003c/em\\u003eStudy design, Supervision, Data analysis, Writing – final revision, Project administration, Funding acquisition, Corresponding author.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eYanjuan Lin:\\u003c/em\\u003e Study design, Supervision, Data analysis, Writing – final revision, Project supervision, Funding acquisition.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgments\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eWe extend our sincere gratitude to all healthcare professionals who participated in this study and to the clinical coordinators at each study site for facilitating data collection.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eMuna S, Al-Ani SA, Amer K, et al. 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BMC Nutr. 2022;8(1):85. doi:10.1186/s40795-022-00577-w\\u003c/li\\u003e\\n\\u003cli\\u003eMurthy VH. Confronting health worker burnout and well-being. N Engl J Med. 2022;387(7):577\\u0026ndash;579. doi:10.1056/NEJMp2207252\\u003c/li\\u003e\\n\\u003cli\\u003eChang BP. The health care workforce under stress: Clinician heal thyself. JAMA Netw Open. 2022;5(1):e2143167. doi:10.1001/jamanetworkopen.2021.43167\\u003c/li\\u003e\\n\\u003cli\\u003eNagle E, Griskevica I, Rajevska O, et al.Factors influencing burnout and conceptual models among healthcare workers: a scoping review. BMC Psychol. 2024;12:637. doi:10.1186/s40359-024-02130-9\\u003c/li\\u003e\\n\\u003cli\\u003eChen G, Wang J, Huang Q, et al.Social support, psychological capital, multidimensional burnout and turnover intention among primary care workers: a path analysis based on Conservation of Resources theory. Hum Resour Health. 2024;22:42. doi:10.1186/s12960-024-00915-y\\u003c/li\\u003e\\n\\u003cli\\u003eHavens DS, Gittell JH, Vasey J. Impact of relational coordination on nurse job satisfaction, work engagement, and burnout: achieving the quadruple aim. J Nurs Adm. 2018;48(3):132\\u0026ndash;139. doi:10.1097/NNA.0000000000000587\\u003c/li\\u003e\\n\\u003cli\\u003eJung J, Matthews R. The impact of psychological support programs and career development plans on healthcare professionals\\u0026apos; job satisfaction. J Health Organ Manag. 2021;35(5):134\\u0026ndash;150. doi:10.1108/JHOM-04-2021-0114\\u003c/li\\u003e\\n\\u003cli\\u003eYoo S, Kwan HY, Liang WY, et al. Factors influencing medication adherence in multi-ethnic Asian patients with chronic diseases in Singapore: a qualitative study. Front Pharmacol. 2023;14:1124297. doi:10.3389/fphar.2023.1124297\\u003c/li\\u003e\\n\\u003cli\\u003eVandecasteele R, Robijn L, Willems S, et al. Barriers and facilitators to culturally sensitive care in general practice: a reflexive thematic analysis. BMC Prim Care. 2024;25(1):381. doi:10.1186/s12875-024-02274-5\\u003c/li\\u003e\\n\\u003cli\\u003eChen HT, Lu Y, Xu C, Guo Y, Yao QH. Exploration of a new mode of whole-process management of nutrition of gastrointestinal malignancy in Chinese and Western medicine. Electron J Metab Nutr Cancer. 2019;6(3):370\\u0026ndash;375. doi:10.16689/j.cnki.cn11-9349/r.2019.03.020\\u003c/li\\u003e\\n\\u003cli\\u003eDe Simone S, Vargas M, Servillo G. Organizational strategies to reduce physician burnout: a systematic review and meta-analysis. Aging Clin Exp Res. 2021;33(4):883\\u0026ndash;894. doi:10.1007/s40520-019-01368-3\\u003c/li\\u003e\\n\\u003cli\\u003eYu MK. Study on influencing factors and improvement strategies of subject compliance and its application in TCM oncology trials [dissertation]. Beijing: Beijing University of Chinese Medicine; 2021. doi:10.26973/d.cnki.gbjzu.2021.000787\\u003c/li\\u003e\\n\\u003cli\\u003eWang N, Deng Z, Wen L. Personalized and culturally tailored features of mobile apps for gestational diabetes mellitus management: a scoping review. JMIR Mhealth Uhealth. 2023;11:e41687. doi:10.2196/41687\\u003c/li\\u003e\\n\\u003cli\\u003eSanto K, Richtering SS, Chalmers J, et al. Mobile apps to improve medication adherence in cardiovascular disease: a systematic review. J Med Internet Res. 2021;23(5):e24190. doi:10.2196/24190\\u003c/li\\u003e\\n\\u003cli\\u003eNgoumou GB, Koppold DA, Wenzel L, et al. An interactive course program on nutrition for medical students: interdisciplinary development and mixed-methods evaluation. BMC Med Educ. 2025;25(1):28. doi:10.1186/s12909-025-04792-y\\u003c/li\\u003e\\n\\u003cli\\u003eAbu Farha RJ, Saadeh R, Al Maharmeh M, et al. 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Front Med. 2022;9:912751. doi:10.3389/fmed.2022.912751\\u003c/li\\u003e\\n\\u003cli\\u003eCheng YX. \\u0026quot;H2H\\u0026quot; nutrition management model based on Internet platform: application and research of chemotherapy in patients with colorectal cancer [基于互联网平台的结直肠癌化疗患者\\u0026quot;H2H\\u0026quot;营养管理模式应用研究] [dissertation]. Taiyuan: Shanxi Medical University; 2023. doi:10.27288/d.cnki.gsxyu.2023.000297\\u003c/li\\u003e\\n\\u003cli\\u003eVrkatić A, Grujičić M, Jovičić-Bata J, Novaković B. Nutritional knowledge, confidence, attitudes towards nutritional care and nutrition counselling practice among general practitioners. Healthcare (Basel). 2022;10(1):178. doi:10.3390/healthcare10010178\\u003c/li\\u003e\\n\\u003cli\\u003eMasoumian Hosseini M, Masoumian Hosseini ST, Qayumi K, et al. Smartwatches in healthcare medicine: assistance and monitoring; a scoping review. 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Nurse practitioner communities of practice: an exploratory study. Aust J Adv Nurs. 2022;39(4):32\\u0026ndash;39. doi:10.37464/2022.394\\u003c/li\\u003e\\n\\u003cli\\u003eSguanci G, Martinez A, Zhou Y, et al. Artificial intelligence in the management of malnutrition in cancer patients: a systematic review. Adv Nutr. 2025;16(3):456\\u0026ndash;472. doi:10.1093/advances/nmae003\\u003c/li\\u003e\\n\\u003cli\\u003eWorld Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. 2013. https://www.wma.net/policies-post/wma-declaration-of-helsinki/. Accessed 19 Jul 2025.\\u003c/li\\u003e\\n\\u003cli\\u003eNational Health Commission of the People\\u0026apos;s Republic of China. Regulations on the management of human biomedical research. 2019. https://clinregs.niaid.nih.gov/country/china. Accessed 19 Jul 2025. \\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-complementary-medicine-and-therapies\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"bcam\",\"sideBox\":\"Learn more about [BMC Complementary Medicine and Therapies](https://bmccomplementmedtherapies.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"\",\"title\":\"BMC Complementary Medicine and Therapies\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"stoa\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-6950861/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-6950861/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eBackground\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe integration of Traditional Chinese Medicine (TCM) and Western nutritional therapy has gained increasing attention in oncology care. However, qualitative insights into healthcare professionals’ (HCPs’) experiences with implementing this integrative approach remain limited, particularly regarding interdisciplinary collaboration challenges and training needs in real-world settings.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eObjective\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eTo explore the lived experiences of multidisciplinary HCPs involved in delivering integrative nutritional care that combines TCM and Western medicine to cancer patients in China.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMethods\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis study employed a descriptive phenomenological design. Sixteen HCPs—including physicians, nurses, and dietitians—were purposively recruited from tertiary hospitals in Fuzhou (2023) until thematic saturation was reached. Data were collected through in-depth semi-structured interviews and analyzed using Colaizzi’s seven-step method, supported by NVivo 12.0. Analytical rigor was ensured through triangulation and member checking.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResults\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eFour major themes emerged:\\u003c/p\\u003e\\n\\u003cp\\u003e⑴ Professional fulfillment coexisting with stress – Participants experienced enhanced professional identity and self-efficacy through integrative care, while also reporting stress due to knowledge limitations, interdisciplinary demands, and expectations for individualized guidance.\\u003c/p\\u003e\\n\\u003cp\\u003e⑵ Patient adherence as a determinant of effectiveness – The success of nutritional interventions was closely linked to patients’ adherence, which was shaped by health literacy, cultural beliefs, and family involvement.\\u003c/p\\u003e\\n\\u003cp\\u003e⑶ Professional training and knowledge sharing – There was a shared call for structured, standardized, and cross-disciplinary training, along with the dissemination of successful clinical strategies.\\u003c/p\\u003e\\n\\u003cp\\u003e⑷ Expectations for integrated and supportive systems – Participants emphasized the need for digital integration, supportive policy frameworks, and sustained institutional support to advance and normalize TCM–Western integrative practice.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusion\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eWhile integrative nutritional management provides synergistic benefits in oncology care, its effective implementation requires structured interprofessional training, culturally adapted models, and technology-enhanced systems. These findings underscore the necessity of developing scalable frameworks aligned with global movements toward personalized, collaborative cancer care.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Integrating Traditional Chinese and Western Medicine in Nutritional Care for Cancer Patients: A Qualitative Study of Healthcare Professionals' Perspectives\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-08-20 06:45:18\",\"doi\":\"10.21203/rs.3.rs-6950861/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2025-08-11T23:01:41+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2025-08-11T22:57:30+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvited\",\"content\":\"\",\"date\":\"2025-07-30T00:04:36+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2025-07-23T15:19:03+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"BMC Complementary Medicine and Therapies\",\"date\":\"2025-07-23T15:14:50+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-complementary-medicine-and-therapies\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"bcam\",\"sideBox\":\"Learn more about [BMC Complementary Medicine and Therapies](https://bmccomplementmedtherapies.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"\",\"title\":\"BMC Complementary Medicine and Therapies\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"stoa\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"354fef95-3d7f-41e5-a183-b13459ada48c\",\"owner\":[],\"postedDate\":\"August 20th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"under-review\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-08-20T06:45:18+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2025-08-20 06:45:18\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-6950861\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-6950861\",\"identity\":\"rs-6950861\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}