Partial Mediation by Self-Efficacy of the Association Between Information-Motivation-Behavioral Skills Nursing and Quality of Life After Lung Cancer Cryoablation: A Retrospective Cohort Study With Propensity Score Matching

For millions of people living with lung cancer, the journey involves more than just the medical procedure itself; it requires navigating a complex recovery where the mind and body must work together. When patients cannot undergo traditional surgery due to age or other health conditions, doctors often turn to cryoablation, a minimally invasive treatment that freezes tumors using extreme cold. While the technology to freeze the cancer is well-established, the human side of recovery—how patients manage their symptoms, stay motivated, and regain confidence—remains a critical area for improvement. Researchers have long looked to a framework called the Information-Motivation-Behavioral Skills model to understand how to help patients. This model suggests that for a person to improve their health, they need three things: clear and accurate information about their condition, a personal drive to act on that information, and the practical skills to carry out daily self-care tasks. A central idea within this framework is that a patient's belief in their own ability to succeed, known as self-efficacy, acts as a bridge. The theory posits that when nurses provide good information and motivation, it boosts a patient's confidence, and that increased confidence is what ultimately leads to a better quality of life.

A team of researchers at Xinqiao Hospital in Chongqing, China, set out to test whether this specific bridge actually exists in the real world for patients recovering from lung cancer cryoablation. They looked back at the records of 552 patients treated between June 2023 and April 2025. During this time, the hospital's thoracic surgery department operated two wards. One ward implemented a specialized nursing program based on the Information-Motivation-Behavioral Skills model, while the other continued with standard, routine care. The specialized program was not just about handing out pamphlets; it was a structured, three-phase approach. Before the procedure, nurses gave patients detailed, illustrated guides and one-on-one teaching about what to expect. They worked with patients to set personal recovery goals and shared stories of others who had successfully recovered to build hope. After the procedure, the focus shifted to teaching specific skills, such as how to breathe deeply, how to cough effectively to clear the lungs, and how to monitor their own pain levels, all through a cycle of demonstration and practice. The control group received standard care, which included vital sign monitoring and basic discharge instructions, but lacked this structured, skill-building education.

To ensure a fair comparison, the researchers used a statistical method to match patients from the specialized ward with similar patients from the routine ward, pairing them up based on age, cancer stage, tumor size, and other health factors. This left them with 264 matched pairs to analyze, effectively creating a scenario where the only major difference between the two groups was the type of nursing care they received. Three months after the procedure, the researchers measured two main things: the patients' quality of life using a detailed survey covering physical, emotional, and social well-being, and their level of self-efficacy using a scale that measures confidence in performing self-care tasks.

The results showed that the specialized nursing program worked. Patients who received the Information-Motivation-Behavioral Skills care reported significantly higher quality of life scores three months later compared to those who received routine care. They also reported higher levels of confidence in managing their own health. When the researchers broke down the relationship to see how much of the improvement in quality of life was due to this boost in confidence, they found a clear, though partial, connection. The increase in self-efficacy explained about 12 percent of the total improvement in quality of life. This means that while building a patient's confidence was a real and effective part of the process, it was not the only reason the specialized care worked. The vast majority of the benefit—roughly 88 percent—came from other factors, such as the structured information provided, the systematic monitoring of symptoms, and the overall standardization of care, which likely reduced anxiety and improved the patient experience directly.

The study also looked at practical outcomes, specifically how long patients stayed in the hospital. The group receiving the specialized care had a shorter average hospital stay, leaving about half a day earlier than the routine care group. While this might seem like a small difference for an individual, the researchers noted that for a hospital performing hundreds of these procedures a year, it translates to freeing up a significant number of bed-days for other patients. However, the researchers were careful to note the limits of their findings. Because they measured both the patients' confidence and their quality of life at the exact same time three months after surgery, they could not prove that the confidence came first and caused the better quality of life, even though the theory suggests it did. They also found that the statistical link between confidence and quality of life was somewhat fragile, meaning that unmeasured factors, such as a patient's personal support system or general health literacy, could have influenced the results.

Ultimately, the study confirms that a nursing approach focused on information, motivation, and skill-building does improve the lives of lung cancer patients recovering from cryoablation. It validates the idea that helping patients feel more confident in their ability to care for themselves is a valuable part of the healing process. Yet, it also clarifies that confidence is just one piece of a larger puzzle. The most effective care appears to be a comprehensive package where teaching skills and building confidence are supported by clear information and consistent, high-quality monitoring. For the patients in this study, the combination of these elements led to a smoother recovery, a shorter time in the hospital, and a better sense of well-being, suggesting that the future of cancer care lies in treating the whole person, not just the disease.