2.1 Study design

This study is designed as a randomized controlled trial (RCT) to evaluate the effectiveness of mind maps and micro-videos in the postoperative care education of lung cancer patients. Randomization was performed using a computer-generated randomization list. Patients were randomly assigned to either the control or intervention group in a 1:1 ratio. The randomization process was conducted by an independent researcher who was not involved in the recruitment or treatment of the patients, ensuring that the allocation was concealed. No stratification factors were applied during the randomization process. The RCT design allows for a rigorous comparison between the intervention group, which receives the educational tools, and the control group, which receives standard care. Randomization ensures that any differences in outcomes can be attributed to the intervention rather than confounding factors, providing robust evidence for the efficacy of the educational tools. The patients were randomly assigned to the control or intervention group using a computer-generated random number table. This method ensured unbiased allocation. No stratification factors were applied in this study. However, baseline characteristics such as age, gender, and clinical stage were carefully compared between the groups to ensure comparability, with no significant differences observed (Table 1). The study was conducted over a period of two years, from January 2022 to December 2023. This timeline includes patient recruitment, randomization, intervention implementation, and follow-up assessments to evaluate the effects of the educational interventions.

Table 1 Comparison of baseline population characteristics between groups

The study was carried out at special ward of Shanghai Chest Hospital, affiliated with Shanghai Jiaotong University School of Medicine, a top-tier medical facility equipped with comprehensive resources and a multidisciplinary team specialized in lung cancer treatment and postoperative care. The hospital's special ward for lung cancer patients provided an ideal setting for conducting the study, ensuring high-quality care and standardized procedures for all participants.

2.2 Participants2.2.1 Inclusion criteria

Patients diagnosed with lung cancer according to the Chinese Medical Association Lung Cancer Clinical Diagnosis and Treatment Guidelines (2018 Edition). The inclusion criteria specifically covered patients with clinical stages I (IA, IB), II (IIA, IIB), and IIIA [13]. Only patients with complete and accurate medical records, including demographic data, clinical history, surgical details, and postoperative follow-up information, were included in the study to ensure the reliability and completeness of the data.

2.2.2 Exclusion criteria

Patients who are unable to perform self-care. Patients who were unable or unwilling to adhere to prescribed postoperative care instructions, including medication regimens, rehabilitation activities, or follow-up visits, were excluded from the study to avoid potential biases in assessing the intervention's impact. Patients with severe arrhythmias or significant liver/kidney abnormalities. Patients who have recently used psychotropic or cognitive-impairing medications. Patients with psychiatric disorders or cognitive impairments that would prevent cooperation with the study protocols.

Sample size was calculated using a power analysis with the following assumptions: an effect size of 0.5 (medium), an alpha level of 0.05, and a desired power of 80%. Based on these parameters, the minimum sample size per group was determined to be 64 patients. To account for potential attrition, 133 patients were recruited (65 in the control group and 68 in the observation group).

2.3 Interventions2.3.1 Control group (n = 65)

Routine Postoperative Care: Patients in the control group received the standard postoperative care. This includes regular monitoring, medication management, wound care, and follow-up appointments as per hospital protocols. Verbal Health Education: In addition to routine care, patients received verbal health education. This education was provided by healthcare professionals and covered essential topics such as wound care, pain management, respiratory exercises, and lifestyle modifications to support recovery after lung cancer surgery.

2.3.2 Intervention group (n = 68)

Patients in the intervention group received the same standard postoperative care as the control group to ensure equivalent basic medical care. In addition, they were provided enhanced health education through mind maps and micro-videos. Each patient received an educational booklet containing mind maps that visually organized essential postoperative care information, including step-by-step self-care instructions, strategies for managing common symptoms, and warnings about potential complications. Patients also had access to a series of short micro-videos, which offered detailed demonstrations on critical aspects of postoperative care, such as respiratory exercises, wound care procedures, pain management, and physical activity. These videos were designed to be engaging and easy to understand, reinforcing the information provided in the mind maps. Topics covered included proper wound care techniques, effective use of pain medications, step-by-step breathing exercises to improve lung function, guidance on gradual physical activity and lifestyle adjustments, and recognizing signs of complications such as infections or deep vein thrombosis. This multi-modal approach aimed to improve patients’ understanding and adherence to postoperative care instructions.

The micro-videos used in this study ranged from 3 to 5 min in length. These videos were designed to be concise yet comprehensive, covering key aspects of postoperative care for lung cancer patients, including medication adherence, wound care, and lifestyle modifications.

To evaluate whether patients actually utilized the mind maps and micro-videos, we incorporated several methods: Patient Self-Report: After the intervention, patients were asked to report on their usage of the mind maps and micro-videos. This was assessed during follow-up visits (one month and two months post-intervention), where patients completed a questionnaire specifically designed to gather information on how frequently they referred to the educational materials. Follow-Up Interviews: In addition to self-reports, a subset of patients in the intervention group participated in brief follow-up interviews to discuss their experiences with the materials. This helped assess not only their engagement with the tools but also their perceived usefulness in managing their postoperative recovery. Adherence Tracking: We also tracked adherence to the recommended postoperative care regimen, such as attendance at follow-up visits, medication adherence, and self-care practices. We hypothesized that higher adherence would correlate with greater usage of the educational tools, and this was evaluated through the nursing compliance data collected during the study.

The patients in the intervention group received the mind maps and micro-videos during their hospital stay, after the surgery but before discharge. Specifically, the materials were introduced once the pathology diagnosis was confirmed and the surgical procedure was completed. This allowed the educational content to be tailored to the patient’s specific postoperative needs. The pathology diagnosis, which confirmed the final diagnosis and staging of the lung cancer, was discussed with the patients before the educational materials were introduced. Therefore, the content was given at a time when patients were fully aware of their diagnosis and surgical outcomes, ensuring they could better relate to the information provided. The mind maps and micro-videos were provided to patients in the intervention group immediately after surgery and prior to hospital discharge. These tools were introduced after the final pathology diagnosis was confirmed, ensuring that the educational materials were relevant and aligned with the patients’ specific postoperative needs. The patients were provided with both physical booklets containing mind maps and access to micro-videos for review during the early postoperative recovery phase.

2.4 Data collection and outcome measures

Demographic information, including age, gender, education level, and socioeconomic status, was collected for all participants. Clinical data encompassed the stage of lung cancer (I–IIIA), the type of surgery performed, comorbidities, and any previous treatments received. These variables were documented to characterize the study population and ensure baseline comparability between groups.

Patient satisfaction with health education was evaluated using the Patient Satisfaction Questionnaire (PSQ), a validated instrument designed to measure satisfaction in healthcare settings. The PSQ assesses key dimensions, including the clarity, usefulness, and overall quality of the health education provided. Measurements were conducted immediately post-intervention and one month later to capture both short-term and sustained satisfaction levels.

Patients’ knowledge of postoperative care was assessed using a structured questionnaire covering critical areas such as wound care, pain management, respiratory exercises, and lifestyle modifications. Assessments were conducted at three time points: baseline (pre-intervention), immediately post-intervention, and one month post-intervention to evaluate knowledge acquisition and retention.

Adherence to postoperative care instructions was evaluated based on patients’ compliance with medication regimens, attendance at follow-up appointments, and adherence to recommended self-care practices. Adherence was categorized into three levels: Compliance: Full adherence to all prescribed care instructions (e.g., taking medications, attending follow-up visits, adhering to dietary guidelines). Basic Compliance: Partial adherence, with some non-compliance in specific areas (e.g., taking medications but missing follow-up appointments). Non-compliance: Failure to follow most or all prescribed care instructions (e.g., missed medications, skipped follow-up visits, ignored dietary recommendations).

Social support was measured using the Social Support Rating Scale (SSRS), which evaluates support from family, friends, and healthcare providers across three dimensions: objective support, subjective support, and utilization of support. Assessments were conducted at baseline (pre-intervention) and one month post-intervention to capture changes in perceived support over time. The SSRS has established validity and reliability in cancer patient populations, including those with lung cancer [14].

Health-related quality of life was assessed using the SF-36 Health Survey, a widely used and validated tool that evaluates eight domains: physical functioning, role limitations due to physical health, role limitations due to emotional problems, energy/fatigue, emotional well-being, social functioning, pain, and general health perceptions. The SF-36 has demonstrated strong validity and reliability in cancer populations, including lung cancer patient [15]. Assessments were conducted at baseline (pre-intervention), immediately post-intervention, one month post-intervention, and two months post-intervention to track changes over time [16].

For any non-standard questionnaires or scales developed specifically for this study, the tools were created through a multi-step process involving expert input and pre-testing with a small sample of lung cancer patients. Reliability and validity were established through pilot testing, followed by statistical analysis to confirm that the tools accurately measured the intended constructs, such as patient satisfaction, knowledge retention, and nursing compliance.

2.5 Statistical analysis2.5.1 Descriptive statistics

Descriptive statistics will be used to summarize baseline characteristics of the study population, including demographics and clinical characteristics. The results will be presented as means and standard deviations for continuous variables, and as frequencies and percentages for categorical variables. Independent t-tests: These tests will be used to compare the means of continuous variables between the control and intervention groups. This includes outcomes such as patient satisfaction scores, knowledge of health education, and various dimensions of the SF-36 Health Survey. Chi-square tests: These tests will be applied to compare categorical variables between the two groups. Examples include nursing compliance rates and the proportions of patients achieving specific levels of social support. Repeated Measures ANOVA: This analysis will be used to compare changes over time within and between groups for repeated measures outcomes. It will assess the interaction between time (pre-intervention, immediately post-intervention, one month post-intervention, two months post-intervention) and group (control vs. observation) for variables such as health education satisfaction, knowledge, and quality of life. A p-value of less than 0.05 will be considered statistically significant. All statistical analyses were performed using SPSS version 25.0 (IBM Corp., Armonk, NY, USA).