There is significant heterogeneity in the level of health promotion and lifestyle among patients with primary liver cancer, which can be divided into three categories
The results of this study showed that the HPLP-II score of PLC patients was (124.53 ± 23.08) points, with “good” or “excellent” levels accounting for 36.42%, indicating that their health promoting lifestyle needs to be improved. This result is similar to the health promoting lifestyle survey conducted by Chen Nana et al.12 on patients with early gastrointestinal cancer, with a score of (125.94 ± 33.17). Possible negative impacts on patient health promotion may be related to the high malignancy of PLC, physical pain caused by complications, concerns about treatment efficacy, fear of cancer recurrence, and pressure on treatment costs20. The survey conducted by Zhao Xinhua et al.21 on the health promotion lifestyle of liver cancer patients with depressive symptoms [(98.12 ± 11.87) points] was significantly lower than the results of this study, indicating that negative psychology should be taken seriously in terms of its negative impact on patients’ health promotion lifestyle. The progress of systemic anti-tumor therapy and comprehensive therapy has brought new hope for improving surgical resection opportunities and treatment outcomes for patients with advanced liver cancer20. The health literacy and health management of PLC patients have received increasing attention. Therefore, medical staff should attach great importance to educating patients on healthy lifestyles, in order to enhance their ability to maintain and promote their own health and improve their quality of life.
This study identified significant heterogeneity in health promoting lifestyles of PLC patients. Based on statistical patterns of the data and clinical relevance of dimensional scores, three distinct profiles were ultimately derived: “Low Health Promotion-Neglectors”, “Moderate Health Promotion-Balancers”, and “High Health Promotion-Lone Warriors”. These classifications provide a foundation for exploring behavioral patterns in this unique population and designing stratified nursing interventions, with the aim of precisely improving health-promoting behaviors, optimizing health management systems, and ultimately enhancing quality of life. While these findings align with the health-promoting lifestyle typologies reported by Song et al.22 in breast cancer patients, PLC patients exhibit more specialized health management needs due to the aggressive nature of the disease and the complexity of treatment regimens. (a) In this study, the “Low Health Promotion – Neglectful” group accounted for 39.51% of the sample, representing the main category of health-promoting lifestyles. This indicates a need for focused screening and attention on the health-promoting lifestyles of these patients. The lowest scoring dimension, “Health Responsibility,” suggests a lack of health awareness among these patients, and their health behaviors such as health information acquisition, self-reporting of symptoms, health consultations, and regular follow-up visits need improvement. Therefore, nursing staff should assist these patients in establishing health management awareness. This can be achieved by utilizing the hospital follow-up system to create a “triggered health education” mechanism23. By identifying these patients through the electronic medical record system and sending customized health reminders postoperatively (such as follow-up schedules and symptom self-checklists), we can motivate them to actively learn and apply knowledge about PLC and health-promoting lifestyles, thereby improving health outcomes. (b) The “Moderate Health Promotion – Balancers” accounted for 26.85% of the sample. This group had a relatively small proportion and showed basic balance across dimensions, which aligns with the overall characteristics of the study’s participants. However, their HPLP-II levels were average and still have room for improvement. Nursing plans for these patients could include a needs assessment component, quantifying the priority of their needs (such as financial assistance and transportation convenience) through surveys, and providing stepped health education4. Collaborating with hospitals and social work departments, interventions can be tailored to provide “precision need matching.” (c) The “High Health Promotion – Lone Warriors” accounted for 33.64% of the sample. These patients had a strong health awareness and demonstrated high initiative and execution in managing their disease. However, they scored significantly lower in the “Interpersonal Relationships” and “Stress Management” dimensions, indicating challenges in interpersonal sensitivity, sociability, and stress regulation. Nursing staff need to focus on how these patients can achieve healthy relationships and adjust individual and even family stress. Future interventions could include constructing a “Stress-Social Support Dual-Channel” intervention: collaborating with psychology departments to design Mindfulness-Based Cognitive Therapy (MBCT) courses, and creating PLC patient mutual aid communities to alleviate stigma through peer support16. Family systems therapy could be introduced by inviting family members to participate in stress management workshops, improving communication patterns between patients and caregivers, and reducing family conflicts during the implementation of health behaviors.In the future, nursing staff can use psychological assessment tools to deeply explore the gap between the support patients expect and what they actually receive, and develop targeted intervention plans based on patients’ care needs.
Potential categories of health promotion and lifestyle in patients with primary liver cancer are influenced by socioeconomic status
The results of this study showed that the characteristics of higher education level, economic income, working status (on-the-job), and lower evaluation of the economic burden caused by diseases constitute the high socioeconomic status attribute, and socioeconomic status has a significant positive predictive effect on the health promoting lifestyle of PLC patients, which is consistent with previous research24 and verifies the social causality theory. Socioeconomic status directly affects individuals’ access to health information and medical services. Therefore, maintaining the health equity of liver cancer patients, strengthening the popularization of liver cancer health science, and promoting patient participatory care models are of great significance in today’s increasingly valued health literacy among liver cancer survivors. In addition, occupational status is one of the key factors that influence individuals to adopt a health promoting lifestyle25. Research has shown that returning to work is beneficial for reducing the economic toxicity of cancer patients26, enhancing their social identity, personal achievement, and sense of social belonging27. However, the current situation of liver cancer patients returning to work is not ideal and faces many challenges28. This suggests that medical staff can increase their attention to the quality of life of liver cancer patients, take effective measures, develop work survival nursing plans, and help patients better return to work; On the other hand, special attention should be paid to the health awareness of non occupational PLC patients, starting from helping them establish good doctor-patient communication methods, obtaining disease-related knowledge and personal health status information, exploring active response resources, strengthening the significance of disease response, etc29. , strengthening their health responsibilities, guiding health behaviors, and promoting the improvement of health literacy.
Potential categories of health promotion lifestyle for patients with primary liver cancer are influenced by the stage of disease treatment
The results of this study showed that PLC patients who did not receive neoadjuvant therapy within 3 months after surgery were more likely to be classified as “low health promotion neglectors”, which may be related to the interference of postoperative physiological trauma, physical discomfort, psychological pain, and other factors that led to a low state of health promotion behavior. Yang Xinyu et al.30 conducted a survey on 216 colorectal cancer survivors using HPLP-II and found that postoperative duration can positively predict health promoting lifestyle. The health promoting lifestyle scores of colorectal cancer survivors with less than 1 year were significantly lower than those with 1–3 years or more. It is suggested to pay attention to the level of health promotion for patients in the short term after surgery and strengthen nursing interventions. In addition, preoperative neoadjuvant therapy can help PLC patients accumulate symptom experience and coping experience during the disease treatment process, thereby promoting their HPLP level. With the continuous maturity of perioperative treatment concepts for liver cancer31, the connotation and extension of whole process management for liver cancer are undergoing changes. The health promotion lifestyle and health management issues of PLC patients are becoming increasingly prominent. Nursing staff can provide personalized nursing plans for patients with different treatment plans and stages. Wang Yanhui et al.32 included the “cycle and precautions of immunotherapy” in the discharge preparation plan for postoperative liver cancer patients, effectively enhancing their recovery confidence after discharge and improving the quality of discharge guidance. Zhang Lanju et al.33 developed a mobile nursing assistance application for PLC patient health literacy management, effectively improving patients’ health literacy level and enhancing their quality of life.
Potential categories of health promoting lifestyle in patients with primary liver cancer are influenced by sleep quality
The results of this study indicate that PLC patients with sleep disorders have a lower level of health promoting lifestyle, which is consistent with the study by Zhong Qing et al.34. The team proposed that improving sleep behavior is a promoting factor in the formation of an overall healthy lifestyle by exploring the impact of sleep behavior on other health behaviors. Poor sleep health is often accompanied by more physical symptoms, psychological problems, and health issues, which are related to poorer quality of life, lower social functioning, and more medication use35. Further analysis shows that in the dimensions of HPLP-II in this study, the scores from low to high are as follows: exercise, stress management, interpersonal relationships, health responsibility, self actualization, and nutrition. It can be seen that PLC patients are particularly weak in terms of exercise, and exercise is widely considered a safe, economical, and easily accessible method to improve sleep36, which plays a significant role in coping with stress and promoting interpersonal relationships. Therefore, in nursing work, in addition to focusing on self-report of patient symptoms10, professional measurement tools such as the Sleep Health Index37, RU-SATED framework38, etc. can also be used for continuous and dynamic evaluation, and Just In Time Adaptive Intervention (JITAI) can be given39. In the future, further research can be conducted on the exercise intervention plan for PLC patients, and longitudinal studies can be combined to explore the timing when patients need or are most likely to accept stress management interventions. Personalized decision points, adaptive variables, and decision rules can be set up to actively or passively provide nursing interventions such as stress relief and emotional support.