Efficacy of traditional Chinese medicine nursing for lung cancer: a systematic review and meta-analysis using the Donabedian model to investigate heterogeneity.

BACKGROUND: Lung cancer patients frequently experience a reduced quality of life and psychological distress during treatment. Traditional Chinese Medicine (TCM) nursing shows promise, but substantial heterogeneity in the evidence base limits clinical interpretation. METHODS: A comprehensive literature search identified 15 randomized controlled trials (RCTs) involving 1,135 participants. A meta-analysis was conducted using RevMan 5.4 and Stata 17. Following the Donabedian framework, data were categorized into structure, process, and outcome dimensions to explore sources of heterogeneity. RESULTS: In the primary analysis, TCM nursing significantly improved all outcomes. For the Karnofsky Performance Status (KPS) score, the primary random-effects analysis showed a significant improvement (MD = 7.18, 95%CI 4.29-10.08). The sensitivity analysis excluding one outlier yielded a consistent effect (MD = 8.71, 95%CI 6.49-10.92). For the Self-Rating Depression Scale (SDS) score, the primary analysis showed a significant reduction (MD = -5.94, 95%CI -6.96 to -4.92). The sensitivity analysis excluding one outlier confirmed the robustness of these results (MD = -5.74, 95%CI -6.39 to -5.09). For the remaining outcomes with low heterogeneity, primary fixed-effects analysis revealed that TCM nursing significantly reduced Self-Rating Anxiety Scale (SAS) scores (MD = -4.65, 95%CI -5.28 to -4.03) and Visual Analog Scale (VAS) pain scores (MD = -1.46, 95%CI -1.56 to -1.36). Additionally, TCM nursing lowered the incidence of gastrointestinal reactions (RR = 0.19, 95%CI 0.06-0.58) and improved nursing compliance (RR = 1.24, 95%CI 1.10-1.39) (all p < 0.01). The subgroup analysis confirmed that comprehensive TCM care was more effective than emotion regulation alone for treating depression (p = 0.01). Intervention timing was suggested as a potential hypothesis-generating source of heterogeneity via sensitivity analysis. Structural factors (staff training, equipment, and qualifications) were critically underreported across all studies included in the analysis. CONCLUSION: TCM nursing significantly improves multidimensional outcomes for lung cancer patients. The Donabedian model effectively identifies sources of process-related heterogeneity and highlights critical structural reporting gaps that require attention in future research. SYSTEMATIC REVIEW REGISTERED: PROSPERO, ID https://www.crd.york.ac.uk/PROSPERO/view/CRD420261339100.