Development of an Evidence-Informed Early Oral Feeding Intervention Protocol for Patients Undergoing Colorectal Cancer Surgery: A Delphi Consensus Study
This study aimed to develop an evidence-informed early oral feeding (EOF) intervention protocol for patients undergoing colorectal cancer surgery. Based on a previously completed evidence synthesis, an initial protocol was developed and refined through a two-round Delphi survey involving experts in gastrointestinal surgery and nutrition. Seventeen experts were invited, and 15 completed both rounds, with response rates of 88% and 100%, respectively. The coefficients of expert authority were 0.95 and 0.94, and Kendall’s W coefficients were 0.114 and 0.218, respectively (p = 0.002 and p < 0.001). After two rounds of consultation, a protocol comprising 6 first-level and 37 second-level items was developed, covering nutritional risk screening and assessment, nutritional therapy, energy and protein management, staged oral feeding, and postoperative feeding tolerance assessment and management. The protocol provides a structured, evidence-informed approach to EOF implementation and may facilitate its standardized clinical application.
[1] Wischmeyer P, Carli F, Evans D, et al., 2018, American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Nutrition Screening and Therapy Within a Surgical Enhanced Recovery Pathway. Anesthesia and Analgesia, 126(6): 1883–1895.
[2] Herbert G, Perry R, Andersen H, et al., 2018, Early Enteral Nutrition Within 24 Hours of Lower Gastrointestinal Surgery Versus Later Commencement for Length of Hospital Stay and Postoperative Complications. Cochrane Database of Systematic Reviews, 10(10): CD004080.
[3] Qiu Z, Lu Y, Xie T, et al., 2020, Effect of Early Oral Feeding After 3D Laparoscopic-Assisted Radical Resection for Colon Cancer. Journal of the Academy of Military Medical Sciences, 41(5): 489–492.
[4] Gao J, Yan Y, 2018, Research Progress on Early Oral Feeding After Laparoscopic Colorectal Cancer Surgery. Medical Recapitulate, 24(2): 290–294 + 300.
[5] Frizon E, de Aguilar-Nascimento J, Zanini J, et al., 2024, Early Refeeding After Colorectal Cancer Surgery Reduces Complications and Length of Hospital Stay. ABCD: Arquivos Brasileiros de Cirurgia Digestiva (São Paulo), 37: e1802.
[6] Williams D, Ohnuma T, Krishnamoorthy V, et al., 2020, Impact of Early Postoperative Oral Nutritional Supplement Utilization on Clinical Outcomes in Colorectal Surgery. Perioperative Medicine, 9: 29.
[7] Chu Y, Jiang Z, Shao M, et al., 2020, Current Status and Influencing Factors of Adherence to Oral Nutritional Supplements Among Patients After Colorectal Cancer Surgery. Chinese Nursing Management, 20(12): 1790–1794.
[8] Cheng L, Feng S, Hu Y, et al., 2019, Development of a Conceptual Model for Evidence Application in Evidence-Based Nursing Practice in China. Journal of Nursing Science, 34(3): 72–77.
[9] Xing W, Hu Y, Zhou Y, et al., 2020, Promoting the Translation of Evidence Into Clinical Practice (VI): Development and Writing of Evidence Summaries. Journal of Nurses Training, 35(12): 1129–1132.
[10] Schifano J, Niederberger M, 2025, How Delphi Studies in the Health Sciences Find Consensus: A Scoping Review. Systematic Reviews, 14(1): 14.
[11] Jiang Y, Xu Y, Xu J, et al., 2026, Best Evidence Summary for Early Oral Feeding After Colorectal Cancer Surgery. Medicine Insights. Advance online publication.
[12] Zhao Q, Wu Q, Sun X, et al., 2020, Development of a Quality Evaluation Indicator System for Transitional Care Among Patients with Stroke. Chinese Journal of Nursing, 55(2): 171–176.
[13] Wang H, Wang H, Song J, et al., 2015, Development of an Independent Assessment Indicator System for Nursing Performance. Chinese Journal of Nursing, 50(3): 262–266.
[14] Chen J, Xi S, Shi M, 2016, Current Application of the Delphi Method in Research on Indicators for Evaluating Specialized Nursing Quality. Chinese Nursing Research, 30(29): 3591–3595.
[15] Shao X, Yin L, Li T, et al., 2020, Study on an Evaluation Indicator System for Party Branch Work in Large Public Hospitals Based on the Delphi Method. Chinese Hospitals, 24(12): 67–68.
[16] Li Q, Shi H, Yang L, 2024, Nutritional Therapy for Cancer Patients. Practical Oncology Journal, 38(6): 417–420.
[17] Li C, Liu K, Deng X, et al., 2021, Expert Consensus on the Prevention and Management of Postoperative Gastrointestinal Dysfunction. International Journal of Anesthesiology and Resuscitation, 42(11): 1133–1142.
[18] Irani J, Hedrick T, Miller T, et al., 2023, Clinical Practice Guidelines for Enhanced Recovery After Colon and Rectal Surgery from the American Society of Colon and Rectal Surgeons and the Society of American Gastrointestinal and Endoscopic Surgeons. Surgical Endoscopy, 37(1): 5–30.
[19] Chinese Society of Surgery, Chinese Society of Anesthesiology, 2021, Chinese Guidelines for Enhanced Recovery After Surgery (2021) (Part I). Medical Journal of Peking Union Medical College Hospital, 12(5): 624–631.
[20] UEG, ESCP, EAES, et al., 2024, European Guidelines for the Assessment and Management of Gastrointestinal Symptoms Following Colorectal Surgery. United European Gastroenterology Journal, 12(8): 1024–1058.
[21] Pagano L, Long J, Francis-Auton E, et al., 2025, A Qualitative Study of How Clinicians Reach Agreement in Perioperative Pathway Development: The Consensus Model for Standardising Healthcare. Implementation Science Communications, 6(1): 1–14.
[22] Geng Y, Hu H, Wang H, et al., 2023, Investigation of Clinical Nurses’ Knowledge and Practice of Evidence-Based Nursing. Journal of Qiqihar Medical University, 44(18): 1790–1794.
[23] Liu P, Shao C, Li H, et al., 2025, Research Progress on Facilitators and Barriers to Evidence-Based Nursing Practice in China. General Nursing, 23(6): 1042–1044.
[24] Institute T, 2014, Joanna Briggs Institute Reviewers’ Manual: 2014 Edition. Adelaide: The Joanna Briggs Institute.
