Psychological strain in nutritional management for gastric cancer patients: a multicenter qualitative study informing a supportive-care pathway

Purpose To identify potentially modifiable determinants underlying psychological strain during nutritional management among gastric cancer patients, and to translate these determinants into actionable components for a supportive-care pathway. Methods This qualitative descriptive study recruited gastric cancer patients from eight hospitals in eastern Sichuan, China, between March and August 2025. Using purposive sampling, we enrolled adults (≥ 18 years) with pathologically confirmed gastric cancer who had nutritional risk (NRS-2002 ≥ 3) and reported barriers to nutritional support. Data were collected via semi-structured interviews and analyzed using thematic analysis. Ethical approval was obtained, and all participants provided informed consent. Results Fifteen interviews were analyzed. Overall, patients’ nutritional management was shaped by competing psychological forces that intensified psychological strain and undermined sustained adherence. Key themes included: (1) The conflict between physiological tolerance and nutritional requirements; (2) Decision paralysis amid knowledge gaps and multi-source conflict; (3) Resource accessibility and affordability constraints; (4) Compliance and conflict driven by family relationships; (5) The negative cycle of psychological strain and social comparison. Conclusions We translate patient experiences into potentially modifiable determinants and outline a supportive-care pathway comprising symptom-linked nutrition coaching, decision support and consistent messaging, resource navigation, family alignment, and psychosocial support with structured follow-up. Future work should pilot the pathway to assess feasibility and acceptability in routine care.