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

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. 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. 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. 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. PROSPERO, ID https://www.crd.york.ac.uk/PROSPERO/view/CRD420261339100.