In this study, convenience sampling method was used to select inpatients with chemotherapy for lung cancer who were hospitalized in the oncology department of a tertiary general hospital in Sichuan Province from November 2022 to August 2023.Inclusion criteria: (1) Pathologically or cytologically confirmed primary lung cancer (12); (2) Age ≥60 years (13); (3) Patients informed about the diagnosis; (4) Able to understand the content of the questionnaire and communicate smoothly; (5) A Padua score of ≥4 on the VTE prevention risk assessment; (6) At least two or more chemotherapy cycles received at this hospital. Exclusion criteria: (1) Presence of mental disorders or impaired consciousness; (2) Participation in other studies; (3) Lost to follow-up during the intervention. This study was reviewed and approved by the hospital's medical ethics committee (approval number: 2022-Ethics Approval-10), and all patients signed an informed consent form.

The sample size estimation of this study was based on the formula of the mean of the two samples: N1 = N2 = 2[(µ_ɑ+µ_β)/(δ/σ)]²+ 0.25µ_ɑ², and the scores of VTE prevention knowledge, willingness to participate and behavior questionnaires were used as the calculation indexes, and u_α and u_β were the u-values corresponding to the test level α and type II error probability β respectively, α = 0.05 (two-sided), β=0.10 (one-sided), u_0.05/2= 1.96, and u_0.1= 1.28. σ is the standard deviation of the population (assuming that the standard deviations of the two populations are equal) and δ is the difference between the means of the two populations. According to the results of the pre-experiment, the scores of VTE prevention knowledge, participation intention and behavior in the control group and intervention group were 97.30 ± 8.69, 104.80 ± 9.59, and N1 = N2 = 35 cases were calculated, considering that the patients may be lost to follow-up and dropped out halfway, and the loss rate was calculated at 20%, and finally N1 = N2 = 42 cases were obtained. Since there was 1 death in the control group, 1 death and 1 withdrawal in the intervention group, finally, 41 in the control group and 40 in the intervention group.

The data obtained were analyzed using IBM SPSS Statistics 26.0. Categorical data were expressed as frequency and percentage; measurement data that conformed to normal distribution were expressed as mean ± standard deviation, and those that did not conform to normal distribution were expressed as median (interquartile range) M (P₂₅, P₇₅). Statistical inference: Measurement data were analyzed using two-sample t-tests or rank sum tests; intergroup and intragroup comparisons before and after intervention were performed using paired sample t-tests or approximate t-tests; categorical data were analyzed using chi-square tests, with the significance level set at α = 0.05.

There was no statistical significance in the comparison of general data between the two groups (P > 0.05), indicating comparability. 9.8% (4/41) of the control group received oral prophylactic drug treatment, 34.1% (14/41) received subcutaneous injection of heparin or low molecular weight heparin sodium treatment; 7.5% (3/40) of the intervention group received oral drug treatment, and a total of 32.5% (13/40) received subcutaneous injection of heparin or low molecular weight heparin treatment. The rest did not receive medication for prevention (χ² = 0.072, P = 0.788), as shown in Supplementary Table S2.

There is interesting in showing that all parameters improved, both in the intervention and control group. And after the intervention, the scores for venous thrombosis prevention knowledge, willingness, behavior, and total scores in the intervention group were higher than those in the control group (P < 0.05), as shown in Supplementary Table S3.

After the intra-group comparison, both groups showed little change in constipation, diarrhea, or financial difficulties(P > 0.05), the patients in the control group improved in physical function, fatigue, pain and insomnia(P < 0.05), and patients in the intervention group were improved effectively in the remaining aspects(P < 0.05). After the intervention, intergroup comparisons revealed statistically significant differences between the two groups in scores for physical function, role function, emotional function, insomnia, appetite loss, and overall health status (P < 0.05), as shown in Supplementary Table S4.

After the intervention, intergroup comparisons revealed statistically significant differences in scores for doctor's professional skills, doctor's information provision, doctor's accessibility, nurse's professional skills, nurse's humanistic care, nurse's information provision, services of other personnel, hospital convenience and overall satisfaction (P < 0.05). Among them, the hospital environment scored the lowest (Z = −1.187, P = 0.235), the comparison between the two groups is most obvious in the “other personnel service” category (Z = −2.447, P = 0.014), as shown in Supplementary Table S5.

The rate of VTE in the intervention group was 2.5% (1/40), and that in the control group was 19.5% (8/41). There was a significant difference (χ² = 4.336, P = 0.037), as shown in Supplementary Table S6.

Globally, public awareness of VTE is generally low (19, 20). Elderly patients, due to various factors, have limited understanding of VTE, further increasing their risk of developing the condition (2, 20–22). Kathryn (23) showed that sources of health knowledge about VTE were primarily the internet (59%), family and friends (47%), magazines and news (18%), and television (17%). When asked about their preferred method of receiving health information on VTE, 87% of participants chose health education. This study implemented health education on VTE prevention based on the IMB model for elderly lung cancer patients, and the results showed that patients in the intervention group significantly improved in terms of VTE prevention knowledge (Z = −3.161, P < 0.05), willingness to participate in prevention (Z = −5.820, P < 0.05), and preventive behavior (t = 5.932, P < 0.05). This indicates that health education based on the IMB model can enhance patients’ self-preventive abilities for VTE more effectively than general health education. Health education for VTE prevention based on the IMB model mainly includes information, motivation, and behavior. Information is a prerequisite; this study, taking into account the clinical characteristics of elderly lung cancer patients, used individualized and group interventions, bedside education, health lectures, and telephone Q&A sessions to provide comprehensive and systematic knowledge of VTE prevention, helping patients to better understand the pathogenesis of VTE and to improve their knowledge of the disease (24, 25). Motivation is the determining factor for behavior change. By organizing patient support groups and medical staff-patient seminars, the study helped patients recognize the importance of VTE prevention and thus stimulated their motivation to establish preventive behaviors (26). The influence of information and motivation on behavior change is mainly realized through behavioral skills. Considering the cultural differences among elderly patients, this study used video guidance and physical demonstrations for interventions and invited family members to learn together to leverage the supervisory role of family members, helping patients establish good and correct exercise habits (27).The results showed that 47.5% (19/40) patients in the intervention group insisted on daily functional exercise, while only 4.9% (2/41) patients in the control group(χ²= 24.815, P < 0.05); When limb swelling, pain and other symptoms occurred, 14.6% (6/41) of the control group chose to actively inform the medical staff, while 65% (26/40) of the intervention group(χ²= 22.244, P < 0.05), it shows that the IMB model plays a positive role in helping patients establish good behavior habits.

Most elderly lung cancer patients undergoing chemotherapy bear a heavy psychological burden due to long-term disease treatment and severe economic pressures, which affects their quality of life (28–30). After the intervention, the intervention group scored higher than the control group in physical function, role function, emotional function, and overall health status, and lower in insomnia and pain (P < 0.05). This indicates that health education based on the IMB skills model can improve the quality of life for elderly lung cancer patients undergoing chemotherapy. The analysis suggests that the health education for VTE prevention based on the IMB model, by guiding patients in functional exercise, not only improves their physical function but also their proactivity (31). Moreover, by conducting support group meetings and face-to-face patient discussions, patients realize the importance of VTE prevention while alleviating stress, enhancing their confidence in coping with the disease, and thus improving their role and emotional functions and overall quality of life (32). Other dimensions such as symptom scales, as well as constipation, diarrhea, and financial difficulties, did not show significant differences after the intervention in both groups, which may be related to disease progression causing increased symptoms and medical expenses (33–35). The IMB skills model, by providing comprehensive and rich information, enables patients to better understand the pathogenesis of VTE and recognize early symptoms, thereby enhancing their understanding of disease knowledge. It emphasizes engaging patients in VTE prevention, enhancing their perception of the risk of VTE, and guiding them to establish behaviors to prevent VTE, which helps to improve self-management abilities and quality of life.

Patient satisfaction during hospitalization is an important indicator for evaluating the quality of hospital service management. By analyzing patients’ subjective responses after receiving medical services, the effectiveness of work can be improved, and patient satisfaction can be increased (36). The results of this study show that patient satisfaction in the intervention group who received health education based on the IMB skills model was higher than in the control group.The intervention program not only focused on disease prevention education but also paid attention to the quality of life of patients and the continuity of services outside the hospital during chemotherapy breaks, aligning with the “biopsychosocial” medical model, hence the significant effect in the humanistic care dimension. The results of the study showed that waiting time, hospital convenience, and hospital environment did not exhibit noticeable improvements, likely due to objective factors such as high patient traffic and outdated infrastructure, which cannot be improved through health education alone.

VTE often has insidious onset, with patients commonly exhibiting no noticeable symptoms or presenting with limb swelling and pain, leading to low early diagnosis rates. The results of this study show that the incidence of VTE in the intervention group over three months was 2.5%, which is lower than that reported in the study by Kenmotsu (37). Health education based on the IMB skills model, which focuses not only on VTE disease prevention during inpatient chemotherapy but also consolidates disease-related knowledge through telephone follow-ups with knowledge quizzes during chemotherapy intervals, has improved the capability of patients to self-prevent VTE behaviors by managing risk factors both inside and outside the hospital setting, thereby reducing the incidence of VTE.