PURPOSE:To clarify the concept of self-management support in the oncology context. METHODS:Walker and Avant's concept analysis method was used. A comprehensive search was conducted in PubMed, Web of Science, Scopus, CINAHL, Cochrane Library, Wanfang, SinoMed, CNKI and ProQuest from database inception to 25 November 2025. Thirty-three publications were included. Data were extracted using a standardised form and analysed using directed content analysis. RESULTS:Five defining attributes were identified: multidimensional support, an ongoing supportive process, collaborative partnership, person-centred care, and professional guidance and resource connection. Four antecedents were identified: the need for long-term illness management, unmet support needs, insufficient self-management capacity, and the complexity of self-management tasks. Five consequences were identified: strengthened self-management capacity, improved self-management behaviours, improved health outcomes, enhanced quality of life, and maintenance of social roles and functioning. CONCLUSION:Self-management support in oncology is an ongoing, person-centred, professionally guided and collaborative process that integrates multidimensional support and resources to strengthen patients' capacity to manage illness-related problems. This concept analysis provides a clearer conceptual foundation for measurement development, intervention design and oncology nursing practice.

Purpose Breast cancer is the second most prevalent cancer among women in the United States. Rural breast cancer survivors (RBCS) face unique challenges because geographical isolation limits access to facilities, support groups, and mental health services. Expressive writing (EW), a therapeutic intervention navigates individuals through traumatic experiences, has demonstrated benefits for RBCS. However, first-person accounts of how RBCS experience EW remain limited. This study addresses this gap. Methods Virtual semi-structured in-depth interviews were conducted with participants (N = 14) who previously completed a virtual EW randomized controlled trial. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. Results Interviewees’ mean age was 54.71 years. Six themes emerged: rural-specific challenges (e.g., travel burden, infrastructure limit, gossip in small towns); emotion regulation and adaptive coping; personal strength through meaning-making; improved relationships; renewed purpose; and appreciation for life. These themes reflect participants’ narratives of how EW fit into their cancer journeys. Conclusions Participants reported varied but positive experiences with EW. The intervention appeared to address key psychosocial needs of RBCS, helping to mitigate rural-specific disparities in supportive care and fostering elements of posttraumatic growth. Centering survivors’ own narratives adds a nuanced understanding of what it feels like to engage in EW and how the process supports adaptation in survivorship. EW may address unmet cognitive and emotional needs among RBCS, and may serve as an economical, accessible, and scalable survivorship support strategy. Future studies may triangulate the writings, self-accounts of experiences and intervention outcomes from EW interventions to contextualize the findings.

Ambivalence over emotional expression (AEE) has been associated with various health and wellbeing outcomes, yet the relational factors that may be associated with AEE have been underexplored. The current study explored the associations between social support, conflict, gender, and AEE across a variety of different relationship types. Participants (N = 135) read scenarios describing situations where they imagined either expressing or suppressing different emotions (anger, pride, apprehension, appreciation) to five different people and then indicated the amount of regret (AEE) they anticipated over that expression decision. The results suggest that although social support was particularly related to emotional expression, conflict was associated with greater anticipated regret. Gender of the participant and gender of the interaction partner were not generally associated with either expression or regret. These findings contribute to our understanding of specific relational factors that may predict the experience of ambivalence over emotional expression and underscore the importance of considering the relational context in future AEE work.

Background Despite the global recognition of advance care planning as a critical component of patient-centred end-of-life care, its implementation remains challenged by skill-based deficiencies (e.g., inadequate training), cultural and communication barriers, and system-level structural impediments within healthcare settings. This study aimed to develop and implement a structured advance care planning communication model to improve nurses' communication practices and facilitate patient engagement in end-of-life care discussions. Methods A participatory action research design with embedded mixed methods was conducted from September 2020 to September 2022 in an oncology palliative care unit at an oncology hospital in Beijing, China. The study integrated the Advance Directive Decision-Making Model with the Meaning-Making Intervention. Data collection included surveys, participant observation, and semi-structured interviews across three phases. Four iterative action cycles were used to co-develop and refine the communication model. Quantitative and qualitative data were triangulated through team debriefings to generate meta-inferences. Results Initial assessments included surveys and observations. Nurses held a foundational knowledge of advance care planning principles (mean knowledge: 68.52%), but expressed hesitation to initiate end-of-life discussions. Iterative cycles developed a three-step communication model. The steps were: (1) Recognize the Present, (2) Life Review, and (3) Face the Future. Post-action data showed improvements in in all areas. Nurses' knowledge increased significantly (mean score increase: 1.90 points). Attitudes scores increased (mean increase = 0.90) Behaviours scores also increased (mean increase = 0.57). Paired t-tests confirmed significant differences for all measures (p < 0.001). Key improvements attributed to the model included the development of time-efficient communication strategies, structured support systems, and adaptive communication techniques tailored to patient needs. Conclusions The structured three-step advance care planning communication model improves nurse-patient communication and patient engagement in end-of-life decision-making. This model provides a practical framework for initiating and guiding advance care planning conversations in oncology care. Future research is needed to evaluate its applicability in diverse settings and its long-term impact on patient outcomes.

Objective The purpose of this study is to develop and validate an improved CA-VTE risk prediction model based on semi-supervised learning (SSL) algorithm.Methods This study used a combined retrospective and prospective cohort design. First, data from 2100 cancer patients in a tertiary hospital in Beijing were retrospectively collected, including a "labeled cohort" with CA-VTE outcomes (N = 1036) and an "unlabeled cohort" without outcomes (N = 1064). Then, another dataset were prospectively collected as an external validation set (N = 321). Eight supervised machine learning (ML) algorithms were used to develop CA-VTE risk prediction models and one SSL algorithm was used to improve generalizability of the models (pre- and post-imputation ML models). Model performance were evaluated using the Area Under the Curve (AUC) and Brier score in the prospective cohort, and compare them with the Khorana score.Results The eight post-imputation ML models (AUC: 0.816-0.868; Brier score: 0.118-0.160) performed better on the external validation set than the pre-imputation models (AUC: 0.798-0.841; Brier score: 0.133-0.171). In contrast, the AUC of the Khorana score remained unchanged (AUC: 0.693), while its Brier score increased (Brier score: 0.172 vs 0.178).Conclusion Based on a retrospective and prospective cohort study design, this study developed eight ML models that outperformed the Khorana score. Using SSL algorithm improved the external validation performance of the models and enhanced prediction accuracy. This study can provide an important reference for the early identification of high-risk factors and stratified preventive care for CA-VTE.

OBJECTIVE:Chinese American breast cancer survivors (CABCS) often face cultural challenges regarding emotional expression. Expressive writing (EW) interventions can improve emotional expression and, thus, quality of life (QOL), but individual responses to EW may vary. We examined whether specific social determinants of health (SDOH)-personal income, education, employment status, and marital status-moderated the effect of EW on QOL among CABCS. METHODS:A three-arm randomized controlled trial of EW was conducted among CABCS (N = 136). Conditions were self-regulation (SR; emotions, coping, positivity), enhanced self-regulation (ESR; coping, emotions, positivity), and cancer facts (control). Participants completed three weekly writing sessions. Separate residual change regressions were performed to examine interactions between intervention condition and each of the four SDOH variables on 6-month QOL, controlling for covariates and baseline QOL. RESULTS:Income significantly moderated intervention efficacy at the 6-month follow-up, with exploratory evidence also suggesting moderation by marital status. In the ESR condition, participants with above poverty-level income (≥ $15,000) reported higher QOL than those with poverty-level income (< $15,000; b = 7.66, p = 0.037). Among participants with above poverty-level income, the ESR group reported significantly higher QOL than participants in the control group (b = 15.16, p < 0.001). In an exploratory finding, among unmarried participants, those in the SR condition had higher QOL than those in the control (b = 12.09, p = 0.038). CONCLUSIONS:EW interventions can improve QOL among CABCS, but their efficacy may depend on individual SDOH factors. These findings suggest that culturally tailored interventions accounting for survivors' SDOH may enhance EW's therapeutic impact. TRIAL REGISTRATION:The trial is registered at ClinicalTrials.gov (Identifier: NCT02946619).

ObjectivesProstate cancer is the most common cancer among men in the United States. This study examines factors associated with active surveillance (AS) uptake, timing of treatment decision making, and whether timing affects quality of life.MethodsWe used data from a population-based observational study of 512 patients aged 40–79 diagnosed with low-risk prostate cancer from 2016 to 2022. Factors associated with AS receipt and treatment decision-making trajectories were assessed using robust Poisson regression models. Patient-reported satisfaction with treatment and PROMIS measures were analyzed using Poisson and linear regression.ResultsAS uptake was 70.9% in the overall sample, higher among non-Hispanic (NH) White (76.6%) and NH Asian American/Pacific Islander (75.0%) patients than among NH Black (64.1%) and Hispanic (57.3%) patients. In adjusted models, higher education was associated with greater AS uptake (prevalence ratio (PR): 1.35; 95% CI: 1.02–1.78), and Hispanic patients were less likely to choose AS (PR: 0.80; 95% CI: 0.65–0.99). Older patients were more likely to delay disease management decisions (60–69 years: PR: 1.47; 95% CI: 1.09–1.98; 70 + years: PR: 1.67; 95% CI: 1.17–2.37), while partnered patients were less likely to delay (PR: 0.69; 95% CI: 0.54–0.88). Late deciders reported lower satisfaction with treatment decisions (PR: 0.92; 95% CI: 0.85–0.99) and higher anxiety scores at follow-up (coef: 1.86; 95% CI: 0.15–3.57).ConclusionsHispanic patients, those who completed less education, and older patients face barriers to timely decisions about disease management. Partner involvement supports earlier decisions, while later decision was linked to lower satisfaction and higher anxiety.

AIM:To assess the current use of personal protective equipment (PPE) among nurses handling chemotherapy drugs in cancer hospitals in China and to explore the factors associated with PPE use by nurses. BACKGROUND:Nurses, the primary handlers of chemotherapy drugs, face significant exposure risks. Accurately assessing PPE use and its determinants is therefore crucial for developing targeted interventions to mitigate exposure and increase occupational safety. METHODS:Convenience sampling was used to select nurses from cancer hospitals in 30 provinces in China from December 1, 2024, to January 6, 2025. A cross-sectional survey was conducted that utilised a general information questionnaire and the Hazardous Drug Handling Questionnaire. Data analysis was performed using SPSS 24.0 and SmartPLS 4.0 software. RESULTS:SmartPLS analysis revealed significant direct effects of interpersonal influences, workplace safety, self-efficacy, perceived barriers, and perceived risks on PPE usage. The mediation analysis revealed that self-efficacy, perceived risk, perceived barriers, and chemotherapy exposure knowledge mediated the relationship between chemotherapy handling experience and PPE use, whereas perceived barriers and interpersonal influences mediated the effect of workplace safety factors on PPE use. Perceived conflict of interest sharing negatively moderated the interaction between interpersonal influences and PPE usage and moderated the mediating effect of interpersonal influences. CONCLUSION:The results validated and extended the applicability of the health promotion model in the field of occupational safety behaviour. The findings revealed that a multilevel intervention system should be developed to increase the PPE utilisation rate among oncology nursing staff. IMPLICATIONS FOR NURSING MANAGEMENT:Management should foster safe environments that enable positive peer interactions, systematically transform nurses' experience into knowledge and risk awareness, and reduce perceived nurse-patient conflicts to strengthen trust and safety norm effectiveness.

BACKGROUND:Given that patients with breast cancer receiving endocrine therapy mainly take medication at home for a long time, they must adopt self-management strategies to deal with the multifaceted challenges associated with long-term treatment. Identifying the factors that influence self-management behaviors is crucial to developing targeted interventions. OBJECTIVE:Based on the Individual and Family Self-management Theory, this study investigates the present status and influencing factors of self-management behaviors in breast cancer survivors receiving endocrine therapy. METHODS:269 patients were selected at a tertiary hospital between September 2024 and May 2025. The survey was conducted using self-reported questionnaires. Structural equation modelling was employed to analyze the influencing factors. RESULTS:The self-management score rate of patients was 80.4%, indicating generally favorable overall self-management behaviors. Symptom distress directly and indirectly influenced patients' self-management behaviors. Social capital and family functioning exerted only indirect effects, while self-efficacy, self-regulation, and social support had direct effects. These factors also functioned as parallel mediators in the relationships between symptom distress and self-management behaviors, as well as between social capital and self-management behaviors. Self-efficacy and social support mediated the association between family functioning and self-management behaviors. CONCLUSION:The Individual and Family Self-management Theory model proved suitable for exploring factors influencing the self-management behaviors of breast cancer survivors. Symptom distress, social capital, family functioning, self-efficacy, self-regulation, and social support were key influence factors of self-management behaviors. IMPLICATIONS FOR PRACTICE:Healthcare professionals can develop targeted interventions based on symptom distress, social capital, family functioning, self-efficacy, self-regulation, and social support to enhance patients' self-management capabilities.

Background and aimPostoperative complications remain common after major gastrointestinal (GI) cancer surgery. Although early nutritional support is a core component of enhanced recovery protocols, optimal postoperative targets for energy and protein intake remain uncertain. This study aimed to characterize dose–response relationships between early postoperative nutritional intake and postoperative complications.MethodsThis prospective observational cohort included adults undergoing elective gastrectomy or partial colectomy for GI malignancy. Postoperative energy and protein intake were quantified during postoperative days 1-2 (POD 1-2). Overall postoperative complications occurring after POD 2 and within 30 days after surgery were the primary outcome; infectious complications were secondary. Nonlinear associations were examined using multivariable logistic regression with restricted cubic splines (RCS) as the primary method, supported by generalized additive and quadratic models. Analyses were adjusted for demographic, surgical, oncologic, and nutritional covariates, including GLIM-defined malnutrition. Optimal intake ranges were defined using a CI-overlap criterion with bootstrap validation.ResultsAmong 642 patients, early postoperative energy intake demonstrated a statistically significant nonlinear association with complication risk (p-for nonlinearity = 0.018). The nadir occurred at 14.4 kcal/kg/day, with an optimal intake range of 12.8–20.1 kcal/kg/day. Protein intake showed a less consistent association, without statistically significant evidence of nonlinearity (p = 0.166). The nadir occurred at 0.81 g/kg/day, with an optimal intake range of 0.55–1.51 g/kg/day, with no consistent upper harm threshold observed within routine clinical ranges.ConclusionEarly postoperative energy intake after GI cancer surgery demonstrated a robust nonlinear association with postoperative complications, with lowest predicted risk observed at moderate caloric provision. In contrast, protein intake showed a less consistent association and a wider estimated optimal range. These findings warrant further investigation of individualized, precision-oriented postoperative nutrition strategies in surgical oncology.

PURPOSE:To identify the associations between dyadic coping, intimate relationship, and reproductive concerns among women of childbearing age with breast cancer, and explore whether intimate relationship serve as a mediator between dyadic coping and reproductive concerns. METHODS:A cross-sectional study was conducted from March 2023 to February 2024 in a tertiary hospital in China. Using convenience sampling, 180 couples (people living with breast cancer of childbearing age and their spouses) were recruited. Data were collected using general information questionnaires, the Dyadic Coping Inventory, the Marital Adjustment Scale, and the Reproductive Concerns After Cancer Scale. The Actor-Partner Interdependence Mediation Model was utilized to analyze the dyadic data. Statistical analyses were completed utilizing SPSS 25.0 and AMOS 28.0 software. RESULTS:Dyadic coping of people living with breast cancer and their spouses positively associated with their own and each other's intimate relationship. Spousal dyadic coping and intimate relationship of people living with breast cancer negatively associated with reproductive concerns. Additionally, the intimate relationship of people living with breast cancer mediated associated between dyadic coping of couples and reproductive concerns. CONCLUSIONS:The study highlights the significant association between couples' dyadic coping and patients' reproductive concerns. In a supportive and collaborative environment, couples tend to better address reproductive health challenges, and this is associated with greater psychological well-being and relationship satisfaction. Further research is needed to explore how dyadic coping impacts reproductive outcomes and to develop customized interventions for couples facing reproductive challenges.

BACKGROUND:Lymphatic pain is an underrecognized symptom among breast cancer survivors and may indicate early lymphatic dysfunction. This study examined the prevalence of lymphatic pain and its associated factors, with a particular focus on the interaction between obesity and breast cancer-related lymphedema (BCRL). METHODS:A secondary analysis was conducted using datasets from 2 previously completed studies. 894 participants who completed arm circumference measurements and symptom assessments were included. Independent t-tests, chi-square tests, Fisher's exact tests, and binary logistic regression analyses were performed to explore group differences and potential predictors of lymphatic pain. An interaction term between obesity and BCRL was incorporated to evaluate effect modification. RESULTS:The prevalence of lymphatic pain was 18.12% (n = 162, 95% CI, 15.8%-20.8%). Participants with lymphatic pain reported a greater number, higher severity, and higher frequency of all symptoms compared to those without lymphatic pain (all P < .001). BCRL was the strongest independent predictor of lymphatic pain (OR = 2.955, 95% CI, 1.957-4.460). Although the main effect of obesity was not statistically significant, a significant obesity × BCRL interaction was identified (P = .032). Predicted probabilities indicated that obesity had minimal effect among participants without BCRL, but increased lymphatic pain risk among those with BCRL. CONCLUSION:Obesity and BCRL are key factors associated with lymphatic pain, and obesity markedly amplifies pain risk in the presence of BCRL. These findings highlight the need for early lymphatic assessment and weight-management-informed survivorship care. Ongoing research is needed to clarify mechanisms and to evaluate targeted interventions.

Purpose To identify the subgroups and symptom networks associated with endocrine therapy in patients with breast cancer. Methods This study was a cross-sectional design using convenience sampling to select patients from a tertiary hospital in China. A total of 406 patients were invited to complete demographic and clinical questionnaires and the Chinese Breast Cancer Prevention Trial Symptom Scale was used to assess their symptoms. Latent profile analysis was used to classify the symptom subgroups of patients with breast cancer undergoing endocrine therapy. Univariate and binary multivariate logistic regression analyses were used to analyze the influence of these factors on different subgroups. Network analysis was used to identify the core symptoms of different subgroups. Results The analysis revealed two distinct subgroups: low symptom distress (74%; Class 1) and high symptom distress (26%; Class 2). Patients who were older, had a lower monthly family income per capita, and had not received radiotherapy were more likely to belong to Class 2. Furthermore, the network analysis results revealed that “difficulty concentrating” was a core symptom of the entire sample. The core symptom for Class 1 was “lack of energy,” and the core symptom for Class 2 was “joint pain.” Conclusion The symptoms of patients with breast cancer undergoing endocrine therapy were heterogeneous. Different subgroups exhibited different core symptoms. Therefore, targeted interventions should be provided according to the characteristics of the different symptom subgroups and their core symptoms to achieve precise and effective symptom management.

Supplemental Table 2 displays covariances among variables included in Path Analysis 1, which examined anticipated HPV vaccination stigma from friends. Standardized coefficients, p-values, and 95% confidence intervals are shown for both the saturated model (all pathways) and the trimmed model (significant pathways only).

BACKGROUND:Advance care planning (ACP), a cornerstone of ethical end-of-life care, upholds patient autonomy. However, its practice in Confucian-influenced societies, like China, is significantly shaped by cultural norms where family preferences often precede individual choice. This study explored cultural and ethical barriers to ACP implementation among oncology nursing professionals, focusing on tensions between patient-centered care and deeply rooted social norms. METHODS:A qualitative thematic analysis was conducted on open-ended responses from oncology hospitals across 22 provinces, 4 municipal cities, and 5 autonomous regions in China. Data were collected via a cross-sectional online survey and analyzed using Braun and Clarke's framework to identify patterns in cultural, ethical, and communicative challenges. RESULTS:A total of 838 oncology nursing professionals participated in the study. Three main interdependent barriers emerged: (1) Cultural norms, including filial piety (15.6% of codes) and death-related taboos (11.0%), often led to family-mediated decision-making (33.1%) over patient autonomy; (2) Ethical dilemmas involved neglecting patient preferences (24.3%) and conflicts between life-prolonging treatments and quality-of-life considerations (8.1%); (3) Communication challenges arose from information asymmetry (7.9%) and power imbalances, which often silenced patient voices. These factors collectively created systemic obstacles to ACP implementation. CONCLUSIONS:Context-specific ACP strategies in China should integrate Confucian ethics into nursing education, support ethics consultation, and develop culturally sensitive communication models. Future research must assess these interventions' impact on balancing cultural values and patient autonomy, advancing equitable end-of-life care in culturally diverse healthcare systems. TRIAL REGISTRATION:Not applicable.