"Don’t Forget That I Am Human": Cancer Survivors’ Communication Experiences with Healthcare Professionals: A Qualitative Study

"Don’t Forget That I Am Human": Cancer Survivors’ Communication Experiences with Healthcare Professionals: A Qualitative Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article "Don’t Forget That I Am Human": Cancer Survivors’ Communication Experiences with Healthcare Professionals: A Qualitative Study Mustafa Sabri Kovancı, Sinem Öcalan, Aylin Bilgin This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9204514/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose This study aimed to explore cancer survivors’ communication experiences with healthcare professionals in the post-treatment phase and to examine how these interactions function as relational processes shaping psychological well-being, coping, and perceptions of care. Methods A qualitative phenomenological design was used. Data were collected through semi-structured, in-depth online interviews with 15 cancer survivors between September 2024 and February 2025. Participants were recruited using purposive and snowball sampling. Interviews were audio-recorded, transcribed verbatim, and analysed using Braun and Clarke’s thematic analysis approach. Results Two overarching themes emerged: Communication Fails and More Than Words. Communication Fails reflected experiences of empathy-deficient interactions and unclear or insufficient information, which were described as distressing and disempowering. In contrast, More Than Words encompassed supportive communication behaviours, including building emotional connection, instilling hope, and respecting the patient’s voice. Eye contact, therapeutic touch, transparent information sharing, and inclusion in decision-making fostered trust, hope, and resilience among survivors. Conclusions Communication operates not merely as information exchange but as an active therapeutic mechanism shaping psychological adjustment and survivorship experiences. Cancer survivorship Health communication Patient–provider communication Empathy Qualitative study Figures Figure 1 Introduction Cancer is a multifaceted health problem that deeply affects individuals’ lives, not only physically but also in terms of their mental, social, and emotional aspects [ 1 ]. According to the World Health Organization, cancer is one of the most common causes of death worldwide, with approximately seven million people losing their lives each year due to this disease [ 2 ]. Projections show that the number of newly diagnosed cancer cases will reach 27 million in 2030, and this number could rise to 35 million in 2050 [ 3 ]. Similarly, it is known that cancer incidence and mortality rates are on an increasing trend in Türkiye [ 4 ]. On the other hand, the widespread use of early diagnosis methods, the effectiveness of screening programs, advances in the field of treatment, and the increase in the quality of healthcare services contribute to the increase in the number of cancer survivors every year [5, [ 6 ]. Moreover, early diagnosis and effective interventions prolong disease-free survival [6, [ 7 ]. Cancer survivorship is defined as “the period in which health and life of a person with cancer post-treatment until the end of life.” [ 8 ]. In the United States, there are approximately 18.1 million cancer survivors by 2022, and this number is expected to increase to 21.6 million by 2030 and 26 million by 2040. In the United States, 70% of survivors lived at least 5 years after diagnosis and 11% lived 25 years or more [ 9 ]. This shows that long-term survival is becoming increasingly common. In Turkey, a study conducted between 1992 and 2017 reported five-year survival rates of 96% for thyroid cancer, 85.3% for breast cancer, 74.2% for prostate cancer, 53.1% for colorectal cancer, 27.3% for gastric cancer, and 15.2% for lung cancer [ 10 ]. The increase in the number of cancer survivors each year has provided an opportunity to examine their experiences in this process in depth. In particular, the experiences of individuals in the post-treatment period draw attention as an important area in terms of the quality and sustainability of health services [11, [ 12 ]. One of the most determining factors that cancer survivors experience during the healthcare process is the communication with healthcare professionals [ 12 ]. Effective communication has multidimensional functions such as not only transferring information but also meeting patients' need for emotional support, establishing a relationship of trust, and increasing adherence to treatment [8, [ 13 ]. Especially for individuals struggling with a life-threatening disease such as cancer, the approach and communication style of healthcare professionals can directly affect the process of coping with the disease [ 14 ]. However, it is frequently emphasized in the literature that cancer survivors may encounter various problems in their communication with healthcare professionals, and this may have negative effects on patient satisfaction, treatment compliance, psychological well-being, and overall quality of life [15, [ 16 ]. Communication breakdowns between healthcare professionals and patients can lead to problems such as patients' needs not being fully met and treatment plans not being understood sufficiently [17, [ 18 ]. Such communication problems may increase the physical and psychosocial difficulties experienced by cancer survivors in the post-treatment period and undermine trust in the treatment process [ 19 ]. Communication problems are not only limited to deficiencies in information transfer, but may also manifest in multidimensional ways, including lack of empathy, insufficient mutual understanding between patients and healthcare professionals, neglect of patients’ emotional states, and limited involvement in decision-making processes [ 19 ]. A comprehensive evaluation of cancer survivors’ perceptions and experiences of communication is therefore essential to align care models with patient needs. As a cornerstone of patient-centered care, communication plays a critical role not only in information exchange but also in shaping emotional experiences and coping processes. Accordingly, this study aims to explore cancer survivors’ communication experiences with healthcare professionals and to examine how these communication processes function as relational mechanisms that shape psychological well-being, coping, and perceptions of care in the post-treatment phase. Methods Study Design This study was designed as a qualitative research utilizing a phenomenological approach to explore the lived communication experiences of cancer survivors with healthcare professionals. The phenomenological design was chosen to allow for an in-depth understanding of participants' subjective experiences, emotions, and meanings attributed to communication throughout their cancer journey [ 20 ]. This study was reported according to the consolidated criteria for qualitative studies (COREQ) [ 21 ]. Setting and Participants The study was conducted between September 2024 and February 2025. Participants were recruited using purposive and snowball sampling methods. Initially, an open call for research was shared via social media platforms targeting cancer survivors (e.g., Facebook, Instagram groups), and the study sample grew as interested individuals were reached and referred. The inclusion criteria for participation were as follows: (1) willingness to voluntarily participate in the study, (2) being 18 years of age or older, (3) being in the remission phase for at least one year following completion of active cancer treatment (e.g., surgery, chemotherapy, radiotherapy), and (4) having access to online communication tools (camera, microphone, computer). A total of 15 participants (n = 15) were included in the study. Research Team and Reflexivity The research team consisted of three members with expertise in nursing and qualitative research. The lead researcher XXXX holds a PhD in psychiatric nursing and currently works as a research assistant in the Department of Psychiatric Nursing at a university. The second researcher XXXX, likewise holding a PhD in psychiatric nursing, is an assistant professor in the same department of the same university. The third researcher XXXX holds a doctoral degree in internal medicine nursing and is currently employed as an assistant professor in a university's nursing faculty. All researchers have prior experience in conducting qualitative research, which informed the study’s design, data collection, and interpretation processes. Data Collection Data were collected between September 2024 and February 2025 through online in-depth interviews conducted via Zoom. A semi-structured interview guide was developed based on a comprehensive review of the relevant literature [8, [12, [ 13 ]. and the researchers’ professional expertise in oncology (Fig. 1 ). The guide was designed to elicit rich, personal narratives regarding participants’ communication experiences with healthcare professionals. Prior to each interview, participants were asked to choose a private, quiet setting where they would feel emotionally safe and comfortable to share their thoughts without interruptions. With informed consent, all interviews were audio-recorded via Zoom, and only voice recordings were retained for confidentiality. On average, interviews lasted approximately 40 minutes, although this varied slightly depending on the depth of each participant’s responses. The interview process continued until data saturation was achieved, which was operationally defined as the point at which no new concepts, categories, or perspectives were emerging from subsequent interviews [ 22 ]. Saturation was observed after the twelfth interview, and to further ensure thematic robustness and coherence, an additional three validation interviews were conducted. These final interviews helped confirm the consistency and completeness of the emerging themes, strengthening the credibility of the findings. Data Analysis Data analysis was conducted in line with Braun and Clarke's (2006) thematic analysis approach [ 23 ]. This approach aims to examine the data in depth and uncover recurring patterns of meaning. All interviews were transcribed verbatim by the researchers and read repeatedly to ensure familiarity with the data. At this stage, notes were taken on first impressions and possible themes. The participant statements were analyzed line by line, separated into meaningful units, and open codes were derived while remaining faithful to the data. The coding process was carried out with both a descriptive and interpretive approach. The resulting codes were brought together, and those with similar meaning characteristics were grouped and transformed into themes. The validity of the themes was tested by comparing them with all coded data and raw data. Inconsistent or weak themes were eliminated or combined with existing themes. Each theme was clearly defined in terms of what it represented, structured with sub-themes, and named to reflect its depth of meaning. The themes were supported by direct quotations from participant statements. The MAXQDA® software program (Version 20.0.6) was used in the data analysis process. The coding process was carried out independently by two researchers; the codes were compared, and in cases of incompatibility, a third researcher was consulted, and a consensus was reached. Rigor In order to increase the validity and reliability of this study, the four criteria developed by Guba (1981) for qualitative research were taken as a basis [ 24 ]. In order to ensure the credibility of the data, the findings obtained after the interviews with the participants were shared with some of the participants again and their verifications were obtained. In addition, data sources were diversified during the analysis process and inter-researcher coder compatibility was ensured. To ensure transferability, Participants' sociodemographic characteristics, context, study environment and data collection process were described in detail. Thus, readers were enabled to evaluate the applicability of the findings in their own contexts. To ensure dependability, the entire research process was systematically documented and interview questions, analysis stages and decision-making processes were recorded in detail. A clear methodological roadmap was provided so that an independent researcher could reach similar conclusions on the same data. For confirmability, the researchers discussed the emerging themes and sub-themes until a consensus was reached and reported the findings obtained from the statements of the participants without comment. In addition, the data were also analyzed to ensure that the research findings were based on the data and not only on the researcher's interpretation [ 24 ]. Results A total of 15 cancer patients (14 female, 1 male) participated in the study, with a mean age of 52.4 ± 8.3 years. The average time since diagnosis was 9.5 ± 4.8 years, and the mean time since treatment completion was 6.4 ± 4.4 years. Most participants were married (73.3%) and reported a moderate economic status (86.7%). In terms of education, 60.0% were university graduates. Breast cancer was the most common diagnosis (73.3%). Two participants had metastasis, and one experienced recurrence. The analysis identified two themes: Communication Fails (lack of empathy, blurry information) and More Than Words (building connection, instilling hope, respecting patient voice) (Table 1 ). All participant quotations were labeled with the signifier “P” to ensure anonymity and confidentiality (Table 2 ). Table 1 Themes and Sub-themes Themes Sub-themes Communication Fails Lack of Empathy Blurry Information More Than Words Building Connection Instilling Hope Respecting Patient Voice Table 2 Characteristics of the participants (n = 16) Participant Age Gender Marital status Cancer diagnosis Time since diagnosis (years) Time since end of treatment (years) Metastasis status Recurrence status P1 66 Female Married Breast 13 3 No No P2 47 Female Married Breast 4 3 No No P3 53 Female Married Breast 8 7 No No P4 56 Female Married Breast 12 4 No No P5 52 Female Single Breast 9 8 No No P6 44 Female Married Malignant Melanoma 9 8 No No P7 44 Female Single Breast 4 3 No No P8 54 Female Single Gastric 11 10 No No P9 60 Female Married Breast 18 2 Yes Yes P10 49 Female Married Breast 12 11 No No P11 60 Female Married Column 13 11 No No P12 46 Male Single Column 4 3 No No P13 52 Female Married Breast 17 17 No No P14 66 Female Married Ovarian 4 3 Yes No P15 37 Female Married Breast 4 3 No No Communication Fails Participants stated that they experienced communication problems with healthcare professionals under this theme. They emphasized that communication lacking empathy and the delivery of unclear information led to negative experiences throughout the cancer process. Lack of Empathy Participants emphasized that while the diagnosis might be a routine and common occurrence for healthcare professionals, for them, cancer was a devastating, unfamiliar, and uncertain experience. They underscored the importance of empathetic communication during such a vulnerable time. The lack of empathy was described as an inability to establish an emotional connection, a failure to acknowledge their concerns, mechanical and insensitive interactions, the abrupt and unprepared disclosure of the cancer diagnosis, and the use of demoralizing statements. They shouldn’t forget that I’m a human being. Of course, they may have their own attitude and personality, and I don’t expect a healthcare professional to be overly affectionate with me. I know it’s a very routine diagnosis for them, but… (S4) There was no real communication with me. He/she just looked and said, “Oh, this is malignant, we need to remove it.” Then, with a serious expression, he added, “This is going to be challenging for us. We need to remove it immediately. It’s not good at all—it’s bad.” There was no reaction, no emotion—he/she seemed almost mechanical. (S3) The doctor said, “Oh, this is a type I really don’t like. If we see it as the size of a hazelnut, we’ll remove it like it’s the size of a walnut. If it looks like a walnut, we’ll take it out like it’s the size of an apple. Your type of cancer is very aggressive,” and before I could even process what was happening, he/she said directly to my face, “I think this is cancer.”… It was a very serious trauma for me. The way he/she addressed me, the manner of expression… (S15) Blurry Information Participants emphasized that ambiguity in the information they received from healthcare professionals had a profoundly negative impact on both the treatment process and its aftermath. They identified communication problems such as incomplete or unclear explanations about the treatment process, lack of guidance on activities like healthy eating, drinking, or exercise, and having their questions either unanswered or addressed with superficial responses. For example, I asked my doctor about the staging of my cancer. He/She responded by saying, "That's not your concern; it's something for us to know. It's a medical matter that concerns us." When I asked something about the surgery, he/she similarly dismissed my question. He/She gave short, blunt answers without any explanation. (S3) I wish they had told me what I should eat and drink. I wish they had explained what I should do, what I could or couldn't do. Instead, I had to learn these things over the years by hearing from others—like “you’re supposed to eat this” or “you shouldn't be doing that.” I wish I hadn’t had to figure it all out on my own. (S5) More Than Words In addition to the challenges they faced, participants also described moments of meaningful and supportive communication with healthcare professionals. Participants emphasized in this theme that communication is more than just words and that positive experiences empowered them throughout the process. This theme included the subthemes ‘Building Connection’, ‘Instilling Hope’, and ‘Respecting Patient Voice’. Building Connection Participants expressed that eye contact, efforts to get to know the patient, therapeutic touch, and friendly communication played a significant role in building a meaningful connection with healthcare professionals. Direct and sincere eye contact made them feel truly seen, while being addressed by name and recognized as individuals—beyond just being patients—helped them feel acknowledged and valued. Supportive and gentle touch during examinations or treatment created a sense of safety that went beyond physical care. When combined with a warm and friendly manner, these elements helped participants feel emotionally at ease and fostered a sense of closeness with healthcare professionals. Making eye contact made me feel good. He/She spoke without ever taking his/her eyes off me. It was clear that the pathology result had come out—he/she was holding the paper in hand. (S13) Even just being recognized by the doctor is enough, believe me. They have so many patients, but when they remember you, it makes you feel special. And that really matters—because every person is special, truly. (S2) He [Doctor] held my hand before the anesthesia was given. I was already in the operating room. With a kind, fatherly attitude, he/she held my hand and tapped it twice, as if to say, “Relax.” I can never forget that moment of support. It was like someone was saying, “I’m here with you,” or making me feel like it was something manageable. (S4) The nurses were really good. I appreciated them a lot. They were so patient and so kind. They never turned me down or made me feel bad. (S7) Instilling Hope Participants stated that the encouragement and hopeful approach of healthcare professionals had a positive effect on their process. They emphasized that the use of calming and reassuring language, highlighting the treatability of the illness, explaining that it is manageable, and sharing the positive aspects of the treatment process gave them emotional strength. These approaches helped reduce their fear and uncertainty, increased their hope. The doctor said, “Don’t worry, I’ve performed this surgery many times before, and I’ll do it again.” He/She reassured me by saying that he/she would approach my surgery with the same dedication and care. (S12) A nurse had said, “We’re going to get through this together.” She said it while placing the IV in my arm, looking directly at my face. It was my first chemotherapy session, and I was feeling anxious. That moment made me really happy. (S8) He/She said, “This is a very early stage, which is really good for us. You’ll have surgery, then chemotherapy, but radiotherapy is not certain yet. We can get through this—as long as you help us too.” (S13) Respecting Patient Voice Participants stated that being asked for their opinions, being actively involved in the treatment process, and having their questions taken seriously made them feel more valued and empowered. They emphasized that being consulted and included in decision-making helped them move from being passive recipients to active participants in their treatment journey. For example, my doctor asked me whether I preferred to have my entire breast removed or just the tumor cleaned out. I said, “Doctor, you know better—do whatever is best.” He/She told me, “I can adapt to either of your decisions, but if you prefer, we can remove the entire breast.” At that moment, I trusted my doctor. (S1) During the follow-up period, it seemed a few times like there was a recurrence. Although the initial tests suggested a recurrence, it later turned out to be a lipoma. But my doctor explained everything to me and would say things like, “These are the tests we’re going to do now—what do you think? How do you feel about this?” This made me feel like he/she truly understood what I was going through. (S10) The nurses provided information and answered every question I asked. They never said, “I don’t know.” For example, when I asked if I could eat something, if it was something I should be eating, they would say, “Of course, you can.” They would always give advice like “Pay attention to this,” “Avoid eating that,” or “Try not to overexert yourself.” (S7) Discussion This study demonstrates that communication during the cancer process extends beyond mere information transfer and functions as a relational process through which empathy, support, and trust are constructed. Participants emphasized that empathy-deficient interactions and unclear or insufficient information negatively affected both the treatment process and their psychological well-being. From a health communication perspective, these experiences indicate that empathy should be understood not as a personal trait of healthcare professionals but as a communication process conveyed through interactional cues such as tone of voice, pacing of information delivery, eye contact, and responsiveness to emotional signals. When these relational communication practices were present, participants described feeling safer, more hopeful, and more empowered; when they were absent or misaligned, communication breakdowns emerged, leading to emotional disconnection and psychological vulnerability. Importantly, these findings suggest that communication operates not only as a contextual feature of care but as an active relational mechanism that shapes psychological safety, coping, and adjustment throughout the survivorship trajectory. In this respect, meaningful communication that values the patient’s voice and fosters hope plays a strengthening role in survivorship care and contributes to the development of a more patient-centred and humane approach to oncology practice. Findings show that the communication style of healthcare professionals during the cancer diagnosis process has profound psychosocial effects on patients. Participants emphasized that while diagnosis may be a routine process for healthcare professionals, it is a devastating, uncertain, and frightening experience for them. In particular, sudden, unprepared, and empathy-deficient communication of the diagnosis creates traumatic effects in patients. Similarly, the literature indicates that the communication style of healthcare professionals working in oncology plays a decisive role in patients' compliance with treatment, psychological well-being, and participation in the treatment process (Azarabadi et al., 2024; Darabos et al., 2022;. Previous studies have also shown that a lack of empathy increases patients' emotional burden and undermines their trust [ 25 ]. It has been reported that the words, tone of voice, and body language used during the communication of the diagnosis directly affect how patients perceive their condition, while negative or mechanical communication increases levels of hopelessness and anxiety [ 26 ]. In addition, this study revealed that the uncertainty of information faced by cancer patients during their treatment process had negative physical and psychological consequences, as evidenced by patient statements. Participants stated they did not receive sufficient, clear, and understandable information during the diagnosis and treatment stages, and that they were not given guidance on nutrition, exercise, and daily activities. The literature also indicates that inadequate information increases anxiety levels in patients, reduces trust in treatment, and causes patients to become passive in their own care processes [27, [ 28 ]. Transparency of information in patient-healthcare professional communication directly affects not only patient satisfaction but also treatment compliance and quality of life [16, [ 17 ]. Especially in diseases requiring long-term treatment, such as cancer, it is critical that patients have access to the necessary information to participate in active decision-making [ 18 ]. Therefore, this study highlights the need for systematic, patient-centered approaches to information provision in cancer care. Another important emphasis of the study was that participants were able to manage their entire process more effectively with healthcare professionals with whom they could establish a connection. Participants reported that therapeutic touch, along with close, attentive, and sincere communication, contributed to the establishment of this connection and helped them feel safer. Studies conducted with cancer patients have indicated that therapeutic touch has positive effects, ranging from physiological symptoms such as pain, nausea, vomiting, and fatigue to quality of life (Aghabati et al., 2010;. In the literature, it has also been reported that cancer survivors who perceived the care they received as thoughtful, compassionate, and caring experienced more positive outcomes [ 29 ]. Similarly, healthcare professionals’ positive, sincere, and energetic attitudes have also been emphasized by cancer patients as reassuring and instilling hope [ 30 ]. This finding can be explained by the fact that patients are in need of not only medical treatment but also human connection and emotional support. Participants found it important that the treatability of the disease was emphasized and that both the positive and negative aspects of the process were shared transparently with them. From the moment it is first heard, a cancer diagnosis may lead many patients to perceive it as an incurable disease that will inevitably result in death [ 31 ]. However, today, cancer treatment methods and options are steadily increasing worldwide [ 32 ]. In the literature, it has been stated that cancer patients felt more prepared to cope with possible adversities when they received information regarding the diagnosis and treatment process [ 33 , 34 ]. In addition, Long Roche et al. (2016) reported that when patients who were considering discontinuing treatment due to severe side effects were encouraged by healthcare professionals to continue, their motivation to persist with treatment increased [ 33 ]. This finding indicates that transparent information sharing both facilitates coping with uncertainty and increases treatment adherence. In this study, participants stated that, in addition to being provided with information by healthcare professionals, being asked for their own opinions and becoming an active rather than a passive part of the process made them feel safer and more supported. A study found that treatment options, long-term consequences, and personal priorities were insufficiently discussed with cancer patients [ 35 ]. Mazor et al. (2013) also noted that cancer patients, because they entrust their lives to healthcare professionals, expect a more equal relationship [ 34 ]. In the literature, cancer survivors have further expressed that it was healing when their doctors did not rush, took time, and included them in the process [ 29 ]. This finding demonstrates that patients are not only individuals receiving treatment but also subjects who want to take an active role in decision-making processes. Importantly, the findings indicate that communication does not merely accompany psychological outcomes in survivorship but actively shapes them. Participants’ narratives demonstrate how communication practices mediated their experiences of hope, control, and emotional safety during and after treatment. From this perspective, communication emerges not as a contextual factor but as a central mechanism through which psychological well-being is negotiated in cancer survivorship. Positioning communication as an active determinant of psychological adjustment underscores the need to conceptualize survivorship care as an inherently communicative process rather than a solely biomedical one. Limitations This study has some limitations. The sample consisted predominantly of women, with breast cancer being the most common diagnosis, which may restrict the transferability of findings to male survivors and those with other cancer types. In addition, the relatively small number of participants recruited through purposive and snowball sampling limits the generalizability of the results. The inclusion of only survivors who had completed active treatment at least one year earlier may also have excluded perspectives of individuals currently undergoing treatment. Implications for Clinical Practice The findings highlight the need for structured communication training for oncology specialists, focusing on empathy, clarity, and shared decision-making. Incorporating strategies such as therapeutic touch, providing transparent information, and active listening can increase patients' trust and resilience. Integrating communication as a fundamental component of survival care models can strengthen patient-centred care, improve treatment adherence, and ultimately contribute to better long-term outcomes for cancer survivors. Conclusion This study emphasizes that communication with healthcare professionals during the cancer process goes beyond the exchange of medical information. Empathy, transparency, and patient involvement emerged as critical elements shaping cancer survivors' psychological well-being and trust in treatment. Conversely, insufficient empathy and ambiguous or dismissive communication experiences increased distress and undermined trust. Therefore, meaningful and supportive communication should be recognised as a therapeutic element of cancer survivors' care. Declarations Competing Interests The authors have no relevant financial or non-financial interests to disclose. Ethical Approval The study protocol was approved by the Ethics Committee of Hacettepe University (Approval Number: 46/26 No: E-26428519-050.90-2024). This study was conducted in accordance with the ethical standards outlined in the Declaration of Helsinki. Prior to data collection, all participants provided both written and oral informed consent. Consent to Participate Informed consent was obtained from all individual participants included in the study. Funding The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Author Contribution All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Mustafa Sabri Kovancı, Sinem Öcalan, and Aylin Bilgin. The first draft of the manuscript was written by Mustafa Sabri Kovancı, Sinem Öcalan, and Aylin Bilgin, and all authors commented on previous versions of the manuscript. 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Adult patient communication experiences with nurses in cancer care settings: a qualitative study. BMC Nurs. 2022;21(1):201. https://doi.org/10.1186/s12912-022-00981-4 Husson O, Mols F, van de Poll-Franse L. The relation between information provision and quality of life, anxiety and depression among cancer survivors: a systematic review. Ann Oncol. 2011;22(4):761–772. https://doi.org/10.1093/annonc/mdq413 Westendorp J, Evers AWM, Stouthard JML, et al. Mind your words: oncologists' communication that potentially harms patients with advanced cancer. Cancer. 2022;128(5):1133–1140. https://doi.org/10.1002/cncr.34018 Ratnapradipa KL, Ranta J, Napit K, et al. Qualitative analysis of cancer care experiences among rural cancer survivors and caregivers. J Rural Health. 2022;38(4):876–885. https://doi.org/10.1111/jrh.12665 Prip A, Pii KH, Nielsen DL, Jarden M. Patients' experience of communication during oncology outpatient treatment: a qualitative study. Cancer Nurs. 2022;45(1):E187–E196. https://doi.org/10.1097/NCC.0000000000000891 Nilsson S, Hård af Segerstad Y, Olsson M. Worrying about death: an initial analysis of young adult cancer patients' needs. J Adolesc Young Adult Oncol. 2021;10(1):105–108. https://doi.org/10.1089/jayao.2020.0033 Kerr AJ, Dodwell D, McGale P, et al. Adjuvant and neoadjuvant breast cancer treatments: a systematic review. Cancer Treat Rev. 2022;105:102375. https://doi.org/10.1016/j.ctrv.2022.102375 Long Roche K, Angarita AM, Cristello A, et al. “Little big things”: a qualitative study of ovarian cancer survivors. J Oncol Pract. 2016;12(12):e974–e980. https://doi.org/10.1200/JOP.2015.007492 Mazor KM, Beard RL, Alexander GL, et al. Patients' and family members' views on patient-centered communication during cancer care. Psychooncology. 2013;22(11):2487–2495. https://doi.org/10.1002/pon.3317 Kuijpers MM, van Veenendaal H, Engelen V, et al. Shared decision making in cancer treatment: a Dutch national survey. Eur J Cancer Care. 2022;31(1):e13534. https://doi.org/10.1111/ecc.13534 Additional Declarations No competing interests reported. Supplementary Files COREQChecklist.pdf Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9204514","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":627985347,"identity":"6111561e-c40b-4549-9b0f-2e71a5b13f9e","order_by":0,"name":"Mustafa Sabri Kovancı","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8UlEQVRIiWNgGAWjYHACNgYGAyAEAwMbIMHYeIAULWkgLQ1EaGGAaWE4DCbxatHtP/zscUUBgzG/RPKzBz8KztutbT8MtKXGJhqXFrMbaeaGZwwYzCRnABk9BreTt51JBGo5lpbbgFMLUHWDAYONwZkDZtIMQC1mB4BaGBsO49Zy/vg3qJbj34BaziWbnX9IQMuBHLAtZgbHe0C2HLAzu0HIlhs55YYNBhLGku09ZZI9BskJZjeAtiTg88v549seNvyxMexnZt8m8eOPnb3Z+fSHDz7U2ODUAgUScFYiWGUCfuWowJ4UxaNgFIyCUTAyAAD2pV4V7igpHgAAAABJRU5ErkJggg==","orcid":"","institution":"Hacettepe University","correspondingAuthor":true,"prefix":"","firstName":"Mustafa","middleName":"Sabri","lastName":"Kovancı","suffix":""},{"id":627985348,"identity":"5f77249d-8e99-4601-bfa4-0b612ecac99a","order_by":1,"name":"Sinem Öcalan","email":"","orcid":"","institution":"Hacettepe University","correspondingAuthor":false,"prefix":"","firstName":"Sinem","middleName":"","lastName":"Öcalan","suffix":""},{"id":627985349,"identity":"c1e63854-7ccc-4eef-8efe-48273f145a81","order_by":2,"name":"Aylin Bilgin","email":"","orcid":"","institution":"Sakarya University of Applied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Aylin","middleName":"","lastName":"Bilgin","suffix":""}],"badges":[],"createdAt":"2026-03-23 21:08:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9204514/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9204514/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107870498,"identity":"81ca1266-f716-4742-8eea-7a440e245932","added_by":"auto","created_at":"2026-04-27 07:39:47","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":89610,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eInterview guide\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9204514/v1/28b5b0ec5a645de36050f4e3.png"},{"id":108493121,"identity":"e78cef9f-31c6-49b5-b05c-e3636c1e222a","added_by":"auto","created_at":"2026-05-05 09:59:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":398156,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9204514/v1/13ab4488-7291-4c1d-adaa-47406496f729.pdf"},{"id":107834686,"identity":"9312ec9c-2d76-4b61-8b27-f7e14fd096b8","added_by":"auto","created_at":"2026-04-26 15:48:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":548510,"visible":true,"origin":"","legend":"","description":"","filename":"COREQChecklist.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9204514/v1/ce43924b718c55c58a4e2883.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003e\"Don’t Forget That I Am Human\": Cancer Survivors’ Communication Experiences with Healthcare Professionals: A Qualitative Study\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCancer is a multifaceted health problem that deeply affects individuals\u0026rsquo; lives, not only physically but also in terms of their mental, social, and emotional aspects [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. According to the World Health Organization, cancer is one of the most common causes of death worldwide, with approximately seven million people losing their lives each year due to this disease [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Projections show that the number of newly diagnosed cancer cases will reach 27\u0026nbsp;million in 2030, and this number could rise to 35\u0026nbsp;million in 2050 [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Similarly, it is known that cancer incidence and mortality rates are on an increasing trend in T\u0026uuml;rkiye [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. On the other hand, the widespread use of early diagnosis methods, the effectiveness of screening programs, advances in the field of treatment, and the increase in the quality of healthcare services contribute to the increase in the number of cancer survivors every year [5, [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Moreover, early diagnosis and effective interventions prolong disease-free survival [6, [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCancer survivorship is defined as \u0026ldquo;the period in which health and life of a person with cancer post-treatment until the end of life.\u0026rdquo; [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In the United States, there are approximately 18.1\u0026nbsp;million cancer survivors by 2022, and this number is expected to increase to 21.6\u0026nbsp;million by 2030 and 26\u0026nbsp;million by 2040. In the United States, 70% of survivors lived at least 5 years after diagnosis and 11% lived 25 years or more [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This shows that long-term survival is becoming increasingly common. In Turkey, a study conducted between 1992 and 2017 reported five-year survival rates of 96% for thyroid cancer, 85.3% for breast cancer, 74.2% for prostate cancer, 53.1% for colorectal cancer, 27.3% for gastric cancer, and 15.2% for lung cancer [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe increase in the number of cancer survivors each year has provided an opportunity to examine their experiences in this process in depth. In particular, the experiences of individuals in the post-treatment period draw attention as an important area in terms of the quality and sustainability of health services [11, [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. One of the most determining factors that cancer survivors experience during the healthcare process is the communication with healthcare professionals [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Effective communication has multidimensional functions such as not only transferring information but also meeting patients' need for emotional support, establishing a relationship of trust, and increasing adherence to treatment [8, [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Especially for individuals struggling with a life-threatening disease such as cancer, the approach and communication style of healthcare professionals can directly affect the process of coping with the disease [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, it is frequently emphasized in the literature that cancer survivors may encounter various problems in their communication with healthcare professionals, and this may have negative effects on patient satisfaction, treatment compliance, psychological well-being, and overall quality of life [15, [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Communication breakdowns between healthcare professionals and patients can lead to problems such as patients' needs not being fully met and treatment plans not being understood sufficiently [17, [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Such communication problems may increase the physical and psychosocial difficulties experienced by cancer survivors in the post-treatment period and undermine trust in the treatment process [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCommunication problems are not only limited to deficiencies in information transfer, but may also manifest in multidimensional ways, including lack of empathy, insufficient mutual understanding between patients and healthcare professionals, neglect of patients\u0026rsquo; emotional states, and limited involvement in decision-making processes [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. A comprehensive evaluation of cancer survivors\u0026rsquo; perceptions and experiences of communication is therefore essential to align care models with patient needs. As a cornerstone of patient-centered care, communication plays a critical role not only in information exchange but also in shaping emotional experiences and coping processes. Accordingly, this study aims to explore cancer survivors\u0026rsquo; communication experiences with healthcare professionals and to examine how these communication processes function as relational mechanisms that shape psychological well-being, coping, and perceptions of care in the post-treatment phase.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eThis study was designed as a qualitative research utilizing a phenomenological approach to explore the lived communication experiences of cancer survivors with healthcare professionals. The phenomenological design was chosen to allow for an in-depth understanding of participants' subjective experiences, emotions, and meanings attributed to communication throughout their cancer journey [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. This study was reported according to the consolidated criteria for qualitative studies (COREQ) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSetting and Participants\u003c/h3\u003e\n\u003cp\u003eThe study was conducted between September 2024 and February 2025. Participants were recruited using purposive and snowball sampling methods. Initially, an open call for research was shared via social media platforms targeting cancer survivors (e.g., Facebook, Instagram groups), and the study sample grew as interested individuals were reached and referred.\u003c/p\u003e \u003cp\u003eThe inclusion criteria for participation were as follows: (1) willingness to voluntarily participate in the study, (2) being 18 years of age or older, (3) being in the remission phase for at least one year following completion of active cancer treatment (e.g., surgery, chemotherapy, radiotherapy), and (4) having access to online communication tools (camera, microphone, computer). A total of 15 participants (n\u0026thinsp;=\u0026thinsp;15) were included in the study.\u003c/p\u003e\n\u003ch3\u003eResearch Team and Reflexivity\u003c/h3\u003e\n\u003cp\u003eThe research team consisted of three members with expertise in nursing and qualitative research. The lead researcher XXXX holds a PhD in psychiatric nursing and currently works as a research assistant in the Department of Psychiatric Nursing at a university. The second researcher XXXX, likewise holding a PhD in psychiatric nursing, is an assistant professor in the same department of the same university. The third researcher XXXX holds a doctoral degree in internal medicine nursing and is currently employed as an assistant professor in a university's nursing faculty. All researchers have prior experience in conducting qualitative research, which informed the study\u0026rsquo;s design, data collection, and interpretation processes.\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eData were collected between September 2024 and February 2025 through online in-depth interviews conducted via Zoom. A semi-structured interview guide was developed based on a comprehensive review of the relevant literature [8, [12, [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. and the researchers\u0026rsquo; professional expertise in oncology (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The guide was designed to elicit rich, personal narratives regarding participants\u0026rsquo; communication experiences with healthcare professionals.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e Prior to each interview, participants were asked to choose a private, quiet setting where they would feel emotionally safe and comfortable to share their thoughts without interruptions. With informed consent, all interviews were audio-recorded via Zoom, and only voice recordings were retained for confidentiality. On average, interviews lasted approximately 40 minutes, although this varied slightly depending on the depth of each participant\u0026rsquo;s responses.\u003c/p\u003e \u003cp\u003eThe interview process continued until data saturation was achieved, which was operationally defined as the point at which no new concepts, categories, or perspectives were emerging from subsequent interviews [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Saturation was observed after the twelfth interview, and to further ensure thematic robustness and coherence, an additional three validation interviews were conducted. These final interviews helped confirm the consistency and completeness of the emerging themes, strengthening the credibility of the findings.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eData analysis was conducted in line with Braun and Clarke's (2006) thematic analysis approach [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. This approach aims to examine the data in depth and uncover recurring patterns of meaning. All interviews were transcribed verbatim by the researchers and read repeatedly to ensure familiarity with the data. At this stage, notes were taken on first impressions and possible themes. The participant statements were analyzed line by line, separated into meaningful units, and open codes were derived while remaining faithful to the data. The coding process was carried out with both a descriptive and interpretive approach. The resulting codes were brought together, and those with similar meaning characteristics were grouped and transformed into themes. The validity of the themes was tested by comparing them with all coded data and raw data. Inconsistent or weak themes were eliminated or combined with existing themes. Each theme was clearly defined in terms of what it represented, structured with sub-themes, and named to reflect its depth of meaning. The themes were supported by direct quotations from participant statements. The MAXQDA\u0026reg; software program (Version 20.0.6) was used in the data analysis process. The coding process was carried out independently by two researchers; the codes were compared, and in cases of incompatibility, a third researcher was consulted, and a consensus was reached.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eRigor\u003c/h2\u003e \u003cp\u003eIn order to increase the validity and reliability of this study, the four criteria developed by Guba (1981) for qualitative research were taken as a basis [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. In order to ensure the credibility of the data, the findings obtained after the interviews with the participants were shared with some of the participants again and their verifications were obtained. In addition, data sources were diversified during the analysis process and inter-researcher coder compatibility was ensured. To ensure transferability, Participants' sociodemographic characteristics, context, study environment and data collection process were described in detail. Thus, readers were enabled to evaluate the applicability of the findings in their own contexts. To ensure dependability, the entire research process was systematically documented and interview questions, analysis stages and decision-making processes were recorded in detail. A clear methodological roadmap was provided so that an independent researcher could reach similar conclusions on the same data. For confirmability, the researchers discussed the emerging themes and sub-themes until a consensus was reached and reported the findings obtained from the statements of the participants without comment. In addition, the data were also analyzed to ensure that the research findings were based on the data and not only on the researcher's interpretation [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 15 cancer patients (14 female, 1 male) participated in the study, with a mean age of 52.4\u0026thinsp;\u0026plusmn;\u0026thinsp;8.3 years. The average time since diagnosis was 9.5\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8 years, and the mean time since treatment completion was 6.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.4 years. Most participants were married (73.3%) and reported a moderate economic status (86.7%). In terms of education, 60.0% were university graduates. Breast cancer was the most common diagnosis (73.3%). Two participants had metastasis, and one experienced recurrence.\u003c/p\u003e \u003cp\u003eThe analysis identified two themes: \u003cem\u003eCommunication Fails\u003c/em\u003e (lack of empathy, blurry information) and \u003cem\u003eMore Than Words\u003c/em\u003e (building connection, instilling hope, respecting patient voice) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). All participant quotations were labeled with the signifier \u0026ldquo;P\u0026rdquo; to ensure anonymity and confidentiality (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThemes and Sub-themes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThemes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSub-themes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCommunication Fails\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLack of Empathy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBlurry Information\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMore Than Words\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBuilding Connection\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInstilling Hope\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRespecting Patient Voice\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of the participants (n\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipant\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCancer diagnosis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTime since\u003c/p\u003e \u003cp\u003ediagnosis (years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eTime since end of treatment (years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMetastasis status\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eRecurrence status\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMalignant Melanoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGastric\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eColumn\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eColumn\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOvarian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eCommunication Fails\u003c/h3\u003e\n\u003cp\u003eParticipants stated that they experienced communication problems with healthcare professionals under this theme. They emphasized that communication lacking empathy and the delivery of unclear information led to negative experiences throughout the cancer process.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eLack of Empathy\u003c/h2\u003e \u003cp\u003eParticipants emphasized that while the diagnosis might be a routine and common occurrence for healthcare professionals, for them, cancer was a devastating, unfamiliar, and uncertain experience. They underscored the importance of empathetic communication during such a vulnerable time. The lack of empathy was described as an inability to establish an emotional connection, a failure to acknowledge their concerns, mechanical and insensitive interactions, the abrupt and unprepared disclosure of the cancer diagnosis, and the use of demoralizing statements.\u003c/p\u003e \u003cp\u003e \u003cem\u003eThey shouldn\u0026rsquo;t forget that I\u0026rsquo;m a human being. Of course, they may have their own attitude and personality, and I don\u0026rsquo;t expect a healthcare professional to be overly affectionate with me. I know it\u0026rsquo;s a very routine diagnosis for them, but\u0026hellip; (S4)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eThere was no real communication with me. He/she just looked and said, \u0026ldquo;Oh, this is malignant, we need to remove it.\u0026rdquo; Then, with a serious expression, he added, \u0026ldquo;This is going to be challenging for us. We need to remove it immediately. It\u0026rsquo;s not good at all\u0026mdash;it\u0026rsquo;s bad.\u0026rdquo; There was no reaction, no emotion\u0026mdash;he/she seemed almost mechanical. (S3)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eThe doctor said, \u0026ldquo;Oh, this is a type I really don\u0026rsquo;t like. If we see it as the size of a hazelnut, we\u0026rsquo;ll remove it like it\u0026rsquo;s the size of a walnut. If it looks like a walnut, we\u0026rsquo;ll take it out like it\u0026rsquo;s the size of an apple. Your type of cancer is very aggressive,\u0026rdquo; and before I could even process what was happening, he/she said directly to my face, \u0026ldquo;I think this is cancer.\u0026rdquo;\u0026hellip; It was a very serious trauma for me. The way he/she addressed me, the manner of expression\u0026hellip;\u003c/em\u003e (S15)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eBlurry Information\u003c/h2\u003e \u003cp\u003eParticipants emphasized that ambiguity in the information they received from healthcare professionals had a profoundly negative impact on both the treatment process and its aftermath. They identified communication problems such as incomplete or unclear explanations about the treatment process, lack of guidance on activities like healthy eating, drinking, or exercise, and having their questions either unanswered or addressed with superficial responses.\u003c/p\u003e \u003cp\u003e \u003cem\u003eFor example, I asked my doctor about the staging of my cancer. He/She responded by saying, \"That's not your concern; it's something for us to know. It's a medical matter that concerns us.\" When I asked something about the surgery, he/she similarly dismissed my question. He/She gave short, blunt answers without any explanation. (S3)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eI wish they had told me what I should eat and drink. I wish they had explained what I should do, what I could or couldn't do. Instead, I had to learn these things over the years by hearing from others\u0026mdash;like \u0026ldquo;you\u0026rsquo;re supposed to eat this\u0026rdquo; or \u0026ldquo;you shouldn't be doing that.\u0026rdquo; I wish I hadn\u0026rsquo;t had to figure it all out on my own. (S5)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eMore Than Words\u003c/h2\u003e \u003cp\u003e In addition to the challenges they faced, participants also described moments of meaningful and supportive communication with healthcare professionals. Participants emphasized in this theme that communication is more than just words and that positive experiences empowered them throughout the process. This theme included the subthemes \u0026lsquo;Building Connection\u0026rsquo;, \u0026lsquo;Instilling Hope\u0026rsquo;, and \u0026lsquo;Respecting Patient Voice\u0026rsquo;.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eBuilding Connection\u003c/h2\u003e \u003cp\u003e Participants expressed that eye contact, efforts to get to know the patient, therapeutic touch, and friendly communication played a significant role in building a meaningful connection with healthcare professionals. Direct and sincere eye contact made them feel truly seen, while being addressed by name and recognized as individuals\u0026mdash;beyond just being patients\u0026mdash;helped them feel acknowledged and valued. Supportive and gentle touch during examinations or treatment created a sense of safety that went beyond physical care. When combined with a warm and friendly manner, these elements helped participants feel emotionally at ease and fostered a sense of closeness with healthcare professionals.\u003c/p\u003e \u003cp\u003e \u003cem\u003eMaking eye contact made me feel good. He/She spoke without ever taking his/her eyes off me. It was clear that the pathology result had come out\u0026mdash;he/she was holding the paper in hand. (S13)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eEven just being recognized by the doctor is enough, believe me. They have so many patients, but when they remember you, it makes you feel special. And that really matters\u0026mdash;because every person is special, truly. (S2)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eHe [Doctor] held my hand before the anesthesia was given. I was already in the operating room. With a kind, fatherly attitude, he/she held my hand and tapped it twice, as if to say, \u0026ldquo;Relax.\u0026rdquo; I can never forget that moment of support. It was like someone was saying, \u0026ldquo;I\u0026rsquo;m here with you,\u0026rdquo; or making me feel like it was something manageable. (S4)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eThe nurses were really good. I appreciated them a lot. They were so patient and so kind. They never turned me down or made me feel bad. (S7)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eInstilling Hope\u003c/h2\u003e \u003cp\u003eParticipants stated that the encouragement and hopeful approach of healthcare professionals had a positive effect on their process. They emphasized that the use of calming and reassuring language, highlighting the treatability of the illness, explaining that it is manageable, and sharing the positive aspects of the treatment process gave them emotional strength. These approaches helped reduce their fear and uncertainty, increased their hope.\u003c/p\u003e \u003cp\u003e \u003cem\u003eThe doctor said, \u0026ldquo;Don\u0026rsquo;t worry, I\u0026rsquo;ve performed this surgery many times before, and I\u0026rsquo;ll do it again.\u0026rdquo; He/She reassured me by saying that he/she would approach my surgery with the same dedication and care. (S12)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eA nurse had said, \u0026ldquo;We\u0026rsquo;re going to get through this together.\u0026rdquo; She said it while placing the IV in my arm, looking directly at my face. It was my first chemotherapy session, and I was feeling anxious. That moment made me really happy. (S8)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eHe/She said, \u0026ldquo;This is a very early stage, which is really good for us. You\u0026rsquo;ll have surgery, then chemotherapy, but radiotherapy is not certain yet. We can get through this\u0026mdash;as long as you help us too.\u0026rdquo; (S13)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eRespecting Patient Voice\u003c/h2\u003e \u003cp\u003e Participants stated that being asked for their opinions, being actively involved in the treatment process, and having their questions taken seriously made them feel more valued and empowered. They emphasized that being consulted and included in decision-making helped them move from being passive recipients to active participants in their treatment journey.\u003c/p\u003e \u003cp\u003e \u003cem\u003eFor example, my doctor asked me whether I preferred to have my entire breast removed or just the tumor cleaned out. I said, \u0026ldquo;Doctor, you know better\u0026mdash;do whatever is best.\u0026rdquo; He/She told me, \u0026ldquo;I can adapt to either of your decisions, but if you prefer, we can remove the entire breast.\u0026rdquo; At that moment, I trusted my doctor. (S1)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eDuring the follow-up period, it seemed a few times like there was a recurrence. Although the initial tests suggested a recurrence, it later turned out to be a lipoma. But my doctor explained everything to me and would say things like, \u0026ldquo;These are the tests we\u0026rsquo;re going to do now\u0026mdash;what do you think? How do you feel about this?\u0026rdquo; This made me feel like he/she truly understood what I was going through. (S10)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eThe nurses provided information and answered every question I asked. They never said, \u0026ldquo;I don\u0026rsquo;t know.\u0026rdquo; For example, when I asked if I could eat something, if it was something I should be eating, they would say, \u0026ldquo;Of course, you can.\u0026rdquo; They would always give advice like \u0026ldquo;Pay attention to this,\u0026rdquo; \u0026ldquo;Avoid eating that,\u0026rdquo; or \u0026ldquo;Try not to overexert yourself.\u0026rdquo; (S7)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study demonstrates that communication during the cancer process extends beyond mere information transfer and functions as a relational process through which empathy, support, and trust are constructed. Participants emphasized that empathy-deficient interactions and unclear or insufficient information negatively affected both the treatment process and their psychological well-being. From a health communication perspective, these experiences indicate that empathy should be understood not as a personal trait of healthcare professionals but as a communication process conveyed through interactional cues such as tone of voice, pacing of information delivery, eye contact, and responsiveness to emotional signals. When these relational communication practices were present, participants described feeling safer, more hopeful, and more empowered; when they were absent or misaligned, communication breakdowns emerged, leading to emotional disconnection and psychological vulnerability. Importantly, these findings suggest that communication operates not only as a contextual feature of care but as an active relational mechanism that shapes psychological safety, coping, and adjustment throughout the survivorship trajectory. In this respect, meaningful communication that values the patient\u0026rsquo;s voice and fosters hope plays a strengthening role in survivorship care and contributes to the development of a more patient-centred and humane approach to oncology practice.\u003c/p\u003e \u003cp\u003eFindings show that the communication style of healthcare professionals during the cancer diagnosis process has profound psychosocial effects on patients. Participants emphasized that while diagnosis may be a routine process for healthcare professionals, it is a devastating, uncertain, and frightening experience for them. In particular, sudden, unprepared, and empathy-deficient communication of the diagnosis creates traumatic effects in patients. Similarly, the literature indicates that the communication style of healthcare professionals working in oncology plays a decisive role in patients' compliance with treatment, psychological well-being, and participation in the treatment process (Azarabadi et al., 2024; Darabos et al., 2022;. Previous studies have also shown that a lack of empathy increases patients' emotional burden and undermines their trust [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. It has been reported that the words, tone of voice, and body language used during the communication of the diagnosis directly affect how patients perceive their condition, while negative or mechanical communication increases levels of hopelessness and anxiety [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn addition, this study revealed that the uncertainty of information faced by cancer patients during their treatment process had negative physical and psychological consequences, as evidenced by patient statements. Participants stated they did not receive sufficient, clear, and understandable information during the diagnosis and treatment stages, and that they were not given guidance on nutrition, exercise, and daily activities. The literature also indicates that inadequate information increases anxiety levels in patients, reduces trust in treatment, and causes patients to become passive in their own care processes [27, [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Transparency of information in patient-healthcare professional communication directly affects not only patient satisfaction but also treatment compliance and quality of life [16, [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Especially in diseases requiring long-term treatment, such as cancer, it is critical that patients have access to the necessary information to participate in active decision-making [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Therefore, this study highlights the need for systematic, patient-centered approaches to information provision in cancer care.\u003c/p\u003e \u003cp\u003eAnother important emphasis of the study was that participants were able to manage their entire process more effectively with healthcare professionals with whom they could establish a connection. Participants reported that therapeutic touch, along with close, attentive, and sincere communication, contributed to the establishment of this connection and helped them feel safer. Studies conducted with cancer patients have indicated that therapeutic touch has positive effects, ranging from physiological symptoms such as pain, nausea, vomiting, and fatigue to quality of life (Aghabati et al., 2010;. In the literature, it has also been reported that cancer survivors who perceived the care they received as thoughtful, compassionate, and caring experienced more positive outcomes [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Similarly, healthcare professionals\u0026rsquo; positive, sincere, and energetic attitudes have also been emphasized by cancer patients as reassuring and instilling hope [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. This finding can be explained by the fact that patients are in need of not only medical treatment but also human connection and emotional support.\u003c/p\u003e \u003cp\u003eParticipants found it important that the treatability of the disease was emphasized and that both the positive and negative aspects of the process were shared transparently with them. From the moment it is first heard, a cancer diagnosis may lead many patients to perceive it as an incurable disease that will inevitably result in death [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. However, today, cancer treatment methods and options are steadily increasing worldwide [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. In the literature, it has been stated that cancer patients felt more prepared to cope with possible adversities when they received information regarding the diagnosis and treatment process [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. In addition, Long Roche et al. (2016) reported that when patients who were considering discontinuing treatment due to severe side effects were encouraged by healthcare professionals to continue, their motivation to persist with treatment increased [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. This finding indicates that transparent information sharing both facilitates coping with uncertainty and increases treatment adherence.\u003c/p\u003e \u003cp\u003eIn this study, participants stated that, in addition to being provided with information by healthcare professionals, being asked for their own opinions and becoming an active rather than a passive part of the process made them feel safer and more supported. A study found that treatment options, long-term consequences, and personal priorities were insufficiently discussed with cancer patients [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Mazor et al. (2013) also noted that cancer patients, because they entrust their lives to healthcare professionals, expect a more equal relationship [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. In the literature, cancer survivors have further expressed that it was healing when their doctors did not rush, took time, and included them in the process [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. This finding demonstrates that patients are not only individuals receiving treatment but also subjects who want to take an active role in decision-making processes.\u003c/p\u003e \u003cp\u003eImportantly, the findings indicate that communication does not merely accompany psychological outcomes in survivorship but actively shapes them. Participants\u0026rsquo; narratives demonstrate how communication practices mediated their experiences of hope, control, and emotional safety during and after treatment. From this perspective, communication emerges not as a contextual factor but as a central mechanism through which psychological well-being is negotiated in cancer survivorship. Positioning communication as an active determinant of psychological adjustment underscores the need to conceptualize survivorship care as an inherently communicative process rather than a solely biomedical one.\u003c/p\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study has some limitations. The sample consisted predominantly of women, with breast cancer being the most common diagnosis, which may restrict the transferability of findings to male survivors and those with other cancer types. In addition, the relatively small number of participants recruited through purposive and snowball sampling limits the generalizability of the results. The inclusion of only survivors who had completed active treatment at least one year earlier may also have excluded perspectives of individuals currently undergoing treatment.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eImplications for Clinical Practice\u003c/h2\u003e \u003cp\u003eThe findings highlight the need for structured communication training for oncology specialists, focusing on empathy, clarity, and shared decision-making. Incorporating strategies such as therapeutic touch, providing transparent information, and active listening can increase patients' trust and resilience. Integrating communication as a fundamental component of survival care models can strengthen patient-centred care, improve treatment adherence, and ultimately contribute to better long-term outcomes for cancer survivors.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study emphasizes that communication with healthcare professionals during the cancer process goes beyond the exchange of medical information. Empathy, transparency, and patient involvement emerged as critical elements shaping cancer survivors' psychological well-being and trust in treatment. Conversely, insufficient empathy and ambiguous or dismissive communication experiences increased distress and undermined trust. Therefore, meaningful and supportive communication should be recognised as a therapeutic element of cancer survivors' care.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eCompeting Interests\u003c/h2\u003e \u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eEthical Approval\u003c/h2\u003e \u003cp\u003e The study protocol was approved by the Ethics Committee of Hacettepe University (Approval Number: 46/26 No: E-26428519-050.90-2024). This study was conducted in accordance with the ethical standards outlined in the Declaration of Helsinki. Prior to data collection, all participants provided both written and oral informed consent.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent to Participate\u003c/strong\u003e \u003cp\u003e Informed consent was obtained from all individual participants included in the study.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Mustafa Sabri Kovancı, Sinem \u0026Ouml;calan, and Aylin Bilgin. The first draft of the manuscript was written by Mustafa Sabri Kovancı, Sinem \u0026Ouml;calan, and Aylin Bilgin, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eDue to the sensitive nature of the qualitative data, the datasets generated and/or analysed during the current study are not publicly available in order to protect participants\u0026rsquo; confidentiality.\u003c/p\u003e\n\u003cp\u003eClinical trial number: not applicable.\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFriedman A. Cancer as multifaceted disease. \u003cem\u003eMath Model Nat Phenom.\u003c/em\u003e 2012;7(1):3\u0026ndash;28. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1051/mmnp/20127102\u003c/span\u003e\u003cspan address=\"10.1051/mmnp/20127102\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. 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Shared decision making in cancer treatment: a Dutch national survey. \u003cem\u003eEur J Cancer Care.\u003c/em\u003e 2022;31(1):e13534. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/ecc.13534\u003c/span\u003e\u003cspan address=\"10.1111/ecc.13534\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Cancer survivorship, Health communication, Patient–provider communication, Empathy, Qualitative study","lastPublishedDoi":"10.21203/rs.3.rs-9204514/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9204514/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eThis study aimed to explore cancer survivors\u0026rsquo; communication experiences with healthcare professionals in the post-treatment phase and to examine how these interactions function as relational processes shaping psychological well-being, coping, and perceptions of care.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA qualitative phenomenological design was used. Data were collected through semi-structured, in-depth online interviews with 15 cancer survivors between September 2024 and February 2025. Participants were recruited using purposive and snowball sampling. Interviews were audio-recorded, transcribed verbatim, and analysed using Braun and Clarke\u0026rsquo;s thematic analysis approach.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eTwo overarching themes emerged: Communication Fails and More Than Words. Communication Fails reflected experiences of empathy-deficient interactions and unclear or insufficient information, which were described as distressing and disempowering. In contrast, More Than Words encompassed supportive communication behaviours, including building emotional connection, instilling hope, and respecting the patient\u0026rsquo;s voice. Eye contact, therapeutic touch, transparent information sharing, and inclusion in decision-making fostered trust, hope, and resilience among survivors.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eCommunication operates not merely as information exchange but as an active therapeutic mechanism shaping psychological adjustment and survivorship experiences.\u003c/p\u003e","manuscriptTitle":"\"Don’t Forget That I Am Human\": Cancer Survivors’ Communication Experiences with Healthcare Professionals: A Qualitative Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-26 15:48:02","doi":"10.21203/rs.3.rs-9204514/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bd541862-f4d8-4e24-9d7c-9d3e5b9ccafa","owner":[],"postedDate":"April 26th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Rejected","date":"2026-05-03T09:13:04+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-03T09:03:41+00:00","index":34,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-03T09:25:00+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-26 15:48:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9204514","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9204514","identity":"rs-9204514","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}