Exploring cancer patients' experiences and acceptability of Traditional Chinese Medicine techniques: a qualitative study

Exploring cancer patients' experiences and acceptability of Traditional Chinese Medicine techniques: 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 Exploring cancer patients' experiences and acceptability of Traditional Chinese Medicine techniques: a qualitative study Yang Liu, Weina Wang, Jiayi Lin, Xia Sheng, Rujia Lin, Xinlei Wu, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6672935/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background The effectiveness of Traditional Chinese Medicine techniques in managing cancer symptoms is gaining increasing recognition. However, acceptance among cancer patients remains imbalanced globally. Researchers have begun focusing on how patients' subjective perceptions influence their acceptance, mostly through quantitative surveys. Yet, no studies have deeply explored cancer patients' subjective experiences and feelings during the use of these techniques, or how cultural and social factors influence acceptance. This study aims to explore the factors affecting cancer patients' acceptance of Traditional Chinese Medicine techniques, based on their experiences, to support broader application. Methods A descriptive qualitative approach was used to explore the experiences of cancer patients. Face-to-face, semi-structured, and in-depth individual interviews were conducted in three tertiary hospitals in southeastern China from March to May 2023. Purposive and differential sampling was used to select eligible participants. Inductive thematic analysis was used to analyze qualitative data and identify categories and subcategories. This study followed the COREQ guidelines. Results Three key themes involving nine sub-themes emerged. (1) Varied experiences of efficacy result in different levels of acceptance. Clear effects and overall comfort promote acceptance, while unmet expectations diminish it. The conflict between rapid relief and the required treatment duration of Traditional Chinese Medicine techniques also restricts acceptance. (2) Progressive trust promotes acceptance of Traditional Chinese Medicine techniques, as internal motivation based on cultural identity and external support from professional guidance, along with suggestions from family and peers, reinforce patients' trust and acceptance. (3) The actual encounter hinders the acceptance of Traditional Chinese Medicine techniques, as insufficient publicity in the modern healthcare environment, uneven technical levels among practitioners and institutions, and financial and time pressures all restrict patients' acceptance. Conclusion This study describes the complex experiences of cancer patients receiving Traditional Chinese Medicine techniques and determines the influence of their experiences on the acceptance of these techniques. These insights guide clinical practice, policy development, and future research, promoting the use of Traditional Chinese Medicine techniques in cancer treatment. Trial registration: Not applicable. Cancer Traditional Chinese Medicine techniques Qualitative research Experience Acceptance Introduction Cancer is a major global health challenge [ 1 ]. Advances in screening and treatment have improved cure rates, extended survival times, and contributed to a growing population of cancer patients [ 2 ]. However, cancer and its treatments often induce distressing symptoms, including pain, nausea, vomiting, fatigue, sleep disturbances, and depression, which persist throughout life and significantly reduce the quality of life of cancer patients [ 3 , 4 ]. Therefore, symptom management has become a primary focus for oncology healthcare professionals. In recent years, Traditional Chinese Medicine techniques, an important branch of complementary medicine, has been actively explored for the management of cancer-related symptoms [ 5 ]. Traditional Chinese Medicine techniques refer to various interventions guided by Traditional Chinese Medicine theory that act on the surface of the body or from outside the body to treat disease [ 6 , 7 ]. These include acupuncture, moxibustion, auricular therapy, acupoint patches, Gua Sha (scraping therapy), cupping, massage, and traditional Chinese exercises (such as Tai Chi, Qigong, or Baduanjin), which are also recommended by the World Health Organization, and are all characterised by simplicity, convenience, and therapeutic benefits [ 7 , 8 ]. Clinical practice guidelines from multiple authoritative professional academic organizations and associated research indicate that Traditional Chinese Medicine techniques are effective in alleviating cancer-related symptoms including insomnia, fatigue, and pain [ 9 – 12 ]. And the research has further revealed that these interventions act via mechanisms such as immune system regulation and improvement of microcirculation [ 6 ]. Multiple evidence also demonstrates that adverse reactions to Traditional Chinese Medicine techniques are few and slight, suggesting a favourable safety profile [ 13 – 15 ]. Given their efficacy and relatively low risk of adverse effects, the utilisation and promotion of Traditional Chinese Medicine techniques among cancer patients continue to attract sustained attention from researchers globally within the mainstream healthcare system [ 5 , 15 – 17 ]. Recent investigations have revealed a paradox: despite cancer patients' high expectations [ 18 ], strong interest, and belief in Traditional Chinese Medicine techniques [ 19 ], actual utilisation rates remain low, with only 1% receiving it [ 19 ]. However, a systematic review on traditional therapies among Asian cancer populations indicates that cancer patients in this region tend to apply complementary and alternative medicine, with a usage rate reaching as high as 49.3% [ 20 ]. This indicates that there is an imbalance in the application of Traditional Chinese Medicine techniques. And some researchers have also begun to study the related factors affecting the application of Traditional Chinese Medicine techniques [ 20 – 21 ]. Although these findings are enlightening, these quantitative studies can only provide data support and have not yet explored the true feelings of cancer patients towards the use of Traditional Chinese Medicine techniques, as well as the complex social and cultural factors and potential mechanisms behind the phenomena. According to Davis' Technology Acceptance Model, user acceptance is a critical factor in the promotion and application of information technologies, in other words, individual attitudes towards technological adoption serve as primary determinants of use and dissemination [ 22 – 23 ]. This theory has widely guided the research in fields such as telemedicine and health applications for cancer patients [ 24 , 25 ]. Consequently, under the guidance of Davis' technology acceptance theory, this study aims to explore the genuine experiences and attitudes of cancer patients towards Traditional Chinese Medicine techniques through qualitative methods. It will uncover the potential drivers and barriers influencing acceptance, and provide feasible suggestions for facilitating the application and promotion of Traditional Chinese Medicine techniques in cancer treatment. Methods Design A descriptive qualitative approach was used to explore the experiences of patients with cancer, conducting semi-structured interviews with cancer patients who had prior experience with Traditional Chinese Medicine techniques from March to May 2023. Participants were purposively selected from inpatients in the oncology departments of three tertiary hospitals, including one affiliated with a university of Traditional Chinese Medicine and two general hospitals. Ethical approval for the study was obtained from the Medical Ethics Committee of The Third Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine (Approval No.: 2023KS-75-1). Participants and setting The sample selection followed the principle of maximum variation and was determined by information saturation. Patients with cancer who met the inclusion and exclusion criteria were recruited for in-depth interviews. Inclusion criteria: (1) Diagnosed with a malignant tumour; (2) Fully aware of their condition and with prior experience of Traditional Chinese Medicine techniques; (3) Aged 18 years or older; (4) Normal hearing and the ability to communicate clearly in Mandarin; (5) Willingness to participate in the interviews. Exclusion criteria: (1) Patients with critical illness or other concomitant serious conditions; (2) Individuals with psychological or mental disorders. Before the interviews, the researchers clearly informed participants of the purpose of the study and their rights, including the option to withdraw at any time. At the same time, participants were assured that the interview data would be used solely for this study. All participants provided written consent. To ensure anonymity, participants' names were replaced with codes (N1 to N15). Data collection The study was conducted in accordance with the COREQ guidelines [ 26 ]. Two postgraduate nursing students (WW and JL) conducted the interviews. They were actively involved in the design, refinement, and implementation of the research and were thoroughly familiar with the research content. They underwent comprehensive qualitative research training, had extensive interview experience, and were skilled in efficiently extracting and interpreting key information. The interview guide of this study was designed around the research objectives, under the guidance of Davis' Technology Acceptance Model, consisting of open-ended questions. It was optimised based on feedback from three pre-interviews with cancer patients and discussions with the research team, ensuring scientific validity, feasibility, and applicability (see Additional file 1 ). The interviews were conducted face-to-face in quiet hospital or demonstration rooms. Each interview lasted 20 to 40 minutes. During the interview, both the interviewer and the interviewee turned off their phones to maintain a quiet environment and prevent any distractions. The interviewer employed techniques such as probing, responding, and repetition to encourage the interviewee to fully express their views, while refraining from providing guidance, suggestions, evaluations, or interventions. At the end of the interview, the interviewer summarised the content, reiterated key information, and conducted member validation to ensure the accuracy, credibility, and validity of the data. The interviews were recorded in full using an audio recorder, with the interviewees' consent, and manually transcribed verbatim into Chinese text within 24 hours, with the interviewees' identifying information anonymised. Data analysis This study employed inductive thematic analysis to analyse the interview data [ 27 ]. Two researchers independently conducted open coding on the verbatim interview transcripts, identifying meaningful units and generating initial codes. These initial codes were then integrated into subcategories and themes through processes of dismantling, merging, and aggregating [ 28 ]. Throughout the analysis, the two researchers regularly discussed the coding results. In the event of disagreements, they consulted with a third researcher (LY) until a consensus was reached, ensuring the reliability of the analysis. This study did not use qualitative data analysis software, opting instead to conduct the analysis manually to maintain flexibility and thoroughness. Data collection and analysis were conducted concurrently until saturation was reached, with no new themes or subcategories emerging. Results This study included interviews with 15 cancer patients. There were 7 males (46.7%) and 8 females (53.3%); ages ranged from 35 to 80 years, with a mean of 54.73 ± 13.87 years. Participants' educational levels were as follows: 3 (20%) had primary or junior high school education, 6 (40%) had completed senior high school or technical secondary school, and 6 (40%) had attained a college or undergraduate degree. The majority of participants (86.7%) were married and had medical insurance. Participants reported using various Traditional Chinese Medicine techniques, including massage, acupoint patches, Gua Sha, cupping, Tai Chi, Chinese herbal foot baths, auricular therapy, hot compresses, and Chinese herbal fumigation. Details are provided in Table 1 . Table 1 Participant characteristics Participant characteristics Frequency [N(%)] Age, mean ± SD 54.73 ± 13.87 years Gender Males 7 (46.7) Females 8 (53.3) Employment status Employed 10 (66.7) Retired 4 (26.7) Unemployed 1 (6.7) Marital status Single or Widowed 2 (13.3) Married 13 (86.7) Educational level Primary or Junior high school 3 (20) Senior high school or Technical secondary school 6 (40) College or Undergraduate 6 (40) Type of health insurance Urban employee insurance 10 (66.7) Urban resident insurance 2 (13.3) Special type 3 (20) Monthly income (CNY) 3000 9 (60) Tumour site Nasopharynx 1 (6.7) Lung 3 (20) Breast 2 (13.3) Liver 1 (6.7) Stomach 2 (13.3) Colorectal 3 (20) Ovary 1 (6.7) Hematologic malignancies (lymphoma, myeloma) 2 (13.3) Tumour stage Ⅰ 3 (20) Ⅱ 6 (40) Ⅲ 4 (26.7) Ⅳ 2 (13.3) Cancer duration (years) 10 1 (6.7) This study conducted in-depth interviews with 15 Chinese cancer patients and employed inductive thematic analysis to generate three key themes and nine sub-themes (Table 2 ). These themes captured patients' nuanced experiences with Traditional Chinese Medicine techniques, encompassing varied experiences of efficacy impacting acceptance, the progressive trust in Traditional Chinese Medicine techniques, and the encountered barriers constraining acceptance. Table 2 Key themes and sub-themes No. Themes Sub-themes 1 Varied experiences of efficacy result in different levels of acceptance Clear effects, overall comfort Unmet expectations, diminished confidence Conflict between rapid relief and the required treatment duration of Traditional Chinese Medicine techniques 2 Progressive trust promotes acceptance of Traditional Chinese Medicine techniques Cultural identity strengthens beliefs Professional guidance are authoritative recognition Suggestions from family and peers are persuasive 3 The actual encounter hinders the acceptance of Traditional Chinese Medicine techniques Insufficient publicity Uneven technical levels Financial and time pressures Theme 1: Varied experiences of efficacy result in different levels of acceptance Participants with prior or ongoing experience of Traditional Chinese Medicine techniques reported varying levels of efficacy and acceptance. Some described clear therapeutic effects, noting improvements in both physical symptoms and psychological well-being, which strengthened their trust and willingness to continue accepting these techniques. Some perceived minimal or no improvement, resulting in disappointment, diminished confidence and hesitation to proceed, with some even discontinuing acceptance. Additionally, some participants experienced a conflict between their desire for rapid relief and the treatment duration of Traditional Chinese Medicine techniques, which further limited their acceptance. Clear effects, overall comfort According to patients' reports, Traditional Chinese Medicine techniques showed significant effects in improving local bodily functions and symptoms. Some cancer patients with long-term chronic conditions reported that massage, as one of these techniques, helped relieve recurring discomfort, reducing physical pain and bringing psychological relaxation. These experiences strengthened patients' confidence in the efficacy of Traditional Chinese Medicine techniques and made them more inclined to accept these techniques during cancer treatment. "I had a severe lumbar disc herniation. At one point, the pain was so intense that I couldn't stand upright and had to walk hunched over. After receiving massage, I was able to walk normally again. The pain disappeared after just two sessions and hasn't come back in the past three years. That experience made me feel like my body was starting to recover, and it brought me a sense of happiness. If it happens again, I'd still choose massage." (N13) Some patients also reported that using Traditional Chinese Medicine techniques, such as practising Tai Chi and soaking the feet in Chinese herbal medicine, effectively relieved the cancer-related adverse reactions they experienced during cancer treatment. The physical comfort improved their mood, further reinforcing their acceptance and trust in Traditional Chinese Medicine techniques. "After practising Tai Chi, I felt completely relaxed. My limbs were more coordinated, and my hands and feet became more flexible. I even walked with a lighter step. I’m going to keep practising Tai Chi." (N14) "Using herbal foot baths helped relieve the numbness in my hands and feet caused by chemo and radiotherapy. It felt really comforting while soaking. On the one hand, it improved blood circulation and eased the numbness. On the other hand, I believed the active ingredients in the herbs nourished my nervous system. I was very willing to accept this technique." (N4) Unmet expectations, diminished confidence However, the efficacy of Traditional Chinese Medicine techniques was not always immediate for every patient. Some cancer patients, after trying various Traditional Chinese Medicine techniques, did not achieve the ideal expectations, which diminished their confidence and led them to question the effectiveness of Traditional Chinese Medicine techniques, making them hesitant about whether to continue acceptance them, or even to abandon them altogether. "At first, I used acupoint patches with hope, thinking it might be effective. But after using it for a while and seeing no results, I lost confidence and wasn't sure whether I should keep accepting it." (N1) "I've been accepting auricular therapy for some time, but I haven't noticed much improvement in my sleep quality. I'm not willing to keep going." (N5) "I tried many different Traditional Chinese Medicine techniques, but the tumour didn't shrink, and that's why we lost confidence. My willingness to continue accepting them wasn't as strong as before." (N3) Cancer patients often had to balance their ideal outcomes with practical results when confronted with treatment plans. Uncertainty about treatment efficacy made decision-making concerning acceptance more complex, and variations in efficacy led to hesitation or even to giving up Traditional Chinese Medicine techniques. Conflict between rapid relief and the required treatment duration of Traditional Chinese Medicine techniques Many participants expressed that Traditional Chinese Medicine techniques failed to meet their expectations for rapid results. The treatment duration required for the therapeutic effects of Traditional Chinese Medicine techniques conflicted with patients' desire for rapid symptom relief, which in turn reduced their acceptance of such techniques. "I feel that Traditional Chinese Medicine techniques are too slow, and I wish they worked faster. Otherwise, I wouldn't consider accepting them." (N3) "We know that Traditional Chinese Medicine techniques work, but it's just too slow. I probably wouldn't accept it again unless there's no other choice." (N14) "If you have a hoarse voice or something, Western medicine can fix it overnight, but some Traditional Chinese Medicine techniques might take at least a week. I just don't want to wait that long, so I'm not willing to accept it." (N14) "The effect of Traditional Chinese Medicine techniques is much slower compared to the speed at which my tumour is growing. I have no time to wait, so I have to give it up." (N3) Theme 2: Progressive trust promotes acceptance of Traditional Chinese Medicine techniques This study found that cancer patients' acceptance of Traditional Chinese Medicine techniques was progressively reinforced through the development of trust. The patients' cultural identity with these techniques, guidance from professionals, along with suggestions from family and peers, served as sources of trust that encouraged them to experience the techniques, thereby strengthening their confidence. This, in turn, increased their willingness to accept Traditional Chinese Medicine techniques. Cultural identity strengthens beliefs Grounding in cultural identity and a profound belief in the principles of Traditional Chinese Medicine techniques provided the basis for patients' trust. This initial cultural connection encouraged patients to engage with techniques that aligned with their health beliefs. As they experienced tangible benefits, their trust was reinforced, ultimately leading to greater acceptance. "Traditional Chinese Medicine techniques are extensive and profound. When I first tried them for my overall health, I found them more effective than Western medicine. That experience made me trust them more, so now, I prefer to use Traditional Chinese Medicine techniques to look after my whole body." (N4) "Traditional Chinese Medicine techniques are the result of thousands of years of cultural wisdom, and I find them reliable. If given the choice, I would definitely choose Traditional Chinese Medicine techniques." (N10) A lung cancer patient self-studied Traditional Chinese Medicine techniques. As he tried them and deepened his understanding, his trust in Traditional Chinese Medicine grew, which strengthened his willingness to incorporate these techniques into his treatment plan. "Traditional Chinese Medicine and Western medicine differ in their understanding of organ functions. For example, in Traditional Chinese Medicine, the kidneys are regarded as the foundation of life and are said to store essence... I relate more to the Traditional Chinese Medicine perspective, which makes me more inclined to accept treatments based on it. After trying these techniques, I noticed positive changes in my health, which strengthened my trust in their effectiveness and deepened my belief in incorporating them into my overall health plan." (N9) "In Traditional Chinese Medicine, the body is seen as an interconnected whole. For example, it's like an empty house—if the house becomes damp, mould starts to grow on the wood. Traditional Chinese Medicine views this as similar to what Western medicine describes as tumours. This way of thinking really resonated with me and gave me the confidence to try Traditional Chinese Medicine techniques as part of my treatment." (N9) A patient with ovarian cancer and her family all have a strong awareness of health preservation. They viewed Traditional Chinese Medicine techniques as the optimal method for regimen and actively incorporated them into their daily routines. "We've always cared deeply about our health, so we try Traditional Chinese Medicine techniques like massage, cupping, and hot compresses in our free time. Whenever I feel a bit unwell, I also visit the local therapy centre for a back rub or a foot soak. " (N5) Professional guidance are authoritative recognition Participants reported that professional guidance was perceived as authoritative endorsement, which helped build trust and encouraged them to try Traditional Chinese Medicine techniques. Despite occasional doubts about efficacy, they tended to follow medical advice, influenced by clinicians' expertise and experience. Once they had positive experiences, their confidence in these techniques was reinforced, fostering greater acceptance. "Since I chose this hospital's treatment plan, I trusted them completely. As long as the medical staff's advice made sense, I went along with it, including trying Traditional Chinese Medicine techniques." (N4) "At the beginning, even though I didn't feel much effect from Traditional Chinese Medicine techniques, I still followed the advice of the healthcare provider and was willing to try different ones. As time went by, their role in my care made me trust them more and accept them more easily.” (N1) Suggestions from family and peers are persuasive External support, including suggestions from family and peers, plays a significant role in encouraging patients to try Traditional Chinese Medicine techniques. These recommendations were often persuasive, especially when rooted in real-life experiences, as they effectively reduced patients' uncertainty in decision-making. Thus, such personal endorsements directly affect the willingness to engage with these techniques, further reinforcing trust and acceptance. This process also facilitated the broader social dissemination of Traditional Chinese Medicine techniques. "A friend of my sister's is also a cancer patient. He would heat coarse salt with Sichuan peppercorns or mugwort, then spread mugwort over it and lie on top to ease the pain. My sister told me how to do it, and after I tried it, it really worked. That made me trust the treatment more and feel more willing to accept it myself." (N2) "Recommendations from other patients meant a lot to me. If they shared specific examples of how it helped them, I'd be more willing to give it a go. After trying it myself and seeing it work, I felt more confident in the treatment and was more willing to use it again." (N1) A colorectal cancer patient mentioned that it was through informal chats with neighbours about their positive experiences with Traditional Chinese Medicine techniques that they decided to try it. After perceiving the benefits themselves, their trust in the treatment grew, which made them more willing to continue to accept it. "When neighbours were chatting and someone mentioned feeling unwell, others would often talk about what had worked for them and suggest trying Traditional Chinese Medicine techniques. Hearing these stories made me more willing to give it a go. After trying it myself and feeling some relief, I began to trust it more and was more inclined to continue accepting it when needed." (N7) These findings illustrate that patients' acceptance of Traditional Chinese Medicine techniques was not static but developed progressively. Initial trust, shaped by cultural identity, social influence, or professional guidance, motivated patients to try these techniques. As they experienced benefits, their trust deepened, further reinforcing their acceptance of integrating Traditional Chinese Medicine techniques into their care. The actual encounter hinders the acceptance of Traditional Chinese Medicine techniques Although there had been progress in the development and application of Traditional Chinese Medicine techniques, cancer patients encountered several barriers that hindered their use, which not only negatively affected their treatment experience but also reduced their willingness to accept these techniques. Insufficient publicity Many participants stated that comprehensive hospitals within a healthcare system dominated by Western medicine provided insufficient publicity for Traditional Chinese Medicine techniques. The insufficient publicity impaired patients' awareness and uptake of these techniques, thereby hindering their wider acceptance in modern healthcare. "During my hospital stay, medical staff didn't suggest using Traditional Chinese Medicine techniques. Medical staff never mentioned it, and we weren't very familiar with it, so we never really thought about whether to accept it." (N3) "Western medicine doesn't really publicise Traditional Chinese Medicine techniques, and it's hard to find any information about them in Western medicine hospitals. As a result, there's little opportunity to consider accepting these techniques in such settings." (N5) One multiple myeloma patient reported that he had to search for information on Traditional Chinese Medicine techniques through his mobile phone, rather than receiving guidance from medical staff or hospital-led publicity efforts. "There's not much publicity in the hospital, so I had to look up information about Traditional Chinese Medicine techniques myself. When I was discharged, no one told me I could ask for help with it, which made it harder for me to consider accepting it." (N2) Uneven technical levels Participants believed that the therapeutic effect of Traditional Chinese Medicine techniques depended on the operators' skill levels. However, the uneven technical levels across medical institutions and practitioners led to inconsistent patient experiences, which in turn affected their willingness to accept these techniques. "I've always believed that Traditional Chinese Medicine techniques can be effective, but it depends on finding the right practitioner. If they're not a good fit, you might not feel any effect. By 'right', I mean both their skill and how effective the treatment is. Without that, it's hard to feel confident enough to accept it." (N7) One breast cancer patient mentioned that there were notable differences in the way various nurses performed acupoint patches, which resulted in variable treatment experiences and influenced her decision to accept the technique. "Skilled nurses will first press on the area before applying the plaster, asking if it hurts as they go along, and will only apply it once they've pressed on the most painful spot. In contrast, less skilled nurses apply only light pressure and immediately place the plaster. If I always had nurses with poor skills performing the procedure, I would feel it wasn't effective and would be reluctant to accept it once more." (N1) A gastric cancer patient expressed concern that some unregulated institutions offering Traditional Chinese Medicine techniques might pose potential technical risks, which could negatively impact patients' experiences and undermine their acceptance of these techniques. "The guarantee of the level of technology is very important. For instance, some private clinics may lead to more serious issues, which can diminish patients' experiences and reduce their acceptance of these techniques, so I tend to avoid them." (N10) Financial and time pressures The high cost of treatment, including both financial and time pressures, reduced cancer patients' acceptance of Traditional Chinese Medicine techniques. Most were already strained by the expense of medication and chemo-radiotherapy, and had to forgo the use of Traditional Chinese Medicine techniques to reduce overall healthcare costs. Some also noted that the rising cost of Traditional Chinese Medicine techniques over the years had further increased their financial burden. "I'm already overwhelmed by the costs of radiotherapy and chemotherapy, so every bit I can save really makes a difference in my decision to accept or not accept additional treatments like Traditional Chinese Medicine techniques." (N4) "Cancer patients like us incur substantial expenses, including transportation and examination fees for multiple visits. On top of that, Traditional Chinese Medicine techniques can also be costly, with prices having risen considerably, which makes it more difficult to consider accepting these techniques." (N3) Meanwhile, time constraints were also an important consideration for cancer patients when choosing treatment options. Due to busy work schedules and career responsibilities, many participants reported being unable to allocate sufficient time for Traditional Chinese Medicine techniques, which restricted their options and diminished their willingness to accept such techniques. "We all have to work. For most people today, time is money, and every moment costs. Who has the luxury of taking things slowly, unless you're retired? Let alone thinking about accepting Traditional Chinese Medicine techniques." (N14) "I started raising bees two years ago, and it's kept me busy. I haven't had the time to experience Traditional Chinese Medicine techniques since, which has made it harder for me to accept them." (N13) Discussion This study explored the experiences and acceptance of Traditional Chinese Medicine techniques among 15 Chinese cancer patients through qualitative interviews. As we know, this study is the first to describe the complex experiences of cancer patients receiving Traditional Chinese Medicine techniques and to identify the impact of these experiences on the acceptance of Traditional Chinese Medicine techniques. The findings of this study provide insights into the experiences of cancer patients with Traditional Chinese Medicine techniques and their influence on the acceptance of these techniques. They also offer new ideas for future research and clinical practice in Traditional Chinese Medicine nursing interventions. Compared to prior research that highlights factors such as economic status, cultural customs, healthcare system differences, and patients' preferences for Traditional Chinese Medicine techniques as influencing acceptance [ 20 – 21 ], this study found that the experience of therapeutic effects had the most significant impact. In addition, the acceptance of Traditional Chinese Medicine techniques is not only closely related to patients' intrinsic motivation and their recognition of its underlying health concepts, but also influenced by external support. For example, suggestions from family and peers, as well as professional guidance endorsed by authorities, can help build trust and thereby increase the willingness to accept these techniques. However, the barriers encountered, such as insufficient publicity, uneven technical levels, and financial and time pressures, negatively affected patients' experiences and limited their acceptance of Traditional Chinese Medicine techniques. The results of this study are consistent with those of previous quantitative studies, and it also supplements the quantitative results to more comprehensively reflect the impact on cancer patients' acceptance of Traditional Chinese Medicine techniques. These findings provide more specific insights into the complex mechanisms influencing cancer patients' acceptance of Traditional Chinese Medicine techniques. Davis found that, compared to ease of use, perceived usefulness had a greater influence on usage behaviour and was a strong correlate of user acceptance [ 22 ]. Cancer patients experienced clear therapeutic effects as well as physical and mental benefits after using Traditional Chinese Medicine techniques and expressed a willingness to continue using them. This indicates that patients perceive the usefulness of Traditional Chinese Medicine techniques, which encourages their acceptance. The results of this study support the theory of Davis' Technology Acceptance Model. Cognitive consistency theory also suggests that positive treatment experiences can strengthen patients' beliefs, thereby improving acceptance [ 29 ]. Similarly, cancer patients showed greater acceptance and compliance when interventions offered positive experiences [ 30 ]. However, when expectations do not align with reality, individuals often alleviate internal conflict by adjusting their behaviour or attitudes [ 31 ]. This study found that when the therapeutic effects of Traditional Chinese Medicine techniques were not evident, cancer patients questioned their efficacy and, in some cases, refused to proceed with such treatment plans. For instance, a colorectal cancer patient (N7) admitted that if there were no effect, she would not continue. Previous studies have shown that negative experiences due to unmet high expectations of efficacy not only exacerbate emotional distress in cancer patients [ 32 ], but also undermine their confidence in the treatment plan [ 33 ]. Moreover, cancer patients experience pain caused by disease and its treatments, often desiring rapid symptom relief through Traditional Chinese Medicine techniques. However, these techniques, influenced by Confucian philosophies such as the harmony between humans and nature and the doctrine of the mean, focus on holistic regulation and body balance, meaning that therapeutic effects typically take time to manifest [ 34 – 35 ]. The inherent beliefs held by some patients in this study regarding the required treatment duration of Traditional Chinese Medicine techniques may stem from a limited understanding of Traditional Chinese Medicine or unrealistic expectations for rapid relief. Therefore, in the future, it is crucial to educate patients and disseminate accurate knowledge about Traditional Chinese Medicine, which will help them form more realistic treatment expectations and enhance their acceptance of Traditional Chinese Medicine techniques. This study further demonstrated that the progressive trust plays a key role in improving patient acceptance. Its development was influenced by various factors. Firstly, cultural identity, as the internal motivation and foundation of patient trust, should not be overlooked. Some participants were deeply influenced by Traditional Chinese Medicine culture; for example, a lung cancer patient (N9) effortlessly quoted the classic saying from the Huangdi Neijing ( The Yellow Emperor's Classic of Internal Medicine , one of the earliest collections of Traditional Chinese Medicine, which is still regarded as a must-read for Traditional Chinese Medicine practitioners.): "When the body's vital energy is abundant, pathogenic factors cannot invade." Patients expressed that the Traditional Chinese Medicine philosophy resonated deeply with their own views on health, thereby strengthening their trust in Traditional Chinese Medicine techniques. The studies by Akhtar et al. also highlighted that respect for traditional wisdom can subtly influence an individual's medical choices, thereby shaping their confidence in and acceptance of treatment methods [ 4 , 36 ]. A study indicated that the usage rate of complementary and alternative medicine among cancer patients in Asia is as high as 49.3%. This is believed to be inevitably linked to patients' recognition and acceptance of the cultural values of this type of medicine [ 20 ]. However, a survey conducted in Sweden shows that although 83% of patients are interested in acupuncture, only 1% actually receive it [ 19 ]. These studies highlight that different cultural backgrounds lead to an imbalance in cancer patients' acceptance. Philosopher Daniel Dennett has noted that human behaviour is largely shaped by culture [ 37 ]. To promote the global acceptance and application of Traditional Chinese Medicine techniques, it is essential to enhance understanding and trust in Traditional Chinese Medicine culture among people from diverse cultural backgrounds. Furthermore, healthcare professionals' expert guidance was crucial in encouraging patients to accept Traditional Chinese Medicine techniques. This is because authoritative professionals possess expertise, experience, and status, and people tend to trust and follow their advice, especially in complex or uncertain situations. Previous studies have pointed out that individuals with professional knowledge and credibility are often regarded as "authorities" and have a significant influence on others' decision-making [ 38 ]. Most participants believed that the guidance provided by healthcare professionals helped clarify their treatment decisions. This is consistent with the findings of Larsen et al., who found that patients generally trust professional judgment in medical decision-making [ 39 ]. In addition, suggestions from family members and fellow patients also provided external support in enhancing trust. According to social proof theory, individuals often rely on the behaviour or opinions of others as a basis for their decisions when faced with uncertainty [ 40 ]. This is especially true when they trust someone they know well. Such reliance and trust can reduce the risk of disappointment and failure associated with new experiences, thereby increasing their acceptance. Sharing real experiences with fellow patients helped alleviate the uncertainty and anxiety cancer patients felt during treatment decision-making by inducing emotional resonance and offering guidance through shared experience. Although Traditional Chinese Medicine techniques show potential in cancer treatment, this study identified the realistic application barriers that constrain patient acceptance. Insufficient publicity in hospitals dominated by Westen medicine results in low accessibility [ 41 ], thus hindering cancer patients' acceptance of these techniques. This challenge is not unique to China, as similar barriers have been reported globally [ 42 ]. Additionally, the uneven technical levels of practitioners directly affects patient trust and acceptance regarding treatment efficacy. The effectiveness of Traditional Chinese Medicine techniques is highly dependent on practitioner skill [ 43 ], with the General Medical Council of the United Kingdom emphasising that professional competence is key to earning patient trust [ 44 ]. One colorectal cancer patient (N7) even travelled long distances to find a skilled Traditional Chinese Medicine practitioner, underscoring the impact of technical disparities on acceptance. Financial and time pressures also significantly contributed to patients' hesitation. Some participants felt that the cost and time required for Traditional Chinese Medicine techniques increased their pressures and disrupted daily routines. Foreign researchers have investigated cancer patients' acceptance of acupuncture. Their findings indicate that economic concerns are a major barrier, with 70% of oncologists viewing cost as the greatest obstacle to integrating acupuncture into cancer treatment [ 45 ]. Similarly, Choi et al.'s systematic review [ 20 ] also mentioned this. In today's fast-paced world, patients often prioritise efficiency [ 46 ], and time restrictions lead some to abandon Traditional Chinese Medicine techniques. Despite its side effects, some still prefer Western medicine for its ability to rapidly control conditions and symptoms [ 47 ], further highlighting the restrictive influence of time costs on acceptance. Implications for clinical practice and research The findings of this study offer insights for clinical practice and future research. Positive experiences with Traditional Chinese Medicine techniques are crucial for enhancing patient acceptance [ 29 ]. Thus, clinical applications and research should concentrate on boosting efficacy and refining treatment plans to facilitate ongoing development. Future research ought to explore the connection between treatment experiences and psychological expectations, assisting patients in establishing practical goals to mitigate the adverse effects of unmet expectations. Healthcare institutions can utilise online platforms and health seminars to disseminate patient experiences, thereby strengthening the influence of suggestions from family and peers. Additionally, promoting Traditional Chinese Medicine culture can cultivate a sense of cultural identity among patients. To alleviate financial pressures, governments ought to augment policy support, enhance healthcare systems, and foster an environment that encourages the use of Traditional Chinese Medicine techniques. Limitations and perspectives This study had some limitations. First, the sample was limited to inpatients with cancer from three hospitals in southeast China, and all participants were Chinese. The findings regarding acceptability may have been influenced by the specific healthcare setting and the fact that China is the birthplace of Traditional Chinese Medicine. Therefore, they may not fully reflect the true situation of the broader cancer patient population. It is suggested that future research should consider sampling from a more diverse range of environments, including individuals from different regions and cultural backgrounds, to enhance the representativeness and generalisability of the results. Secondly, the study only collected data from patients and excluded other relevant groups, such as medical staff and family members. Future research should integrate data from multiple sources to better understand the acceptance of Traditional Chinese Medicine techniques and the factors influencing it. Third, this study used in-depth interviews at a specific time point, so it could only reflect the experience and acceptance at that time and couldn't capture dynamic changes. In the future, a longitudinal design could be adopted to track the patient's usage process and include data on the patient's treatment course, in order to capture patient experience and acceptability more accurately. Conclusion This study revealed differences in the perceived therapeutic effects of Traditional Chinese Medicine techniques among cancer patients. Patients' experiences of therapeutic efficacy, trust, and encountered obstacles influenced their acceptance of these techniques. These findings provide direction for clinical practice, future research, and a theoretical basis for health administrative authorities to formulate promotional policies to encourage the use of Traditional Chinese Medicine techniques in cancer treatment. Declarations Ethics approval and consent to participate This study was approved by the Medical Ethics Committee of the Third People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine (Approval No.: 2023KS-75-1). All participants provided written informed consent before participating in the study. All methods were performed in accordance with the relevant guidelines and regulations. Consent for publication Not applicable. Availability of data and materials The dataset generated and analysed during the current study is available from the corresponding author upon reasonable request. Due to privacy concerns, the data supporting the findings of this article are not publicly available. However, the data are available upon request from the corresponding author with proper permission. Competing interests The author declares that there is no conflict of interest. Funding This study was funded by the Natural Science Foundation of Fujian Province (Grant No. 2023J01875). The funding agency was not involved in the design of the study, data collection, analysis, data interpretation, or manuscript writing. Authors ' contributions LY: Writing – original draft, Conceptualization, Funding acquisition, Methodology, Formal analysis, Validation, Supervision, Resources, Project administration. WW: Writing – original draft, Investigation, Data curation, Formal analysis, Validation, Resources. JL: Writing – original draft, Investigation, Data curation, Formal analysis, Validation, Resources. XS: Writing – review & editing, Formal analysis, Validation. RL: Formal analysis, Validation, Writing – review & editing. XW: Validation, Writing – review & editing. YY: Data curation. ZT: Data curation. YL: Validation, Resources, Supervision, Writing – review & editing. All authors have read and approved the final manuscript and each author meets the criteria for authorship established by the International Committee of Medical Journal Editors and has verified the validity of the reported results. Acknowledgements We thank all participants for their valuable insights and contributions to this study. Author details 1 School of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China. 2 Nursing Department, The Second People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China. 3 Nursing Department, Fujian Medical University Union Hospital, Fuzhou, Fujian, China. References Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229-263. https://doi.org/10.3322/caac.21834. Miller KD, Nogueira L, Devasia T, et al. Cancer treatment and survivorship statistics, 2022. CA Cancer J Clin. 2022;72(5):409-436. https://doi.org/10.3322/caac.21731. Chen Q, Li Y, Lin Y, et al. Effectiveness of non-pharmacological interventions in managing symptom clusters among lung cancer patients: a systematic review. BMC Cancer. 2024;24(1):1505. https://doi.org/10.1186/s12885-024-13246-x. Li S, Xi Z, Barnett P, et al. 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Liou KT, Trevino KM, Meghani SH, et al. Fear of analgesic side effects predicts preference for acupuncture: a cross-sectional study of cancer patients with pain in the USA. Support Care Cancer. 2021;29(1):427-435. https://doi.org/10.1007/s00520-020-05504-y. Davis FD. Perceived usefulness, perceived ease of use, and user acceptance of information technology. MIS quarterly. 1989: 319-340. https://doi.org/ 10.2307/249008 . Davis FD, Bagozzi RP, Warshaw PR. User acceptance of computer technology: A comparison of two theoretical models. Management science. 1989;35(8): 982-1003. https://doi.org/ 10.1287/mnsc.35.8.982 . Chan ZY, Lim CF, Leow JL, et al. Using the technology acceptance model to examine acceptance of telemedicine by cancer patients in an ambulatory care setting. Proceedings of Singapore Healthcare. 2022;31: 20101058221104578. https://doi.org/10.1177/20101058221104578. Park YE, Tak YW, Kim I, et al. User Experience and Extended Technology Acceptance Model in Commercial Health Care App Usage Among Patients With Cancer: Mixed Methods Study. J Med Internet Res. 2024;26:e55176. https://doi.org/10.2196/55176. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349-357. https://doi.org/10.1093/intqhc/mzm042. Christou PA. How to use thematic analysis in qualitative research. Journal of Qualitative Research in Tourism. 2022;3(2): 79-95. https://doi.org/10.4337/jqrt.2023.0006 . Williams M, Moser T. The art of coding and thematic exploration in qualitative research. International management review. 2019;15(1): 45-55. Insko CA, Schopler J. Triadic consistency: a statement of affective-cognitive-conative consistency. Psychol Rev. 1967;74(5):361-376. https://doi.org/10.1037/h0020278. Sattar S, Papadopoulos E, Smith GVH, et al. State of research, feasibility, safety, acceptability, and outcomes examined on remotely delivered exercises using technology for older adult with cancer: a scoping review. J Cancer Surviv. 2024;18(6):1861-1888. https://doi.org/10.1007/s11764-023-01427-9. Cooper J. Cognitive dissonance: Where we’ve been and where we’re going. International Review of Social Psychology. 2019. https://doi.org/10.5334/irsp.277. Getie A, Ayalneh M, Bimerew M. Global prevalence and determinant factors of pain, depression, and anxiety among cancer patients: an umbrella review of systematic reviews and meta-analyses. BMC Psychiatry. 2025;25(1):156. https://doi.org/10.1186/s12888-025-06599-5. Kasetti P, Husain NF, Skinner TC, et al. Personality traits and pre-treatment beliefs and cognitions predicting patient adherence to continuous positive airway pressure: A systematic review. Sleep Med Rev. 2024;74:101910. https://doi.org/10.1016/j.smrv.2024.101910. Fu L, Wang YR, Zhao YP, et al. The concept of traditional chinese medicine:history, theory and empirical research. Zhonghua Yi Shi Za Zhi. 2022;52(4):195-205. https://doi.org/10.3760/cma.j.cn112155-20220516-00062. Li S, Chen X, Shi H, et al. Tailoring traditional Chinese medicine in cancer therapy. Mol Cancer. 2025;24(1):27. https://doi.org/10.1186/s12943-024-02213-6. Akhtar MU, Bhatti ME, Fredericks S. What factors influence patient autonomy in healthcare decision-making? A systematic review of studies from the Global South. Nurs Ethics. 2025;32(3):875-891. https://doi.org/10.1177/09697330241272794. Zalans A. THE RELATIONSHIP BETWEEN CULTURE AND COGNITION. European Journal of Literary Studies. 2024;5(1). http://dx.doi.org/10.46827/ejls.v5i1.515. Sestino A, Nasta L, Bernando A, et al. Just the right push! Social media as a therapeutical catalyst: The impact of influencers’ motivational (vs. neutral) communication on healthy consumption. Technol Soc. 2024;78:102601. https://doi.org/10.1016/j.techsoc.2024.102601 . Larsen LT, Cecchini M. Connective and Tactfully Tactical: Connective Tactics and Professional Authority in Doctor-Patient Relationships. Soc Sci Med. 2023;326:115924. https://doi.org/10.1016/j.socscimed.2023.115924. Pálfi B, Arora K, Prociuk D, et al. Risk prediction algorithms and clinical judgment: Impact of advice distance, social proof, and feature-importance explanations. Comput Human Behav. 2024;153:108102. https://doi.org/10.1016/j.chb.2023.108102. Zhou MC, Fei YT, Lai XZ, et al. Progress and challenges in integrated traditional Chinese and western medicine in China from 2002 to 2021. Front Pharmacol. 2024;15:1425940. https://doi.org/10.3389/fphar.2024.1425940. Rybicka M, Zhao J, Piotrowicz K, et al. Promoting whole person health: Exploring the role of traditional Chinese medicine in Polish healthcare. J Integr Med. 2023;21(6):509-517. https://doi.org/10.1016/j.joim.2023.10.001. Li J, Graham D. The importance of regulating the education and training of Traditional Chinese Medicine practitioners and a potential role for ISO/TC 249. Pharmacol Res. 2020;161:105217. https://doi.org/10.1016/j.phrs.2020.105217. Goddard VCT, Brockbank S. Re-opening Pandora's box: Who owns professionalism and is it time for a 21st century definition?. Med Educ. 2023;57(1):66-75. https://doi.org/10.1111/medu.14862. Veleber S, Cohen MR, Weitzman M, et al. Characteristics and Challenges of Providing Acupuncture and Chinese Herbal Medicine in Oncology Treatment: Report of Survey Data and Experience of Five Unique Clinical Settings. Integr Cancer Ther. 2024;23:15347354241226640. https://doi.org/10.1177/15347354241226640. Yeganeh H. Conceptions of time, socioeconomic development and cultural values. Int J Sociol Soc Policy. 2024;44(7/8):760-775. https://doi.org/10.1108/IJSSP-11-2023-0305. Zhang M, He X, Wu J, Xie F. Differences between physician and patient preferences for cancer treatments: a systematic review. BMC Cancer. 2023;23(1):1126. https://doi.org/10.1186/s12885-023-11598-4. Additional Declarations No competing interests reported. Supplementary Files Additionalfile1.docx Additional file 1. Interview guide Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 10 May, 2026 Reviews received at journal 27 Jun, 2025 Reviewers agreed at journal 20 Jun, 2025 Reviewers agreed at journal 12 Jun, 2025 Reviewers invited by journal 11 Jun, 2025 Editor invited by journal 27 May, 2025 Editor assigned by journal 19 May, 2025 Submission checks completed at journal 19 May, 2025 First submitted to journal 15 May, 2025 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. 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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-6672935","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":471118293,"identity":"9f013018-ba7f-4695-9e40-78d386bf0d9a","order_by":0,"name":"Yang Liu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA40lEQVRIie3QvQrCMBDA8SuBuhRdK8WPR4gEqqD4LBXBLlEcHQuuxd236Bt4ksFF6dqxLuLgUHQVNFbntG6C+UMgw/3gEgCd7ldLKTQrAeZ3IyhFPArMQvEVARiFSEoSujuIszcXfmjE22sCg0aE5JQqyX426XlUTEMQxOEwYRGaXaokyF36IhsQJuEgRhFapq0k8SUnvvUmjxIk4SyVxPsQLCb15OLKT/Y78i3M4XTM1sJ0laQac5Zl937LsrfHG18MG6vd8qQkbYTPGja+9pSHqOZlrQBIlt9qQcGoTqfT/W1PWGNNcbaAQ4cAAAAASUVORK5CYII=","orcid":"","institution":"Fujian University of Traditional Chinese Medicine","correspondingAuthor":true,"prefix":"","firstName":"Yang","middleName":"","lastName":"Liu","suffix":""},{"id":471118294,"identity":"d0c67d1f-9933-4842-9a92-84c252775513","order_by":1,"name":"Weina Wang","email":"","orcid":"","institution":"Fujian University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Weina","middleName":"","lastName":"Wang","suffix":""},{"id":471118295,"identity":"c9b44027-6cce-4a4c-98e4-1f52bd6afc53","order_by":2,"name":"Jiayi Lin","email":"","orcid":"","institution":"Fujian University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Jiayi","middleName":"","lastName":"Lin","suffix":""},{"id":471118297,"identity":"bc14f520-e3d3-4eae-869d-1e2358bd371f","order_by":3,"name":"Xia Sheng","email":"","orcid":"","institution":"The Second People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China","correspondingAuthor":false,"prefix":"","firstName":"Xia","middleName":"","lastName":"Sheng","suffix":""},{"id":471118299,"identity":"5d116e79-d60b-47b7-ae27-3a039424361f","order_by":4,"name":"Rujia Lin","email":"","orcid":"","institution":"Fujian University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Rujia","middleName":"","lastName":"Lin","suffix":""},{"id":471118300,"identity":"80be20f1-ac0b-4dd5-be0b-510e0c532e1f","order_by":5,"name":"Xinlei Wu","email":"","orcid":"","institution":"Fujian University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Xinlei","middleName":"","lastName":"Wu","suffix":""},{"id":471118301,"identity":"928fe091-2370-4d1c-91d9-08a07e80b370","order_by":6,"name":"Yiping Yang","email":"","orcid":"","institution":"Fujian University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Yiping","middleName":"","lastName":"Yang","suffix":""},{"id":471118302,"identity":"12074873-da9d-4452-a3c5-ee050e6360fd","order_by":7,"name":"Zhouqi Teng","email":"","orcid":"","institution":"Fujian University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Zhouqi","middleName":"","lastName":"Teng","suffix":""},{"id":471118303,"identity":"294b4fad-f1c3-4ff8-8cd9-be9fd8580c5d","order_by":8,"name":"Yanjuan Lin","email":"","orcid":"","institution":"Fujian Medical University Union Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yanjuan","middleName":"","lastName":"Lin","suffix":""}],"badges":[],"createdAt":"2025-05-15 13:08:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6672935/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6672935/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84678744,"identity":"f0a4c49e-e2e7-4717-927b-3ca834d8e0ad","added_by":"auto","created_at":"2025-06-16 08:00:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1088450,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6672935/v1/0e078552-b9ee-41c7-8871-ceb3f9d38439.pdf"},{"id":84677281,"identity":"1d5e6686-9882-4ea4-8741-ca3eaadaacc9","added_by":"auto","created_at":"2025-06-16 07:52:21","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":12635,"visible":true,"origin":"","legend":"\u003cp\u003eAdditional file 1. Interview guide\u003c/p\u003e","description":"","filename":"Additionalfile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6672935/v1/d958a1b937fdef7e61f84347.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eExploring cancer patients' experiences and acceptability of Traditional Chinese Medicine techniques: a qualitative study\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCancer is a major global health challenge [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Advances in screening and treatment have improved cure rates, extended survival times, and contributed to a growing population of cancer patients [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. However, cancer and its treatments often induce distressing symptoms, including pain, nausea, vomiting, fatigue, sleep disturbances, and depression, which persist throughout life and significantly reduce the quality of life of cancer patients [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Therefore, symptom management has become a primary focus for oncology healthcare professionals.\u003c/p\u003e \u003cp\u003eIn recent years, Traditional Chinese Medicine techniques, an important branch of complementary medicine, has been actively explored for the management of cancer-related symptoms [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Traditional Chinese Medicine techniques refer to various interventions guided by Traditional Chinese Medicine theory that act on the surface of the body or from outside the body to treat disease [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. These include acupuncture, moxibustion, auricular therapy, acupoint patches, Gua Sha (scraping therapy), cupping, massage, and traditional Chinese exercises (such as Tai Chi, Qigong, or Baduanjin), which are also recommended by the World Health Organization, and are all characterised by simplicity, convenience, and therapeutic benefits [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Clinical practice guidelines from multiple authoritative professional academic organizations and associated research indicate that Traditional Chinese Medicine techniques are effective in alleviating cancer-related symptoms including insomnia, fatigue, and pain [\u003cspan additionalcitationids=\"CR10 CR11\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. And the research has further revealed that these interventions act via mechanisms such as immune system regulation and improvement of microcirculation [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Multiple evidence also demonstrates that adverse reactions to Traditional Chinese Medicine techniques are few and slight, suggesting a favourable safety profile [\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGiven their efficacy and relatively low risk of adverse effects, the utilisation and promotion of Traditional Chinese Medicine techniques among cancer patients continue to attract sustained attention from researchers globally within the mainstream healthcare system [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Recent investigations have revealed a paradox: despite cancer patients' high expectations [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], strong interest, and belief in Traditional Chinese Medicine techniques [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], actual utilisation rates remain low, with only 1% receiving it [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. However, a systematic review on traditional therapies among Asian cancer populations indicates that cancer patients in this region tend to apply complementary and alternative medicine, with a usage rate reaching as high as 49.3% [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. This indicates that there is an imbalance in the application of Traditional Chinese Medicine techniques. And some researchers have also begun to study the related factors affecting the application of Traditional Chinese Medicine techniques [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Although these findings are enlightening, these quantitative studies can only provide data support and have not yet explored the true feelings of cancer patients towards the use of Traditional Chinese Medicine techniques, as well as the complex social and cultural factors and potential mechanisms behind the phenomena.\u003c/p\u003e \u003cp\u003eAccording to Davis' Technology Acceptance Model, user acceptance is a critical factor in the promotion and application of information technologies, in other words, individual attitudes towards technological adoption serve as primary determinants of use and dissemination [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. This theory has widely guided the research in fields such as telemedicine and health applications for cancer patients [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eConsequently, under the guidance of Davis' technology acceptance theory, this study aims to explore the genuine experiences and attitudes of cancer patients towards Traditional Chinese Medicine techniques through qualitative methods. It will uncover the potential drivers and barriers influencing acceptance, and provide feasible suggestions for facilitating the application and promotion of Traditional Chinese Medicine techniques in cancer treatment.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign\u003c/h2\u003e \u003cp\u003eA descriptive qualitative approach was used to explore the experiences of patients with cancer, conducting semi-structured interviews with cancer patients who had prior experience with Traditional Chinese Medicine techniques from March to May 2023. Participants were purposively selected from inpatients in the oncology departments of three tertiary hospitals, including one affiliated with a university of Traditional Chinese Medicine and two general hospitals. Ethical approval for the study was obtained from the Medical Ethics Committee of The Third Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine (Approval No.: 2023KS-75-1).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants and setting\u003c/h3\u003e\n\u003cp\u003eThe sample selection followed the principle of maximum variation and was determined by information saturation. Patients with cancer who met the inclusion and exclusion criteria were recruited for in-depth interviews. Inclusion criteria: (1) Diagnosed with a malignant tumour; (2) Fully aware of their condition and with prior experience of Traditional Chinese Medicine techniques; (3) Aged 18 years or older; (4) Normal hearing and the ability to communicate clearly in Mandarin; (5) Willingness to participate in the interviews. Exclusion criteria: (1) Patients with critical illness or other concomitant serious conditions; (2) Individuals with psychological or mental disorders.\u003c/p\u003e \u003cp\u003eBefore the interviews, the researchers clearly informed participants of the purpose of the study and their rights, including the option to withdraw at any time. At the same time, participants were assured that the interview data would be used solely for this study. All participants provided written consent. To ensure anonymity, participants' names were replaced with codes (N1 to N15).\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eThe study was conducted in accordance with the COREQ guidelines [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Two postgraduate nursing students (WW and JL) conducted the interviews. They were actively involved in the design, refinement, and implementation of the research and were thoroughly familiar with the research content. They underwent comprehensive qualitative research training, had extensive interview experience, and were skilled in efficiently extracting and interpreting key information. The interview guide of this study was designed around the research objectives, under the guidance of Davis' Technology Acceptance Model, consisting of open-ended questions. It was optimised based on feedback from three pre-interviews with cancer patients and discussions with the research team, ensuring scientific validity, feasibility, and applicability (see \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eAdditional file 1\u003c/span\u003e). The interviews were conducted face-to-face in quiet hospital or demonstration rooms. Each interview lasted 20 to 40 minutes. During the interview, both the interviewer and the interviewee turned off their phones to maintain a quiet environment and prevent any distractions. The interviewer employed techniques such as probing, responding, and repetition to encourage the interviewee to fully express their views, while refraining from providing guidance, suggestions, evaluations, or interventions. At the end of the interview, the interviewer summarised the content, reiterated key information, and conducted member validation to ensure the accuracy, credibility, and validity of the data. The interviews were recorded in full using an audio recorder, with the interviewees' consent, and manually transcribed verbatim into Chinese text within 24 hours, with the interviewees' identifying information anonymised.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eThis study employed inductive thematic analysis to analyse the interview data [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Two researchers independently conducted open coding on the verbatim interview transcripts, identifying meaningful units and generating initial codes. These initial codes were then integrated into subcategories and themes through processes of dismantling, merging, and aggregating [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Throughout the analysis, the two researchers regularly discussed the coding results. In the event of disagreements, they consulted with a third researcher (LY) until a consensus was reached, ensuring the reliability of the analysis. This study did not use qualitative data analysis software, opting instead to conduct the analysis manually to maintain flexibility and thoroughness. Data collection and analysis were conducted concurrently until saturation was reached, with no new themes or subcategories emerging.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThis study included interviews with 15 cancer patients. There were 7 males (46.7%) and 8 females (53.3%); ages ranged from 35 to 80 years, with a mean of 54.73\u0026thinsp;\u0026plusmn;\u0026thinsp;13.87 years. Participants' educational levels were as follows: 3 (20%) had primary or junior high school education, 6 (40%) had completed senior high school or technical secondary school, and 6 (40%) had attained a college or undergraduate degree. The majority of participants (86.7%) were married and had medical insurance. Participants reported using various Traditional Chinese Medicine techniques, including massage, acupoint patches, Gua Sha, cupping, Tai Chi, Chinese herbal foot baths, auricular therapy, hot compresses, and Chinese herbal fumigation. Details are provided in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\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\u003eParticipant characteristics\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\u003eParticipant characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency [N(%)]\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54.73\u0026thinsp;\u0026plusmn;\u0026thinsp;13.87 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMales\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (46.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemales\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (53.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEmployment status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (66.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRetired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (26.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (6.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle or Widowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (13.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (86.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducational level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary or Junior high school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (20)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSenior high school or Technical secondary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (40)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCollege or Undergraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (40)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of health insurance\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban employee insurance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (66.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban resident insurance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (13.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpecial type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (20)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMonthly income (CNY)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;1000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (13.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1000\u0026ndash;2000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (26.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;3000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (60)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTumour site\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNasopharynx\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (6.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLung\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (20)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBreast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (13.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiver\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (6.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStomach\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (13.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eColorectal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (20)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOvary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (6.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHematologic malignancies (lymphoma, myeloma)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (13.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTumour stage\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅠ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (20)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅡ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (40)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅢ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (26.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅣ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (13.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCancer duration (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (33.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (46.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (13.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (6.7)\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\u003eThis study conducted in-depth interviews with 15 Chinese cancer patients and employed inductive thematic analysis to generate three key themes and nine sub-themes (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). These themes captured patients' nuanced experiences with Traditional Chinese Medicine techniques, encompassing varied experiences of efficacy impacting acceptance, the progressive trust in Traditional Chinese Medicine techniques, and the encountered barriers constraining acceptance.\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\u003eKey themes and sub-themes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThemes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\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\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVaried experiences of efficacy result in different levels of acceptance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eClear effects, overall comfort\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUnmet expectations, diminished confidence\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eConflict between rapid relief and the required treatment duration of Traditional Chinese Medicine techniques\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProgressive trust promotes acceptance of Traditional Chinese Medicine techniques\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCultural identity strengthens beliefs\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eProfessional guidance are authoritative recognition\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSuggestions from family and peers are persuasive\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe actual encounter hinders the acceptance of Traditional Chinese Medicine techniques\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInsufficient publicity\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUneven technical levels\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFinancial and time pressures\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eTheme 1: Varied experiences of efficacy result in different levels of acceptance\u003c/h2\u003e \u003cp\u003eParticipants with prior or ongoing experience of Traditional Chinese Medicine techniques reported varying levels of efficacy and acceptance. Some described clear therapeutic effects, noting improvements in both physical symptoms and psychological well-being, which strengthened their trust and willingness to continue accepting these techniques. Some perceived minimal or no improvement, resulting in disappointment, diminished confidence and hesitation to proceed, with some even discontinuing acceptance. Additionally, some participants experienced a conflict between their desire for rapid relief and the treatment duration of Traditional Chinese Medicine techniques, which further limited their acceptance.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eClear effects, overall comfort\u003c/h3\u003e\n\u003cp\u003eAccording to patients' reports, Traditional Chinese Medicine techniques showed significant effects in improving local bodily functions and symptoms. Some cancer patients with long-term chronic conditions reported that massage, as one of these techniques, helped relieve recurring discomfort, reducing physical pain and bringing psychological relaxation. These experiences strengthened patients' confidence in the efficacy of Traditional Chinese Medicine techniques and made them more inclined to accept these techniques during cancer treatment.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I had a severe lumbar disc herniation. At one point, the pain was so intense that I couldn't stand upright and had to walk hunched over. After receiving massage, I was able to walk normally again. The pain disappeared after just two sessions and hasn't come back in the past three years. That experience made me feel like my body was starting to recover, and it brought me a sense of happiness. If it happens again, I'd still choose massage.\" (N13)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eSome patients also reported that using Traditional Chinese Medicine techniques, such as practising Tai Chi and soaking the feet in Chinese herbal medicine, effectively relieved the cancer-related adverse reactions they experienced during cancer treatment. The physical comfort improved their mood, further reinforcing their acceptance and trust in Traditional Chinese Medicine techniques.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"After practising Tai Chi, I felt completely relaxed. My limbs were more coordinated, and my hands and feet became more flexible. I even walked with a lighter step. I\u0026rsquo;m going to keep practising Tai Chi.\" (N14)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Using herbal foot baths helped relieve the numbness in my hands and feet caused by chemo and radiotherapy. It felt really comforting while soaking. On the one hand, it improved blood circulation and eased the numbness. On the other hand, I believed the active ingredients in the herbs nourished my nervous system. I was very willing to accept this technique.\" (N4)\u003c/em\u003e \u003c/p\u003e\n\u003ch3\u003eUnmet expectations, diminished confidence\u003c/h3\u003e\n\u003cp\u003eHowever, the efficacy of Traditional Chinese Medicine techniques was not always immediate for every patient. Some cancer patients, after trying various Traditional Chinese Medicine techniques, did not achieve the ideal expectations, which diminished their confidence and led them to question the effectiveness of Traditional Chinese Medicine techniques, making them hesitant about whether to continue acceptance them, or even to abandon them altogether.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"At first, I used acupoint patches with hope, thinking it might be effective. But after using it for a while and seeing no results, I lost confidence and wasn't sure whether I should keep accepting it.\" (N1)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I've been accepting auricular therapy for some time, but I haven't noticed much improvement in my sleep quality. I'm not willing to keep going.\" (N5)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I tried many different Traditional Chinese Medicine techniques, but the tumour didn't shrink, and that's why we lost confidence. My willingness to continue accepting them wasn't as strong as before.\" (N3)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eCancer patients often had to balance their ideal outcomes with practical results when confronted with treatment plans. Uncertainty about treatment efficacy made decision-making concerning acceptance more complex, and variations in efficacy led to hesitation or even to giving up Traditional Chinese Medicine techniques.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eConflict between rapid relief and the required treatment duration of Traditional Chinese Medicine techniques\u003c/h2\u003e \u003cp\u003eMany participants expressed that Traditional Chinese Medicine techniques failed to meet their expectations for rapid results. The treatment duration required for the therapeutic effects of Traditional Chinese Medicine techniques conflicted with patients' desire for rapid symptom relief, which in turn reduced their acceptance of such techniques.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I feel that Traditional Chinese Medicine techniques are too slow, and I wish they worked faster. Otherwise, I wouldn't consider accepting them.\" (N3)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\"We know that Traditional Chinese Medicine techniques work, but it's just too slow. I probably wouldn't accept it again unless there's no other choice.\" (N14)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\"If you have a hoarse voice or something, Western medicine can fix it overnight, but some Traditional Chinese Medicine techniques might take at least a week. I just don't want to wait that long, so I'm not willing to accept it.\" (N14)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\"The effect of Traditional Chinese Medicine techniques is much slower compared to the speed at which my tumour is growing. I have no time to wait, so I have to give it up.\" (N3)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eTheme 2: Progressive trust promotes acceptance of Traditional Chinese Medicine techniques\u003c/h2\u003e \u003cp\u003eThis study found that cancer patients' acceptance of Traditional Chinese Medicine techniques was progressively reinforced through the development of trust. The patients' cultural identity with these techniques, guidance from professionals, along with suggestions from family and peers, served as sources of trust that encouraged them to experience the techniques, thereby strengthening their confidence. This, in turn, increased their willingness to accept Traditional Chinese Medicine techniques.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eCultural identity strengthens beliefs\u003c/h2\u003e \u003cp\u003eGrounding in cultural identity and a profound belief in the principles of Traditional Chinese Medicine techniques provided the basis for patients' trust. This initial cultural connection encouraged patients to engage with techniques that aligned with their health beliefs. As they experienced tangible benefits, their trust was reinforced, ultimately leading to greater acceptance.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Traditional Chinese Medicine techniques are extensive and profound. When I first tried them for my overall health, I found them more effective than Western medicine. That experience made me trust them more, so now, I prefer to use Traditional Chinese Medicine techniques to look after my whole body.\" (N4)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Traditional Chinese Medicine techniques are the result of thousands of years of cultural wisdom, and I find them reliable. If given the choice, I would definitely choose Traditional Chinese Medicine techniques.\" (N10)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eA lung cancer patient self-studied Traditional Chinese Medicine techniques. As he tried them and deepened his understanding, his trust in Traditional Chinese Medicine grew, which strengthened his willingness to incorporate these techniques into his treatment plan.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Traditional Chinese Medicine and Western medicine differ in their understanding of organ functions. For example, in Traditional Chinese Medicine, the kidneys are regarded as the foundation of life and are said to store essence... I relate more to the Traditional Chinese Medicine perspective, which makes me more inclined to accept treatments based on it. After trying these techniques, I noticed positive changes in my health, which strengthened my trust in their effectiveness and deepened my belief in incorporating them into my overall health plan.\" (N9)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\"In Traditional Chinese Medicine, the body is seen as an interconnected whole. For example, it's like an empty house\u0026mdash;if the house becomes damp, mould starts to grow on the wood. Traditional Chinese Medicine views this as similar to what Western medicine describes as tumours. This way of thinking really resonated with me and gave me the confidence to try Traditional Chinese Medicine techniques as part of my treatment.\" (N9)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eA patient with ovarian cancer and her family all have a strong awareness of health preservation. They viewed Traditional Chinese Medicine techniques as the optimal method for regimen and actively incorporated them into their daily routines.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"We've always cared deeply about our health, so we try Traditional Chinese Medicine techniques like massage, cupping, and hot compresses in our free time. Whenever I feel a bit unwell, I also visit the local therapy centre for a back rub or a foot soak. \" (N5)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eProfessional guidance are authoritative recognition\u003c/h2\u003e \u003cp\u003eParticipants reported that professional guidance was perceived as authoritative endorsement, which helped build trust and encouraged them to try Traditional Chinese Medicine techniques. Despite occasional doubts about efficacy, they tended to follow medical advice, influenced by clinicians' expertise and experience. Once they had positive experiences, their confidence in these techniques was reinforced, fostering greater acceptance.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Since I chose this hospital's treatment plan, I trusted them completely. As long as the medical staff's advice made sense, I went along with it, including trying Traditional Chinese Medicine techniques.\" (N4)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\"At the beginning, even though I didn't feel much effect from Traditional Chinese Medicine techniques, I still followed the advice of the healthcare provider and was willing to try different ones. As time went by, their role in my care made me trust them more and accept them more easily.\u0026rdquo; (N1)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eSuggestions from family and peers are persuasive\u003c/h2\u003e \u003cp\u003eExternal support, including suggestions from family and peers, plays a significant role in encouraging patients to try Traditional Chinese Medicine techniques. These recommendations were often persuasive, especially when rooted in real-life experiences, as they effectively reduced patients' uncertainty in decision-making. Thus, such personal endorsements directly affect the willingness to engage with these techniques, further reinforcing trust and acceptance. This process also facilitated the broader social dissemination of Traditional Chinese Medicine techniques.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"A friend of my sister's is also a cancer patient. He would heat coarse salt with Sichuan peppercorns or mugwort, then spread mugwort over it and lie on top to ease the pain. My sister told me how to do it, and after I tried it, it really worked. That made me trust the treatment more and feel more willing to accept it myself.\" (N2)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Recommendations from other patients meant a lot to me. If they shared specific examples of how it helped them, I'd be more willing to give it a go. After trying it myself and seeing it work, I felt more confident in the treatment and was more willing to use it again.\" (N1)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eA colorectal cancer patient mentioned that it was through informal chats with neighbours about their positive experiences with Traditional Chinese Medicine techniques that they decided to try it. After perceiving the benefits themselves, their trust in the treatment grew, which made them more willing to continue to accept it.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"When neighbours were chatting and someone mentioned feeling unwell, others would often talk about what had worked for them and suggest trying Traditional Chinese Medicine techniques. Hearing these stories made me more willing to give it a go. After trying it myself and feeling some relief, I began to trust it more and was more inclined to continue accepting it when needed.\" (N7)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThese findings illustrate that patients' acceptance of Traditional Chinese Medicine techniques was not static but developed progressively. Initial trust, shaped by cultural identity, social influence, or professional guidance, motivated patients to try these techniques. As they experienced benefits, their trust deepened, further reinforcing their acceptance of integrating Traditional Chinese Medicine techniques into their care.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eThe actual encounter hinders the acceptance of Traditional Chinese Medicine techniques\u003c/h2\u003e \u003cp\u003eAlthough there had been progress in the development and application of Traditional Chinese Medicine techniques, cancer patients encountered several barriers that hindered their use, which not only negatively affected their treatment experience but also reduced their willingness to accept these techniques.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eInsufficient publicity\u003c/h2\u003e \u003cp\u003eMany participants stated that comprehensive hospitals within a healthcare system dominated by Western medicine provided insufficient publicity for Traditional Chinese Medicine techniques. The insufficient publicity impaired patients' awareness and uptake of these techniques, thereby hindering their wider acceptance in modern healthcare.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"During my hospital stay, medical staff didn't suggest using Traditional Chinese Medicine techniques. Medical staff never mentioned it, and we weren't very familiar with it, so we never really thought about whether to accept it.\" (N3)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Western medicine doesn't really publicise Traditional Chinese Medicine techniques, and it's hard to find any information about them in Western medicine hospitals. As a result, there's little opportunity to consider accepting these techniques in such settings.\" (N5)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eOne multiple myeloma patient reported that he had to search for information on Traditional Chinese Medicine techniques through his mobile phone, rather than receiving guidance from medical staff or hospital-led publicity efforts.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"There's not much publicity in the hospital, so I had to look up information about Traditional Chinese Medicine techniques myself. When I was discharged, no one told me I could ask for help with it, which made it harder for me to consider accepting it.\" (N2)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eUneven technical levels\u003c/h2\u003e \u003cp\u003eParticipants believed that the therapeutic effect of Traditional Chinese Medicine techniques depended on the operators' skill levels. However, the uneven technical levels across medical institutions and practitioners led to inconsistent patient experiences, which in turn affected their willingness to accept these techniques.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I've always believed that Traditional Chinese Medicine techniques can be effective, but it depends on finding the right practitioner. If they're not a good fit, you might not feel any effect. By 'right', I mean both their skill and how effective the treatment is. Without that, it's hard to feel confident enough to accept it.\" (N7)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eOne breast cancer patient mentioned that there were notable differences in the way various nurses performed acupoint patches, which resulted in variable treatment experiences and influenced her decision to accept the technique.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Skilled nurses will first press on the area before applying the plaster, asking if it hurts as they go along, and will only apply it once they've pressed on the most painful spot. In contrast, less skilled nurses apply only light pressure and immediately place the plaster. If I always had nurses with poor skills performing the procedure, I would feel it wasn't effective and would be reluctant to accept it once more.\" (N1)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eA gastric cancer patient expressed concern that some unregulated institutions offering Traditional Chinese Medicine techniques might pose potential technical risks, which could negatively impact patients' experiences and undermine their acceptance of these techniques.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"The guarantee of the level of technology is very important. For instance, some private clinics may lead to more serious issues, which can diminish patients' experiences and reduce their acceptance of these techniques, so I tend to avoid them.\" (N10)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eFinancial and time pressures\u003c/h2\u003e \u003cp\u003eThe high cost of treatment, including both financial and time pressures, reduced cancer patients' acceptance of Traditional Chinese Medicine techniques. Most were already strained by the expense of medication and chemo-radiotherapy, and had to forgo the use of Traditional Chinese Medicine techniques to reduce overall healthcare costs. Some also noted that the rising cost of Traditional Chinese Medicine techniques over the years had further increased their financial burden.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I'm already overwhelmed by the costs of radiotherapy and chemotherapy, so every bit I can save really makes a difference in my decision to accept or not accept additional treatments like Traditional Chinese Medicine techniques.\" (N4)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Cancer patients like us incur substantial expenses, including transportation and examination fees for multiple visits. On top of that, Traditional Chinese Medicine techniques can also be costly, with prices having risen considerably, which makes it more difficult to consider accepting these techniques.\" (N3)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eMeanwhile, time constraints were also an important consideration for cancer patients when choosing treatment options. Due to busy work schedules and career responsibilities, many participants reported being unable to allocate sufficient time for Traditional Chinese Medicine techniques, which restricted their options and diminished their willingness to accept such techniques.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"We all have to work. For most people today, time is money, and every moment costs. Who has the luxury of taking things slowly, unless you're retired? Let alone thinking about accepting Traditional Chinese Medicine techniques.\" (N14)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I started raising bees two years ago, and it's kept me busy. I haven't had the time to experience Traditional Chinese Medicine techniques since, which has made it harder for me to accept them.\" (N13)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study explored the experiences and acceptance of Traditional Chinese Medicine techniques among 15 Chinese cancer patients through qualitative interviews. As we know, this study is the first to describe the complex experiences of cancer patients receiving Traditional Chinese Medicine techniques and to identify the impact of these experiences on the acceptance of Traditional Chinese Medicine techniques. The findings of this study provide insights into the experiences of cancer patients with Traditional Chinese Medicine techniques and their influence on the acceptance of these techniques. They also offer new ideas for future research and clinical practice in Traditional Chinese Medicine nursing interventions.\u003c/p\u003e \u003cp\u003eCompared to prior research that highlights factors such as economic status, cultural customs, healthcare system differences, and patients' preferences for Traditional Chinese Medicine techniques as influencing acceptance [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], this study found that the experience of therapeutic effects had the most significant impact. In addition, the acceptance of Traditional Chinese Medicine techniques is not only closely related to patients' intrinsic motivation and their recognition of its underlying health concepts, but also influenced by external support. For example, suggestions from family and peers, as well as professional guidance endorsed by authorities, can help build trust and thereby increase the willingness to accept these techniques. However, the barriers encountered, such as insufficient publicity, uneven technical levels, and financial and time pressures, negatively affected patients' experiences and limited their acceptance of Traditional Chinese Medicine techniques. The results of this study are consistent with those of previous quantitative studies, and it also supplements the quantitative results to more comprehensively reflect the impact on cancer patients' acceptance of Traditional Chinese Medicine techniques. These findings provide more specific insights into the complex mechanisms influencing cancer patients' acceptance of Traditional Chinese Medicine techniques.\u003c/p\u003e \u003cp\u003eDavis found that, compared to ease of use, perceived usefulness had a greater influence on usage behaviour and was a strong correlate of user acceptance [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Cancer patients experienced clear therapeutic effects as well as physical and mental benefits after using Traditional Chinese Medicine techniques and expressed a willingness to continue using them. This indicates that patients perceive the usefulness of Traditional Chinese Medicine techniques, which encourages their acceptance. The results of this study support the theory of Davis' Technology Acceptance Model. Cognitive consistency theory also suggests that positive treatment experiences can strengthen patients' beliefs, thereby improving acceptance [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Similarly, cancer patients showed greater acceptance and compliance when interventions offered positive experiences [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. However, when expectations do not align with reality, individuals often alleviate internal conflict by adjusting their behaviour or attitudes [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. This study found that when the therapeutic effects of Traditional Chinese Medicine techniques were not evident, cancer patients questioned their efficacy and, in some cases, refused to proceed with such treatment plans. For instance, a colorectal cancer patient (N7) admitted that if there were no effect, she would not continue. Previous studies have shown that negative experiences due to unmet high expectations of efficacy not only exacerbate emotional distress in cancer patients [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], but also undermine their confidence in the treatment plan [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Moreover, cancer patients experience pain caused by disease and its treatments, often desiring rapid symptom relief through Traditional Chinese Medicine techniques. However, these techniques, influenced by Confucian philosophies such as the harmony between humans and nature and the doctrine of the mean, focus on holistic regulation and body balance, meaning that therapeutic effects typically take time to manifest [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. The inherent beliefs held by some patients in this study regarding the required treatment duration of Traditional Chinese Medicine techniques may stem from a limited understanding of Traditional Chinese Medicine or unrealistic expectations for rapid relief. Therefore, in the future, it is crucial to educate patients and disseminate accurate knowledge about Traditional Chinese Medicine, which will help them form more realistic treatment expectations and enhance their acceptance of Traditional Chinese Medicine techniques.\u003c/p\u003e \u003cp\u003eThis study further demonstrated that the progressive trust plays a key role in improving patient acceptance. Its development was influenced by various factors. Firstly, cultural identity, as the internal motivation and foundation of patient trust, should not be overlooked. Some participants were deeply influenced by Traditional Chinese Medicine culture; for example, a lung cancer patient (N9) effortlessly quoted the classic saying from the \u003cem\u003eHuangdi Neijing\u003c/em\u003e (\u003cem\u003eThe Yellow Emperor's Classic of Internal Medicine\u003c/em\u003e, one of the earliest collections of Traditional Chinese Medicine, which is still regarded as a must-read for Traditional Chinese Medicine practitioners.): \"When the body's vital energy is abundant, pathogenic factors cannot invade.\" Patients expressed that the Traditional Chinese Medicine philosophy resonated deeply with their own views on health, thereby strengthening their trust in Traditional Chinese Medicine techniques. The studies by Akhtar et al. also highlighted that respect for traditional wisdom can subtly influence an individual's medical choices, thereby shaping their confidence in and acceptance of treatment methods [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. A study indicated that the usage rate of complementary and alternative medicine among cancer patients in Asia is as high as 49.3%. This is believed to be inevitably linked to patients' recognition and acceptance of the cultural values of this type of medicine [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. However, a survey conducted in Sweden shows that although 83% of patients are interested in acupuncture, only 1% actually receive it [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. These studies highlight that different cultural backgrounds lead to an imbalance in cancer patients' acceptance. Philosopher Daniel Dennett has noted that human behaviour is largely shaped by culture [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. To promote the global acceptance and application of Traditional Chinese Medicine techniques, it is essential to enhance understanding and trust in Traditional Chinese Medicine culture among people from diverse cultural backgrounds. Furthermore, healthcare professionals' expert guidance was crucial in encouraging patients to accept Traditional Chinese Medicine techniques. This is because authoritative professionals possess expertise, experience, and status, and people tend to trust and follow their advice, especially in complex or uncertain situations. Previous studies have pointed out that individuals with professional knowledge and credibility are often regarded as \"authorities\" and have a significant influence on others' decision-making [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Most participants believed that the guidance provided by healthcare professionals helped clarify their treatment decisions. This is consistent with the findings of Larsen et al., who found that patients generally trust professional judgment in medical decision-making [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. In addition, suggestions from family members and fellow patients also provided external support in enhancing trust. According to social proof theory, individuals often rely on the behaviour or opinions of others as a basis for their decisions when faced with uncertainty [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. This is especially true when they trust someone they know well. Such reliance and trust can reduce the risk of disappointment and failure associated with new experiences, thereby increasing their acceptance. Sharing real experiences with fellow patients helped alleviate the uncertainty and anxiety cancer patients felt during treatment decision-making by inducing emotional resonance and offering guidance through shared experience.\u003c/p\u003e \u003cp\u003eAlthough Traditional Chinese Medicine techniques show potential in cancer treatment, this study identified the realistic application barriers that constrain patient acceptance. Insufficient publicity in hospitals dominated by Westen medicine results in low accessibility [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e], thus hindering cancer patients' acceptance of these techniques. This challenge is not unique to China, as similar barriers have been reported globally [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Additionally, the uneven technical levels of practitioners directly affects patient trust and acceptance regarding treatment efficacy. The effectiveness of Traditional Chinese Medicine techniques is highly dependent on practitioner skill [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e], with the General Medical Council of the United Kingdom emphasising that professional competence is key to earning patient trust [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. One colorectal cancer patient (N7) even travelled long distances to find a skilled Traditional Chinese Medicine practitioner, underscoring the impact of technical disparities on acceptance. Financial and time pressures also significantly contributed to patients' hesitation. Some participants felt that the cost and time required for Traditional Chinese Medicine techniques increased their pressures and disrupted daily routines. Foreign researchers have investigated cancer patients' acceptance of acupuncture. Their findings indicate that economic concerns are a major barrier, with 70% of oncologists viewing cost as the greatest obstacle to integrating acupuncture into cancer treatment [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Similarly, Choi et al.'s systematic review [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] also mentioned this. In today's fast-paced world, patients often prioritise efficiency [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e], and time restrictions lead some to abandon Traditional Chinese Medicine techniques. Despite its side effects, some still prefer Western medicine for its ability to rapidly control conditions and symptoms [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e], further highlighting the restrictive influence of time costs on acceptance.\u003c/p\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eImplications for clinical practice and research\u003c/h2\u003e \u003cp\u003eThe findings of this study offer insights for clinical practice and future research. Positive experiences with Traditional Chinese Medicine techniques are crucial for enhancing patient acceptance [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Thus, clinical applications and research should concentrate on boosting efficacy and refining treatment plans to facilitate ongoing development. Future research ought to explore the connection between treatment experiences and psychological expectations, assisting patients in establishing practical goals to mitigate the adverse effects of unmet expectations. Healthcare institutions can utilise online platforms and health seminars to disseminate patient experiences, thereby strengthening the influence of suggestions from family and peers. Additionally, promoting Traditional Chinese Medicine culture can cultivate a sense of cultural identity among patients. To alleviate financial pressures, governments ought to augment policy support, enhance healthcare systems, and foster an environment that encourages the use of Traditional Chinese Medicine techniques.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eLimitations and perspectives\u003c/h2\u003e \u003cp\u003eThis study had some limitations. First, the sample was limited to inpatients with cancer from three hospitals in southeast China, and all participants were Chinese. The findings regarding acceptability may have been influenced by the specific healthcare setting and the fact that China is the birthplace of Traditional Chinese Medicine. Therefore, they may not fully reflect the true situation of the broader cancer patient population. It is suggested that future research should consider sampling from a more diverse range of environments, including individuals from different regions and cultural backgrounds, to enhance the representativeness and generalisability of the results. Secondly, the study only collected data from patients and excluded other relevant groups, such as medical staff and family members. Future research should integrate data from multiple sources to better understand the acceptance of Traditional Chinese Medicine techniques and the factors influencing it. Third, this study used in-depth interviews at a specific time point, so it could only reflect the experience and acceptance at that time and couldn't capture dynamic changes. In the future, a longitudinal design could be adopted to track the patient's usage process and include data on the patient's treatment course, in order to capture patient experience and acceptability more accurately.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study revealed differences in the perceived therapeutic effects of Traditional Chinese Medicine techniques among cancer patients. Patients' experiences of therapeutic efficacy, trust, and encountered obstacles influenced their acceptance of these techniques. These findings provide direction for clinical practice, future research, and a theoretical basis for health administrative authorities to formulate promotional policies to encourage the use of Traditional Chinese Medicine techniques in cancer treatment.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Medical Ethics Committee of the Third People\u0026apos;s Hospital Affiliated to Fujian University of Traditional Chinese Medicine (Approval No.: 2023KS-75-1). All participants provided written informed consent before participating in the study. All methods were performed in accordance with the relevant guidelines and regulations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset generated and analysed during the current study is available from the corresponding author upon reasonable request. Due to privacy concerns, the data supporting the findings of this article are not publicly available. However, the data are available upon request from the corresponding author with proper permission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author declares that there is no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by the Natural Science Foundation of Fujian Province (Grant No. 2023J01875). The funding agency was not involved in the design of the study, data collection, analysis, data interpretation, or manuscript writing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u003c/strong\u003e\u0026apos;\u003cstrong\u003e\u0026nbsp;contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLY: Writing \u0026ndash; original draft, Conceptualization, Funding acquisition, Methodology, Formal analysis, Validation, Supervision, Resources, Project administration. WW: Writing \u0026ndash; original draft, Investigation, Data curation, Formal analysis, Validation, Resources. JL: Writing \u0026ndash; original draft, Investigation, Data curation, Formal analysis, Validation, Resources. XS: Writing \u0026ndash; review \u0026amp; editing, Formal analysis, Validation. RL: Formal analysis, Validation, Writing \u0026ndash; review \u0026amp; editing. XW: Validation, Writing \u0026ndash; review \u0026amp; editing. YY: Data curation. ZT: Data curation. YL: Validation, Resources, Supervision, Writing \u0026ndash; review \u0026amp; editing. All authors have read and approved the final manuscript and each author meets the criteria for authorship established by the International Committee of Medical Journal Editors and has verified the validity of the reported results.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank all participants for their valuable insights and contributions to this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eSchool of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China. \u003csup\u003e2\u003c/sup\u003eNursing Department, The Second People\u0026apos;s Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China. \u003csup\u003e3\u003c/sup\u003eNursing Department, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBray F, Laversanne M, Sung H, et al. 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Front Pharmacol. 2024;15:1425940. https://doi.org/10.3389/fphar.2024.1425940.\u003c/li\u003e\n\u003cli\u003eRybicka M, Zhao J, Piotrowicz K, et al. Promoting whole person health: Exploring the role of traditional Chinese medicine in Polish healthcare. J Integr Med. 2023;21(6):509-517. https://doi.org/10.1016/j.joim.2023.10.001.\u003c/li\u003e\n\u003cli\u003eLi J, Graham D. The importance of regulating the education and training of Traditional Chinese Medicine practitioners and a potential role for ISO/TC 249. Pharmacol Res. 2020;161:105217. https://doi.org/10.1016/j.phrs.2020.105217.\u003c/li\u003e\n\u003cli\u003eGoddard VCT, Brockbank S. Re-opening Pandora\u0026apos;s box: Who owns professionalism and is it time for a 21st century definition?. Med Educ. 2023;57(1):66-75. https://doi.org/10.1111/medu.14862.\u003c/li\u003e\n\u003cli\u003eVeleber S, Cohen MR, Weitzman M, et al. Characteristics and Challenges of Providing Acupuncture and Chinese Herbal Medicine in Oncology Treatment: Report of Survey Data and Experience of Five Unique Clinical Settings. Integr Cancer Ther. 2024;23:15347354241226640. https://doi.org/10.1177/15347354241226640.\u003c/li\u003e\n\u003cli\u003eYeganeh H. Conceptions of time, socioeconomic development and cultural values. Int J Sociol Soc Policy. 2024;44(7/8):760-775. https://doi.org/10.1108/IJSSP-11-2023-0305.\u003c/li\u003e\n\u003cli\u003eZhang M, He X, Wu J, Xie F. Differences between physician and patient preferences for cancer treatments: a systematic review. BMC Cancer. 2023;23(1):1126. https://doi.org/10.1186/s12885-023-11598-4.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"bmc-complementary-medicine-and-therapies","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcam","sideBox":"Learn more about [BMC Complementary Medicine and Therapies](https://bmccomplementmedtherapies.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Complementary Medicine and Therapies","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Cancer, Traditional Chinese Medicine techniques, Qualitative research, Experience, Acceptance","lastPublishedDoi":"10.21203/rs.3.rs-6672935/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6672935/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe effectiveness of Traditional Chinese Medicine techniques in managing cancer symptoms is gaining increasing recognition. However, acceptance among cancer patients remains imbalanced globally. Researchers have begun focusing on how patients' subjective perceptions influence their acceptance, mostly through quantitative surveys. Yet, no studies have deeply explored cancer patients' subjective experiences and feelings during the use of these techniques, or how cultural and social factors influence acceptance. This study aims to explore the factors affecting cancer patients' acceptance of Traditional Chinese Medicine techniques, based on their experiences, to support broader application.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA descriptive qualitative approach was used to explore the experiences of cancer patients. Face-to-face, semi-structured, and in-depth individual interviews were conducted in three tertiary hospitals in southeastern China from March to May 2023. Purposive and differential sampling was used to select eligible participants. Inductive thematic analysis was used to analyze qualitative data and identify categories and subcategories. This study followed the COREQ guidelines.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThree key themes involving nine sub-themes emerged. (1) Varied experiences of efficacy result in different levels of acceptance. Clear effects and overall comfort promote acceptance, while unmet expectations diminish it. The conflict between rapid relief and the required treatment duration of Traditional Chinese Medicine techniques also restricts acceptance. (2) Progressive trust promotes acceptance of Traditional Chinese Medicine techniques, as internal motivation based on cultural identity and external support from professional guidance, along with suggestions from family and peers, reinforce patients' trust and acceptance. (3) The actual encounter hinders the acceptance of Traditional Chinese Medicine techniques, as insufficient publicity in the modern healthcare environment, uneven technical levels among practitioners and institutions, and financial and time pressures all restrict patients' acceptance.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study describes the complex experiences of cancer patients receiving Traditional Chinese Medicine techniques and determines the influence of their experiences on the acceptance of these techniques. These insights guide clinical practice, policy development, and future research, promoting the use of Traditional Chinese Medicine techniques in cancer treatment.\u003c/p\u003e\u003ch2\u003eTrial registration:\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e","manuscriptTitle":"Exploring cancer patients' experiences and acceptability of Traditional Chinese Medicine techniques: a qualitative study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-16 07:52:16","doi":"10.21203/rs.3.rs-6672935/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"154961819556943549787723199245727396089","date":"2026-05-11T02:39:22+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-27T17:01:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"154961819556943549787723199245727396089","date":"2025-06-21T03:52:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"271391694744684605091084537282099758791","date":"2025-06-12T10:25:57+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-11T22:35:37+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-27T09:19:06+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-19T09:43:07+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-19T09:38:53+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Complementary Medicine and Therapies","date":"2025-05-15T13:03:01+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-complementary-medicine-and-therapies","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcam","sideBox":"Learn more about [BMC Complementary Medicine and Therapies](https://bmccomplementmedtherapies.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Complementary Medicine and Therapies","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4df581bf-db22-40d6-a964-e816fb323b64","owner":[],"postedDate":"June 16th, 2025","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"154961819556943549787723199245727396089","date":"2026-05-11T02:39:22+00:00","index":73,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-06-16T07:52:16+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-16 07:52:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6672935","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6672935","identity":"rs-6672935","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}