Exploring the dignity support needs of colorectal cancer stoma survivors in China: a qualitative study

Exploring the dignity support needs of colorectal cancer stoma survivors in China: 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 the dignity support needs of colorectal cancer stoma survivors in China: a qualitative study xi LI, Wei JIANG, Rui LUO, Yu HE, Shuli WANG, Shan WEI, Chi ZHANG, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8606147/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Objective To explore the dignity support needs of colorectal cancer (CRC) stoma survivors in China. Methods A qualitative study from a phenomenological perspective.CRC stoma patients (N = 11) from two hospitals in Zhuzhou, China, participated in semi-structured interviews to explore their needs for dignity support. Transcripts were analyzed using an inductive process and interpretive analysis.The Consolidated criteria for reporting qualitative research (COREQ) guidelines for qualitative research were followed. Results Five themes were identified: striving for autonomy, defending dignity, becoming valuable, relationship support, and social acceptance. Conclusions The dignity support needs of Chinese colorectal cancer (CRC) stoma survivors are multidimensional, culturally embedded and dynamic. Core elements include the restoration of autonomy, relational dignity defence (i.e. family and peer support) and social identity reconstruction (i.e. role continuity). In contrast to dignity models within Western, individualistic frameworks, Chinese patients emphasise 'responsibility-driven autonomy' and collective belonging, thereby highlighting the role of cultural values in shaping health narratives. Clinical practice requires the establishment of a tiered intervention system. Healthcare professionals should address patients’ needs relating to family roles, ensure information autonomy and improve patients’ experiences of dignity by protecting their privacy. Colorectal cancer stoma dignity support needs qualitative research acculturation family support 1 Background Colorectal cancer (CRC) is a major global public health challenge with a rapidly increasing disease burden (Qu et al., 2022 ). According to global cancer statistics, there are more than 1.9 million new cases of CRC annually, and the incidence rate is expected to increase to 3.2 million by 2035, with a particularly significant increase in developing countries (Hossain et al., 2022 ; Sung et al., 2021 ). China is a region with a high incidence of CRC, with 555,000 new cases per year and the second highest disease-related mortality rate of all malignancies(Xia et al., 2022 ). Stoma surgery, as a key treatment for patients with intermediate and advanced CRC, significantly prolongs survival, but results in patients facing a complex transition of physiological-psychological-social functioning: worldwide, approximately 1.3 million patients undergo colostomy each year, and the number of stoma survivors in China has exceeded 100,000/year, with an increasing trend year by year (Li et al., 2023 ; Vonk-Klaassen et al., 2016 ; Yu, 2005 ). Stoma-induced changes in physiological function and bodily integrity (e.g., permanent artificial anus in the abdomen, uncontrolled bowel movements) have a multidimensional impact on the dignity of CRC stoma survivors, including social stigma (e.g, the label of "abnormal body"), collapse of self-worth (e.g., shame of dependency, career disruption), and relational identity crises (e.g., weakened family roles) (Alenezi et al., 2021 ; Ayaz-Alkaya, 2019 ; Wang et al., 2024 ; Yuan et al., 2018 ). Studies have shown that 50.9% of Chinese CRC stoma survivors suffer from severe dignity impairment(Jinhu, 2022 ), and that loss of dignity is a central driver of depression, social isolation, and even the desire to hasten death in patients(Monforte-Royo et al., 2012 ; Wang et al., 2019 ; Xiao et al., 2020 ; Xiao et al., 2021 ). Despite the existing research focusing on quality of life and psychological adjustment of CRC patients with stoma, there are significant research gaps(Jansen et al., 2010 ; Kovoor et al., 2023 ; Sprangers et al., 1995 ; Zhang et al., 2019 ): first, there is a paucity of intervention studies addressing the dignity dimension; second, traditional psychosocial interventions mostly focus on symptom management and fail to integrate individualized strategies for dignity maintenance (e.g., role maintenance, spiritual support) and social environment improvement (e.g., privacy protection, destigmatization) (Castro-Espin & Agudo, 2022 ; Shaw & Ivatury, 2021 ; Zielińska et al., 2021 ); furthermore, in the Chinese cultural context, patients' specific perceptions of "bodily integrity" and unique expressions of stigma may lead to differentiated needs that have not yet been fully explained(Yuan et al., 2018 ). The Dignity Model provides an innovative perspective on the systematic deconstruction of dignity support needs for CRC stoma survivors. The model emphasizes dignity as a dynamic balance between disease symptom control (physiological-psychological complex needs), individual meaning construction (autonomy, role continuity), and social interaction accommodation (privacy, destigmatization) (Chochinov et al., 2005 ; Chochinov et al., 2002 ). However, its applicability in non-Western contexts has not been fully tested, especially in the absence of an examination of "dignity preservation mechanisms" in collectivist cultures. In the present study, the dignity model was used as a theoretical framework and qualitative interviews were conducted to understand the dignity support needs of Chinese CRC stoma survivors.The results of this study will contribute to the cultural adaptation of dignity theory and provide an empirical basis for the development of a precise dignity support intervention program. 2 Methods 2.1 Research Design A qualitative descriptive study was employed. This methodology "captures the complexity and detail of experience in elaborate detail", allowing the researcher to understand the deeper perspectives of the participants(Patton, 2015 ). and allows for a deeper interpretation of the research phenomenon, revealing details that quantitative data cannot touch (Strauss & Corbin, 1998 ). Descriptive qualitative research is therefore an appropriate choice when the goal of the research is to gain insight into the human experience in a particular context. The report of this study follows the Consolidated Standards for Reporting Qualitative Research (COREQ) checklist. 2.2Participants This study was conducted between June and August 2024 in the anorectal and oncology departments of two tertiary care hospitals in central China. The inpatient department was chosen over the outpatient department to allow sufficient and appropriate time to conduct interviews with participants. Participants were recruited using purposive sampling and were required to be adults over 18 years of age, CRC patients who had undergone stoma surgery, were conscious and able to communicate independently, agreed to participate, and signed an informed consent form. We initially invited 15 participants to be interviewed; 2 participants declined to participate due to illness and 2 participants later declined to participate due to time constraints. We did not continue the interviews due to data saturation. Eleven were ultimately included in the analysis for this study. 2.3 Data collection All data were collected through face-to-face semi-structured interviews. Lead authors with experience in interviewing and qualitative writing were responsible for interviews and field notes. The researchers were female nurses and had postgraduate degrees, and all were trained in qualitative research methods and software analysis. Prior to the interviews, participants received a written informed consent form stating that they had been informed of the purpose and procedures of the study, including the benefits and risks of participating in the study, and that they could withdraw from the study at any time. Potential participants were referred by staff in the inpatient anorectal and oncology departments. When these subjects were first approached by the research team, they were informed that an interview would be conducted and the purpose and content of the interview was patiently explained. Following the explanation, we ensured that all participants understood the interview questions. After synthesizing the physical and psychological profiles of CRC stoma survivors, we scheduled an interview. We designed the interview outline based on the Dignity Model framework, focusing on the dignity needs of CRC stoma survivors. We tested and revised it in pilot interviews with the first 2 participants. The Dignity Support Needs Interview included the following 1. What do you think affects your sense of dignity? Can you tell me more? 2. What support and help do you think would increase your sense of dignity? 3. What do you think is the main source of your sense of dignity? The interviews were conducted in a quiet, separate room in the inpatient area of the hospital and lasted approximately 40 minutes. Each interview was conducted by two researchers together, with one researcher conducting the interview based on an interview outline and the other taking field notes, including tone of voice, facial expressions, and emotions. Each interview was recording recorded, transcribed using Nvivo, and manually reviewed by the lead researcher to ensure the accuracy of the information. All interviews were conducted in an environment where the participants felt comfortable, and confidentiality and privacy issues were taken into account. 2.4Data analysis The transcribed data were analyzed using thematic analysis. First, two members of the study listened to and transcribed the recordings to gain an initial understanding of the data. Key words and concepts were then identified through close reading and line-by-line coding. After further analysis, we refined the coding and identified candidate categories and themes. To validate the accuracy of the analysis, we provided participants with a summary of themes and quotes related to their experiences to verify the accuracy of the content and to solicit their feedback. 2.5Ethics This study was conducted under the guidance of the Declaration of Helsinki and was approved by the Ethics Committee of Hunan Provincial Direct Hospital of Traditional Chinese Medicine (KY-2024032201). 3 Results 3.1Basic characteristics The mean age of the participants was 60.63 years (SD 0.92), ranging from 49 to 80 years old.7 (63.6%) participants were male and employed, 4 (36.4%) were employed and had a high school diploma, and 9 (81.8%) were married and had a long-term stoma. The basic characteristics of the participants are shown in Table 1 . Table 1 Basic information about the interviewer (N = 11) Characteristics N or Mean ± SD Gender Male 7 Female 4 Age (years) 60.63 ± 0.92 Careers Worker 3 Employee 4 Freelancer 2 Farmer 2 Education level Elementary school 2 Middle school 3 High school 4 College 2 Work state Active 7 Retired 4 Marital status Married 9 Widowhood 2 Stoma situation Long-term 9 Short-term 2 3.2Pursuing autonomy Besides taking control of their bodies, CRC stoma survivors described a strong desire for autonomy to support dignity in their living situation. Changes in physiological structure and function triggered by stoma surgery significantly affect survivors' perceptions of autonomy, making it common for them to experience cognitive dilemmas and dependency anxiety arising from the loss of autonomy as they adapt to their new state of being. At the primary care level, CRC stoma survivors expressed a strong willingness to reconfigure their autonomous caregiving abilities, viewing independent completion of stoma care as a critical node for dignity restoration.’ I would like to complete the stoma bag changing operation independently so that I can adjust the pace of care according to my own needs instead of being subjected to someone else's schedule (P11)’. At the level of life adaptation, CRC stoma survivors referred to the erosive effect of the state of dependency on self-independence.’ The situation of being continuously dependent on others for assistance during hospitalisation due to limited mobility has caused me to feel a strong sense of guilt, always believing that I have become a burden to others (P7)’. 3.2 Defence of dignity CRC stoma survivors present a strong need to defend their dignity during the adaptation to the disease. This theme can be deconstructed into two related sub-themes. 3.2.1 Expectation of being respected Survivors expressed the existence of a clear expectation of dignity defence of equal status in doctor-patient/family interactions, which mainly included: maintenance of personal dignity, informed information, and participation in autonomous decision-making.CRC stoma survivors described that ‘the curtains are drawn when the caregiver changes the stoma bag, and the family members always maintain a natural demeanour when assisting with the care, and that this kind of non-verbal acceptance is much more powerful than the comfort of words’ (P3). powerful’ (P3). Meanwhile information autonomy constitutes an important element of dignity maintenance. Survivors emphasised the importance of the right to information about their condition, especially in relation to key points such as adjustments to treatment regimens and prognostic assessments. Typical statements such as, ‘When the doctor takes the lab results and discusses whether to adjust the follow-up plan, I expect to be at the centre of the dialogue rather than a bystander’ (P7). Another survivor pointed out that medical information was selectively communicated: ‘The family and the doctor made a tacit agreement to replace professional explanations with vague expressions such as “minor problems” and “recovery is going well”, which essentially deprived me of participation in decision-making’ (P9). 3.2.3 Privacy Protection Privacy protection encompasses both the physical protection of physical privacy and the social control of information privacy. The altered integrity of the body due to the stoma and the visibility of the device outside the body expose CRC stoma survivors to a unique risk of privacy exposure that arises not only from the uncontrollable nature of physiological functioning, but also from the tension with socio-cultural normative perceptions of the ‘normal body’. ‘I would repeatedly adjust my clothing to ensure that my stoma bag was completely hidden, and I refused to dress lightly even in the summer months; I was afraid of being asked about it, and this nervousness made me avoid crowded places (P1)’. Survivors emphasised absolute control over stoma-related information and refused passive disclosure in non-essential situations. ‘The stoma is my most private physiological state, and I do not want anyone to feel free to discuss or ask about it unless it is medically necessary (P2)’. In addition, threatened by privacy, some survivors actively limit the scope of their social activities. ‘I cancelled a lot of my previous social activities because I don't want people to know about my current condition and can't afford the risk of potentially exposing myself (P5)’. 3.3 Becoming Worthy The essence of self-worth is the ongoing pursuit of subjective identity and social connectedness, and new CRC stoma survivors seek to reconstruct the self-worth cut off by the disease by participating in family caregiving, occupational activities, and social interactions to counteract the erosion of their subjective worth by "patient identity. Survivors generally see the continuity of family roles as an important anchor of self-worth. The patient's effort to maintain responsibility for family members despite postoperative physical limitations was symbolised as transcending instrumental care: 'Even though my health isn't as good as it used to be, I still insist on preparing dinner for my family - it makes me feel that I'm still needed (P4)'. The dynamic practice of family roles (e.g. participating in childcare, supporting the elderly) was not only a source of autonomy but also a defence mechanism against the perception of 'worthlessness'. Some study participants even internalised family responsibilities as a motivation for recovery: 'I need to recover as soon as possible, my son is not grown up and my family needs me (P7)'. Returning to work was seen as a dual certification of physical functioning and social resilience, and occupational activity reinforces the patient's experience of dignity through the creation of social value'. Returning to work proves that I have not been defeated by my illness, that my stoma does not rob me of my professional value and that I can still shine (P6)'。 3.4 Expectation of being supported and connected 3.4.1 Family Connection Family support embodies the dual dimensions of emotional connection and instrumental support, and the strength of family support directly affects CRC stoma survivors' perceptions of their own value, their ability to adapt to the disease, and the strength of their sense of dignity. When survivors perceived the depth of understanding of their family members' experience of their disease, their “fear of abandonment” was significantly reduced, which strengthened their sense of meaning. ‘The fact that my son quit his job to be with me reinforces the fact that I am still needed - this sense of worthiness supports my adherence to treatment (P8).’ Substantial involvement of family members in caregiving activities was given symbolic meaning by survivors that went beyond functionality. Family members‘ acquisition of stoma care skills (e.g., changing stoma bags, recognising complications) not only relieved survivors’ anxiety about handling, but also conveyed emotional signals of ‘shared responsibility’. ‘My daughter's early acquisition of nursing skills reassured me - it proved that my plight was not shunned by the family (P9)’; family agency in medical matters (e.g., booking tests, purchasing supplies) indirectly preserving the dignity of their autonomy. ‘My son manages all my medical bills and saves me from financial shame (P10)’. 3.4.2 Social support The role of social support is mainly realised through the synergy of the three dimensions of professional support, psychological support and peer support. The quality of the social support network also has a direct impact on the efficacy of CRC stoma survivors in adapting to the disease, their perception of self-worth, and the strength of their sense of dignity. Standardised nursing training significantly improves patients' self-management abilities through skills that enable survivors to master the sense of control over their bodies after reconstruction.’ The nurses demonstrated the steps of stoma cleaning and replacement step by step, and this precise instruction took away my fear of dealing with sudden leaks alone (P6).’ In addition, the transparent transfer of medical knowledge can alleviate the survivor's ‘fear of the unknown’, such as the explanation of complication prevention strategies, which can reduce their anxiety level.’ After the doctor explained how the stoma worked using a 3D model, I suddenly realised that it was just a new way of communicating with the body (P10)’. At the same time, the ‘situational support network’ formed by the group of patients demonstrated a unique healing value, as the exchange of stories of the disease constructed a collective identity that resisted stigma. ‘Hearing about other patients returning to the workplace convinced me that my stoma wouldn't be the end of my career (P2).’ 3.5 Acceptance Social acceptance is essentially the result of the interaction between the CRC stoma survivor's claim to integrity of identity and external de-pathologising feedback. Acceptance is achieved by crossing the double barrier of ‘physical difference’ and ‘social stigma’. When patients perceive ‘selective avoidance’ in social interactions (e.g., reduced invitations to gatherings, avoidance of physical contact), they experience a strong ‘degradation of their identity.’ After the illness, the number of gatherings decreased sharply, and the detachment of my friends still made me feel that I was no longer a complete social subject (P5)’; on the contrary, naturalised patterns of living together (e.g., maintaining the frequency of previous interactions, avoiding excessive attention to the stoma) conveyed a signal of acknowledgement of the “constancy of value”.’ Colleagues knew about the condition but did not treat me differently, apart from diet, and treated me as a normal person, discussing my professional content at work as usual - this proves that my social identity has not been redefined by the disease (P9)’. In addition, the paradigm of social perception of the stoma community has a profound impact on patients' experience of dignity, as the social understanding of stoma remains in a pathologised framework of “physical abnormality”, and despite the rapid advances in medical technology, there is still a clear disconnect with the evolution of social perceptions. For example, ‘public acceptance of artificial hearts and dialysis machines is much higher than that of stomas, despite the fact that they are also life-supporting technologies (P11)’. Discussion This study illustrates the multifaceted nature of the need for dignity support among CRC stoma survivors. Through the narratives of CRC stoma survivors, four interrelated dimensions were identified as critical to dignity support: restoration of autonomy, preservation of dignity, restoration of self-esteem, and relational support systems. These dimensions are included within the framework of the existing dignity model, but are expanded upon, particularly in the emphasis on family interdependence, social cohesion, and collective identity. This study deepens our knowledge and understanding of the dignity support needs of CRC stoma survivors, and provides guidance for the development of dignity support intervention programs. Survivors' emphasis on regaining autonomy over stoma care and daily living is consistent with the dignity model framework, which views autonomy as a cornerstone of mental health (Chochinov et al., 2002 ) Survivors described independent stoma management as a "critical point in the restoration of dignity," reflecting a symbolic restoration of bodily agency disrupted by surgery, a finding consistent with Hardiman et al. ( 2016 ) assertion that mastery of self-care predicts postoperative resilience. However, the Chinese sociocultural context introduces a unique tension between individual autonomy and family interdependence. While Western studies typically define autonomy as an independent right essential to dignity (Ortiz Contreras et al., 2021 ), participants in this study redefined autonomy as "responsibility-driven independence"-a way to avoid becoming a "burden" that prioritizes social obligations over purely personal empowerment. This cultural nuance is crucial: the desire to regain independence in ostomy care highlights the symbolic link between independence and dignity in the Chinese context (Liu et al., 2024 ), where physical competence is intrinsically linked to social value and family harmony (Liu et al., 2020). This highlights the need for culturally sensitive rehabilitation programs that should develop interventions that balance the development of independent caregiving skills with family education to address survivors' “dependency guilt.” Survivors' emphasis on maintaining family and occupational roles (e.g., "making dinner for the family," "going back to work") underscores role continuity as a dignity-preserving strategy to counteract the identity disruption caused by illness. This effort to maintain pre-morbid roles is consistent with Bury ( 1982 ) notion of biographical rupture, in which chronic illness fragments the self-narrative and requires symbolic acts to restore coherence. However, unlike Western narratives that view role continuity as a personal achievement (Spiro & Howard, 1996 ), Chinese survivors reinterpreted role continuity through a collectivist lens: family responsibilities were internalized as the driving force for recovery ("my family needs me"), reflecting culturally ingrained coping strategies that prioritize relational harmony over individual autonomy(Tao et al., 2023 ; WANG Jing-rong, 2023). Here, role continuity serves the dual function of preserving dignity-resisting stigmatized "worthlessness" and reaffirming a sense of social belonging-reinforced in societies where productivity and contribution to the family are moral imperatives (J. Zhang, 2022; Xie et al., 2024 ). For example, survivors insist on returning to work not only for personal empowerment, but also to fulfill social expectations of productivity, which is an important marker of dignity in China. Healthcare professionals can capitalize on this cultural asset by designing rehabilitation goals that are consistent with the survivor's role priorities, thereby improving treatment adherence and dignity. Chinese survivors' reliance on family support is consistent with research emphasizing family-centeredness in collectivist cultures(Guo et al., 2025 ) Instrumental support (e.g., managing the son's expenses) is symbolic and reinforces survivors' sense of being valued despite their reliance on family(Lee et al., 2018 ), a dynamic less emphasized in Western settings where professional services often substitute for family care. Peer support from fellow patients is also a unique type of "situational community" that reflects the Chinese concept of "predestined kinship" and promotes solidarity among those with the same disease (Ito & Kazuma, 2010 ). Strengthening peer support networks can therefore complement family efforts while bridging the gap with professional mental health services and aligning support with survivors' needs for dignity in a collectivist context. Survivors' descriptions of social exclusion ("fewer invitations to gatherings") and pathologization ("public acceptance of dialysis; ostomy") highlight the ongoing impact of sociocultural norms on dignity. These experiences reflect Taleporos and McCabe ( 2003 ) theory of "bodily hierarchy," whereby visible disability invites greater stigma. Unlike Western societies with strong disability rights movements, Chinese survivors internalize stigma as a personal failure, leading to greater social avoidance. To address the dissonance between medical advances such as life-saving ostomies and stagnant social attitudes, the anti-stigma movement employs culturally resonant tactics that reimagine ostomies as symbols of restored competence rather than "abnormality. Linking the restoration of dignity to social values is analogous to media literacy programs that reduce the stigma of AIDS. Implications (clinical and research) This study reveals the uniqueness of the dignity support needs of CRC stoma survivors in the Chinese cultural context, and expands the applicability of dignity theory in a collectivist society. By emphasising family interdependence, social role continuity, and the role of peer ‘contextual community’, this study provides an empirical basis for developing culturally sensitive intervention strategies, and fills a gap in existing research centred on Western individualism. Limitations The monocultural focus of this study limits cross-cultural comparisons. Future research should conduct comparative studies across regions and with other collectivist cultures to deepen the understanding of cultural mediators of dignity maintenance. In addition, longitudinal studies could be conducted to explore the evolution of dignity support needs across the trajectories of CRC stoma survivors. Conclusion This study demonstrates that the dignity support needs of CRC stoma survivors are multidimensional, culturally embedded, and dynamic processes involving three core areas: autonomy restoration (e.g., independent caregiving ability), relational dignity maintenance (family/peer support), and social identity reconstruction (role continuity). Compared to the dignity model under the Western individualistic framework, Chinese survivors' experience of dignity places more emphasis on responsibility-driven autonomy and collective belonging, highlighting the profound shaping of cultural values on health narratives. In order to achieve dignity-oriented care, clinical practice needs to build a stepped intervention system: short-term focus on skills training and collaborative family care, medium-term strengthening of peer support networks, and long-term promotion of social anti-stigma policies. Through cross-cultural comparisons and longitudinal tracking, future research should reveal the dynamic evolution and cultural plasticity of dignity-supporting mechanisms, in order to provide more comprehensive theoretical frameworks and practice guidelines for the care of CRC stoma survivors worldwide. Declarations Ethics approval and consent to participate The experimental protocol was established, according to the ethical guidelines of the Helsinki Declaration and was approved by the Medical Research Ethics Review Committee of The First Affiliated Hospital of Hunan College of TCM (Ethical Review No. E2020126). All methods were carried out in accordance with relevant guidelines and regulations. Consent for publication Not applicable. Availability of data and materials All data generated or analysed during this study are included in this published article. Competing interests The authors declare that they have no competing interests. Funding This study was supported in part by grants from the Hunan Provincial Health Commission Fund (Grant No. W20243090) and the Hunan Provincial Department of Education Fund (Grant No. 24C1174). Authors' contributions Conceptualization: Xi Li, Xia Zhang; Methodology: Xi Li, Wei Jiang,; Formal analysis and investigation: Xi Li, Wei Jiang, Yu He, ; Writing - original draft preparation: Xi Li; Writing - review and editing: Xi Li, Wei Jiang, Shuli Wang, Shan Wei, Chi Zhang, Xia Zhang; Funding acquisition: Xia Zhang; Resources: Xia Zhang; Supervision: Xia Zhang; Ethical guidance: Rui Luo, Chi Zhang. Acknowledgements The authors sincerely express our gratitude to all the participants in our study. 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L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. (2021). Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin , 71 (3), 209-249. https://doi.org/10.3322/caac.21660 Taleporos, G., & McCabe, M. P. (2003). Relationships, sexuality and adjustment among people with physical disability. Sexual and Relationship Therapy , 18 (1), 25-43. https://doi.org/10.1080/1468199031000061245 Tao, L., Hu, X., Fu, L., Zhang, X., & Chen, H. (2023). Effects of family beliefs and family strength on individual resilience and quality of life among young breast cancer survivors: A cross-sectional study. J Clin Nurs , 32 (11-12), 2616-2626. https://doi.org/10.1111/jocn.16321 Vonk-Klaassen, S. M., de Vocht, H. M., den Ouden, M. E., Eddes, E. H., & Schuurmans, M. J. (2016). Ostomy-related problems and their impact on quality of life of colorectal cancer ostomates: a systematic review. Qual Life Res , 25 (1), 125-133. https://doi.org/10.1007/s11136-015-1050-3 WANG Jing-rong, W. X.-l., QIAO Li-na, JIN Xian-zhen, FAN Hui , LIU Xuan-xuan, LUO Li-qun，, XIAO Qian (2023). Construction of core care skill index system for family caregivers of patients with enterostomy in early stage. Journal of Nursing（China） , 30 (12), 1-6. Wang, L., Wei, Y., Xue, L., Guo, Q., & Liu, W. (2019). Dignity and its influencing factors in patients with cancer in North China: a cross-sectional study. Curr Oncol , 26 (2), e188-e193. https://doi.org/10.3747/co.26.4679 Wang, X., Zou, W., Du, Q., Xie, J., Zhong, M., Li, X., Wu, X., & Zhang, M. (2024). Longitudinal Trajectories of Psychological Distress and Its Influence Factors in Young and Middle-Aged Patients With Colorectal Cancer. J Adv Nurs . https://doi.org/10.1111/jan.16585 Xia, C., Dong, X., Li, H., Cao, M., Sun, D., He, S., Yang, F., Yan, X., Zhang, S., Li, N., & Chen, W. (2022). Cancer statistics in China and United States, 2022: profiles, trends, and determinants. Chin Med J (Engl) , 135 (5), 584-590. https://doi.org/10.1097/cm9.0000000000002108 Xiao, J., Chow, K. M., Chan, C. W., Li, M., & Deng, Y. (2020). Qualitative study on perceived dignity of cancer patients undergoing chemotherapy in China. Support Care Cancer , 28 (6), 2921-2929. https://doi.org/10.1007/s00520-019-05123-2 Xiao, J., Ng, M. S. N., Yan, T., Chow, K. M., & Chan, C. W. H. (2021). How patients with cancer experience dignity: An integrative review. Psychooncology , 30 (8), 1220-1231. https://doi.org/10.1002/pon.5687 Xie, M., Wang, C., Li, Z., Xu, W., Wang, Y., Wu, Y., & Hu, R. (2024). Effects of remote dignity therapy on mental health among patients with hematologic neoplasms and their significant others: A randomized controlled trial. Int J Nurs Stud , 151 , 104668. https://doi.org/10.1016/j.ijnurstu.2023.104668 Yu, D. H. (2005). Current status and prospect of enterostomy treatment in China. Chinese Nursing Journal , 06 , 415-417. Yuan, J. M., Zhang, J. E., Zheng, M. C., & Bu, X. Q. (2018). Stigma and its influencing factors among Chinese patients with stoma. Psychooncology , 27 (6), 1565-1571. https://doi.org/10.1002/pon.4695 Zhang, Y., Xian, H., Yang, Y., Zhang, X., & Wang, X. (2019). Relationship between psychosocial adaptation and health-related quality of life of patients with stoma: A descriptive, cross-sectional study. J Clin Nurs , 28 (15-16), 2880-2888. https://doi.org/10.1111/jocn.14876 Zielińska, A., Włodarczyk, M., Makaro, A., Sałaga, M., & Fichna, J. (2021). Management of pain in colorectal cancer patients. Crit Rev Oncol Hematol , 157 , 103122. https://doi.org/10.1016/j.critrevonc.2020.103122 Additional Declarations No competing interests reported. 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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-8606147","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":595361941,"identity":"54dfebda-184e-4af1-8e97-d76ac5ed5c0d","order_by":0,"name":"xi LI","email":"","orcid":"","institution":"The First Affiliated Hospital of Hunan Traditional Chinese Medical College (Hunan Provincial Directly Affiliated Hospital of Traditional Chinese Medicine)","correspondingAuthor":false,"prefix":"","firstName":"xi","middleName":"","lastName":"LI","suffix":""},{"id":595361943,"identity":"4a820532-168e-4fb2-8044-e38de29d6be5","order_by":1,"name":"Wei JIANG","email":"","orcid":"","institution":"The First Affiliated Hospital of Hunan Traditional Chinese Medical College (Hunan Provincial Directly Affiliated Hospital of Traditional Chinese Medicine)","correspondingAuthor":false,"prefix":"","firstName":"Wei","middleName":"","lastName":"JIANG","suffix":""},{"id":595361944,"identity":"3901aa9b-414d-4001-bafa-6eff80621557","order_by":2,"name":"Rui LUO","email":"","orcid":"","institution":"The First Affiliated Hospital of Hunan Traditional Chinese Medical College (Hunan Provincial Directly Affiliated Hospital of Traditional Chinese Medicine)","correspondingAuthor":false,"prefix":"","firstName":"Rui","middleName":"","lastName":"LUO","suffix":""},{"id":595361947,"identity":"6ae6deee-fab6-4c45-abe1-b59a0dd06f1d","order_by":3,"name":"Yu HE","email":"","orcid":"","institution":"Hunan University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Yu","middleName":"","lastName":"HE","suffix":""},{"id":595361949,"identity":"9fa8e746-d0de-4a88-909e-2f47388fb2dc","order_by":4,"name":"Shuli WANG","email":"","orcid":"","institution":"The First Affiliated Hospital of Hunan Traditional Chinese Medical College (Hunan Provincial Directly Affiliated Hospital of Traditional Chinese Medicine)","correspondingAuthor":false,"prefix":"","firstName":"Shuli","middleName":"","lastName":"WANG","suffix":""},{"id":595361951,"identity":"5c9942fe-f63a-4f69-a4af-0d63c683f443","order_by":5,"name":"Shan WEI","email":"","orcid":"","institution":"The First Affiliated Hospital of Hunan Traditional Chinese Medical College (Hunan Provincial Directly Affiliated Hospital of Traditional Chinese Medicine)","correspondingAuthor":false,"prefix":"","firstName":"Shan","middleName":"","lastName":"WEI","suffix":""},{"id":595361952,"identity":"06440c18-c6f2-437c-a3e6-13d8b4178294","order_by":6,"name":"Chi ZHANG","email":"","orcid":"","institution":"Central South University","correspondingAuthor":false,"prefix":"","firstName":"Chi","middleName":"","lastName":"ZHANG","suffix":""},{"id":595361953,"identity":"ad1cf714-0497-4265-ba18-bcb7ee3bb17f","order_by":7,"name":"Xia ZHANG","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1UlEQVRIiWNgGAWjYBACNvbmgw8+GNTI2c9/fIA4LXw8x5INZ1QcMzZgSEsgToucRI6aMM8Z5sQNDDkGRDpMIoeNgbeNjXE7w5mPN94w2MnpNhDSwvP22APJNhlmy8bezZZzGJKNzQ4Q0sKel25g2MbGxnCYd5s0D8OBxG0EtTDkmEkktjHzMBzjeUakFg6glgNnmCUMzvCwEakFFMgNFccMJGewGVvOMSDCL/LtzQcf/zGoqe+XYH54402FnRxBLShAgofIqEHWQqqOUTAKRsEoGBEAALCyQEatupVmAAAAAElFTkSuQmCC","orcid":"","institution":"The First Affiliated Hospital of Hunan Traditional Chinese Medical College (Hunan Provincial Directly Affiliated Hospital of Traditional Chinese Medicine)","correspondingAuthor":true,"prefix":"","firstName":"Xia","middleName":"","lastName":"ZHANG","suffix":""}],"badges":[],"createdAt":"2026-01-15 02:38:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8606147/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8606147/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":103328209,"identity":"42880556-d6cb-4ba9-ae9a-25604caf4ca3","added_by":"auto","created_at":"2026-02-24 13:17:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":685868,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8606147/v1/963c66f5-0f6f-46ed-bc0e-eeda1cc3a501.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Exploring the dignity support needs of colorectal cancer stoma survivors in China: a qualitative study","fulltext":[{"header":"1 Background","content":"\u003cp\u003eColorectal cancer (CRC) is a major global public health challenge with a rapidly increasing disease burden (Qu et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). According to global cancer statistics, there are more than 1.9\u0026nbsp;million new cases of CRC annually, and the incidence rate is expected to increase to 3.2\u0026nbsp;million by 2035, with a particularly significant increase in developing countries (Hossain et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Sung et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). China is a region with a high incidence of CRC, with 555,000 new cases per year and the second highest disease-related mortality rate of all malignancies(Xia et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Stoma surgery, as a key treatment for patients with intermediate and advanced CRC, significantly prolongs survival, but results in patients facing a complex transition of physiological-psychological-social functioning: worldwide, approximately 1.3\u0026nbsp;million patients undergo colostomy each year, and the number of stoma survivors in China has exceeded 100,000/year, with an increasing trend year by year (Li et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Vonk-Klaassen et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Yu, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2005\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eStoma-induced changes in physiological function and bodily integrity (e.g., permanent artificial anus in the abdomen, uncontrolled bowel movements) have a multidimensional impact on the dignity of CRC stoma survivors, including social stigma (e.g, the label of \"abnormal body\"), collapse of self-worth (e.g., shame of dependency, career disruption), and relational identity crises (e.g., weakened family roles) (Alenezi et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Ayaz-Alkaya, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Wang et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Yuan et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Studies have shown that 50.9% of Chinese CRC stoma survivors suffer from severe dignity impairment(Jinhu, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), and that loss of dignity is a central driver of depression, social isolation, and even the desire to hasten death in patients(Monforte-Royo et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Wang et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Xiao et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Xiao et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite the existing research focusing on quality of life and psychological adjustment of CRC patients with stoma, there are significant research gaps(Jansen et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Kovoor et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Sprangers et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e1995\u003c/span\u003e; Zhang et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2019\u003c/span\u003e): first, there is a paucity of intervention studies addressing the dignity dimension; second, traditional psychosocial interventions mostly focus on symptom management and fail to integrate individualized strategies for dignity maintenance (e.g., role maintenance, spiritual support) and social environment improvement (e.g., privacy protection, destigmatization) (Castro-Espin \u0026amp; Agudo, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Shaw \u0026amp; Ivatury, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Zielińska et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2021\u003c/span\u003e); furthermore, in the Chinese cultural context, patients' specific perceptions of \"bodily integrity\" and unique expressions of stigma may lead to differentiated needs that have not yet been fully explained(Yuan et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe Dignity Model provides an innovative perspective on the systematic deconstruction of dignity support needs for CRC stoma survivors. The model emphasizes dignity as a dynamic balance between disease symptom control (physiological-psychological complex needs), individual meaning construction (autonomy, role continuity), and social interaction accommodation (privacy, destigmatization) (Chochinov et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2005\u003c/span\u003e; Chochinov et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2002\u003c/span\u003e). However, its applicability in non-Western contexts has not been fully tested, especially in the absence of an examination of \"dignity preservation mechanisms\" in collectivist cultures.\u003c/p\u003e \u003cp\u003eIn the present study, the dignity model was used as a theoretical framework and qualitative interviews were conducted to understand the dignity support needs of Chinese CRC stoma survivors.The results of this study will contribute to the cultural adaptation of dignity theory and provide an empirical basis for the development of a precise dignity support intervention program.\u003c/p\u003e"},{"header":"2 Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Research Design\u003c/h2\u003e \u003cp\u003eA qualitative descriptive study was employed. This methodology \"captures the complexity and detail of experience in elaborate detail\", allowing the researcher to understand the deeper perspectives of the participants(Patton, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). and allows for a deeper interpretation of the research phenomenon, revealing details that quantitative data cannot touch (Strauss \u0026amp; Corbin, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e1998\u003c/span\u003e). Descriptive qualitative research is therefore an appropriate choice when the goal of the research is to gain insight into the human experience in a particular context. The report of this study follows the Consolidated Standards for Reporting Qualitative Research (COREQ) checklist.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2Participants\u003c/h2\u003e \u003cp\u003e This study was conducted between June and August 2024 in the anorectal and oncology departments of two tertiary care hospitals in central China. The inpatient department was chosen over the outpatient department to allow sufficient and appropriate time to conduct interviews with participants. Participants were recruited using purposive sampling and were required to be adults over 18 years of age, CRC patients who had undergone stoma surgery, were conscious and able to communicate independently, agreed to participate, and signed an informed consent form. We initially invited 15 participants to be interviewed; 2 participants declined to participate due to illness and 2 participants later declined to participate due to time constraints. We did not continue the interviews due to data saturation. Eleven were ultimately included in the analysis for this study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Data collection\u003c/h2\u003e \u003cp\u003eAll data were collected through face-to-face semi-structured interviews. Lead authors with experience in interviewing and qualitative writing were responsible for interviews and field notes. The researchers were female nurses and had postgraduate degrees, and all were trained in qualitative research methods and software analysis. Prior to the interviews, participants received a written informed consent form stating that they had been informed of the purpose and procedures of the study, including the benefits and risks of participating in the study, and that they could withdraw from the study at any time.\u003c/p\u003e \u003cp\u003ePotential participants were referred by staff in the inpatient anorectal and oncology departments. When these subjects were first approached by the research team, they were informed that an interview would be conducted and the purpose and content of the interview was patiently explained. Following the explanation, we ensured that all participants understood the interview questions. After synthesizing the physical and psychological profiles of CRC stoma survivors, we scheduled an interview.\u003c/p\u003e \u003cp\u003eWe designed the interview outline based on the Dignity Model framework, focusing on the dignity needs of CRC stoma survivors. We tested and revised it in pilot interviews with the first 2 participants. The Dignity Support Needs Interview included the following 1. What do you think affects your sense of dignity? Can you tell me more? 2. What support and help do you think would increase your sense of dignity? 3. What do you think is the main source of your sense of dignity?\u003c/p\u003e \u003cp\u003eThe interviews were conducted in a quiet, separate room in the inpatient area of the hospital and lasted approximately 40 minutes. Each interview was conducted by two researchers together, with one researcher conducting the interview based on an interview outline and the other taking field notes, including tone of voice, facial expressions, and emotions. Each interview was recording recorded, transcribed using Nvivo, and manually reviewed by the lead researcher to ensure the accuracy of the information. All interviews were conducted in an environment where the participants felt comfortable, and confidentiality and privacy issues were taken into account.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4Data analysis\u003c/h2\u003e \u003cp\u003eThe transcribed data were analyzed using thematic analysis. First, two members of the study listened to and transcribed the recordings to gain an initial understanding of the data. Key words and concepts were then identified through close reading and line-by-line coding. After further analysis, we refined the coding and identified candidate categories and themes. To validate the accuracy of the analysis, we provided participants with a summary of themes and quotes related to their experiences to verify the accuracy of the content and to solicit their feedback.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5Ethics\u003c/h2\u003e \u003cp\u003e This study was conducted under the guidance of the Declaration of Helsinki and was approved by the Ethics Committee of Hunan Provincial Direct Hospital of Traditional Chinese Medicine (KY-2024032201).\u003c/p\u003e \u003c/div\u003e"},{"header":"3 Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.1Basic characteristics\u003c/h2\u003e \u003cp\u003eThe mean age of the participants was 60.63 years (SD 0.92), ranging from 49 to 80 years old.7 (63.6%) participants were male and employed, 4 (36.4%) were employed and had a high school diploma, and 9 (81.8%) were married and had a long-term stoma. The basic characteristics of the participants are shown 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\u003eBasic information about the interviewer (N\u0026thinsp;=\u0026thinsp;11)\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\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN or Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60.63\u0026thinsp;\u0026plusmn;\u0026thinsp;0.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eCareers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWorker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmployee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFreelancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFarmer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEducation level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eElementary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMiddle school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCollege\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eWork state\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eActive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRetired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWidowhood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eStoma situation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLong-term\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eShort-term\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.2Pursuing autonomy\u003c/h2\u003e \u003cp\u003eBesides taking control of their bodies, CRC stoma survivors described a strong desire for autonomy to support dignity in their living situation. Changes in physiological structure and function triggered by stoma surgery significantly affect survivors' perceptions of autonomy, making it common for them to experience cognitive dilemmas and dependency anxiety arising from the loss of autonomy as they adapt to their new state of being. At the primary care level, CRC stoma survivors expressed a strong willingness to reconfigure their autonomous caregiving abilities, viewing independent completion of stoma care as a critical node for dignity restoration.\u0026rsquo; I would like to complete the stoma bag changing operation independently so that I can adjust the pace of care according to my own needs instead of being subjected to someone else's schedule (P11)\u0026rsquo;. At the level of life adaptation, CRC stoma survivors referred to the erosive effect of the state of dependency on self-independence.\u0026rsquo; The situation of being continuously dependent on others for assistance during hospitalisation due to limited mobility has caused me to feel a strong sense of guilt, always believing that I have become a burden to others (P7)\u0026rsquo;.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Defence of dignity\u003c/h2\u003e \u003cp\u003eCRC stoma survivors present a strong need to defend their dignity during the adaptation to the disease. This theme can be deconstructed into two related sub-themes.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003e3.2.1 Expectation of being respected\u003c/h2\u003e \u003cp\u003eSurvivors expressed the existence of a clear expectation of dignity defence of equal status in doctor-patient/family interactions, which mainly included: maintenance of personal dignity, informed information, and participation in autonomous decision-making.CRC stoma survivors described that \u0026lsquo;the curtains are drawn when the caregiver changes the stoma bag, and the family members always maintain a natural demeanour when assisting with the care, and that this kind of non-verbal acceptance is much more powerful than the comfort of words\u0026rsquo; (P3). powerful\u0026rsquo; (P3). Meanwhile information autonomy constitutes an important element of dignity maintenance. Survivors emphasised the importance of the right to information about their condition, especially in relation to key points such as adjustments to treatment regimens and prognostic assessments. Typical statements such as, \u0026lsquo;When the doctor takes the lab results and discusses whether to adjust the follow-up plan, I expect to be at the centre of the dialogue rather than a bystander\u0026rsquo; (P7). Another survivor pointed out that medical information was selectively communicated: \u0026lsquo;The family and the doctor made a tacit agreement to replace professional explanations with vague expressions such as \u0026ldquo;minor problems\u0026rdquo; and \u0026ldquo;recovery is going well\u0026rdquo;, which essentially deprived me of participation in decision-making\u0026rsquo; (P9).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003ch2\u003e3.2.3 Privacy Protection\u003c/h2\u003e \u003cp\u003ePrivacy protection encompasses both the physical protection of physical privacy and the social control of information privacy. The altered integrity of the body due to the stoma and the visibility of the device outside the body expose CRC stoma survivors to a unique risk of privacy exposure that arises not only from the uncontrollable nature of physiological functioning, but also from the tension with socio-cultural normative perceptions of the \u0026lsquo;normal body\u0026rsquo;. \u0026lsquo;I would repeatedly adjust my clothing to ensure that my stoma bag was completely hidden, and I refused to dress lightly even in the summer months; I was afraid of being asked about it, and this nervousness made me avoid crowded places (P1)\u0026rsquo;. Survivors emphasised absolute control over stoma-related information and refused passive disclosure in non-essential situations. \u0026lsquo;The stoma is my most private physiological state, and I do not want anyone to feel free to discuss or ask about it unless it is medically necessary (P2)\u0026rsquo;. In addition, threatened by privacy, some survivors actively limit the scope of their social activities. \u0026lsquo;I cancelled a lot of my previous social activities because I don't want people to know about my current condition and can't afford the risk of potentially exposing myself (P5)\u0026rsquo;.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Becoming Worthy\u003c/h2\u003e \u003cp\u003eThe essence of self-worth is the ongoing pursuit of subjective identity and social connectedness, and new CRC stoma survivors seek to reconstruct the self-worth cut off by the disease by participating in family caregiving, occupational activities, and social interactions to counteract the erosion of their subjective worth by \"patient identity. Survivors generally see the continuity of family roles as an important anchor of self-worth. The patient's effort to maintain responsibility for family members despite postoperative physical limitations was symbolised as transcending instrumental care: 'Even though my health isn't as good as it used to be, I still insist on preparing dinner for my family - it makes me feel that I'm still needed (P4)'. The dynamic practice of family roles (e.g. participating in childcare, supporting the elderly) was not only a source of autonomy but also a defence mechanism against the perception of 'worthlessness'. Some study participants even internalised family responsibilities as a motivation for recovery: 'I need to recover as soon as possible, my son is not grown up and my family needs me (P7)'. Returning to work was seen as a dual certification of physical functioning and social resilience, and occupational activity reinforces the patient's experience of dignity through the creation of social value'. Returning to work proves that I have not been defeated by my illness, that my stoma does not rob me of my professional value and that I can still shine (P6)'。\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Expectation of being supported and connected\u003c/h2\u003e \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e \u003ch2\u003e3.4.1 Family Connection\u003c/h2\u003e \u003cp\u003eFamily support embodies the dual dimensions of emotional connection and instrumental support, and the strength of family support directly affects CRC stoma survivors' perceptions of their own value, their ability to adapt to the disease, and the strength of their sense of dignity. When survivors perceived the depth of understanding of their family members' experience of their disease, their \u0026ldquo;fear of abandonment\u0026rdquo; was significantly reduced, which strengthened their sense of meaning. \u0026lsquo;The fact that my son quit his job to be with me reinforces the fact that I am still needed - this sense of worthiness supports my adherence to treatment (P8).\u0026rsquo; Substantial involvement of family members in caregiving activities was given symbolic meaning by survivors that went beyond functionality. Family members\u0026lsquo; acquisition of stoma care skills (e.g., changing stoma bags, recognising complications) not only relieved survivors\u0026rsquo; anxiety about handling, but also conveyed emotional signals of \u0026lsquo;shared responsibility\u0026rsquo;. \u0026lsquo;My daughter's early acquisition of nursing skills reassured me - it proved that my plight was not shunned by the family (P9)\u0026rsquo;; family agency in medical matters (e.g., booking tests, purchasing supplies) indirectly preserving the dignity of their autonomy. \u0026lsquo;My son manages all my medical bills and saves me from financial shame (P10)\u0026rsquo;.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section3\"\u003e \u003ch2\u003e3.4.2 Social support\u003c/h2\u003e \u003cp\u003eThe role of social support is mainly realised through the synergy of the three dimensions of professional support, psychological support and peer support. The quality of the social support network also has a direct impact on the efficacy of CRC stoma survivors in adapting to the disease, their perception of self-worth, and the strength of their sense of dignity. Standardised nursing training significantly improves patients' self-management abilities through skills that enable survivors to master the sense of control over their bodies after reconstruction.\u0026rsquo; The nurses demonstrated the steps of stoma cleaning and replacement step by step, and this precise instruction took away my fear of dealing with sudden leaks alone (P6).\u0026rsquo; In addition, the transparent transfer of medical knowledge can alleviate the survivor's \u0026lsquo;fear of the unknown\u0026rsquo;, such as the explanation of complication prevention strategies, which can reduce their anxiety level.\u0026rsquo; After the doctor explained how the stoma worked using a 3D model, I suddenly realised that it was just a new way of communicating with the body (P10)\u0026rsquo;. At the same time, the \u0026lsquo;situational support network\u0026rsquo; formed by the group of patients demonstrated a unique healing value, as the exchange of stories of the disease constructed a collective identity that resisted stigma. \u0026lsquo;Hearing about other patients returning to the workplace convinced me that my stoma wouldn't be the end of my career (P2).\u0026rsquo;\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e3.5 Acceptance\u003c/h2\u003e \u003cp\u003eSocial acceptance is essentially the result of the interaction between the CRC stoma survivor's claim to integrity of identity and external de-pathologising feedback. Acceptance is achieved by crossing the double barrier of \u0026lsquo;physical difference\u0026rsquo; and \u0026lsquo;social stigma\u0026rsquo;. When patients perceive \u0026lsquo;selective avoidance\u0026rsquo; in social interactions (e.g., reduced invitations to gatherings, avoidance of physical contact), they experience a strong \u0026lsquo;degradation of their identity.\u0026rsquo; After the illness, the number of gatherings decreased sharply, and the detachment of my friends still made me feel that I was no longer a complete social subject (P5)\u0026rsquo;; on the contrary, naturalised patterns of living together (e.g., maintaining the frequency of previous interactions, avoiding excessive attention to the stoma) conveyed a signal of acknowledgement of the \u0026ldquo;constancy of value\u0026rdquo;.\u0026rsquo; Colleagues knew about the condition but did not treat me differently, apart from diet, and treated me as a normal person, discussing my professional content at work as usual - this proves that my social identity has not been redefined by the disease (P9)\u0026rsquo;. In addition, the paradigm of social perception of the stoma community has a profound impact on patients' experience of dignity, as the social understanding of stoma remains in a pathologised framework of \u0026ldquo;physical abnormality\u0026rdquo;, and despite the rapid advances in medical technology, there is still a clear disconnect with the evolution of social perceptions. For example, \u0026lsquo;public acceptance of artificial hearts and dialysis machines is much higher than that of stomas, despite the fact that they are also life-supporting technologies (P11)\u0026rsquo;.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study illustrates the multifaceted nature of the need for dignity support among CRC stoma survivors. Through the narratives of CRC stoma survivors, four interrelated dimensions were identified as critical to dignity support: restoration of autonomy, preservation of dignity, restoration of self-esteem, and relational support systems. These dimensions are included within the framework of the existing dignity model, but are expanded upon, particularly in the emphasis on family interdependence, social cohesion, and collective identity. This study deepens our knowledge and understanding of the dignity support needs of CRC stoma survivors, and provides guidance for the development of dignity support intervention programs.\u003c/p\u003e \u003cp\u003eSurvivors' emphasis on regaining autonomy over stoma care and daily living is consistent with the dignity model framework, which views autonomy as a cornerstone of mental health (Chochinov et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2002\u003c/span\u003e) Survivors described independent stoma management as a \"critical point in the restoration of dignity,\" reflecting a symbolic restoration of bodily agency disrupted by surgery, a finding consistent with Hardiman et al. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2016\u003c/span\u003e) assertion that mastery of self-care predicts postoperative resilience. However, the Chinese sociocultural context introduces a unique tension between individual autonomy and family interdependence. While Western studies typically define autonomy as an independent right essential to dignity (Ortiz Contreras et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), participants in this study redefined autonomy as \"responsibility-driven independence\"-a way to avoid becoming a \"burden\" that prioritizes social obligations over purely personal empowerment. This cultural nuance is crucial: the desire to regain independence in ostomy care highlights the symbolic link between independence and dignity in the Chinese context (Liu et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), where physical competence is intrinsically linked to social value and family harmony (Liu et al., 2020). This highlights the need for culturally sensitive rehabilitation programs that should develop interventions that balance the development of independent caregiving skills with family education to address survivors' \u0026ldquo;dependency guilt.\u0026rdquo;\u003c/p\u003e \u003cp\u003eSurvivors' emphasis on maintaining family and occupational roles (e.g., \"making dinner for the family,\" \"going back to work\") underscores role continuity as a dignity-preserving strategy to counteract the identity disruption caused by illness. This effort to maintain pre-morbid roles is consistent with Bury (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e1982\u003c/span\u003e) notion of biographical rupture, in which chronic illness fragments the self-narrative and requires symbolic acts to restore coherence. However, unlike Western narratives that view role continuity as a personal achievement (Spiro \u0026amp; Howard, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e1996\u003c/span\u003e), Chinese survivors reinterpreted role continuity through a collectivist lens: family responsibilities were internalized as the driving force for recovery (\"my family needs me\"), reflecting culturally ingrained coping strategies that prioritize relational harmony over individual autonomy(Tao et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; WANG Jing-rong, 2023). Here, role continuity serves the dual function of preserving dignity-resisting stigmatized \"worthlessness\" and reaffirming a sense of social belonging-reinforced in societies where productivity and contribution to the family are moral imperatives (J. Zhang, 2022; Xie et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). For example, survivors insist on returning to work not only for personal empowerment, but also to fulfill social expectations of productivity, which is an important marker of dignity in China. Healthcare professionals can capitalize on this cultural asset by designing rehabilitation goals that are consistent with the survivor's role priorities, thereby improving treatment adherence and dignity.\u003c/p\u003e \u003cp\u003eChinese survivors' reliance on family support is consistent with research emphasizing family-centeredness in collectivist cultures(Guo et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) Instrumental support (e.g., managing the son's expenses) is symbolic and reinforces survivors' sense of being valued despite their reliance on family(Lee et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), a dynamic less emphasized in Western settings where professional services often substitute for family care. Peer support from fellow patients is also a unique type of \"situational community\" that reflects the Chinese concept of \"predestined kinship\" and promotes solidarity among those with the same disease (Ito \u0026amp; Kazuma, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). Strengthening peer support networks can therefore complement family efforts while bridging the gap with professional mental health services and aligning support with survivors' needs for dignity in a collectivist context.\u003c/p\u003e \u003cp\u003eSurvivors' descriptions of social exclusion (\"fewer invitations to gatherings\") and pathologization (\"public acceptance of dialysis; ostomy\") highlight the ongoing impact of sociocultural norms on dignity. These experiences reflect Taleporos and McCabe (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2003\u003c/span\u003e) theory of \"bodily hierarchy,\" whereby visible disability invites greater stigma. Unlike Western societies with strong disability rights movements, Chinese survivors internalize stigma as a personal failure, leading to greater social avoidance. To address the dissonance between medical advances such as life-saving ostomies and stagnant social attitudes, the anti-stigma movement employs culturally resonant tactics that reimagine ostomies as symbols of restored competence rather than \"abnormality. Linking the restoration of dignity to social values is analogous to media literacy programs that reduce the stigma of AIDS.\u003c/p\u003e \u003cp\u003e \u003cb\u003eImplications (clinical and research)\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis study reveals the uniqueness of the dignity support needs of CRC stoma survivors in the Chinese cultural context, and expands the applicability of dignity theory in a collectivist society. By emphasising family interdependence, social role continuity, and the role of peer \u0026lsquo;contextual community\u0026rsquo;, this study provides an empirical basis for developing culturally sensitive intervention strategies, and fills a gap in existing research centred on Western individualism.\u003c/p\u003e \u003cp\u003e \u003cb\u003eLimitations\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe monocultural focus of this study limits cross-cultural comparisons. Future research should conduct comparative studies across regions and with other collectivist cultures to deepen the understanding of cultural mediators of dignity maintenance. In addition, longitudinal studies could be conducted to explore the evolution of dignity support needs across the trajectories of CRC stoma survivors.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrates that the dignity support needs of CRC stoma survivors are multidimensional, culturally embedded, and dynamic processes involving three core areas: autonomy restoration (e.g., independent caregiving ability), relational dignity maintenance (family/peer support), and social identity reconstruction (role continuity). Compared to the dignity model under the Western individualistic framework, Chinese survivors' experience of dignity places more emphasis on responsibility-driven autonomy and collective belonging, highlighting the profound shaping of cultural values on health narratives. In order to achieve dignity-oriented care, clinical practice needs to build a stepped intervention system: short-term focus on skills training and collaborative family care, medium-term strengthening of peer support networks, and long-term promotion of social anti-stigma policies. Through cross-cultural comparisons and longitudinal tracking, future research should reveal the dynamic evolution and cultural plasticity of dignity-supporting mechanisms, in order to provide more comprehensive theoretical frameworks and practice guidelines for the care of CRC stoma survivors worldwide.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe experimental protocol was established, according to the ethical guidelines of the Helsinki Declaration and was approved by the Medical Research Ethics Review Committee of The First Affiliated Hospital of Hunan College of TCM (Ethical Review No. E2020126). All methods were carried out in accordance with relevant guidelines and regulations.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported in part by grants from the Hunan Provincial Health Commission Fund (Grant No. W20243090) and the Hunan Provincial Department of Education Fund (Grant No. 24C1174).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors\u0026apos; contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: Xi Li, Xia Zhang;\u003c/p\u003e\n\u003cp\u003eMethodology:\u0026nbsp;Xi Li, Wei Jiang,;\u003c/p\u003e\n\u003cp\u003eFormal analysis and investigation:\u0026nbsp;Xi Li, Wei Jiang, Yu He, ;\u003c/p\u003e\n\u003cp\u003eWriting - original draft preparation: Xi Li;\u003c/p\u003e\n\u003cp\u003eWriting - review and editing:\u0026nbsp;Xi Li, Wei Jiang, Shuli Wang, Shan Wei, Chi Zhang, Xia Zhang;\u003c/p\u003e\n\u003cp\u003eFunding acquisition: Xia Zhang;\u003c/p\u003e\n\u003cp\u003eResources:\u0026nbsp;Xia Zhang;\u003c/p\u003e\n\u003cp\u003eSupervision:\u0026nbsp;Xia Zhang;\u003c/p\u003e\n\u003cp\u003eEthical guidance:\u0026nbsp;Rui Luo, Chi Zhang.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors sincerely express our gratitude to all the participants in our study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAlenezi, A., McGrath, I., Kimpton, A., \u0026amp; Livesay, K. 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Management of pain in colorectal cancer patients. \u003cem\u003eCrit Rev Oncol Hematol\u003c/em\u003e,\u003cem\u003e\u0026nbsp;157\u003c/em\u003e, 103122. https://doi.org/10.1016/j.critrevonc.2020.103122\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":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Colorectal cancer, stoma, dignity support needs, qualitative research, acculturation, family support","lastPublishedDoi":"10.21203/rs.3.rs-8606147/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8606147/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo explore the dignity support needs of colorectal cancer (CRC) stoma survivors in China.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e A qualitative study from a phenomenological perspective.CRC stoma patients (N\u0026thinsp;=\u0026thinsp;11) from two hospitals in Zhuzhou, China, participated in semi-structured interviews to explore their needs for dignity support. Transcripts were analyzed using an inductive process and interpretive analysis.The Consolidated criteria for reporting qualitative research (COREQ) guidelines for qualitative research were followed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eFive themes were identified: striving for autonomy, defending dignity, becoming valuable, relationship support, and social acceptance.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe dignity support needs of Chinese colorectal cancer (CRC) stoma survivors are multidimensional, culturally embedded and dynamic. Core elements include the restoration of autonomy, relational dignity defence (i.e. family and peer support) and social identity reconstruction (i.e. role continuity). In contrast to dignity models within Western, individualistic frameworks, Chinese patients emphasise 'responsibility-driven autonomy' and collective belonging, thereby highlighting the role of cultural values in shaping health narratives. Clinical practice requires the establishment of a tiered intervention system. Healthcare professionals should address patients\u0026rsquo; needs relating to family roles, ensure information autonomy and improve patients\u0026rsquo; experiences of dignity by protecting their privacy.\u003c/p\u003e","manuscriptTitle":"Exploring the dignity support needs of colorectal cancer stoma survivors in China: a qualitative study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-24 13:16:45","doi":"10.21203/rs.3.rs-8606147/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"218425806534065145345682052886614777881","date":"2026-04-18T23:59:41+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-07T10:21:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"219818760098681104647636778278564033572","date":"2026-04-07T09:47:48+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-19T16:14:52+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-19T16:12:42+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-30T03:21:01+00:00","index":"","fulltext":""},{"type":"submitted","content":"Supportive Care in Cancer","date":"2026-01-15T02:26:04+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"f8092927-5a60-4295-af21-e54aeaa771ea","owner":[],"postedDate":"February 24th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-24T13:16:45+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-24 13:16:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8606147","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8606147","identity":"rs-8606147","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}