The Value Experience of Intrathecal Pump Implantation for Cancer Pain Patients: A Qualitative Study Focusing on Family Caregivers

The Value Experience of Intrathecal Pump Implantation for Cancer Pain Patients: A Qualitative Study Focusing on Family Caregivers | 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 The Value Experience of Intrathecal Pump Implantation for Cancer Pain Patients: A Qualitative Study Focusing on Family Caregivers lijun Liao, wenzhi Duan, yili Gao, jiawen Qin, zhenyuan Liu, qianhao Hou, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8497612/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background Cancer represents a major public health challenge globally and in China, with its incidence continuing to rise, imposing a heavy physical and psychological burden on patients and diminishing their quality of life. Cancer pain, one of the most common and complex symptoms experienced by cancer patients, has a high prevalence and diverse origins, severely impacting patients' quality of life. Opioids remain central to cancer pain management, yet their efficacy is often suboptimal. Intrathecal drug delivery systems, a highly effective and safe treatment for refractory cancer pain, remain underutilized in clinical practice. Concurrently, family caregivers play a pivotal role in pain management decisions, with their perception of treatment value directly influencing acceptance and implementation. Therefore, exploring family caregivers' value perceptions, decision-making motivations, and core needs regarding intrathecal pumps holds significant importance for optimizing patient-centered, precision pain management pathways. Method This study aims to uncover the decision-making factors influencing family caregivers' acceptance of intrathecal analgesic pumps, their core demands regarding pain management value, and pain points in caregiving needs among cancer pain patients. It seeks to provide empirical evidence for optimizing precision pain management pathways centered on preserving patients' dignity and quality of life. This qualitative descriptive study conducted in-depth semi-structured interviews at the Pain Management Department of Shanghai East Hospital, Tongji University, from April to September 2025. All interviews were audio-recorded and transcribed. Analysis followed Colaizzi's seven-step method, identifying and organizing thematic clusters from statements within the transcribed interviews. MAXQDA software was used to code and identify relationships between themes and subthemes. Results Data saturation was achieved with 20 participants. Based on value perception theory, analysis from the primary family caregiver perspective revealed six themes and 15 subthemes: (1) core objectives of pain management (improve patients' quality of life, achieving physical and mental liberation for caregivers); (2) preoperative decision-making motivations and perceptions (source of motivation, cognitive preparation for caregivers); (3) multidimensional manifestations of value perception (improving patients' physical and mental well-being, reduce the burden on caregivers); (4) key trigger points for surgical acceptance (external support system evaluation, assessment of disease severity, patient eligibility assessment, surgical value assessment); (5) key focus areas and pain points in care needs (perioperative comprehensive management, pain management throughout the entire process); (6) Postoperative rational expectations regarding the condition (effective pain control, anticipating synergy and continuity in cancer treatment, rational understanding of the underlying disease). Conclusion Pain management teams must establish an integrated care model anchored in the educational principle of “pain controllability,” guided by shared decision-making between physicians and patients, and culminating in holistic care addressing physical, psychological, and social dimensions. By early assessment of factors delaying patient decision-making, this approach breaks the “endure pain-breakdown” cycle. Technical precision safeguards patients' dignity in living, while sustained social support systems address gaps in care. Cancer Pain Intrathecal Pump Perceived Value Family Caregivers Qualitative Research Figures Figure 1 Figure 2 Background Cancer is a large group of heterogeneous malignant tumors. The most commonly diagnosed cancer types in adults are lung cancer, colorectal cancer, breast cancer in women, skin melanoma, and prostate cancer [1] . According to estimates by the American Cancer Society, between 2015 and 2019, the incidence rates of breast cancer, pancreatic cancer, and endometrial cancer increased by 0.6% to 1% annually, while prostate cancer, liver cancer (in women), and kidney cancer met annual increases of 2% to 3%. Incidence rates for cervical cancer among young adults (ages 30–44) and colorectal cancer (under age 55) also increased by 1%-2% annually [2] . Globally, there are approximately 20 million new cancer cases and 9.7 million cancer deaths each year [3] . In China, according to the 2022 Global Cancer Statistics Report released by the International Agency for Research on Cancer (IARC), newly diagnosed lung cancer cases accounted for 22% of all new cancer cases, ranking first globally. The high incidence of cancer imposes a severe disease burden on patients' families and society, representing a major public health challenge for both the world and China. Patients face risks including stalled career advancement, increased financial pressure, and changes in social relationships and family responsibilities, leading to a significant decline in their quality of life [4] . Cancer pain is one of the most common, complex, and persistent symptoms during and after cancer treatment, with a prevalence rate of approximately 55% for concurrent pain during cancer treatment [5] . A systematic review and meta-analysis indicate that 66.4% of patients with advanced, metastatic, or terminal disease experience pain, while 39.3% report pain following curative treatment. Additionally, 38% of cancer patients endure moderate to severe pain, and those who survive cancer treatment often face lifelong chronic pain [6] . The sources of cancer-related pain are complex, including the tumor itself, which can directly cause nociceptive pain, visceral pain, and/or neuropathic pain, as well as metastatic lesions. Cancer treatments themselves may lead to various specific pain conditions secondary to chemotherapy, radiotherapy, and surgery [7] . The experience of pain can profoundly impact patients’ emotional state, leading to feelings of depression, increased anxiety, and even cognitive impairment. The NCCN Clinical Practice Guidelines in Oncology indicate that the core approach to managing cancer pain remains the use of opioids, alongside optimizing non-opioid analgesics and adjunctive medications. However, clinical outcomes are often suboptimal, necessitating combined management with other therapeutic modalities, including the treatment of complex regional pain syndrome [8] . For patients who fail conservative medical interventions and less invasive pain management approaches, intrathecal drug therapy represents a viable treatment option. The placement of an intrathecal pain pump is a safe and effective method for managing pain in cancer patients, helping to maximize pain control in those experiencing refractory pain due to the disease process or treatments associated with malignant tumors. However, due to its high complexity and lack of understanding, there is an issue of underutilization in clinical practice [9, 10] , reduced the effectiveness of pain management specialists and oncologists in providing precise pain management for patients. Family caregivers for cancer patients shoulder heavy responsibilities across various cancer-related treatments and ongoing care tasks. Moreover, primary family caregivers hold the final decision-making authority regarding treatment options, medication adjustments, and whether to undergo invasive procedures such as intrathecal pump implantation [11] . Throughout the pain management process, individuals face numerous physical and emotional challenges, including accessing medical information, providing psychological support to loved ones, and maintaining close communication with the healthcare team [12, 13] . In China, only certain regions such as Shanghai and Beijing currently include intrathecal pumps in their medical insurance coverage. Without insurance coverage, the total perioperative costs for patients can reach as high as 150,000 to 200,000 RMB. Under these circumstances, family caregivers do not uniformly accept intrathecal pump implantation, necessitating consideration of its overall value. Perceived value serves as a prerequisite for forming acceptance attitudes. Value refers to the relationship between an object's attributes and functions and the subject's needs, defined as individuals' perception of the benefits obtainable through using the object [14] . Patient Perceived Value (PPV) is an extension of value perception theory in the healthcare sector, referring to the comprehensive assessment of patients' expectations versus actual experiences regarding the utility of healthcare services [15] . Therefore, when patients consider accepting intrathecal pump implantation as a treatment option, it is essential to help them recognize the broad value this technology offers. This study delves into the value perceptions of caregivers for cancer pain patients by examining the decision-making drivers for accepting intrathecal analgesic pumps, core demands for pain management value, and pain points in care needs. By dissecting these key motivators, it provides evidence-based support for optimizing precision pain management pathways centered on preserving patients' dignity and quality of life. Method Research Design This study employed a phenomenological research approach as a qualitative research method. Through semi-structured face-to-face interviews, it explored in depth the nursing experiences and value perceptions of family caregivers for cancer pain patients at Shanghai East Hospital during the perioperative period and home-based pain management when adopting the intrathecal pump implantation treatment plan. Based on literature review and expert consultation, an interview outline grounded in “value perception” theory was developed. Prior to the main study, two primary caregivers participated in pre-interviews. The final outline was refined based on their feedback and expert input. The interview content of this section is presented in Appendix 1.To ensure rigor and clarity throughout the research process, the Core Qualitative Research Reporting Standards (COREQ) framework was adopted. Each of its 32 items was systematically referenced to document the entire process—from study design and data collection to results presentation—ensuring full traceability and reviewability of every stage of the in-depth interviews [16] . Participants and Sample Size This study employed purposive sampling. Between March and October 2025, 20 family caregivers of cancer pain patients admitted to the Pain Management Department of Shanghai East Hospital were selected as research subjects. Inclusion criteria were as follows: (1) Subjects aged ≥ 18 years who served as unpaid primary caregivers (primary caregiver) for patients, being immediate family members or close friends, excluding paid professional nursing staff [17] ;(2) The research subjects provided over 8 hours of care daily, with continuous caregiving exceeding 4 weeks [18] ; (3) Assume primary responsibility for caregiving and medical decision-making during the patient's hospitalization; (4) The patient has been diagnosed with moderate to severe cancer pain, with an NRS score ≥ 4; (5) The patient has a clearly defined condition and confirmed acceptance of intrathecal pump implantation; (6) The subject has clear verbal expression without cognitive or communication impairments; (7) The subject has signed an informed consent form and voluntarily participates in this study. Exclusion criteria are as follows: (1) Patients who do not meet surgical indications or have not fully confirmed acceptance of surgery; (2) Subjects with a history of psychiatric disorders or cognitive impairment; (3) Subjects who refuse to participate in this study. Data Collection and Analysis Basic information about patients and their primary caregivers was gathered using a basic information form. Interview data was collected via a semi-structured in-depth interview questionnaire. Researchers developed the basic information form by reviewing relevant literature. It comprised nine questions covering the following information: patient age, marital status, primary tumor type, preoperative NRS score, postoperative NRS score, whether the pump body was fully implanted, payment method, primary caregiver-patient relationship, educational attainment, and employment status [19–23] . The Colaizzi's seven-step phenomenological analysis method [24] was applied for data analysis. Within 24 hours of the interview, two researchers repeatedly listened to the recordings and transcribed them to create interview transcripts. ① Carefully read all interview texts; ② Extract representative original statements; ③ Code and mark high-frequency and meaningful statements; ④ Identify common characteristics and concepts within coded content to refine preliminary themes; ⑤ Systematically articulate the intrinsic connections between each theme and the research phenomenon; ⑥ Integrate similar viewpoints to elevate them into final core themes; ⑦ Return findings to interviewees for verification and confirmation. This study employed MAXQDA 2025 software to assist in analyzing interview data, forming themes, subthemes, and codes. The findings were visualized through the creation of Sankey diagrams. Results Descriptive Characteristics Table 1 presents the descriptive characteristics of participants. This study included 20 pairs of care recipients and primary caregivers, collecting their basic personal information. Interviews were conducted with primary caregivers, achieving a 100% completion rate. Care recipients ranged in age from 29 to 95 years, with lung cancer being the most common diagnosis (40%, 8/20). All patients experienced severe preoperative pain (NRS score ≥ 7) and achieved significant postoperative relief (NRS score reduced to 0–3). Analysis of primary caregivers revealed spouses as the predominant care providers (55%, 11/20). Employment status analysis revealed that 45% (9/20) of caregivers were unemployed, with this phenomenon particularly pronounced among spousal caregivers, whose unemployment rate reached 54.5% (6/11). In contrast, the majority of caregivers who were children (85.7%, 6/7) were employed. Table 1: Basic Information Form for the Person Under Care and Primary Caregiver The protected Primary caregiver Num Age Marital Status Tumor location Preoperative NRS Postoperative NRS Is the pump body fully implanted within the body Patient Relationship Educational background Employment Situation P1 70 Married Lungs 7-8 2-3 Yes Daughter vocational high school Employment P2 81 Widowed Pancreas 6-8 2-3 Yes Daughter vocational high school Employment P3 40 Married Stomach 7-8 2-3 Yes Spouse Undergraduate Employment P4 95 Married Lungs 6-8 1-2 No Daughter Junior college Employment P5 46 Married Lungs 8-9 1-2 No Spouse Undergraduate Unemployment P6 61 Married Lungs 7-8 2-3 No Daughter Undergraduate Employment P7 65 Married Lungs 7-8 2-3 Yes Spouse Junior High School Employment P8 29 Married Stomach 8-9 2-3 Yes Spouse Junior college Unemployment P9 76 Married Lungs 7-8 1-2 Yes Spouse Elementary School Unemployment P10 62 Married Oral cavity 8-9 2-3 No Spouse Elementary School Unemployment P11 68 Married esophagus 7-8 1-2 Yes Son Junior college Employment P12 78 Married Lungs 7-8 1-2 Yes Daughter Junior college Employment P13 47 Married Rectum 9-10 1-2 Yes Spouse Junior High School Unemployment P14 48 Married Lungs 7-8 1-2 No Sister Junior High School Employment P15 44 Married Ureter 7-8 2-3 Yes Brother Elementary School Employment P16 76 Widowed Lungs 7-8 1-2 No Daughter Junior High School Employment P17 88 Married Skin 6-7 0-1 No Son Junior college Employment P18 61 Married Pancreas 7-8 1-2 Yes Son Undergraduate Employment P19 52 Married Liver 9-10 2-3 No Son Undergraduate Employment P20 48 Married lymph node 7-8 1-2 Yes Spouse vocational high school Unemployment Special Topic Synthesis: Qualitative Findings on Primary Family Caregivers' Value Perception Regarding Intrathecal Pump Implantation Thematic Analysis: Thematic Analysis: Qualitative Findings on Family Caregivers' Value Perception Regarding Intrathecal Pump Implantation. This study employed content analysis to examine qualitative data, ultimately identifying six themes and 15 subthemes: core objectives of pain management, preoperative decision-making motivations and cognition, multidimensional manifestations of value perception, key starting points for surgical acceptance, focal points and pain points of care needs, and rational postoperative expectations regarding the condition. Specific themes and subthemes are detailed in Table 2 and Figure 1. Table 2: Themes and Subthemes Regarding Family Caregivers' Perceived Value of Intrathecal Pumps Themes Sub-themes Codes Core Objectives of Pain Management Improve patients' quality of life Effectively relieve pain Overcome drug dependence Maintain daily life Enhance the comfort of daily life Achieving physical and mental liberation for caregivers Ease emotions Improve daily routines Preoperative decision-making motivations and perceptions Source of motivation Patient treatment outcomes Media information Professional pain management decision-making Recommendations for primary disease treatment Cognitive preparation for caregivers Dosage Route of administration Surgical procedure Surgical risks Long-term efficacy The multidimensional manifestation of value perception Improve patients' physical and mental well-being Reduce analgesic dosage and side effects Strengthen patients' belief in overcoming illness Improve patients' quality of life Restore confidence in treating the underlying disease Reduce the burden on caregivers Physical burden Emotional burden Social burden Reduce caregiving conflicts Key trigger points for surgical acceptance External support system evaluation Improving Health Insurance Long-term treatment costs are low The family's financial burden is light Caregiver burden Assessment of disease severity High severity of pain Severe pain-related complications Patient eligibility assessment The patient is willing and/or able to undergo surgery Postoperative convenience for patients Surgical value assessment The current approach does not alleviate the pain Surgical treatment yields excellent results The benefits of surgery outweigh the risks Key focus areas and pain points in care needs Perioperative comprehensive management Surgical incision care Intrathecal pump housing maintenance Postoperative instructions Medication guidance Pain management throughout the entire process Pain assessment Provide emergency support Multidisciplinary collaboration Online and offline integration Postoperative rational expectations regarding the condition Effective pain control Relieve pain Reduce pain-related complications Anticipating synergy and continuity in cancer treatment Palliative care Appropriately extend the product lifecycle Continue treatment for the underlying condition Rational understanding of the underlying disease Clear understanding of the disease This study employs a Sankey diagram to visualize the hierarchical coding associations of family value experiences with intrathecal pumps: Over 50 specific expressions at the Codes level (e.g.“Effectively relieve pain”) were clustered into 20 Sub-themes (e.g.“Cognitive preparation for caregivers”), ultimately consolidated into 6 Themes. Among these, “Key trigger points for surgical acceptance” emerged as the core aggregating theme with 83 occurrences. The associative pathways across coding levels clearly reveal the multidimensional composition of family members' value experiences. Theme 1 ； Core objectives of pain management Sub-theme1 ： Improve patients' quality of life Pain management for cancer patients troubles countless primary caregivers. In interviews, many primary caregivers mentioned that their core motivation for choosing intrathecal pump implantation during pain management was to improve end-of-life quality of life by effectively relieving pain, reducing medication dependency, maintaining daily activities, and enhancing overall comfort in daily living. Effectively relieve pain “The primary goal is to alleviate the patient's pain, as we are dealing with gastrointestinal tumors. Previously, oral pain medications had significant side effects and provided poor pain relief.” (Participant 8) Overcome drug dependence “I hope the patient's pain management remains relatively stable, unlike before when sometimes medication worked and other times multiple injections were needed to control it. The pain fluctuated too unpredictably, leaving us family members at a loss.” (Participant 17) Maintain daily life “Keep pain stable at a low level that the patient can tolerate, without interfering with eating or sleeping, allowing the patient to get a full night's rest.” (Participant 10) Enhance the comfort of daily life I hope he can use the bathroom on his own without having to grit his teeth in pain every time someone helps him. I also hope he can sleep at least 3-4 hours straight at night without constantly waking up in pain. I wish he could rest peacefully for a while, watch TV, or communicate with us. (Participant 12) Sub-theme 2: Achieving physical and mental liberation for caregivers Within the context of traditional Confucian culture in China, family members' care for cancer patients carries profound ethical significance, regarded as a concrete manifestation of filial piety and benevolence. However, due to these cultural expectations, the reality of cancer caregiving often translates into a heavy dual burden on caregivers—both physical and psychological—who endure guilt and moral anxiety stemming from their inability to meet these demands. Ease emotions “ From my selfish perspective, I no longer wish to hear her agonizing moans day and night—that sound tears at my heart. ” (Participant 2) Improve daily routines “ I think the patient himself is rather dramatic. He constantly cries and screams at home, and we can't get any rest day or night either. ” (Participant 16) Theme 2: Preoperative decision-making motivations and perceptions Sub-theme3: Source of motivation This study found that primary caregivers are not making decisions about intrathecal pump implantation blindly. They base their decisions on multiple information channels, including observing treatment outcomes in fellow patients, media information dissemination, clinical decisions made by pain specialists, and treatment recommendations for the underlying disease. Patient treatment outcomes “We have a patient discussion group where several patients have undergone this procedure, and the outcomes have been generally positive. That's why we decided to go ahead with it.” (Participant 19) Media information “We saw reports about the treatment in Shanghai's Xinmin Evening News. Family members recommended it to me, saying this approach might help treat my father.” (Participant 4) “I learned about it through an online video. I also consulted some AI software and found this to be a relatively credible treatment method.” (Participant 19) Professional pain management decision-making “ We first visited the pain clinic, where the director recommended starting with a semi-implanted device. If it proved effective, we could proceed with full implantation later. The pain specialist explained the treatment plan in great detail and offered various alternative therapies. Ultimately, the decision to proceed with the intrathecal pump implantation was our own choice. ” (Participant 4) Recommendations for primary disease treatment “I hadn't been aware of this treatment option before. The oncologist recommended that if the medication couldn't control the pain anymore, we should consult the pain management department to see if there were other options.” (Participant 13) Sub-theme4 ： Cognitive preparation for caregivers According to value perception theory, caregivers' cognitive readiness prior to intrathecal morphine pump implantation directly influences their assessment of the treatment's value, thereby determining their support for or acceptance of this intervention. This study found that caregivers' cognitive readiness is primarily manifested in the following aspects: Dosage “I know this pump can precisely control medication dosage, which reduces the side effects of certain drugs. For example, we used to frequently experience constipation, but now with less medication, his bowel movements are regular.” (Participant 17) Route of administration “I know that during surgery, doctors insert a very thin tube into the patient's spine so that medication can be delivered directly.” (Participant 20) Surgical procedure “ We learned there are two surgical approaches: semi-implant and full-implant. Initially, we thought the full-implant might be more convenient, but the doctor felt the patient's survival period might not be very long. After careful consideration, we opted for the semi-implant procedure. ” (Participant 5) Surgical risks “ I know that fully implantable surgery carries a lower risk of infection, with no exposed tubing, allowing for greater freedom of movement. You don't have to worry about water splashing on the tubing when showering or getting dressed. ” (Participant 10) Long-term efficacy “I understand it provides longer-lasting results than some neuro-radiofrequency procedures or nerve blocks, potentially offering a permanent solution.” (Participant 17) Theme3 ： The multidimensional manifestation of value perception Sub-theme5: Improve patients' physical and mental well-being Participants indicated that intrathecal pump implantation not only reduces patients' analgesic dosage and side effects but also strengthens their belief in overcoming the disease. This approach enhances patients' quality of life and restores their confidence in treating the primary condition. This value perception process has a bidirectional effect: it improves treatment adherence while simultaneously promoting the positive regulatory function of the family support system. Reduce analgesic dosage and side effects “We observed that avoiding high doses of potent oral analgesics postoperatively spared the burden on the gastrointestinal tract, liver, and kidneys, as well as side effects like drowsiness, allowing patients to remain alert and conscious.” (Participant 10) Strengthen patients' belief in overcoming illness “For my mom, this is a life-saving value. She used to be in so much pain that she repeatedly said she didn't want to live anymore. We couldn't leave her side for a single moment, afraid she might do something reckless. Now that the pain is gone, she's starting to regain her confidence.” (Participant 2) Improve patients' quality of life “Before, when he was taking morphine tablets and getting injections, he was drowsy all day long, suffering from nausea and constipation—it was very uncomfortable. Now that the dosage has been reduced, he's much more alert during the day. Seeing him in less pain, his quality of life has improved a bit.” (Participant 7) Restore confidence in treating the underlying disease “ For him, the greatest value is that the pain relief allows him to live well again. We're now focusing on planning subsequent tumor treatments—the pain has become a thing of the past. ” (Participant 11) Sub-theme 6: Reduce the burden on caregivers Several participants mentioned that effective pain management can alleviate the physical, mental, and social burdens on caregivers while also reducing care conflicts with patients. Physical burden “After the intrathecal pump implantation, things became much easier for me. Otherwise, seeing her refuse to eat or drink, and then tossing and turning at night, was taking a toll on my body. Our family had to take 24-hour shifts just to care for her.” (Participant 14) Emotional burden “ His expression of pain has lessened, and we can now have some peaceful conversations or simply enjoy quiet companionship. This is so much better than before, when he was constantly tormented by pain and I was perpetually anxious and worried. ” (Participant 18) Social burden “ As his wife, my greatest wish and responsibility is to do everything I can to ensure he lives with greater comfort, dignity, and less suffering during the time he has left. ” (Participant 10) Reduce caregiving conflicts “Now any care we give her feels like torture. She resists fiercely, and we can't bear to see her suffer. If her pain is managed, I can bathe her, turn her over, and change her clothes without struggle—it won't be a painful ordeal for either of us.” (Participant 2) Theme 4: Key trigger points for surgical acceptance Sub-theme 7: External support system evaluation Some participants indicated they would first evaluate external support systems, such as whether health insurance coverage is adequate, long-term treatment costs are low, the family's existing financial burden is manageable, and whether the current caregiver's workload is overwhelmingly burdensome. These are all factors they would assess before deciding to undergo surgery. Improving health insurance “Since my father's medical insurance is from outside Shanghai, we might also have financial considerations. So we want to ensure the semi-implantable pump works well before deciding on the fully implantable one.” (Participant 4) “I've looked into the cost of this pump, and it's affordable for us because our insurance coverage is quite high. It doesn't pose a financial burden.” (Participant 14) Long-term treatment costs are low “At present, I don't know how long he can use it. The patient has been using it for a month now. If it can last three to five years, then I think it's worth it.” (Participant 16) The family's financial burden is light “I'm not too familiar with other families, who might consider financial factors, but for our family, I believe we can afford it financially.” (Participant 16) “I first looked into the cost of the implantable pump. I know it might cost over 100,000 yuan out-of-pocket since it's not covered by insurance. Financial considerations are important, but after discussing it as a family, we're all willing to pay this amount for Dad's treatment.” (Participant 4) Caregiver burden “When the patient was at home, we couldn't get any rest day or night, so why didn't we consider other factors and just operate on him?” (Participant 1) Sub-theme 8 ： Assessment of disease severity Caregivers' assessment of the patient's disease severity is the most critical factor influencing the acceptance of surgical decisions. All participants indicated that they would only consent to intrathecal pump intervention when the patient's pain exceeded tolerable limits or when severe complications had already developed. High severity of pain “I didn't consider other factors because the patient was already in unbearable pain.” (Participant 9) “I believe surgery should only be performed when pain control is no longer sufficient. If done prematurely, isn't that overtreatment? Why resort to surgery when conservative treatment is possible?” (Participant 19) Severe pain-related complications “We've been taking the strongest painkillers, but they're no longer effective. The doses are so high that the side effects—like drowsiness, constipation, nausea, and breathing issues—have become unbearable.” (Participant 7) “The pain has persisted for a very long time, severely impacting my ability to walk, sleep, and perform basic daily activities.” (Participant 17) Sub-theme 9: Patient eligibility assessment Several participants indicated that they would first ascertain the patient's willingness to undergo surgery, which they considered crucial. If the patient themselves were unwilling to accept surgery or their underlying health conditions rendered them unsuitable for the procedure, family caregivers would not necessarily blindly pursue surgery either. The patient is willing and/or able to undergo surgery “The patient has a strong desire for pain relief, and his physical condition has been assessed as capable of tolerating surgery.” (Participant 2) “Her current physical condition can withstand this surgery, and she herself is utterly terrified of the pain and has suffered enough, willing to try this new treatment.” (Participant 12) Postoperative convenience for patients “We previously considered that having a long-term pump implanted in the body might also affect daily life, so we didn't initially agree to the implantable pump surgery.” (Participant 6) Sub-theme10 ： Surgical value assessment The value of postoperative recovery is also crucial for participants. One participant stated that the surgery represented the final effort to treat the patient, and they could accept it even if the outcome was unsatisfactory. The others all hoped that the postoperative value would meet their expectations. The current approach does not alleviate the pain “His body is too weak to handle anti-tumor treatments like radiation and chemotherapy. The doctors said conventional pain management has reached its limits.” (Participant 7) Surgical treatment yields excellent results “ For us, a month ago it was a state worse than death, but now the semi-implantable pump is working well. For long-term safety and comfort, switching to a fully implantable one is the necessary choice.” (Participant 10) The benefits of surgery outweigh the risks “Our primary concern was the surgical risks. I didn't want to choose a more invasive procedure just to alleviate pain, only to accelerate the patient's deterioration—that was my greatest worry.” (Participant 17) Theme 5: Key focus areas and pain points in care needs Sub-theme 11: Perioperative comprehensive management Health education for caregivers is essential to comprehensive perioperative management. The findings of this study indicate that family caregivers exhibit knowledge gaps in home-based care management, specifically in four areas: surgical incision care, maintenance of the intrathecal pump reservoir, postoperative precautions, and medication guidance. Surgical incision care “Our current concern is this wound. The patient finds it painful and refuses to turn over, which may hinder proper healing.” (Participant 13) “How should the wound be cared for at home? When can the patient shower? How can we tell if the wound is infected? We hope the inpatient nurses can provide clear instructions, ideally with written materials or a video.” (Participant 7) Intrathecal pump housing maintenance “Where should the pump be positioned? How can we avoid issues like bumping or pressure points—for example, what sleeping positions are recommended? How should the safety belt be fastened?” (Participant 8) Postoperative instructions What should I be mindful of in daily life? For instance, bathing, activity restrictions, or whether I can undergo certain tests like MRIs—please make sure the nursing staff explains these thoroughly. (Participant 12) Medication guidance “We applied it yesterday. The doctor gave us a general explanation, but it didn't help with the pain. I didn't dare to use it, afraid that too much medication might cause side effects.” (Participant 15) Sub-theme 12: Pain management throughout the entire process Multidisciplinary collaboration and thorough assessment are central to perioperative pain management with intrathecal pumps [25] , Participants emphasized the need for comprehensive pain management for patients, including how to assess their pain levels and provide emergency support when drug side effects occur. They also expressed hope that the research team could assist with pain management through multidisciplinary collaborative treatment approaches, combining both online and offline formats. Pain assessment How can I determine if my intrathecal pump is working well after surgery? Should I keep a pain diary? If I feel my pain control is unsatisfactory or experience breakthrough pain, how should I adjust my medication? (Participant 10) Provide emergency support “For instance, in handling emergencies—if an elderly person accidentally takes too high a dose and experiences side effects—how should family members respond?” (Participant 11) Multidisciplinary collaboration The patient is experiencing both oropharyngeal cancer pain and postherpetic neuralgia. How can these two types of pain be managed simultaneously? Is it necessary to add other oral medications? We hope the pain management team and oncology team can communicate to provide us with a comprehensive pain management plan. (Participant 10) Online and offline integration “The pain management department has been very thorough with our follow-up care. There's a WeChat group where we can consult online anytime, which I find very convenient. The engineer handling the pump operation is also very reliable.” (Participant 3) Theme 6: Postoperative rational expectations regarding the condition Sub-theme 13: Effective pain control Effective pain control following intrathecal pump implantation is a reasonable expectation shared by all participants. Participants believe that post-implantation pain relief should be provided while minimizing pain-related complications. Relieve pain “We only hope he's no longer in pain, and that everyone can help him through his final days with ease. That alone would be enough for us.” (Participant 1) Reduce pain-related complications “I hope he no longer fears eating or loses sleep due to excruciating pain, and that he can achieve consistent, restful sleep.” (Participant 10) Sub-theme 14 : Anticipating synergy and continuity in cancer treatment Due to the physical toll of pain on patients, they often cannot tolerate treatments such as chemotherapy and radiotherapy for tumors. Some participants indicated that with effective pain management, patients could continue tumor treatments and achieve peace in their final stages. Five family caregivers expressed hope that pain relief would moderately extend the patients' survival period. Palliative care “We hope patients can spend their final days in peace, without too much suffering, and that family members can accompany them through their last journey with ease.” (Participant 17) Appropriately extend the product lifecycle We still hold onto hope that patients will stay with us a little longer. All we can do is be there for them in their final days. (Participant 6) Continue treatment for the underlying condition “The current hope is to alleviate his suffering and give him the strength to undergo the next phase of treatment. That might lead to an improvement in his condition, which would be the best outcome.” (Participant 15) Sub-theme15: Rational understanding of the underlying disease Most participants believed the tumor's progression was uncontrollable, hoping only that postoperative care could alleviate the physical and mental suffering caused by pain. They had a relatively clear understanding of the primary disease. Clear understanding of the disease “When it comes to tumors, they'll do what they're going to do. We wouldn't expect a patient with advanced cancer to suddenly get better.” (Participant 11) Discussion This study, based on qualitative interviews, found that the decision-making process for intrathecal pump implantation is fundamentally a balancing act for family caregivers weighing “treatment value” against multiple burdens. Caregivers commonly face the triple pressures of psychological anxiety, physical exhaustion, and loss of social roles, consistent with previous research findings [26, 27] . Analysis indicates that these pressures may stem directly from the high-intensity care demands resulting from inadequate pain management in patients, a factor considered the primary driver of the care burden [28] . Therefore, the “mutual benefit for patients and caregivers” provided by intrathecal pumps extends beyond the medical dimension of pain relief to encompass the overall maintenance of family system functionality. Research confirms that effective pain intervention can directly alleviate the physical and mental stress experienced by caregivers [29] , This is consistent with our research findings. However, research indicates that the realization of perceived value among family caregivers following intrathecal pump implantation is constrained by both knowledge gaps and management anxieties. Although our institution partially alleviated post-implantation management anxieties through comprehensive perioperative care and digital support platforms (such as patient WeChat groups and online consultations), Nevertheless, findings indicate that caregivers' concerns about the technical complexity and treatment costs often outweigh their awareness of the harm caused by pain itself. This tendency leads them to favor maintaining the status over pursuing active intervention when making decisions [30] . Many families remain trapped in the cognitive dilemma of “pain endurance culture” and “treatment aversion.” Therefore, it is recommended that pain management teams prioritize systematic pre-treatment assessments. Within clinical pathways, caregivers' value perception factors should be identified early on—encompassing not only their financial capacity and caregiving capabilities but also the balance between “risk perception” and “benefit recognition” in their decision-making psychology. Through structured communication and education, transforming intrathecal pump management from an “unknown burden” into a “manageable process” can help families overcome decision barriers. This approach enables precise pain management centered on patient quality of life and grounded in family support systems. This study further reveals a decision-making framework model for family caregivers of patients undergoing intrathecal pump implantation (Fig. 2). Centered on “key decision-making starting points,” this model reflects the multidimensional interactive mechanism of value perception. Within the model, four core elements are interconnected, encompassing specific considerations such as the family's financial burden and caregiving pressure, pain levels and related complications, risk-benefit assessments and the effectiveness of current treatment plans, as well as patient convenience and tolerance. Simultaneously, these core elements are dynamically influenced by peripheral factors including decision drivers, cognitive factors, value perceptions, reasonable expectations, and care needs. Collectively, they converge toward the core objective of caregiver decision-making, revealing the complex process by which family caregivers balance medical needs, patient condition, external support, and personal value judgments in healthcare decisions [31] . This aligns with the critical role of value perception in major healthcare decisions, as highlighted in the study by Gonçalves et al [32] . When healthcare providers systematically involve family caregivers in shared decision-making, patients receive better home care and may achieve optimized clinical outcomes [33] . Moreover, in today's era of widespread digital information, Chinese citizens have a particular preference for this type of health science communication [34] . Healthcare professionals can guide caregivers to enhance their understanding of intrathecal pump technology through authoritative visual educational content (such as curated medical animations, short videos, etc.) to alleviating the decline in decision-making participation and assessment capabilities caused by information asymmetry [35, 36] , and enhancing the acceptance and adherence to medical recommendations. This process fundamentally transforms caregivers from passive implementers into informed decision-making partners by increasing their clarity of value perception and sense of control. Therefore, clinical pain management teams must conduct systematic shared decision-making communication before recommending such high-cost interventions, proactively assessing and addressing caregivers' specific concerns across four key dimensions. Poorly controlled cancer pain significantly reduces patients' quality of life and exacerbates their anxiety and depression [37] . At the same time, the central role of family caregivers in pain management is often undermined by inadequate social support systems [38] . Ultimately, this leads to a vicious cycle of “poor pain management exacerbating caregiver burden”. Social support systems are not merely emotionally oriented caregiving assistance [39] , including structural safeguards such as the medical insurance system and healthcare management pathways [40] . For example, in this study, some families opted for the more economical semi-implantable pump option under their doctors' recommendations due to limitations imposed by their health insurance plans. This suggests that health insurance directly impacts the accessibility of medical decisions [41] . The medical team should proactively assess the patient's financial resources and balance medical necessity with economic sustainability when developing treatment plans [42] . This enhances families' trust in treatment recommendations, laying the decision-making foundation for ultimately achieving patient-centered precision pain management. Currently, postoperative management of intrathecal pumps in China remains primarily inpatient-based, lacking a systematic “clinical-home-community” transition pathway [43] . This study reveals that caregivers commonly face knowledge and skill gaps regarding pump maintenance, pain assessment, and daily life management after discharge. Therefore, it is essential to establish a comprehensive support pathway covering the entire care cycle: from preoperative comprehensive assessment, education, and adaptive training; to self-management skill development during treatment; to continuous reinforcement of home care capabilities post-discharge; ultimately facilitating the restoration and reintegration of social functioning for both patients and caregivers. Only through a multi-tiered, continuous support system can we truly overcome the current limitations in cancer pain management and achieve precise, family-centered care. Limitations All study participants were drawn from inpatient pain management units, where high adherence to analgesic treatment may introduce selection bias. Future research will expand to additional clinical settings, such as oncology departments, to explore the underlying reasons for acceptance or rejection of intrathecal pump implantation across diverse patient populations, thereby enhancing the study's external validity. Conclusion This study employed a descriptive phenomenological approach to explore the value perception process of family caregivers in cancer patients during decision-making for intrathecal analgesic pump implantation. Results indicate that this decision inherently represents a “patient-caregiver mutual benefit” choice, yet most patients remain trapped in a vicious cycle of “enduring pain-breaking down.” Recommendations are as follows: First, systematically assess the medical background and decision-influencing factors of both patients and caregivers, provide psychological support and conceptual guidance, and develop individualized treatment strategies. Second, for families opting for implantation, establish multidisciplinary teams to implement comprehensive perioperative management and home care competency training. Future efforts should center on “pain manageability” as the educational core, using shared decision-making as the pathway to build an integrated care model encompassing physiological, psychological, and social dimensions. By early identification and intervention of factors delaying decision-making, the vicious cycle can be broken. Precise technology should uphold patient dignity, while systemic support should bridge care gaps. Declarations Acknowledgements We sincerely thank all the participants in this research for their time and effort invested. Special thanks go to Dr. Liao Lijun for her project consultation and financial support provided for this study. Approved for Publication This manuscript does not contain any data, images, or other materials that could identify participants personally. Therefore, this section is not applicable. Funding 1 Pudong New Area Health System Medical Discipline Construction Funding 2 Quality Clinical Specialty Program of High-end Medical Disciplinary Construction in Shanghai Pudong New Area （2024-PWXZ-02） 3 The Outstanding Leaders Training Program of Shanghai Pudong New Area Health Commission (PWR12024-07) 4 Shanghai East Hospital Talent Research Launch Plan (DFRC2024002) Conflict of interest All the authors have no conflict of interest. Data availability The data used in this study can be provided to the corresponding author upon reasonable request. Author Contributions Research Design: Gao Yili, Qin Jiawen, Liao Lijun, Duan Wenzhi Data Collection: Gao Yili, Liu Zhenyuan, Zhang Jinyuan, Yu Xiuqin, Hou Qianhao Data Analysis: Gao Yili, Qin Jiawen, Duan Wenzhi First Draft Writing: Gao Yili, Qin Jiawen Consultation on the Project: Liao Lijun, Wang Xiangrui Ethics approval and consent to participate Ethical Approval and Informed Consent This study was thoroughly reviewed and subsequently approved by the Ethics Committee of East Hospital Affiliated to Tongji University in Shanghai, China (Approval Number: 2025YS-007). All research procedures strictly followed the ethical principles outlined in the Helsinki Declaration. Informed consent forms were obtained from all participants. Consent for publication Not Applicable References SCHWARTZ S M. Epidemiology of Cancer [J]. Clin Chem, 2024, 70(1): 140–9. 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Psychooncology, 2016, 25(11): 1278–85. REGIER N G, TAYLOR J L, SZANTON S L, et al. Pain in persons with dementia and the direct and indirect impacts on caregiver burden [J]. Geriatr Nurs, 2021, 42(2): 366–71. LEBARON V, HOMDEE N, OGUNJIRIN E, et al. Describing and visualizing the patient and caregiver experience of cancer pain in the home context using ecological momentary assessments [J]. Digit Health, 2023, 9: 20552076231194936. SIR E, BATUR SIR G D. Evaluating treatment modalities in chronic pain treatment by the multi-criteria decision making procedure [J]. BMC Med Inform Decis Mak, 2019, 19(1): 191. GONçALVES E. Advanced therapy medicinal products: value judgement and ethical evaluation in health technology assessment [J]. Eur J Health Econ, 2020, 21(3): 311–20. STEFFENSEN K D, BERRY L. Shared Decision Making Can-and Should-Actively Involve Family Caregivers [J]. JCO Oncol Pract, 2025: Op2500340. RABBEN J, VIVAT B, FOSSUM M, et al. Shared decision-making in palliative cancer care: A systematic review and metasynthesis [J]. Palliat Med, 2024, 38(4): 406–22. XIAO L, MIN H, WU Y, et al. Public's preferences for health science popularization short videos in China: a discrete choice experiment [J]. Front Public Health, 2023, 11: 1160629. SHAH A M, YAN X, SHAH S A A, et al. Exploring the impact of online information signals in leveraging the economic returns of physicians [J]. J Biomed Inform, 2019, 98: 103272. GUO S, WANG K, YANG L, et al. Extending Signaling Theory in Online Health Communities to Address Medical Information Asymmetry: Systematic Review With Narrative Synthesis [J]. J Med Internet Res, 2025, 27: e73208. MAINDET C, BURNOD A, MINELLO C, et al. Strategies of complementary and integrative therapies in cancer-related pain-attaining exhaustive cancer pain management [J]. Support Care Cancer, 2019, 27(8): 3119–32. AKTER J, KONLAN K D, NESA M, et al. Factors influencing cancer patients' caregivers' burden and quality of life: An integrative review [J]. Heliyon, 2023, 9(11): e21243. JADIDI A, AMERI F. Social Support and Meaning of Life in Women with Breast Cancer [J]. Ethiop J Health Sci, 2022, 32(4): 709–14. CUI P, SHI J, LI S, et al. Family resilience and its influencing factors among advanced cancer patients and their family caregivers: a multilevel modeling analysis [J]. BMC Cancer, 2023, 23(1): 623. KAUFF N D, SCHEUER L, ROBSON M E, et al. Insurance reimbursement for risk-reducing mastectomy and oophorectomy in women with BRCA1 or BRCA2 mutations [J]. Genet Med, 2001, 3(6): 422–5. CHEN J E, LOU V W, JIAN H, et al. Objective and subjective financial burden and its associations with health-related quality of life among lung cancer patients [J]. Support Care Cancer, 2018, 26(4): 1265–72. SUN L, FANG M, XU T, et al. Application of Healthcare Failure Mode and Effect Analysis in the Management of Patients With Intrathecal Morphine Pump Implantation [J]. Pain Manag Nurs, 2025, 26(2): e207–e14. Additional Declarations No competing interests reported. Supplementary Files Appendix1.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 29 Jan, 2026 Reviewers invited by journal 29 Jan, 2026 Editor assigned by journal 28 Jan, 2026 Submission checks completed at journal 27 Jan, 2026 First submitted to journal 27 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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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-8497612","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":582598964,"identity":"e5dc7b0e-995a-4cdf-b326-d5fad3084150","order_by":0,"name":"lijun 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2","display":"","copyAsset":false,"role":"figure","size":1033553,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDecision-Making Model for Family Caregivers of Patients Undergoing Intrathecal Pump Implantation Based on Value Perception\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8497612/v1/434add4af8c43f9be2fa6a69.jpeg"},{"id":101755718,"identity":"ccc736f3-a71d-4131-8e4e-f2ad5a839c38","added_by":"auto","created_at":"2026-02-03 10:54:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":6967189,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8497612/v1/d1d709bd-0c35-4ea2-912e-76004fa7c8da.pdf"},{"id":101754224,"identity":"08393354-b90a-4f65-aa05-52d8450d43a6","added_by":"auto","created_at":"2026-02-03 10:42:04","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":15270,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8497612/v1/40846e54b44a560a506348ac.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Value Experience of Intrathecal Pump Implantation for Cancer Pain Patients: A Qualitative Study Focusing on Family Caregivers","fulltext":[{"header":"Background","content":"\u003cp\u003eCancer is a large group of heterogeneous malignant tumors. The most commonly diagnosed cancer types in adults are lung cancer, colorectal cancer, breast cancer in women, skin melanoma, and prostate cancer\u003csup\u003e[1]\u003c/sup\u003e. According to estimates by the American Cancer Society, between 2015 and 2019, the incidence rates of breast cancer, pancreatic cancer, and endometrial cancer increased by 0.6% to 1% annually, while prostate cancer, liver cancer (in women), and kidney cancer met annual increases of 2% to 3%. Incidence rates for cervical cancer among young adults (ages 30\u0026ndash;44) and colorectal cancer (under age 55) also increased by 1%-2% annually\u003csup\u003e[2]\u003c/sup\u003e. Globally, there are approximately 20\u0026nbsp;million new cancer cases and 9.7\u0026nbsp;million cancer deaths each year\u003csup\u003e[3]\u003c/sup\u003e. In China, according to the 2022 Global Cancer Statistics Report released by the International Agency for Research on Cancer (IARC), newly diagnosed lung cancer cases accounted for 22% of all new cancer cases, ranking first globally. The high incidence of cancer imposes a severe disease burden on patients' families and society, representing a major public health challenge for both the world and China. Patients face risks including stalled career advancement, increased financial pressure, and changes in social relationships and family responsibilities, leading to a significant decline in their quality of life\u003csup\u003e[4]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eCancer pain is one of the most common, complex, and persistent symptoms during and after cancer treatment, with a prevalence rate of approximately 55% for concurrent pain during cancer treatment\u003csup\u003e[5]\u003c/sup\u003e. A systematic review and meta-analysis indicate that 66.4% of patients with advanced, metastatic, or terminal disease experience pain, while 39.3% report pain following curative treatment. Additionally, 38% of cancer patients endure moderate to severe pain, and those who survive cancer treatment often face lifelong chronic pain\u003csup\u003e[6]\u003c/sup\u003e. The sources of cancer-related pain are complex, including the tumor itself, which can directly cause nociceptive pain, visceral pain, and/or neuropathic pain, as well as metastatic lesions. Cancer treatments themselves may lead to various specific pain conditions secondary to chemotherapy, radiotherapy, and surgery\u003csup\u003e[7]\u003c/sup\u003e. The experience of pain can profoundly impact patients\u0026rsquo; emotional state, leading to feelings of depression, increased anxiety, and even cognitive impairment. The NCCN Clinical Practice Guidelines in Oncology indicate that the core approach to managing cancer pain remains the use of opioids, alongside optimizing non-opioid analgesics and adjunctive medications. However, clinical outcomes are often suboptimal, necessitating combined management with other therapeutic modalities, including the treatment of complex regional pain syndrome\u003csup\u003e[8]\u003c/sup\u003e. For patients who fail conservative medical interventions and less invasive pain management approaches, intrathecal drug therapy represents a viable treatment option. The placement of an intrathecal pain pump is a safe and effective method for managing pain in cancer patients, helping to maximize pain control in those experiencing refractory pain due to the disease process or treatments associated with malignant tumors. However, due to its high complexity and lack of understanding, there is an issue of underutilization in clinical practice\u003csup\u003e[9, 10]\u003c/sup\u003e, reduced the effectiveness of pain management specialists and oncologists in providing precise pain management for patients.\u003c/p\u003e \u003cp\u003eFamily caregivers for cancer patients shoulder heavy responsibilities across various cancer-related treatments and ongoing care tasks. Moreover, primary family caregivers hold the final decision-making authority regarding treatment options, medication adjustments, and whether to undergo invasive procedures such as intrathecal pump implantation\u003csup\u003e[11]\u003c/sup\u003e. Throughout the pain management process, individuals face numerous physical and emotional challenges, including accessing medical information, providing psychological support to loved ones, and maintaining close communication with the healthcare team\u003csup\u003e[12, 13]\u003c/sup\u003e. In China, only certain regions such as Shanghai and Beijing currently include intrathecal pumps in their medical insurance coverage. Without insurance coverage, the total perioperative costs for patients can reach as high as 150,000 to 200,000 RMB. Under these circumstances, family caregivers do not uniformly accept intrathecal pump implantation, necessitating consideration of its overall value. Perceived value serves as a prerequisite for forming acceptance attitudes. Value refers to the relationship between an object's attributes and functions and the subject's needs, defined as individuals' perception of the benefits obtainable through using the object\u003csup\u003e[14]\u003c/sup\u003e. Patient Perceived Value (PPV) is an extension of value perception theory in the healthcare sector, referring to the comprehensive assessment of patients' expectations versus actual experiences regarding the utility of healthcare services\u003csup\u003e[15]\u003c/sup\u003e. Therefore, when patients consider accepting intrathecal pump implantation as a treatment option, it is essential to help them recognize the broad value this technology offers. This study delves into the value perceptions of caregivers for cancer pain patients by examining the decision-making drivers for accepting intrathecal analgesic pumps, core demands for pain management value, and pain points in care needs. By dissecting these key motivators, it provides evidence-based support for optimizing precision pain management pathways centered on preserving patients' dignity and quality of life.\u003c/p\u003e"},{"header":"Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eResearch Design\u003c/h2\u003e \u003cp\u003eThis study employed a phenomenological research approach as a qualitative research method. Through semi-structured face-to-face interviews, it explored in depth the nursing experiences and value perceptions of family caregivers for cancer pain patients at Shanghai East Hospital during the perioperative period and home-based pain management when adopting the intrathecal pump implantation treatment plan. Based on literature review and expert consultation, an interview outline grounded in \u0026ldquo;value perception\u0026rdquo; theory was developed. Prior to the main study, two primary caregivers participated in pre-interviews. The final outline was refined based on their feedback and expert input. The interview content of this section is presented in Appendix 1.To ensure rigor and clarity throughout the research process, the Core Qualitative Research Reporting Standards (COREQ) framework was adopted. Each of its 32 items was systematically referenced to document the entire process\u0026mdash;from study design and data collection to results presentation\u0026mdash;ensuring full traceability and reviewability of every stage of the in-depth interviews\u003csup\u003e[16]\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants and Sample Size\u003c/h3\u003e\n\u003cp\u003eThis study employed purposive sampling. Between March and October 2025, 20 family caregivers of cancer pain patients admitted to the Pain Management Department of Shanghai East Hospital were selected as research subjects. Inclusion criteria were as follows: (1) Subjects aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years who served as unpaid primary caregivers (primary caregiver) for patients, being immediate family members or close friends, excluding paid professional nursing staff\u003csup\u003e[17]\u003c/sup\u003e;(2) The research subjects provided over 8 hours of care daily, with continuous caregiving exceeding 4 weeks\u003csup\u003e[18]\u003c/sup\u003e; (3) Assume primary responsibility for caregiving and medical decision-making during the patient's hospitalization; (4) The patient has been diagnosed with moderate to severe cancer pain, with an NRS score\u0026thinsp;\u0026ge;\u0026thinsp;4; (5) The patient has a clearly defined condition and confirmed acceptance of intrathecal pump implantation; (6) The subject has clear verbal expression without cognitive or communication impairments; (7) The subject has signed an informed consent form and voluntarily participates in this study. Exclusion criteria are as follows: (1) Patients who do not meet surgical indications or have not fully confirmed acceptance of surgery; (2) Subjects with a history of psychiatric disorders or cognitive impairment; (3) Subjects who refuse to participate in this study.\u003c/p\u003e\n\u003ch3\u003eData Collection and Analysis\u003c/h3\u003e\n\u003cp\u003eBasic information about patients and their primary caregivers was gathered using a basic information form. Interview data was collected via a semi-structured in-depth interview questionnaire. Researchers developed the basic information form by reviewing relevant literature. It comprised nine questions covering the following information: patient age, marital status, primary tumor type, preoperative NRS score, postoperative NRS score, whether the pump body was fully implanted, payment method, primary caregiver-patient relationship, educational attainment, and employment status \u003csup\u003e[19\u0026ndash;23]\u003c/sup\u003e. The Colaizzi's seven-step phenomenological analysis method\u003csup\u003e[24]\u003c/sup\u003e was applied for data analysis. Within 24 hours of the interview, two researchers repeatedly listened to the recordings and transcribed them to create interview transcripts. ① Carefully read all interview texts; ② Extract representative original statements; ③ Code and mark high-frequency and meaningful statements; ④ Identify common characteristics and concepts within coded content to refine preliminary themes; ⑤ Systematically articulate the intrinsic connections between each theme and the research phenomenon; ⑥ Integrate similar viewpoints to elevate them into final core themes; ⑦ Return findings to interviewees for verification and confirmation. This study employed MAXQDA 2025 software to assist in analyzing interview data, forming themes, subthemes, and codes. The findings were visualized through the creation of Sankey diagrams.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eDescriptive Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 1 presents the descriptive characteristics of participants. This study included 20 pairs of care recipients and primary caregivers, collecting their basic personal information. Interviews were conducted with primary caregivers, achieving a 100% completion rate. Care recipients ranged in age from 29 to 95 years, with lung cancer being the most common diagnosis (40%, 8/20). All patients experienced severe preoperative pain (NRS score \u0026ge; 7) and achieved significant postoperative relief (NRS score reduced to 0\u0026ndash;3). Analysis of primary caregivers revealed spouses as the predominant care providers (55%, 11/20). Employment status analysis revealed that 45% (9/20) of caregivers were unemployed, with this phenomenon particularly pronounced among spousal caregivers, whose unemployment rate reached 54.5% (6/11). In contrast, the majority of caregivers who were children (85.7%, 6/7) were employed.\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"104%\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"12\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 1: Basic Information Form for the Person Under Care and Primary Caregiver\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"7\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eThe protected\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 36px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrimary caregiver\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eNum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eMarital Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eTumor location\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003ePreoperative NRS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 11.5429%;\"\u003e\n \u003cp\u003ePostoperative NRS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.6632%;\"\u003e\n \u003cp\u003eIs the pump body fully implanted within the body\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003ePatient Relationship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eEducational background\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eEmployment Situation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eP1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eLungs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 11.2016%;\"\u003e\n \u003cp\u003e7-8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2955%;\"\u003e\n \u003cp\u003e2-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.6631%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003eDaughter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003evocational high school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eEmployment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eP2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003ePancreas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 11.2016%;\"\u003e\n \u003cp\u003e6-8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2955%;\"\u003e\n \u003cp\u003e2-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.6631%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003eDaughter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003evocational high school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eEmployment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eP3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eStomach\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 11.2016%;\"\u003e\n \u003cp\u003e7-8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2955%;\"\u003e\n \u003cp\u003e2-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.6631%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003eSpouse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eEmployment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eP4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eLungs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 11.2016%;\"\u003e\n \u003cp\u003e6-8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2955%;\"\u003e\n \u003cp\u003e1-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.6631%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003eDaughter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eJunior college\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eEmployment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eP5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eLungs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 11.2016%;\"\u003e\n \u003cp\u003e8-9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2955%;\"\u003e\n \u003cp\u003e1-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.6631%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003eSpouse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eUnemployment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eP6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eLungs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 11.2016%;\"\u003e\n \u003cp\u003e7-8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2955%;\"\u003e\n \u003cp\u003e2-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.6631%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003eDaughter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eEmployment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eP7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eLungs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 11.2016%;\"\u003e\n \u003cp\u003e7-8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2955%;\"\u003e\n \u003cp\u003e2-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.6631%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003eSpouse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eJunior High School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eEmployment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eP8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eStomach\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 11.2016%;\"\u003e\n \u003cp\u003e8-9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2955%;\"\u003e\n \u003cp\u003e2-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.6631%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003eSpouse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eJunior college\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eUnemployment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eP9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eLungs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 11.2016%;\"\u003e\n \u003cp\u003e7-8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2955%;\"\u003e\n \u003cp\u003e1-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.6631%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003eSpouse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eElementary School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eUnemployment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eP10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eOral cavity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 11.2016%;\"\u003e\n \u003cp\u003e8-9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2955%;\"\u003e\n \u003cp\u003e2-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.6631%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003eSpouse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eElementary School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eUnemployment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eP11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eesophagus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 11.2016%;\"\u003e\n \u003cp\u003e7-8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2955%;\"\u003e\n \u003cp\u003e1-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.6631%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003eSon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eJunior college\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eEmployment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eP12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eLungs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 11.2016%;\"\u003e\n \u003cp\u003e7-8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2955%;\"\u003e\n \u003cp\u003e1-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.6631%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003eDaughter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eJunior college\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eEmployment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eP13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eRectum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 11.2016%;\"\u003e\n \u003cp\u003e9-10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2955%;\"\u003e\n \u003cp\u003e1-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.6631%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003eSpouse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eJunior High School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eUnemployment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eP14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eLungs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 11.2016%;\"\u003e\n \u003cp\u003e7-8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2955%;\"\u003e\n \u003cp\u003e1-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.6631%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003eSister\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eJunior High School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eEmployment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eP15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eUreter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 11.2016%;\"\u003e\n \u003cp\u003e7-8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2955%;\"\u003e\n \u003cp\u003e2-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.6631%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003eBrother\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eElementary School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eEmployment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eP16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eLungs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 11.2016%;\"\u003e\n \u003cp\u003e7-8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2955%;\"\u003e\n \u003cp\u003e1-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.6631%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003eDaughter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eJunior High School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eEmployment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eP17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eSkin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 11.2016%;\"\u003e\n \u003cp\u003e6-7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2955%;\"\u003e\n \u003cp\u003e0-1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.6631%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003eSon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eJunior college\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eEmployment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eP18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003ePancreas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 11.2016%;\"\u003e\n \u003cp\u003e7-8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2955%;\"\u003e\n \u003cp\u003e1-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.6631%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003eSon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eEmployment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eP19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eLiver\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 11.2016%;\"\u003e\n \u003cp\u003e9-10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2955%;\"\u003e\n \u003cp\u003e2-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.6631%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003eSon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eEmployment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eP20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003elymph node\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 11.2016%;\"\u003e\n \u003cp\u003e7-8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2955%;\"\u003e\n \u003cp\u003e1-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.6631%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003eSpouse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003evocational high school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eUnemployment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eSpecial Topic Synthesis:\u003c/strong\u003e Qualitative Findings on Primary Family Caregivers\u0026apos; Value Perception Regarding Intrathecal Pump Implantation\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThematic Analysis:\u0026nbsp;\u003c/strong\u003eThematic Analysis: Qualitative Findings on Family Caregivers\u0026apos; Value Perception Regarding Intrathecal Pump Implantation. This study employed content analysis to examine qualitative data, ultimately identifying six themes and 15 subthemes: core objectives of pain management, preoperative decision-making motivations and cognition, multidimensional manifestations of value perception, key starting points for surgical acceptance, focal points and pain points of care needs, and rational postoperative expectations regarding the condition. Specific themes and subthemes are detailed in Table 2 and Figure 1.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2: Themes and Subthemes Regarding Family Caregivers\u0026apos; Perceived Value of Intrathecal Pumps\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eThemes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSub-themes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCodes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" style=\"width: 14px;\"\u003e\n \u003cp\u003eCore Objectives of Pain Management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 41px;\"\u003e\n \u003cp\u003eImprove patients\u0026apos; quality of life\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eEffectively relieve pain\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eOvercome drug dependence\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eMaintain daily life\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eEnhance the comfort of daily life\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 41px;\"\u003e\n \u003cp\u003eAchieving physical and mental liberation for caregivers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eEase emotions\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eImprove daily routines\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"9\" style=\"width: 14px;\"\u003e\n \u003cp\u003ePreoperative decision-making motivations and perceptions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 41px;\"\u003e\n \u003cp\u003eSource of motivation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003ePatient treatment outcomes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eMedia information\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eProfessional pain management decision-making\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eRecommendations for primary disease treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 41px;\"\u003e\n \u003cp\u003eCognitive preparation for caregivers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eDosage\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eRoute of administration\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eSurgical procedure\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eSurgical risks\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eLong-term efficacy\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"8\" style=\"width: 14px;\"\u003e\n \u003cp\u003eThe multidimensional manifestation of value perception\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 41px;\"\u003e\n \u003cp\u003eImprove patients\u0026apos; physical and mental well-being\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eReduce analgesic dosage and side effects\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eStrengthen patients\u0026apos; belief in overcoming illness\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eImprove patients\u0026apos; quality of life\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eRestore confidence in treating the underlying disease\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 41px;\"\u003e\n \u003cp\u003eReduce the burden on caregivers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003ePhysical burden\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eEmotional burden\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eSocial burden\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eReduce caregiving conflicts\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"11\" style=\"width: 14px;\"\u003e\n \u003cp\u003eKey trigger points for surgical acceptance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 41px;\"\u003e\n \u003cp\u003eExternal support system evaluation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eImproving Health Insurance\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eLong-term treatment costs are low\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eThe family\u0026apos;s financial burden is light\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eCaregiver burden\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 41px;\"\u003e\n \u003cp\u003eAssessment of disease severity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eHigh severity of pain\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eSevere pain-related complications\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 41px;\"\u003e\n \u003cp\u003ePatient eligibility assessment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eThe patient is willing and/or able to undergo surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003ePostoperative convenience for patients\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 41px;\"\u003e\n \u003cp\u003eSurgical value assessment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eThe current approach does not alleviate the pain\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eSurgical treatment yields excellent results\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eThe benefits of surgery outweigh the risks\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"8\" style=\"width: 14px;\"\u003e\n \u003cp\u003eKey focus areas and pain points in care needs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 41px;\"\u003e\n \u003cp\u003ePerioperative comprehensive\u0026nbsp;\u003c/p\u003e\n \u003cp\u003emanagement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eSurgical incision care\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eIntrathecal pump housing maintenance\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003ePostoperative instructions\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eMedication guidance\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 41px;\"\u003e\n \u003cp\u003ePain management throughout the entire process\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003ePain assessment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eProvide emergency support\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eMultidisciplinary collaboration\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eOnline and offline integration\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" style=\"width: 14px;\"\u003e\n \u003cp\u003ePostoperative rational expectations regarding the condition\u003c/p\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 41px;\"\u003e\n \u003cp\u003eEffective pain control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eRelieve pain\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eReduce pain-related complications\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 41px;\"\u003e\n \u003cp\u003eAnticipating synergy and continuity in cancer treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003ePalliative care\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eAppropriately extend the product lifecycle\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eContinue treatment for the underlying condition\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003eRational understanding of the underlying disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eClear understanding of the disease\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThis study employs a Sankey diagram to visualize the hierarchical coding associations of family value experiences with intrathecal pumps: Over 50 specific expressions at the Codes level (e.g.\u0026ldquo;Effectively relieve pain\u0026rdquo;) were clustered into 20 Sub-themes (e.g.\u0026ldquo;Cognitive preparation for caregivers\u0026rdquo;), ultimately consolidated into 6 Themes. Among these, \u0026ldquo;Key trigger points for surgical acceptance\u0026rdquo; emerged as the core aggregating theme with 83 occurrences. The associative pathways across coding levels clearly reveal the multidimensional composition of family members\u0026apos; value experiences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 1\u003c/strong\u003e\u003cstrong\u003e；\u003c/strong\u003e\u003cstrong\u003eCore objectives of pain management\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme1\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003e\u003cstrong\u003eImprove patients\u0026apos; quality of life\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePain management for cancer patients troubles countless primary caregivers. In interviews, many primary caregivers mentioned that their core motivation for choosing intrathecal pump implantation during pain management was to improve end-of-life quality of life by effectively relieving pain, reducing medication dependency, maintaining daily activities, and enhancing overall comfort in daily living.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEffectively relieve pain\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;The primary goal is to alleviate the patient\u0026apos;s pain, as we are dealing with gastrointestinal tumors. Previously, oral pain medications had significant side effects and provided poor pain relief.\u0026rdquo; (Participant 8)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOvercome drug dependence\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I hope the patient\u0026apos;s pain management remains relatively stable, unlike before when sometimes medication worked and other times multiple injections were needed to control it. The pain fluctuated too unpredictably, leaving us family members at a loss.\u0026rdquo; (Participant 17)\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaintain daily life\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Keep pain stable at a low level that the patient can tolerate, without interfering with eating or sleeping, allowing the patient to get a full night\u0026apos;s rest.\u0026rdquo; (Participant 10)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEnhance the comfort of daily life\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eI hope he can use the bathroom on his own without having to grit his teeth in pain every time someone helps him. I also hope he can sleep at least 3-4 hours straight at night without constantly waking up in pain. I wish he could rest peacefully for a while, watch TV, or communicate with us. (Participant 12)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme 2:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Achieving physical and mental liberation for caregivers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWithin the context of traditional Confucian culture in China, family members\u0026apos; care for cancer patients carries profound ethical significance, regarded as a concrete manifestation of filial piety and benevolence. However, due to these cultural expectations, the reality of cancer caregiving often translates into a heavy dual burden on caregivers\u0026mdash;both physical and psychological\u0026mdash;who endure guilt and moral anxiety stemming from their inability to meet these demands.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEase emotions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u003c/em\u003e\u003cem\u003eFrom my selfish perspective, I no longer wish to hear her agonizing moans day and night\u0026mdash;that sound tears at my heart.\u003c/em\u003e\u003cem\u003e\u0026rdquo;\u003c/em\u003e\u003cem\u003e\u0026nbsp;(Participant 2)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImprove daily routines\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u003c/em\u003e\u003cem\u003eI think the patient himself is rather dramatic. He constantly cries and screams at home, and we can\u0026apos;t get any rest day or night either.\u003c/em\u003e\u003cem\u003e\u0026rdquo;\u003c/em\u003e\u003cem\u003e\u0026nbsp;(Participant 16)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 2: Preoperative decision-making motivations and perceptions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme3:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Source of motivation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study found that primary caregivers are not making decisions about intrathecal pump implantation blindly. They base their decisions on multiple information channels, including observing treatment outcomes in fellow patients, media information dissemination, clinical decisions made by pain specialists, and treatment recommendations for the underlying disease.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient treatment outcomes\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;We have a patient discussion group where several patients have undergone this procedure, and the outcomes have been generally positive. That\u0026apos;s why we decided to go ahead with it.\u0026rdquo; (Participant 19)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMedia information\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;We saw reports about the treatment in Shanghai\u0026apos;s Xinmin Evening News. Family members recommended it to me, saying this approach might help treat my father.\u0026rdquo; (Participant 4)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I learned about it through an online video. I also consulted some AI software and found this to be a relatively credible treatment method.\u0026rdquo; (Participant 19)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProfessional pain management decision-making\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u003c/em\u003e\u003cem\u003eWe first visited the pain clinic, where the director recommended starting with a semi-implanted device. If it proved effective, we could proceed with full implantation later. The pain specialist explained the treatment plan in great detail and offered various alternative therapies. Ultimately, the decision to proceed with the intrathecal pump implantation was our own choice.\u003c/em\u003e\u003cem\u003e\u0026rdquo;\u003c/em\u003e\u003cem\u003e\u0026nbsp;(Participant 4)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRecommendations for primary disease treatment\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I hadn\u0026apos;t been aware of this treatment option before. The oncologist recommended that if the medication couldn\u0026apos;t control the pain anymore, we should consult the pain management department to see if there were other options.\u0026rdquo; (Participant 13)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme4\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003e\u003cstrong\u003eCognitive preparation for caregivers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to value perception theory, caregivers\u0026apos; cognitive readiness prior to intrathecal morphine pump implantation directly influences their assessment of the treatment\u0026apos;s value, thereby determining their support for or acceptance of this intervention. This study found that caregivers\u0026apos; cognitive readiness is primarily manifested in the following aspects:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDosage\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I know this pump can precisely control medication dosage, which reduces the side effects of certain drugs. For example, we used to frequently experience constipation, but now with less medication, his bowel movements are regular.\u0026rdquo; (Participant 17)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRoute of administration\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I know that during surgery, doctors insert a very thin tube into the patient\u0026apos;s spine so that medication can be delivered directly.\u0026rdquo; (Participant 20)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSurgical procedure\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u003c/em\u003e\u003cem\u003eWe learned there are two surgical approaches: semi-implant and full-implant. Initially, we thought the full-implant might be more convenient, but the doctor felt the patient\u0026apos;s survival period might not be very long. After careful consideration, we opted for the semi-implant procedure.\u003c/em\u003e\u003cem\u003e\u0026rdquo;\u003c/em\u003e\u003cem\u003e\u0026nbsp;(Participant 5)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSurgical risks\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u003c/em\u003e\u003cem\u003eI know that fully implantable surgery carries a lower risk of infection, with no exposed tubing, allowing for greater freedom of movement. You don\u0026apos;t have to worry about water splashing on the tubing when showering or getting dressed.\u003c/em\u003e\u003cem\u003e\u0026rdquo;\u003c/em\u003e\u003cem\u003e\u0026nbsp;(Participant 10)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLong-term efficacy\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I understand it provides longer-lasting results than some neuro-radiofrequency procedures or nerve blocks, potentially offering a permanent solution.\u0026rdquo; (Participant 17)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme3\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003e\u003cstrong\u003eThe multidimensional manifestation of value perception\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme5:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Improve patients\u0026apos; physical and mental well-being\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants indicated that intrathecal pump implantation not only reduces patients\u0026apos; analgesic dosage and side effects but also strengthens their belief in overcoming the disease. This approach enhances patients\u0026apos; quality of life and restores their confidence in treating the primary condition. This value perception process has a bidirectional effect: it improves treatment adherence while simultaneously promoting the positive regulatory function of the family support system.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eReduce analgesic dosage and side effects\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;We observed that avoiding high doses of potent oral analgesics postoperatively spared the burden on the gastrointestinal tract, liver, and kidneys, as well as side effects like drowsiness, allowing patients to remain alert and conscious.\u0026rdquo; (Participant 10)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrengthen patients\u0026apos; belief in overcoming illness\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;For my mom, this is a life-saving value. She used to be in so much pain that she repeatedly said she didn\u0026apos;t want to live anymore. We couldn\u0026apos;t leave her side for a single \u0026nbsp; moment, afraid she might do something reckless. Now that the pain is gone, she\u0026apos;s starting to regain her confidence.\u0026rdquo; (Participant 2)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImprove patients\u0026apos; quality of life\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Before, when he was taking morphine tablets and getting injections, he was drowsy all day long, suffering from nausea and constipation\u0026mdash;it was very uncomfortable. Now that the dosage has been reduced, he\u0026apos;s much more alert during the day. Seeing him in less pain, his quality of life has improved a bit.\u0026rdquo; (Participant 7)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRestore confidence in treating the underlying disease\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u003c/em\u003e\u003cem\u003eFor him, the greatest value is that the pain relief allows him to live well again. We\u0026apos;re now focusing on planning subsequent tumor treatments\u0026mdash;the pain has become a thing of the past.\u003c/em\u003e\u003cem\u003e\u0026rdquo;\u003c/em\u003e\u003cem\u003e\u0026nbsp;(Participant 11)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme 6:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Reduce the burden on caregivers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSeveral participants mentioned that effective pain management can alleviate the physical, mental, and social burdens on caregivers while also reducing care conflicts with patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePhysical burden\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;After the intrathecal pump implantation, things became much easier for me. Otherwise, seeing her refuse to eat or drink, and then tossing and turning at night, was taking a toll on my body. Our family had to take 24-hour shifts just to care for her.\u0026rdquo; (Participant 14)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEmotional burden\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u003c/em\u003e\u003cem\u003eHis expression of pain has lessened, and we can now have some peaceful conversations or simply enjoy quiet companionship. This is so much better than before, when he was constantly tormented by pain and I was perpetually anxious and worried.\u003c/em\u003e\u003cem\u003e\u0026rdquo;\u003c/em\u003e\u003cem\u003e\u0026nbsp;(Participant 18)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSocial burden\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u003c/em\u003e\u003cem\u003eAs his wife, my greatest wish and responsibility is to do everything I can to ensure he lives with greater comfort, dignity, and less suffering during the time he has left.\u003c/em\u003e\u003cem\u003e\u0026rdquo;\u003c/em\u003e\u003cem\u003e\u0026nbsp;(Participant 10)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eReduce caregiving conflicts\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Now any care we give her feels like torture. She resists fiercely, and we can\u0026apos;t bear to see her suffer. If her pain is managed, I can bathe her, turn her over, and change her clothes without struggle\u0026mdash;it won\u0026apos;t be a painful ordeal for either of us.\u0026rdquo; (Participant 2)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 4:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Key trigger points for surgical acceptance\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme 7:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eExternal support system evaluation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSome participants indicated they would first evaluate external support systems, such as whether health insurance coverage is adequate, long-term treatment costs are low, the family\u0026apos;s existing financial burden is manageable, and whether the current caregiver\u0026apos;s workload is overwhelmingly burdensome. These are all factors they would assess before deciding to undergo surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImproving health insurance\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Since my father\u0026apos;s medical insurance is from outside Shanghai, we might also have financial considerations. So we want to ensure the semi-implantable pump works well before deciding on the fully implantable one.\u0026rdquo; (Participant 4)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I\u0026apos;ve looked into the cost of this pump, and it\u0026apos;s affordable for us because our insurance coverage is quite high. It doesn\u0026apos;t pose a financial burden.\u0026rdquo; (Participant 14)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLong-term treatment costs are low\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;At present, I don\u0026apos;t know how long he can use it. The patient has been using it for a month now. If it can last three to five years, then I think it\u0026apos;s worth it.\u0026rdquo; (Participant 16)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe family\u0026apos;s financial burden is light\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I\u0026apos;m not too familiar with other families, who might consider financial factors, but for our family, I believe we can afford it financially.\u0026rdquo; (Participant 16)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I first looked into the cost of the implantable pump. I know it might cost over 100,000 yuan out-of-pocket since it\u0026apos;s not covered by insurance. Financial considerations are important, but after discussing it as a family, we\u0026apos;re all willing to pay this amount for Dad\u0026apos;s treatment.\u0026rdquo; (Participant 4)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCaregiver burden\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;When the patient was at home, we couldn\u0026apos;t get any rest day or night, so why didn\u0026apos;t we consider other factors and just operate on him?\u0026rdquo; (Participant 1)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme 8\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003e\u003cstrong\u003eAssessment of disease severity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCaregivers\u0026apos; assessment of the patient\u0026apos;s disease severity is the most critical factor influencing the acceptance of surgical decisions. All participants indicated that they would only consent to intrathecal pump intervention when the patient\u0026apos;s pain exceeded tolerable limits or when severe complications had already developed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHigh severity of pain\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I didn\u0026apos;t consider other factors because the patient was already in unbearable pain.\u0026rdquo; (Participant 9)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I believe surgery should only be performed when pain control is no longer sufficient. If done prematurely, isn\u0026apos;t that overtreatment? Why resort to surgery when conservative treatment is possible?\u0026rdquo; (Participant 19)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSevere pain-related complications\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;We\u0026apos;ve been taking the strongest painkillers, but they\u0026apos;re no longer effective. The doses are so high that the side effects\u0026mdash;like drowsiness, constipation, nausea, and breathing issues\u0026mdash;have become unbearable.\u0026rdquo; (Participant 7)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;The pain has persisted for a very long time, severely impacting my ability to walk, sleep, and perform basic daily activities.\u0026rdquo; (Participant 17)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme 9:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Patient eligibility assessment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSeveral participants indicated that they would first ascertain the patient\u0026apos;s willingness to undergo surgery, which they considered crucial. If the patient themselves were unwilling to accept surgery or their underlying health conditions rendered them unsuitable for the procedure, family caregivers would not necessarily blindly pursue surgery either.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eThe patient is willing and/or able to undergo surgery\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;The patient has a strong desire for pain relief, and his physical condition has been assessed as capable of tolerating surgery.\u0026rdquo; (Participant 2)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Her current physical condition can withstand this surgery, and she herself is utterly terrified of the pain and has suffered enough, willing to try this new treatment.\u0026rdquo; (Participant 12)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePostoperative convenience for patients\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;We previously considered that having a long-term pump implanted in the body might also affect daily life, so we didn\u0026apos;t initially agree to the implantable pump surgery.\u0026rdquo; (Participant 6)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme10\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003e\u003cstrong\u003eSurgical value assessment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe value of postoperative recovery is also crucial for participants. One participant stated that the surgery represented the final effort to treat the patient, and they could accept it even if the outcome was unsatisfactory. The others all hoped that the postoperative value would meet their expectations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe current approach does not alleviate the pain\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;His body is too weak to handle anti-tumor treatments like radiation and chemotherapy. The doctors said conventional pain management has reached its limits.\u0026rdquo; (Participant 7)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSurgical treatment yields excellent results\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u003c/em\u003e\u003cem\u003eFor us, a month ago it was a state worse than death, but now the semi-implantable pump is working well. For long-term safety and comfort, switching to a fully implantable one is the necessary choice.\u0026rdquo; (Participant 10)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe benefits of surgery outweigh the risks\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Our primary concern was the surgical risks. I didn\u0026apos;t want to choose a more invasive procedure just to alleviate pain, only to accelerate the patient\u0026apos;s deterioration\u0026mdash;that was my greatest worry.\u0026rdquo; (Participant 17)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 5:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Key focus areas and pain points in care needs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme 11:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Perioperative comprehensive management\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHealth education for caregivers is essential to comprehensive perioperative management. The findings of this study indicate that family caregivers exhibit knowledge gaps in home-based care management, specifically in four areas: surgical incision care, maintenance of the intrathecal pump reservoir, postoperative precautions, and medication guidance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSurgical incision care\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Our current concern is this wound. The patient finds it painful and refuses to turn over, which may hinder proper healing.\u0026rdquo; (Participant 13)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;How should the wound be cared for at home? When can the patient shower? How can we tell if the wound is infected? We hope the inpatient nurses can provide clear instructions, ideally with written materials or a video.\u0026rdquo; (Participant 7)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIntrathecal pump housing maintenance\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Where should the pump be positioned? How can we avoid issues like bumping or pressure points\u0026mdash;for example, what sleeping positions are recommended? How should the safety belt be fastened?\u0026rdquo; (Participant 8)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePostoperative instructions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eWhat should I be mindful of in daily life? For instance, bathing, activity restrictions, or whether I can undergo certain tests like MRIs\u0026mdash;please make sure the nursing staff explains these thoroughly. (Participant 12)\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMedication guidance\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;We applied it yesterday. The doctor gave us a general explanation, but it didn\u0026apos;t help with the pain. I didn\u0026apos;t dare to use it, afraid that too much medication might cause side effects.\u0026rdquo; (Participant 15)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme 12:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Pain management throughout the entire process\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMultidisciplinary collaboration and thorough assessment are central to perioperative pain management with intrathecal pumps\u003csup\u003e[25]\u003c/sup\u003e,\u0026nbsp;Participants emphasized the need for comprehensive pain management for patients, including how to assess their pain levels and provide emergency support when drug side effects occur. They also expressed hope that the research team could assist with pain management through multidisciplinary collaborative treatment approaches, combining both online and offline formats.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePain assessment\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eHow can I determine if my intrathecal pump is working well after surgery? Should I keep a pain diary? If I feel my pain control is unsatisfactory or experience breakthrough pain, how should I adjust my medication? (Participant 10)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProvide emergency support\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;For instance, in handling emergencies\u0026mdash;if an elderly person accidentally takes too high a dose and experiences side effects\u0026mdash;how should family members respond?\u0026rdquo; (Participant 11)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMultidisciplinary collaboration\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe patient is experiencing both oropharyngeal cancer pain and postherpetic neuralgia. How can these two types of pain be managed simultaneously? Is it necessary to add other oral medications? We hope the pain management team and oncology team can communicate to provide us with a comprehensive pain management plan. (Participant 10)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOnline and offline integration\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;The pain management department has been very thorough with our follow-up care. There\u0026apos;s a WeChat group where we can consult online anytime, which I find very convenient. The engineer handling the pump operation is also very reliable.\u0026rdquo; (Participant 3)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 6: Postoperative rational expectations regarding the condition\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme 13:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Effective pain control\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEffective pain control following intrathecal pump implantation is a reasonable expectation shared by all participants. Participants believe that post-implantation pain relief should be provided while minimizing pain-related complications.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRelieve pain\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;We only hope he\u0026apos;s no longer in pain, and that everyone can help him through his final days with ease. That alone would be enough for us.\u0026rdquo; (Participant 1)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eReduce pain-related complications\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I hope he no longer fears eating or loses sleep due to excruciating pain, and that he can achieve consistent, restful sleep.\u0026rdquo; (Participant 10)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme 14\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;: Anticipating synergy and continuity in cancer treatment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDue to the physical toll of pain on patients, they often cannot tolerate treatments such as chemotherapy and radiotherapy for tumors. Some participants indicated that with effective pain management, patients could continue tumor treatments and achieve peace in their final stages. Five family caregivers expressed hope that pain relief would moderately extend the patients\u0026apos; survival period.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePalliative care\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;We hope patients can spend their final days in peace, without too much suffering, and that family members can accompany them through their last journey with ease.\u0026rdquo; (Participant 17)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAppropriately extend the product lifecycle\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eWe still hold onto hope that patients will stay with us a little longer. All we can do is be there for them in their final days. (Participant 6)\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContinue treatment for the underlying condition\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;The current hope is to alleviate his suffering and give him the strength to undergo the next phase of treatment. That might lead to an improvement in his condition, which would be the best outcome.\u0026rdquo; (Participant 15)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme15:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Rational understanding of the underlying disease\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMost participants believed the tumor\u0026apos;s progression was uncontrollable, hoping only that postoperative care could alleviate the physical and mental suffering caused by pain. They had a relatively clear understanding of the primary disease.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClear understanding of the disease\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;When it comes to tumors, they\u0026apos;ll do what they\u0026apos;re going to do. We wouldn\u0026apos;t expect a patient with advanced cancer to suddenly get better.\u0026rdquo; (Participant 11)\u003c/em\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study, based on qualitative interviews, found that the decision-making process for intrathecal pump implantation is fundamentally a balancing act for family caregivers weighing \u0026ldquo;treatment value\u0026rdquo; against multiple burdens. Caregivers commonly face the triple pressures of psychological anxiety, physical exhaustion, and loss of social roles, consistent with previous research findings\u003csup\u003e[26, 27]\u003c/sup\u003e. Analysis indicates that these pressures may stem directly from the high-intensity care demands resulting from inadequate pain management in patients, a factor considered the primary driver of the care burden\u003csup\u003e[28]\u003c/sup\u003e. Therefore, the \u0026ldquo;mutual benefit for patients and caregivers\u0026rdquo; provided by intrathecal pumps extends beyond the medical dimension of pain relief to encompass the overall maintenance of family system functionality. Research confirms that effective pain intervention can directly alleviate the physical and mental stress experienced by caregivers\u003csup\u003e[29]\u003c/sup\u003e, This is consistent with our research findings. However, research indicates that the realization of perceived value among family caregivers following intrathecal pump implantation is constrained by both knowledge gaps and management anxieties. Although our institution partially alleviated post-implantation management anxieties through comprehensive perioperative care and digital support platforms (such as patient WeChat groups and online consultations), Nevertheless, findings indicate that caregivers' concerns about the technical complexity and treatment costs often outweigh their awareness of the harm caused by pain itself. This tendency leads them to favor maintaining the status over pursuing active intervention when making decisions\u003csup\u003e[30]\u003c/sup\u003e. Many families remain trapped in the cognitive dilemma of \u0026ldquo;pain endurance culture\u0026rdquo; and \u0026ldquo;treatment aversion.\u0026rdquo; Therefore, it is recommended that pain management teams prioritize systematic pre-treatment assessments. Within clinical pathways, caregivers' value perception factors should be identified early on\u0026mdash;encompassing not only their financial capacity and caregiving capabilities but also the balance between \u0026ldquo;risk perception\u0026rdquo; and \u0026ldquo;benefit recognition\u0026rdquo; in their decision-making psychology. Through structured communication and education, transforming intrathecal pump management from an \u0026ldquo;unknown burden\u0026rdquo; into a \u0026ldquo;manageable process\u0026rdquo; can help families overcome decision barriers. This approach enables precise pain management centered on patient quality of life and grounded in family support systems.\u003c/p\u003e \u003cp\u003eThis study further reveals a decision-making framework model for family caregivers of patients undergoing intrathecal pump implantation (Fig.\u0026nbsp;2). Centered on \u0026ldquo;key decision-making starting points,\u0026rdquo; this model reflects the multidimensional interactive mechanism of value perception. Within the model, four core elements are interconnected, encompassing specific considerations such as the family's financial burden and caregiving pressure, pain levels and related complications, risk-benefit assessments and the effectiveness of current treatment plans, as well as patient convenience and tolerance. Simultaneously, these core elements are dynamically influenced by peripheral factors including decision drivers, cognitive factors, value perceptions, reasonable expectations, and care needs. Collectively, they converge toward the core objective of caregiver decision-making, revealing the complex process by which family caregivers balance medical needs, patient condition, external support, and personal value judgments in healthcare decisions \u003csup\u003e[31]\u003c/sup\u003e. This aligns with the critical role of value perception in major healthcare decisions, as highlighted in the study by Gon\u0026ccedil;alves et al \u003csup\u003e[32]\u003c/sup\u003e. When healthcare providers systematically involve family caregivers in shared decision-making, patients receive better home care and may achieve optimized clinical outcomes\u003csup\u003e[33]\u003c/sup\u003e. Moreover, in today's era of widespread digital information, Chinese citizens have a particular preference for this type of health science communication\u003csup\u003e[34]\u003c/sup\u003e. Healthcare professionals can guide caregivers to enhance their understanding of intrathecal pump technology through authoritative visual educational content (such as curated medical animations, short videos, etc.) to alleviating the decline in decision-making participation and assessment capabilities caused by information asymmetry\u003csup\u003e[35, 36]\u003c/sup\u003e, and enhancing the acceptance and adherence to medical recommendations. This process fundamentally transforms caregivers from passive implementers into informed decision-making partners by increasing their clarity of value perception and sense of control. Therefore, clinical pain management teams must conduct systematic shared decision-making communication before recommending such high-cost interventions, proactively assessing and addressing caregivers' specific concerns across four key dimensions.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003ePoorly controlled cancer pain significantly reduces patients' quality of life and exacerbates their anxiety and depression\u003csup\u003e[37]\u003c/sup\u003e. At the same time, the central role of family caregivers in pain management is often undermined by inadequate social support systems\u003csup\u003e[38]\u003c/sup\u003e. Ultimately, this leads to a vicious cycle of \u0026ldquo;poor pain management exacerbating caregiver burden\u0026rdquo;. Social support systems are not merely emotionally oriented caregiving assistance\u003csup\u003e[39]\u003c/sup\u003e, including structural safeguards such as the medical insurance system and healthcare management pathways\u003csup\u003e[40]\u003c/sup\u003e. For example, in this study, some families opted for the more economical semi-implantable pump option under their doctors' recommendations due to limitations imposed by their health insurance plans. This suggests that health insurance directly impacts the accessibility of medical decisions\u003csup\u003e[41]\u003c/sup\u003e. The medical team should proactively assess the patient's financial resources and balance medical necessity with economic sustainability when developing treatment plans\u003csup\u003e[42]\u003c/sup\u003e. This enhances families' trust in treatment recommendations, laying the decision-making foundation for ultimately achieving patient-centered precision pain management. Currently, postoperative management of intrathecal pumps in China remains primarily inpatient-based, lacking a systematic \u0026ldquo;clinical-home-community\u0026rdquo; transition pathway\u003csup\u003e[43]\u003c/sup\u003e. This study reveals that caregivers commonly face knowledge and skill gaps regarding pump maintenance, pain assessment, and daily life management after discharge. Therefore, it is essential to establish a comprehensive support pathway covering the entire care cycle: from preoperative comprehensive assessment, education, and adaptive training; to self-management skill development during treatment; to continuous reinforcement of home care capabilities post-discharge; ultimately facilitating the restoration and reintegration of social functioning for both patients and caregivers. Only through a multi-tiered, continuous support system can we truly overcome the current limitations in cancer pain management and achieve precise, family-centered care.\u003c/p\u003e\n\u003ch3\u003eLimitations\u003c/h3\u003e\n\u003cp\u003eAll study participants were drawn from inpatient pain management units, where high adherence to analgesic treatment may introduce selection bias. Future research will expand to additional clinical settings, such as oncology departments, to explore the underlying reasons for acceptance or rejection of intrathecal pump implantation across diverse patient populations, thereby enhancing the study's external validity.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study employed a descriptive phenomenological approach to explore the value perception process of family caregivers in cancer patients during decision-making for intrathecal analgesic pump implantation. Results indicate that this decision inherently represents a \u0026ldquo;patient-caregiver mutual benefit\u0026rdquo; choice, yet most patients remain trapped in a vicious cycle of \u0026ldquo;enduring pain-breaking down.\u0026rdquo; Recommendations are as follows: First, systematically assess the medical background and decision-influencing factors of both patients and caregivers, provide psychological support and conceptual guidance, and develop individualized treatment strategies. Second, for families opting for implantation, establish multidisciplinary teams to implement comprehensive perioperative management and home care competency training. Future efforts should center on \u0026ldquo;pain manageability\u0026rdquo; as the educational core, using shared decision-making as the pathway to build an integrated care model encompassing physiological, psychological, and social dimensions. By early identification and intervention of factors delaying decision-making, the vicious cycle can be broken. Precise technology should uphold patient dignity, while systemic support should bridge care gaps.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe sincerely thank all the participants in this research for their time and effort invested. Special thanks go to Dr. Liao Lijun for her project consultation and financial support provided for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eApproved for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis manuscript does not contain any data, images, or other materials that could identify participants personally. Therefore, this section is not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1 Pudong New Area Health System Medical Discipline Construction Funding\u003c/p\u003e\n\u003cp\u003e2 Quality Clinical Specialty Program of High-end Medical Disciplinary Construction in Shanghai Pudong New Area\u0026nbsp;（2024-PWXZ-02）\u003c/p\u003e\n\u003cp\u003e3 The Outstanding Leaders Training Program of Shanghai Pudong New Area Health Commission (PWR12024-07)\u003c/p\u003e\n\u003cp\u003e4 Shanghai East Hospital Talent Research Launch Plan (DFRC2024002)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the authors have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data used in this study can be provided to the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eResearch Design: Gao Yili, Qin Jiawen, Liao Lijun, Duan Wenzhi\u003c/p\u003e\n\u003cp\u003eData Collection: Gao Yili, Liu Zhenyuan, Zhang Jinyuan, Yu Xiuqin, Hou Qianhao\u003c/p\u003e\n\u003cp\u003eData Analysis: Gao Yili, Qin Jiawen, Duan Wenzhi\u003c/p\u003e\n\u003cp\u003eFirst Draft Writing: Gao Yili, Qin Jiawen\u003c/p\u003e\n\u003cp\u003eConsultation on the Project: Liao Lijun, Wang Xiangrui\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical Approval and Informed Consent This study was thoroughly reviewed and subsequently approved by the Ethics Committee of East Hospital Affiliated to Tongji University in Shanghai, China (Approval Number: 2025YS-007). All research procedures strictly followed the ethical principles outlined in the Helsinki Declaration. Informed consent forms were obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSCHWARTZ S M. Epidemiology of Cancer [J]. Clin Chem, 2024, 70(1): 140\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eSIEGEL R L, GIAQUINTO A N, JEMAL A. Cancer statistics, 2024 [J]. CA Cancer J Clin, 2024, 74(1): 12\u0026ndash;49.\u003c/li\u003e\n\u003cli\u003eWu Qi, Fan Boman, Li Yan. Analysis and Interpretation of the 2022 Global Cancer Statistics Report: Cancer Disease Burden and Epidemiological Trends in China and Worldwide [J]. Theory and Practice of Diagnosis, 2025, 24(02): 135\u0026ndash;45.\u003c/li\u003e\n\u003cli\u003eCai Lin, Zhu Chengxin, Yuan Jiani, et al. 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Strategies of complementary and integrative therapies in cancer-related pain-attaining exhaustive cancer pain management [J]. Support Care Cancer, 2019, 27(8): 3119\u0026ndash;32.\u003c/li\u003e\n\u003cli\u003eAKTER J, KONLAN K D, NESA M, et al. Factors influencing cancer patients\u0026apos; caregivers\u0026apos; burden and quality of life: An integrative review [J]. Heliyon, 2023, 9(11): e21243.\u003c/li\u003e\n\u003cli\u003eJADIDI A, AMERI F. Social Support and Meaning of Life in Women with Breast Cancer [J]. Ethiop J Health Sci, 2022, 32(4): 709\u0026ndash;14.\u003c/li\u003e\n\u003cli\u003eCUI P, SHI J, LI S, et al. Family resilience and its influencing factors among advanced cancer patients and their family caregivers: a multilevel modeling analysis [J]. BMC Cancer, 2023, 23(1): 623.\u003c/li\u003e\n\u003cli\u003eKAUFF N D, SCHEUER L, ROBSON M E, et al. Insurance reimbursement for risk-reducing mastectomy and oophorectomy in women with BRCA1 or BRCA2 mutations [J]. 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Pain Manag Nurs, 2025, 26(2): e207\u0026ndash;e14.\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-palliative-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pcar","sideBox":"Learn more about [BMC Palliative Care](http://bmcpalliatcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pcar/default.aspx","title":"BMC Palliative Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Cancer, Pain, Intrathecal Pump, Perceived Value, Family Caregivers, Qualitative Research","lastPublishedDoi":"10.21203/rs.3.rs-8497612/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8497612/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eCancer represents a major public health challenge globally and in China, with its incidence continuing to rise, imposing a heavy physical and psychological burden on patients and diminishing their quality of life. Cancer pain, one of the most common and complex symptoms experienced by cancer patients, has a high prevalence and diverse origins, severely impacting patients' quality of life. Opioids remain central to cancer pain management, yet their efficacy is often suboptimal. Intrathecal drug delivery systems, a highly effective and safe treatment for refractory cancer pain, remain underutilized in clinical practice. Concurrently, family caregivers play a pivotal role in pain management decisions, with their perception of treatment value directly influencing acceptance and implementation. Therefore, exploring family caregivers' value perceptions, decision-making motivations, and core needs regarding intrathecal pumps holds significant importance for optimizing patient-centered, precision pain management pathways.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eThis study aims to uncover the decision-making factors influencing family caregivers' acceptance of intrathecal analgesic pumps, their core demands regarding pain management value, and pain points in caregiving needs among cancer pain patients. It seeks to provide empirical evidence for optimizing precision pain management pathways centered on preserving patients' dignity and quality of life. This qualitative descriptive study conducted in-depth semi-structured interviews at the Pain Management Department of Shanghai East Hospital, Tongji University, from April to September 2025. All interviews were audio-recorded and transcribed. Analysis followed Colaizzi's seven-step method, identifying and organizing thematic clusters from statements within the transcribed interviews. MAXQDA software was used to code and identify relationships between themes and subthemes.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eData saturation was achieved with 20 participants. Based on value perception theory, analysis from the primary family caregiver perspective revealed six themes and 15 subthemes: (1) core objectives of pain management (improve patients' quality of life, achieving physical and mental liberation for caregivers); (2) preoperative decision-making motivations and perceptions (source of motivation, cognitive preparation for caregivers); (3) multidimensional manifestations of value perception (improving patients' physical and mental well-being, reduce the burden on caregivers); (4) key trigger points for surgical acceptance (external support system evaluation, assessment of disease severity, patient eligibility assessment, surgical value assessment); (5) key focus areas and pain points in care needs (perioperative comprehensive management, pain management throughout the entire process); (6) Postoperative rational expectations regarding the condition (effective pain control, anticipating synergy and continuity in cancer treatment, rational understanding of the underlying disease).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003ePain management teams must establish an integrated care model anchored in the educational principle of \u0026ldquo;pain controllability,\u0026rdquo; guided by shared decision-making between physicians and patients, and culminating in holistic care addressing physical, psychological, and social dimensions. By early assessment of factors delaying patient decision-making, this approach breaks the \u0026ldquo;endure pain-breakdown\u0026rdquo; cycle. Technical precision safeguards patients' dignity in living, while sustained social support systems address gaps in care.\u003c/p\u003e","manuscriptTitle":"The Value Experience of Intrathecal Pump Implantation for Cancer Pain Patients: A Qualitative Study Focusing on Family Caregivers","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-02 10:19:55","doi":"10.21203/rs.3.rs-8497612/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"73904460209690091723980553405495666463","date":"2026-01-29T12:56:56+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-29T12:01:30+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-28T08:03:05+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-28T03:09:35+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Palliative Care","date":"2026-01-28T03:03:28+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-palliative-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pcar","sideBox":"Learn more about [BMC Palliative Care](http://bmcpalliatcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pcar/default.aspx","title":"BMC Palliative Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"42a82b65-88f4-470f-8850-9377ba0516a2","owner":[],"postedDate":"February 2nd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-02T10:19:55+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-02 10:19:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8497612","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8497612","identity":"rs-8497612","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}