Empowering Kuwaiti adults with cancer: oncology nurses’ perspectives on home-based self-management

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As cancer care increasingly shifts toward outpatient and home-based models, this study aimed to explore oncology nurses’ perspectives on how Kuwaiti adults with these cancers navigate home-based self-management, and to identify strategies used to empower patients in this process. Methods: A qualitative study using a constructivist grounded theory approach was conducted in 2022 at a specialized cancer care center in Kuwait. Semi-structured interviews were held with seven purposively selected oncology nurses, each with at least two years of experience. Data were analyzed using constant comparative methods and theoretical coding. Results: The central theme identified was “Holistic empowerment and self-management in cancer care amidst systemic challenges,” supported by eight subthemes including patient education, emotional support, cultural sensitivity, and resource limitations. Nurses emphasized the importance of personalized education, emotional care during transitions, and culturally sensitive communication. Systemic barriers such as staff shortages, limited educational resources, and socioeconomic disparities were highlighted. Community organizations were noted as key partners in supplementing care. Conclusion: Oncology nurses play a vital role in facilitating home-based self-management for cancer patients in Kuwait. Strengthening their capacity through targeted training, policy support, and resource allocation can enhance patient autonomy and improve outcomes. These findings underscore the need for systemic reforms to support nurse-led empowerment strategies in oncology care. oncology nurses cancer self-management breast cancer colorectal cancer patient empowerment Kuwait Background Cancer remains a significant global health burden, characterized by high morbidity and mortality rates [1]. In Kuwait, breast and colorectal cancers are particularly prevalent, representing a growing public health concern [2]. Addressing the challenges faced by survivors’ post-diagnosis is crucial, especially in fostering effective home-based self-management practices. Self-management is defined as an individual's capacity to manage symptoms, treatments, and lifestyle adjustments in collaboration with family, healthcare providers, and the community [3]. This multifaceted process is shaped by factors such as health literacy, familial support, and professional guidance. Oncology nurses play a pivotal role in this context by equipping patients with the tools and confidence needed to navigate their chronic conditions [4, 5]. Empowered patients often achieve better health outcomes through effective self-management strategies [4]. However, barriers such as limited health service knowledge, cultural stigma, and inadequate resources can undermine these efforts [6]. Comprehensive health education campaigns are essential for addressing these challenges, promoting informed decision-making, and reducing societal stigma associated with cancer. Oncology nursing and patient empowerment Oncology nurses are at the forefront of cancer care, with responsibilities that include education, emotional support, and ongoing monitoring. Their role extends to fostering health literacy and improving adherence to treatment protocols, ultimately enhancing patient outcomes [7]. Nurses empower patients to take an active role in their care, building confidence and autonomy [4]. By offering tailored support and timely information, oncology nurses enable cancer survivors to address both medical and psychosocial challenges. Aim of the study This constructive grounded study explores the home self-management processes of Kuwaiti adults living with breast and colorectal cancer, focusing on insights from oncology nurses. By incorporating nurses’ perspectives, this research aims to develop a mid-range substantive theory to enhance cancer management strategies in Kuwait. Research question The study investigates the question: What are the perceptions of oncology nurses regarding how Kuwaiti adults living with colorectal or breast cancer navigate the home-based self-management process? Methodology This study employed a constructivist grounded theory approach to explore home self-management processes related to cancer. Data collection involved semi-structured interviews with seven purposively sampled oncology nurses working in a cancer center in Kuwait. Design This qualitative study adopted Charmaz's [8], constructivist grounded theory methodology, emphasizing the co-construction of knowledge and prioritizing participants' subjective realities within their sociocultural context [9]. This approach facilitated an in-depth understanding of the nurses’ perspectives regarding cancer self-management among breast and colorectal cancer survivors in Kuwait. Sampling procedure and sample size determination We employed both purposive and theoretical sampling to select study participants. Purposive sampling ensured initial participants were representative of the phenomenon under study. As data collection and coding progressed, theoretical sampling was employed to refine and enrich emerging categories, adhering to grounded theory principles. Grounded theory research determines sample size by theoretical saturation, where no new data emerges, and categories are fully developed [9]. The study achieved data saturation after collecting data from seven oncology nurses. Recruitment Recruitment involved advertising materials that were approved by relevant authorities. Interested participants contacted the research team via email or telephone and underwent eligibility screening. Eligible participants received detailed study information and provided informed consent through fax, electronic submission, or in person and all participants who were contacted agreed to participate. Eligibility criteria Oncology nurses with at least two years of experience providing direct care to cancer patients, fluent in English or Arabic, and willing to participate in the study were included. Data collection Data collection involved demographic questionnaires and qualitative data obtained through face-to-face semi-structured individual interviews. Participants could opt for telephone or video conference interviews for flexibility. Interviews lasted approximately 60 minutes and were guided by open-ended questions exploring the nurses’ perspectives on cancer self-management. Interviews were audio-recorded, transcribed verbatim, and supplemented with field notes documenting observations and reflections during the interviews. Demographic data, interview transcripts, and consent forms were initially prepared in Arabic and translated into English after analysis. All interviews were conducted in private settings to maintain confidentiality. Data analysis Data analysis followed Charmaz and Belgrave's [10] constructivist grounded theory framework, employing the constant comparative approach: Initial coding : Labels were assigned to words, lines, or sections to identify emerging themes [10]. Memo writing : Memos captured reflections on themes, concepts, and participant-shared relationships [10, 11]. Focused coding : Targeted codes developed theoretical categories, with constant comparisons identifying patterns within and across interviews [10]. Theoretical coding : Relationships between major categories were conceptualized to develop a substantive theory, articulating core psychosocial processes related to the phenomenon [10, 11]. This iterative process compared new data with existing categories, ensuring a robust theoretical framework. The analysis culminated in a core category addressing the study's primary research question. Data analysis was manually conducted and is detailed in Supplementary File 1. The first author, an Assistant Professor experienced in qualitative nursing research, led the data collection and analysis. No prior relationship existed between the researcher and participants. All coding and interpretations were verified by other research team members. Findings The study identified a core category and eight interconnected subcategories that together highlight the significant roles oncology nurses play in cancer care in Kuwait. These findings shed light on the challenges and opportunities in empowering cancer patients through holistic, patient-centered approaches amidst systemic barriers. Core Category: Holistic empowerment and self-management in cancer care amidst systemic challenges The central theme emerging from this study- holistic empowerment and self-management in cancer care amidst systemic challenges captures the dynamic and multifaceted role of oncology nurses in supporting Kuwaiti adults living with breast and colorectal cancer. This core category reflects how nurses navigate complex healthcare environments to empower patients and their families through education, emotional support, and culturally sensitive care, despite facing significant systemic and resource-related constraints. Oncology nurses in Kuwait adopt a comprehensive approach to empowerment that extends beyond clinical instruction. They provide patients with practical tools for managing symptoms, medications, and post-treatment care at home, while also addressing emotional and psychological needs. This dual focus on technical and emotional support is particularly critical during care transitions, such as post-surgery discharge or palliative care initiation, where patients often experience heightened vulnerability. Nurses act as consistent sources of reassurance, offering empathetic communication and referrals to psychological services when needed. However, this empowerment process unfolds within a healthcare system marked by notable limitations. Nurses reported chronic staff shortages, insufficient educational materials, and limited access to affordable medications. These constraints often force them to rely on external organizations and charities to bridge care gaps. Despite these challenges, nurses remain committed to delivering patient-centered care, adapting their strategies to meet individual needs and readiness levels for self-management. Cultural and socioeconomic disparities further complicate the empowerment process. Language barriers, health literacy gaps, and financial hardship influence patients’ ability to engage in self-care. Nurses respond by tailoring communication strategies, advocating financial support, and ensuring that care is respectful of cultural norms and values. For example, they address body image concerns and fear-driven treatment decisions, such as opting for mastectomy due to stigma, by facilitating informed, compassionate discussions that honor patient autonomy. Importantly, nurses recognize that empowerment is not a one-size-fits-all process. Patients vary in their emotional resilience, technical understanding, and willingness to assume responsibility for their care. Nurses must therefore remain flexible, adjusting their approach to provide either technical guidance or emotional reassurance as needed. This adaptability is a hallmark of holistic care and is essential for building trust and fostering long-term engagement in self-management. In summary, this core category illustrates how oncology nurses in Kuwait serve as both caregivers and advocates, working within and around systemic barriers to empower patients. Their efforts underscore the need for institutional support, including targeted training, policy reforms, and resource allocation, to sustain and enhance nurse-led empowerment strategies in cancer care. By embracing a holistic model of care, nurses not only improve patient outcomes but also contribute to a more equitable and responsive healthcare system. Subcategories: Patient empowerment through health education and family support Oncology nurses placed significant emphasis on equipping patients and their families with the skills and knowledge required for effective self-care at home. This included practical training on medication management, wound care, and post-surgical exercises, as well as strategies to manage anxiety and emotional distress. One nurse shared, “We constantly give them health teaching... how to empower them to be self-reliant or to do self-management at home.” Another nurse highlighted, “For breast cancer patients, we discuss with them how to perform postmastectomy arm exercises with the help of our physiotherapists.” Smoking cessation education was also an area of focus, reflecting nurses’ commitment to promoting long-term health. Care coordination and emotional care during transitions Care transitions, particularly in late-stage cancer, often cause emotional distress as one nurse stated, “They need psychological support, most patients will be depressed due to their condition.” Nurses provide essential emotional care, fostering trust and continuity during these vulnerable periods. Their support includes active listening, reassurance, and empathetic communication to help patients and families navigate the complexities of care. In some cases, nurses refer more complicated cases such as those in emotional distress for further management; “We will inform the doctor and refer the patient to the psychiatrist or the Al Sidra team.” Resource limitations affecting care delivery Nurses identified significant resource shortages, including staffing, educational materials, medical supplies, and affordable medications. One nurse stated how staff shortage is a reality at their facility; “Nowadays we face a lot of staff shortage. So, it is very difficult to find time.” Oncology nurses reported often relying on external organizations and charities to fill these gaps. This constraint impacts the delivery of comprehensive care, requiring nurses to adapt and innovate to ensure patients receive the best possible support. One nurse recollected; “If we get more resources like audiovisual aids, we could help them understand better.” Cultural and socioeconomic disparities in care Cultural norms, language barriers, and financial limitations influence patient care as one nurse reported; “The main barrier is communication. Some patients do not understand English”. Nurses demonstrated adaptability by modifying communication strategies and offering culturally sensitive care. They also advocated for patients by connecting them with financial assistance programs and ensuring their voices were heard within the healthcare system. Fear-driven treatment choices and body image concerns Fear of recurrence and concerns about body image emerged as significant factors in patients’ treatment decisions. One nurse stated; "Their concern is that people might judge them, like when they see them without their breasts, or their spouses would see them." Many patients opted for aggressive treatments like mastectomy over less invasive options due to fears. Nurses played a critical role in addressing these concerns by offering emotional reassurance and facilitating informed decision-making. Readiness and reluctance for self-management Successful self-management depends heavily on the readiness of patients and families. Nurses frequently encountered resistance or lack of preparedness, necessitating gradual education and encouragement. This process involved building trust, addressing fears, and tailoring strategies to individual circumstances as one nurse noted; "We constantly give them health teaching. If we have ample time to be with them, sit with them, discuss with them what they can do, or how to empower them like to be self-reliant or to be able to do self-management of their condition in the home." Community and external support for emotional and financial relief Community organizations provided essential supplementary support, including financial assistance and counseling. These resources eased the burden on patients and families, complementing the care delivered by nurses. One nurse explained; "We offer them some psychological help. In our KCCC we can get psychological help from our Alsidra, it's a non-governmental organization." This external support system was vital for addressing gaps in healthcare access and affordability. Adaptive care to meet diverse patient needs Nurses demonstrated remarkable flexibility in tailoring care to meet individual patient needs. Some patients required technical guidance, while others benefited more from emotional reassurance as highlighted by one nurse; "Not all patients respond the same way. Some need constant reassurance, others need technical advice, and we have to adjust our approach." This adaptability highlights the importance of personalized care in fostering trust and improving outcomes. Discussion The findings of this study underscore the vital role of oncology nurses in empowering cancer patients and their families. By addressing knowledge, emotional support, care coordination, and systemic barriers, nurses create a framework for effective self-management and improved quality of life of people with breast and colorectal cancer. Patient education emerged as a cornerstone of empowerment, reducing anxiety and enhancing self-care capabilities. Nurses focused on practical guidance, such as medication management and post-surgical care, and emotional support strategies. Studies like Jiang and Liu [12], corroborate these findings, showing that nurse-led interventions significantly reduce depression and anxiety while improving quality of life of patients with cancer. Lin and Fang [13], also emphasized the value of discharge education in improving readiness for home care, aligning with the practices reported by nurses in this study. Emotional distress during care transitions, particularly for late-stage cancer patients, necessitates compassionate support. Nurses play a pivotal role in alleviating fears and providing continuity of care, as also reported by Jiang and Liu [12], who found behavioral-focused nursing interventions to be instrumental in enhancing emotional well-being and treatment compliance. Resource shortages pose significant challenges to care delivery, as highlighted in this study and in Walsh and Harrison [14]. These limitations necessitate innovative approaches and partnerships with external organizations. Advocacy for increased resource allocation is critical to addressing these systemic barriers. Cultural and socioeconomic factors create inequities in healthcare access, necessitating culturally sensitive care approaches. Ferraris amd Coppini [15], in their study highlighted similar challenges, emphasizing the need for tailored interventions to bridge these disparities. Psychological factors such as fear of recurrence and body image concerns heavily influence treatment choices. Amini-Tehrani and Zamanian [16], found that these factors exacerbate psychological distress, underscoring the need for integrated psycho-oncological support in oncology care. Communication barriers and lack of readiness for self-management are consistent challenges, as also noted by Banerjee, Manna [17]. Training programs for nurses in communication skills can help address these issues and foster better engagement with patients and families. The involvement of community organizations in providing emotional and financial relief in cancer care complements the role of nurses, as highlighted by Carrera, Kantarjian [18]. Enhancing these partnerships can further alleviate patient and family burdens. Personalized care strategies that account for individual needs and circumstances are critical for improving patient outcomes. This adaptability ensures that care is responsive and effective, fostering trust and long-term engagement. Implications The findings of this study have significant implications for oncology nursing practice, healthcare policy, and future research. Nursing practice Oncology nurses must continue to focus on patient and family education as a means to empower self-management and promote long-term health outcomes. Emotional care should be emphasized as an integral component of oncology nursing, particularly during transitions in care and end-of-life stages. Nurses need training in culturally sensitive care approaches to bridge disparities and provide equitable healthcare. Healthcare policy Policymakers should address systemic resource shortages by increasing funding for oncology care, including educational materials, medical supplies, and affordable medications. Healthcare systems should strengthen collaborations with community organizations to provide supplementary financial and emotional support to patients and families. Reforms should aim to reduce cultural and socioeconomic barriers to cancer care, ensuring equitable access to resources and services for all patients. Future research Further studies should explore the long-term outcomes of nurse-led interventions on patient empowerment, self-management, and quality of life. Research should also investigate strategies for addressing the psychological factors, such as fear and body image concerns, that influence patient decision-making. The effectiveness of culturally tailored interventions in reducing disparities in care delivery warrants deeper examination. Limitations of the study This study has several limitations that should be acknowledged: The research was conducted with a limited sample size of oncology nurses in Kuwait, which may not fully represent the diversity of experiences across different regions or healthcare systems. Self-reported data from participants may be subject to recall bias or social desirability bias, potentially influencing the authenticity of the responses. The study focused exclusively on the perspectives of oncology nurses, omitting the experiences and views of cancer patients and their families, which could provide a more comprehensive understanding of the challenges and opportunities in cancer care. Nevertheless, these perspectives have been reported in other publication. The qualitative nature of the study, while valuable for depth, limits the ability to generalize findings to broader populations. Conclusion This study highlights the pivotal role of oncology nurses in empowering breast and colorectal cancer patients and their families through holistic, patient-centered care in Kuwait. By providing education, emotional support, and self-management guidance, nurses help patients navigate the complexities of cancer treatment and improve their quality of life. However, systemic challenges, including resource limitations, cultural disparities, and psychological barriers, continue to hinder optimal care delivery. Addressing these challenges requires a multi-faceted approach involving enhanced training for nurses, increased resource allocation, and policy reforms aimed at equitable healthcare. Future research should focus on broadening the scope of this study to include patient perspectives and quantitative data, further informing strategies to empower cancer patients worldwide. The findings underscore the critical need for healthcare systems to support oncology nurses in their roles, ensuring they have the tools and resources necessary to deliver effective, compassionate, and culturally sensitive care. Declarations Acknowledgements: We sincerely acknowledge and extend our gratitude to the oncology nurses who participated in this study, sharing their invaluable insights and experiences to advance the understanding of cancer care in Kuwait. Competing interests : The authors have no relevant financial or non-financial interests to disclose. Funding: The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Author contributions : MA conceptualized the study, spearheaded data collection, analysis and drafting the manuscript. KA, EA, and DT contributed in conceptualization of the study, participated in data collection and analysis, and proofread the manuscript. SN contributed in writing and editing the manuscript and preparation of the final submission documents. All authors read and approved of the final manuscript and agree to be accountable for all aspects of the work. Ethics approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the Ministry of Health, Kuwait, reference number (2022/2176). Consent to participate: Informed consent was obtained from all individual participants included in the study. References Kocarnik, J.M., et al., Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life Years for 29 Cancer Groups From 2010 to 2019: A Systematic Analysis for the Global Burden of Disease Study 2019. JAMA Oncol, 2022. 8 (3): p. 420-444. Alhuraiji, A., et al., General Oncology Care in Kuwait , in Cancer in the Arab World , H.O. Al-Shamsi, et al., Editors. 2022, Springer Singapore: Singapore. p. 99-114. Dineen-Griffin, S., et al., Helping patients help themselves: A systematic review of self-management support strategies in primary health care practice. PLoS One, 2019. 14 (8): p. e0220116. Howell, D., et al., Management of Cancer and Health After the Clinic Visit: A Call to Action for Self-Management in Cancer Care. J Natl Cancer Inst, 2021. 113 (5): p. 523-531. van Dongen, S.I., et al., Self-management of patients with advanced cancer: A systematic review of experiences and attitudes. Palliat Med, 2020. 34 (2): p. 160-178. Franklin, M., et al., Chronic condition self-management is a social practice. Journal of Sociology, 2021. 59 (1): p. 215-231. Levit, L.A., et al., Delivering high-quality cancer care: charting a new course for a system in crisis. 2013. Charmaz, K., The Power of Constructivist Grounded Theory for Critical Inquiry. Qualitative Inquiry, 2016. 23 (1): p. 34-45. Charmaz, K., 'Grounded Theory as an Emergent Method'. Handbook of Emergent Methods, 2008: p. 155-172. Charmaz, K. and L.L. Belgrave. Qualitative interviewing and grounded theory analysis . 2012. Strauss, A. and J. Corbin, Basics of qualitative research: Techniques and procedures for developing grounded theory, 2nd ed . Basics of qualitative research: Techniques and procedures for developing grounded theory, 2nd ed. 1998, Thousand Oaks, CA, US: Sage Publications, Inc. xiii, 312-xiii, 312. Jiang, R., et al., Impact of Empowerment Theory-Based Nursing Intervention on the Quality of Life and Negative Emotions of Patients Diagnosed with Brain Metastasis Post Breast Cancer Surgery. J Multidiscip Healthc, 2024. 17 : p. 2303-2312. Lin, L., et al., The effects of a nurse-led discharge planning on the health outcomes of colorectal cancer patients with stomas: A randomized controlled trial. Int J Nurs Stud, 2024. 155 : p. 104769. Walsh, J., et al., What are the current barriers to effective cancer care coordination? A qualitative study. BMC Health Serv Res, 2010. 10 : p. 132. Ferraris, G., et al., Understanding Reasons for Cancer Disparities in Italy: A Qualitative Study of Barriers and Needs of Cancer Patients and Healthcare Providers. Cancer Control, 2024. 31 : p. 10732748241258589. Amini-Tehrani, M., et al., Body image, internalized stigma and enacted stigma predict psychological distress in women with breast cancer: A serial mediation model. J Adv Nurs, 2021. 77 (8): p. 3412-3423. Banerjee, S.C., et al., Oncology nurses' communication challenges with patients and families: A qualitative study. Nurse Educ Pract, 2016. 16 (1): p. 193-201. Carrera, P.M., H.M. Kantarjian, and V.S. Blinder, The financial burden and distress of patients with cancer: Understanding and stepping-up action on the financial toxicity of cancer treatment. CA Cancer J Clin, 2018. 68 (2): p. 153-165. Additional Declarations No competing interests reported. Supplementary Files SupplementaryFile1Dataanalysis.docx Cite Share Download PDF Status: Published Journal Publication published 02 Jan, 2026 Read the published version in Supportive Care in Cancer → Version 1 posted Editorial decision: Revision requested 22 Oct, 2025 Reviews received at journal 15 Oct, 2025 Reviewers agreed at journal 25 Sep, 2025 Reviewers invited by journal 30 Jul, 2025 Editor assigned by journal 30 Jul, 2025 Submission checks completed at journal 19 Jun, 2025 First submitted to journal 13 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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-6890966","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":494843488,"identity":"6227801b-523d-4866-941c-41a37f2ef6f0","order_by":0,"name":"Muna Alshammari","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+ElEQVRIiWNgGAWjYDACdgY2CIMZiBOAkJ+gFmZ0LZINRGuBgAQGgwMEdPA3sz978DNnm7x5OwPbg4c70hI3Xzv+7AFDjU00Li0Sh3nMDXu33Tacc5iB3SDxTE7itts55gYMx9JycTrwMA+bBO+224wzgC6USGyrAGlhk2BsOIxTi/xh9meSf7fdtodr2Tw7/RleLQaHGcykgbYkQrXkJG6QTjDDq8XwMI+ZtOy228lALUC/tKUZz7idYyaRgMcvcsfbn0m+3Xbbdgb/AbaHP9uSZftBDvtQY4Pb+wjA/w1EOoJVJhBWDgbgOLUnUvEoGAWjYBSMIAAAfLJXKLj8HGQAAAAASUVORK5CYII=","orcid":"","institution":"Public Authority for Applied Education and Training","correspondingAuthor":true,"prefix":"","firstName":"Muna","middleName":"","lastName":"Alshammari","suffix":""},{"id":494843489,"identity":"4d8cd08f-83fb-40ef-8c18-0ad167ef9bb1","order_by":1,"name":"Khaldoun AldiabatM","email":"","orcid":"","institution":"Cape Breton University","correspondingAuthor":false,"prefix":"","firstName":"Khaldoun","middleName":"","lastName":"AldiabatM","suffix":""},{"id":494843490,"identity":"692012f7-2eb2-4b48-a4e7-fdd966d6372c","order_by":2,"name":"Enam Alsarayeen","email":"","orcid":"","institution":"Cape Breton Regional Hospital","correspondingAuthor":false,"prefix":"","firstName":"Enam","middleName":"","lastName":"Alsarayeen","suffix":""},{"id":494843491,"identity":"023d64c9-7ecb-456c-8912-1eb92f94d1fd","order_by":3,"name":"Sylivia Nalubega","email":"","orcid":"","institution":"Fatima College of Health Sciences","correspondingAuthor":false,"prefix":"","firstName":"Sylivia","middleName":"","lastName":"Nalubega","suffix":""},{"id":494843492,"identity":"4294ccd2-6c02-4b26-a7db-8c5c6062972c","order_by":4,"name":"Deepa Thomas","email":"","orcid":"","institution":"Public Authority for Applied Education and Training","correspondingAuthor":false,"prefix":"","firstName":"Deepa","middleName":"","lastName":"Thomas","suffix":""}],"badges":[],"createdAt":"2025-06-13 23:08:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6890966/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6890966/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00520-025-10267-5","type":"published","date":"2026-01-02T15:57:50+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":99545566,"identity":"d862f320-94c8-4212-a21f-b3f2b38e6802","added_by":"auto","created_at":"2026-01-05 16:08:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":800145,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6890966/v1/7e989fc7-9cb4-4214-a452-47707584381e.pdf"},{"id":88315093,"identity":"778d9593-8897-4e9f-a6c5-3a1d9e0aebe7","added_by":"auto","created_at":"2025-08-05 07:46:08","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":41933,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile1Dataanalysis.docx","url":"https://assets-eu.researchsquare.com/files/rs-6890966/v1/0a45c8e57f8d73c1afc20b6d.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Empowering Kuwaiti adults with cancer: oncology nurses’ perspectives on home-based self-management","fulltext":[{"header":"Background","content":"\u003cp\u003eCancer remains a significant global health burden, characterized by high morbidity and mortality rates [1]. In Kuwait, breast and colorectal cancers are particularly prevalent, representing a growing public health concern [2]. Addressing the challenges faced by survivors\u0026rsquo; post-diagnosis is crucial, especially in fostering effective home-based self-management practices.\u003c/p\u003e\n\u003cp\u003eSelf-management is defined as an individual\u0026apos;s capacity to manage symptoms, treatments, and lifestyle adjustments in collaboration with family, healthcare providers, and the community [3]. This multifaceted process is shaped by factors such as health literacy, familial support, and professional guidance. Oncology nurses play a pivotal role in this context by equipping patients with the tools and confidence needed to navigate their chronic conditions [4, 5].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEmpowered patients often achieve better health outcomes through effective self-management strategies [4]. However, barriers such as limited health service knowledge, cultural stigma, and inadequate resources can undermine these efforts [6].\u0026nbsp;Comprehensive health education campaigns are essential for addressing these challenges, promoting informed decision-making, and reducing societal stigma associated with cancer.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOncology nursing and patient empowerment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOncology nurses are at the forefront of cancer care, with responsibilities that include education, emotional support, and ongoing monitoring. Their role extends to fostering health literacy and improving adherence to treatment protocols, ultimately enhancing patient outcomes [7].\u0026nbsp;Nurses empower patients to take an active role in their care, building confidence and autonomy [4].\u0026nbsp;By offering tailored support and timely information, oncology nurses enable cancer survivors to address both medical and psychosocial challenges.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAim of the study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis constructive grounded study explores the home self-management processes of Kuwaiti adults living with breast and colorectal cancer, focusing on insights from oncology nurses. By incorporating nurses\u0026rsquo; perspectives, this research aims to develop a mid-range substantive theory to enhance cancer management strategies in Kuwait. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResearch question\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study investigates the question: What are the perceptions of oncology nurses regarding how Kuwaiti adults living with colorectal or breast cancer navigate the home-based self-management process?\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003eThis study employed a constructivist grounded theory approach to explore home self-management processes related to cancer. Data collection involved semi-structured interviews with seven purposively sampled oncology nurses working in a cancer center in Kuwait.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDesign\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis qualitative study adopted Charmaz\u0026apos;s [8], constructivist grounded theory methodology, emphasizing the co-construction of knowledge and prioritizing participants\u0026apos; subjective realities within their sociocultural context [9]. This approach facilitated an in-depth understanding of the nurses\u0026rsquo; perspectives regarding cancer self-management among breast and colorectal cancer survivors in Kuwait.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSampling procedure and sample size determination\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe employed both purposive and theoretical sampling to select study participants. Purposive sampling ensured initial participants were representative of the phenomenon under study. As data collection and coding progressed, theoretical sampling was employed to refine and enrich emerging categories, adhering to grounded theory principles. Grounded theory research determines sample size by theoretical saturation, where no new data emerges, and categories are fully developed [9]. The study achieved data saturation after collecting data from seven oncology nurses.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRecruitment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRecruitment involved advertising materials that were approved by relevant authorities. Interested participants contacted the research team via email or telephone and underwent eligibility screening. Eligible participants received detailed study information and provided informed consent through fax, electronic submission, or in person and all participants who were contacted agreed to participate.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEligibility criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOncology nurses with at least two years of experience providing direct care to cancer patients, fluent in English or Arabic, and willing to participate in the study were included.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData collection involved demographic questionnaires and qualitative data obtained through face-to-face semi-structured individual interviews. Participants could opt for telephone or video conference interviews for flexibility. Interviews lasted approximately 60 minutes and were guided by open-ended questions exploring the nurses\u0026rsquo; perspectives on cancer self-management. Interviews were audio-recorded, transcribed verbatim, and supplemented with field notes documenting observations and reflections during the interviews. Demographic data, interview transcripts, and consent forms were initially prepared in Arabic and translated into English after analysis. All interviews were conducted in private settings to maintain confidentiality.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData analysis followed Charmaz and Belgrave\u0026apos;s [10] constructivist grounded theory framework, employing the constant comparative approach:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInitial coding\u003c/strong\u003e: Labels were assigned to words, lines, or sections to identify emerging themes [10].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMemo writing\u003c/strong\u003e: Memos captured reflections on themes, concepts, and participant-shared relationships [10, 11].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFocused coding\u003c/strong\u003e: Targeted codes developed theoretical categories, with constant comparisons identifying patterns within and across interviews [10].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheoretical coding\u003c/strong\u003e: Relationships between major categories were conceptualized to develop a substantive theory, articulating core psychosocial processes related to the phenomenon [10, 11]. This iterative process compared new data with existing categories, ensuring a robust theoretical framework. The analysis culminated in a core category addressing the study\u0026apos;s primary research question.\u003c/p\u003e\n\u003cp\u003eData analysis was manually conducted and is detailed in Supplementary File 1. The first author, an Assistant Professor experienced in qualitative nursing research, led the data collection and analysis. No prior relationship existed between the researcher and participants. All coding and interpretations were verified by other research team members.\u003c/p\u003e"},{"header":"Findings","content":"\u003cp\u003eThe study identified a core category and eight interconnected subcategories that together highlight the significant roles oncology nurses play in cancer care in Kuwait. These findings shed light on the challenges and opportunities in empowering cancer patients through holistic, patient-centered approaches amidst systemic barriers.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCore Category: Holistic empowerment and self-management in cancer care amidst systemic challenges\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe central theme emerging from this study-\u003cem\u003eholistic empowerment and self-management in cancer care amidst systemic challenges\u003c/em\u003e captures the dynamic and multifaceted role of oncology nurses in supporting Kuwaiti adults living with breast and colorectal cancer. This core category reflects how nurses navigate complex healthcare environments to empower patients and their families through education, emotional support, and culturally sensitive care, despite facing significant systemic and resource-related constraints.\u003c/p\u003e\n\u003cp\u003eOncology nurses in Kuwait adopt a comprehensive approach to empowerment that extends beyond clinical instruction. They provide patients with practical tools for managing symptoms, medications, and post-treatment care at home, while also addressing emotional and psychological needs. This dual focus on technical and emotional support is particularly critical during care transitions, such as post-surgery discharge or palliative care initiation, where patients often experience heightened vulnerability. Nurses act as consistent sources of reassurance, offering empathetic communication and referrals to psychological services when needed.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHowever, this empowerment process unfolds within a healthcare system marked by notable limitations. Nurses reported chronic staff shortages, insufficient educational materials, and limited access to affordable medications. These constraints often force them to rely on external organizations and charities to bridge care gaps. Despite these challenges, nurses remain committed to delivering patient-centered care, adapting their strategies to meet individual needs and readiness levels for self-management.\u003c/p\u003e\n\u003cp\u003eCultural and socioeconomic disparities further complicate the empowerment process. Language barriers, health literacy gaps, and financial hardship influence patients\u0026rsquo; ability to engage in self-care. Nurses respond by tailoring communication strategies, advocating financial support, and ensuring that care is respectful of cultural norms and values. For example, they address body image concerns and fear-driven treatment decisions, such as opting for mastectomy due to stigma, by facilitating informed, compassionate discussions that honor patient autonomy.\u003c/p\u003e\n\u003cp\u003eImportantly, nurses recognize that empowerment is not a one-size-fits-all process. Patients vary in their emotional resilience, technical understanding, and willingness to assume responsibility for their care. Nurses must therefore remain flexible, adjusting their approach to provide either technical guidance or emotional reassurance as needed. This adaptability is a hallmark of holistic care and is essential for building trust and fostering long-term engagement in self-management.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn summary, this core category illustrates how oncology nurses in Kuwait serve as both caregivers and advocates, working within and around systemic barriers to empower patients. Their efforts underscore the need for institutional support, including targeted training, policy reforms, and resource allocation, to sustain and enhance nurse-led empowerment strategies in cancer care. By embracing a holistic model of care, nurses not only improve patient outcomes but also contribute to a more equitable and responsive healthcare system.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubcategories:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient empowerment through health education and family support\u003c/strong\u003e\u003cbr\u003eOncology nurses placed significant emphasis on equipping patients and their families with the skills and knowledge required for effective self-care at home. This included practical training on medication management, wound care, and post-surgical exercises, as well as strategies to manage anxiety and emotional distress. One nurse shared, \u003cem\u003e\u0026ldquo;We constantly give them health teaching... how to empower them to be self-reliant or to do self-management at home.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAnother nurse highlighted, \u003cem\u003e\u0026ldquo;For breast cancer patients, we discuss with them how to perform postmastectomy arm exercises with the help of our physiotherapists.\u0026rdquo;\u003c/em\u003e\u003cbr\u003e\u0026nbsp;Smoking cessation education was also an area of focus, reflecting nurses\u0026rsquo; commitment to promoting long-term health.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCare coordination and emotional care during transitions\u003c/strong\u003e\u003cbr\u003eCare transitions, particularly in late-stage cancer, often cause emotional distress as one nurse stated, \u003cem\u003e\u0026ldquo;They need psychological support, most patients will be depressed due to their condition.\u0026rdquo;\u003c/em\u003e Nurses provide essential emotional care, fostering trust and continuity during these vulnerable periods. Their support includes active listening, reassurance, and empathetic communication to help patients and families navigate the complexities of care. In some cases, nurses refer more complicated cases such as those in emotional distress for further management; \u003cem\u003e\u0026ldquo;We will inform the doctor and refer the patient to the psychiatrist or the Al Sidra team.\u0026rdquo;\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResource limitations affecting care delivery\u003c/strong\u003e\u003cbr\u003eNurses identified significant resource shortages, including staffing, educational materials, medical supplies, and affordable medications. One nurse stated how staff shortage is a reality at their facility; \u003cem\u003e\u0026ldquo;Nowadays we face a lot of staff shortage. So, it is very difficult to find time.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eOncology nurses reported often relying on external organizations and charities to fill these gaps. This constraint impacts the delivery of comprehensive care, requiring nurses to adapt and innovate to ensure patients receive the best possible support. One nurse recollected;\u003cem\u003e\u0026nbsp;\u0026ldquo;If we get more resources like audiovisual aids, we could help them understand better.\u0026rdquo;\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCultural and socioeconomic disparities in care\u003c/strong\u003e\u003cbr\u003eCultural norms, language barriers, and financial limitations influence patient care as one nurse reported;\u003cem\u003e\u0026nbsp;\u0026ldquo;The main barrier is communication. Some patients do not understand English\u0026rdquo;.\u0026nbsp;\u003c/em\u003eNurses demonstrated adaptability by modifying communication strategies and offering culturally sensitive care. They also advocated for patients by connecting them with financial assistance programs and ensuring their voices were heard within the healthcare system. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFear-driven treatment choices and body image concerns\u003c/strong\u003e\u003cbr\u003eFear of recurrence and concerns about body image emerged as significant factors in patients\u0026rsquo; treatment decisions. One nurse stated; \u003cem\u003e\u0026quot;Their concern is that people might judge them, like when they see them without their breasts, or their spouses would see them.\u0026quot;\u0026nbsp;\u003c/em\u003eMany patients opted for aggressive treatments like mastectomy over less invasive options due to fears. Nurses played a critical role in addressing these concerns by offering emotional reassurance and facilitating informed decision-making.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eReadiness and reluctance for self-management\u003c/strong\u003e\u003cbr\u003eSuccessful self-management depends heavily on the readiness of patients and families. Nurses frequently encountered resistance or lack of preparedness, necessitating gradual education and encouragement. This process involved building trust, addressing fears, and tailoring strategies to individual circumstances as one nurse noted; \u003cem\u003e\u0026quot;We constantly give them health teaching. If we have ample time to be with them, sit with them, discuss with them what they can do, or how to empower them like to be self-reliant or to be able to do self-management of their condition in the home.\u0026quot;\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCommunity and external support for emotional and financial relief\u003c/strong\u003e\u003cbr\u003eCommunity organizations provided essential supplementary support, including financial assistance and counseling. These resources eased the burden on patients and families, complementing the care delivered by nurses. One nurse explained;\u003cem\u003e\u0026nbsp;\u0026quot;We offer them some psychological help. In our KCCC we can get psychological help from our Alsidra, it\u0026apos;s a non-governmental organization.\u0026quot;\u0026nbsp;\u003c/em\u003eThis external support system was vital for addressing gaps in healthcare access and affordability.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdaptive care to meet diverse patient needs\u003c/strong\u003e\u003cbr\u003eNurses demonstrated remarkable flexibility in tailoring care to meet individual patient needs. Some patients required technical guidance, while others benefited more from emotional reassurance as highlighted by one nurse; \u003cem\u003e\u0026quot;Not all patients respond the same way. Some need constant reassurance, others need technical advice, and we have to adjust our approach.\u0026quot;\u0026nbsp;\u003c/em\u003eThis adaptability highlights the importance of personalized care in fostering trust and improving outcomes.\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings of this study underscore the vital role of oncology nurses in empowering cancer patients and their families. By addressing knowledge, emotional support, care coordination, and systemic barriers, nurses create a framework for effective self-management and improved quality of life of people with breast and colorectal cancer.\u003c/p\u003e\n\u003cp\u003ePatient education emerged as a cornerstone of empowerment, reducing anxiety and enhancing self-care capabilities. Nurses focused on practical guidance, such as medication management and post-surgical care, and emotional support strategies. Studies like Jiang and Liu [12], corroborate these findings, showing that nurse-led interventions significantly reduce depression and anxiety while improving quality of life of patients with cancer. Lin and Fang [13], also emphasized the value of discharge education in improving readiness for home care, aligning with the practices reported by nurses in this study.\u003cbr\u003eEmotional distress during care transitions, particularly for late-stage cancer patients, necessitates compassionate support. Nurses play a pivotal role in alleviating fears and providing continuity of care, as also reported by Jiang and Liu [12], who found behavioral-focused nursing interventions to be instrumental in enhancing emotional well-being and treatment compliance.\u003c/p\u003e\n\u003cp\u003eResource shortages pose significant challenges to care delivery, as highlighted in this study and in Walsh and Harrison [14]. These limitations necessitate innovative approaches and partnerships with external organizations. Advocacy for increased resource allocation is critical to addressing these systemic barriers.\u003cbr\u003eCultural and socioeconomic factors create inequities in healthcare access, necessitating culturally sensitive care approaches. Ferraris amd Coppini [15], in their study highlighted similar challenges, emphasizing the need for tailored interventions to bridge these disparities.\u003cbr\u003ePsychological factors such as fear of recurrence and body image concerns heavily influence treatment choices. Amini-Tehrani and Zamanian [16], found that these factors exacerbate psychological distress, underscoring the need for integrated psycho-oncological support in oncology care.\u003c/p\u003e\n\u003cp\u003eCommunication barriers and lack of readiness for self-management are consistent challenges, as also noted by Banerjee, Manna [17]. Training programs for nurses in communication skills can help address these issues and foster better engagement with patients and families.\u003cbr\u003eThe involvement of community organizations in providing emotional and financial relief in cancer care complements the role of nurses, as highlighted by Carrera, Kantarjian [18]. Enhancing these partnerships can further alleviate patient and family burdens.\u003cbr\u003ePersonalized care strategies that account for individual needs and circumstances are critical for improving patient outcomes. This adaptability ensures that care is responsive and effective, fostering trust and long-term engagement.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImplications\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe findings of this study have significant implications for oncology nursing practice, healthcare policy, and future research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNursing practice\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eOncology nurses must continue to focus on patient and family education as a means to empower self-management and promote long-term health outcomes.\u003c/li\u003e\n \u003cli\u003eEmotional care should be emphasized as an integral component of oncology nursing, particularly during transitions in care and end-of-life stages.\u003c/li\u003e\n \u003cli\u003eNurses need training in culturally sensitive care approaches to bridge disparities and provide equitable healthcare.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eHealthcare policy\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003ePolicymakers should address systemic resource shortages by increasing funding for oncology care, including educational materials, medical supplies, and affordable medications.\u003c/li\u003e\n \u003cli\u003eHealthcare systems should strengthen collaborations with community organizations to provide supplementary financial and emotional support to patients and families.\u003c/li\u003e\n \u003cli\u003eReforms should aim to reduce cultural and socioeconomic barriers to cancer care, ensuring equitable access to resources and services for all patients.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eFuture research\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eFurther studies should explore the long-term outcomes of nurse-led interventions on patient empowerment, self-management, and quality of life.\u003c/li\u003e\n \u003cli\u003eResearch should also investigate strategies for addressing the psychological factors, such as fear and body image concerns, that influence patient decision-making.\u003c/li\u003e\n \u003cli\u003eThe effectiveness of culturally tailored interventions in reducing disparities in care delivery warrants deeper examination.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations of the study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has several limitations that should be acknowledged:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eThe research was conducted with a limited sample size of oncology nurses in Kuwait, which may not fully represent the diversity of experiences across different regions or healthcare systems.\u003c/li\u003e\n \u003cli\u003eSelf-reported data from participants may be subject to recall bias or social desirability bias, potentially influencing the authenticity of the responses.\u003c/li\u003e\n \u003cli\u003eThe study focused exclusively on the perspectives of oncology nurses, omitting the experiences and views of cancer patients and their families, which could provide a more comprehensive understanding of the challenges and opportunities in cancer care. Nevertheless, these perspectives have been reported in other publication.\u003c/li\u003e\n \u003cli\u003eThe qualitative nature of the study, while valuable for depth, limits the ability to generalize findings to broader populations.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Conclusion","content":"\u003cp\u003e This study highlights the pivotal role of oncology nurses in empowering breast and colorectal cancer patients and their families through holistic, patient-centered care in Kuwait. By providing education, emotional support, and self-management guidance, nurses help patients navigate the complexities of cancer treatment and improve their quality of life. However, systemic challenges, including resource limitations, cultural disparities, and psychological barriers, continue to hinder optimal care delivery.\u003c/p\u003e\u003cp\u003eAddressing these challenges requires a multi-faceted approach involving enhanced training for nurses, increased resource allocation, and policy reforms aimed at equitable healthcare. Future research should focus on broadening the scope of this study to include patient perspectives and quantitative data, further informing strategies to empower cancer patients worldwide.\u003c/p\u003e\u003cp\u003eThe findings underscore the critical need for healthcare systems to support oncology nurses in their roles, ensuring they have the tools and resources necessary to deliver effective, compassionate, and culturally sensitive care.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e We sincerely acknowledge and extend our gratitude to the oncology nurses who participated in this study, sharing their invaluable insights and experiences to advance the understanding of cancer care in Kuwait.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e: The authors have no relevant financial or non-financial interests to disclose.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e: MA conceptualized the study, spearheaded data collection, analysis and drafting the manuscript. KA, EA, and DT contributed in conceptualization of the study, participated in data collection and analysis, and proofread the manuscript. \u0026nbsp;SN contributed in writing and editing the manuscript and preparation of the final submission documents. All authors read and approved of the final manuscript and agree to be accountable for all aspects of the work.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval:\u0026nbsp;\u003c/strong\u003eThis study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of\u0026nbsp;the\u0026nbsp;Ministry of Health, Kuwait,\u0026nbsp;reference number (2022/2176).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate:\u0026nbsp;\u003c/strong\u003eInformed consent was obtained from all individual participants included in the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKocarnik, J.M., et al., \u003cem\u003eCancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life Years for 29 Cancer Groups From 2010 to 2019: A Systematic Analysis for the Global Burden of Disease Study 2019.\u003c/em\u003e JAMA Oncol, 2022. \u003cstrong\u003e8\u003c/strong\u003e(3): p. 420-444.\u003c/li\u003e\n\u003cli\u003eAlhuraiji, A., et al., \u003cem\u003eGeneral Oncology Care in Kuwait\u003c/em\u003e, in \u003cem\u003eCancer in the Arab World\u003c/em\u003e, H.O. Al-Shamsi, et al., Editors. 2022, Springer Singapore: Singapore. p. 99-114.\u003c/li\u003e\n\u003cli\u003eDineen-Griffin, S., et al., \u003cem\u003eHelping patients help themselves: A systematic review of self-management support strategies in primary health care practice.\u003c/em\u003e PLoS One, 2019. \u003cstrong\u003e14\u003c/strong\u003e(8): p. e0220116.\u003c/li\u003e\n\u003cli\u003eHowell, D., et al., \u003cem\u003eManagement of Cancer and Health After the Clinic Visit: A Call to Action for Self-Management in Cancer Care.\u003c/em\u003e J Natl Cancer Inst, 2021. \u003cstrong\u003e113\u003c/strong\u003e(5): p. 523-531.\u003c/li\u003e\n\u003cli\u003evan Dongen, S.I., et al., \u003cem\u003eSelf-management of patients with advanced cancer: A systematic review of experiences and attitudes.\u003c/em\u003e Palliat Med, 2020. \u003cstrong\u003e34\u003c/strong\u003e(2): p. 160-178.\u003c/li\u003e\n\u003cli\u003eFranklin, M., et al., \u003cem\u003eChronic condition self-management is a social practice.\u003c/em\u003e Journal of Sociology, 2021. \u003cstrong\u003e59\u003c/strong\u003e(1): p. 215-231.\u003c/li\u003e\n\u003cli\u003eLevit, L.A., et al.,\u003cem\u003e Delivering high-quality cancer care: charting a new course for a system in crisis.\u003c/em\u003e 2013.\u003c/li\u003e\n\u003cli\u003eCharmaz, K., \u003cem\u003eThe Power of Constructivist Grounded Theory for Critical Inquiry.\u003c/em\u003e Qualitative Inquiry, 2016. \u003cstrong\u003e23\u003c/strong\u003e(1): p. 34-45.\u003c/li\u003e\n\u003cli\u003eCharmaz, K., \u003cem\u003e\u0026apos;Grounded Theory as an Emergent Method\u0026apos;.\u003c/em\u003e Handbook of Emergent Methods, 2008: p. 155-172.\u003c/li\u003e\n\u003cli\u003eCharmaz, K. and L.L. Belgrave. \u003cem\u003eQualitative interviewing and grounded theory analysis\u003c/em\u003e. 2012.\u003c/li\u003e\n\u003cli\u003eStrauss, A. and J. Corbin, \u003cem\u003eBasics of qualitative research: Techniques and procedures for developing grounded theory, 2nd ed\u003c/em\u003e. Basics of qualitative research: Techniques and procedures for developing grounded theory, 2nd ed. 1998, Thousand Oaks, CA, US: Sage Publications, Inc. xiii, 312-xiii, 312.\u003c/li\u003e\n\u003cli\u003eJiang, R., et al., \u003cem\u003eImpact of Empowerment Theory-Based Nursing Intervention on the Quality of Life and Negative Emotions of Patients Diagnosed with Brain Metastasis Post Breast Cancer Surgery.\u003c/em\u003e J Multidiscip Healthc, 2024. \u003cstrong\u003e17\u003c/strong\u003e: p. 2303-2312.\u003c/li\u003e\n\u003cli\u003eLin, L., et al., \u003cem\u003eThe effects of a nurse-led discharge planning on the health outcomes of colorectal cancer patients with stomas: A randomized controlled trial.\u003c/em\u003e Int J Nurs Stud, 2024. \u003cstrong\u003e155\u003c/strong\u003e: p. 104769.\u003c/li\u003e\n\u003cli\u003eWalsh, J., et al., \u003cem\u003eWhat are the current barriers to effective cancer care coordination? A qualitative study.\u003c/em\u003e BMC Health Serv Res, 2010. \u003cstrong\u003e10\u003c/strong\u003e: p. 132.\u003c/li\u003e\n\u003cli\u003eFerraris, G., et al., \u003cem\u003eUnderstanding Reasons for Cancer Disparities in Italy: A Qualitative Study of Barriers and Needs of Cancer Patients and Healthcare Providers.\u003c/em\u003e Cancer Control, 2024. \u003cstrong\u003e31\u003c/strong\u003e: p. 10732748241258589.\u003c/li\u003e\n\u003cli\u003eAmini-Tehrani, M., et al., \u003cem\u003eBody image, internalized stigma and enacted stigma predict psychological distress in women with breast cancer: A serial mediation model.\u003c/em\u003e J Adv Nurs, 2021. \u003cstrong\u003e77\u003c/strong\u003e(8): p. 3412-3423.\u003c/li\u003e\n\u003cli\u003eBanerjee, S.C., et al., \u003cem\u003eOncology nurses\u0026apos; communication challenges with patients and families: A qualitative study.\u003c/em\u003e Nurse Educ Pract, 2016. \u003cstrong\u003e16\u003c/strong\u003e(1): p. 193-201.\u003c/li\u003e\n\u003cli\u003eCarrera, P.M., H.M. Kantarjian, and V.S. Blinder, \u003cem\u003eThe financial burden and distress of patients with cancer: Understanding and stepping-up action on the financial toxicity of cancer treatment.\u003c/em\u003e CA Cancer J Clin, 2018. \u003cstrong\u003e68\u003c/strong\u003e(2): p. 153-165.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"oncology nurses, cancer self-management, breast cancer, colorectal cancer, patient empowerment, Kuwait","lastPublishedDoi":"10.21203/rs.3.rs-6890966/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6890966/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose:\u003c/strong\u003e Breast and colorectal cancers are among the most prevalent malignancies in Kuwait. As cancer care increasingly shifts toward outpatient and home-based models, this study aimed to explore oncology nurses’ perspectives on how Kuwaiti adults with these cancers navigate home-based self-management, and to identify strategies used to empower patients in this process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A qualitative study using a constructivist grounded theory approach was conducted in 2022 at a specialized cancer care center in Kuwait. Semi-structured interviews were held with seven purposively selected oncology nurses, each with at least two years of experience. Data were analyzed using constant comparative methods and theoretical coding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The central theme identified was “Holistic empowerment and self-management in cancer care amidst systemic challenges,” supported by eight subthemes including patient education, emotional support, cultural sensitivity, and resource limitations. Nurses emphasized the importance of personalized education, emotional care during transitions, and culturally sensitive communication. Systemic barriers such as staff shortages, limited educational resources, and socioeconomic disparities were highlighted. Community organizations were noted as key partners in supplementing care.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Oncology nurses play a vital role in facilitating home-based self-management for cancer patients in Kuwait. Strengthening their capacity through targeted training, policy support, and resource allocation can enhance patient autonomy and improve outcomes. These findings underscore the need for systemic reforms to support nurse-led empowerment strategies in oncology care.\u003c/p\u003e","manuscriptTitle":"Empowering Kuwaiti adults with cancer: oncology nurses’ perspectives on home-based self-management","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-05 07:46:04","doi":"10.21203/rs.3.rs-6890966/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-22T21:47:28+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-15T08:25:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"79634946936969255042685786445868128103","date":"2025-09-26T03:56:04+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-30T18:15:35+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-30T18:14:03+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-19T07:38:20+00:00","index":"","fulltext":""},{"type":"submitted","content":"Supportive Care in Cancer","date":"2025-06-13T22:56:57+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"2664cefd-ec49-4b80-99c3-3003099976ae","owner":[],"postedDate":"August 5th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-05T16:06:58+00:00","versionOfRecord":{"articleIdentity":"rs-6890966","link":"https://doi.org/10.1007/s00520-025-10267-5","journal":{"identity":"supportive-care-in-cancer","isVorOnly":false,"title":"Supportive Care in Cancer"},"publishedOn":"2026-01-02 15:57:50","publishedOnDateReadable":"January 2nd, 2026"},"versionCreatedAt":"2025-08-05 07:46:04","video":"","vorDoi":"10.1007/s00520-025-10267-5","vorDoiUrl":"https://doi.org/10.1007/s00520-025-10267-5","workflowStages":[]},"version":"v1","identity":"rs-6890966","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6890966","identity":"rs-6890966","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}