Barriers and facilitators to self-management among patients with breast cancer receiving neoadjuvant chemotherapy: A qualitative study informed by the integrated theory of health behavior change

Objective To explore barriers to and facilitators of self-management and related support needs across the pathway from neoadjuvant chemotherapy (NAC) to surgery by integrating the perspectives of patients and healthcare professionals in an analysis informed by the Integrated Theory of Health Behavior Change (ITHBC). Methods We used a qualitative descriptive design and maximum variation purposive sampling to recruit 16 individuals who were receiving NAC or awaiting surgery, together with 11 healthcare professionals involved in NAC care or self-management support. Data were collected through face-to-face, semi-structured interviews. The ITHBC informed the interview guides and initial analytic framework. Directed content analysis combined deductive coding guided by the framework with inductive analysis of data not captured by the framework. Patient and healthcare professional data were analyzed separately and then integrated. Results Four interrelated themes were constructed. First, patients varied in their understanding of why chemotherapy preceded surgery and how to interpret tumor changes; some regarded tumor shrinkage as evidence that treatment was complete. Second, cumulative toxicity constrained nutrition, physical activity, and functional readiness for surgery. Third, day-to-day self-management was shaped by the timeliness and credibility of professional guidance, as well as family and social circumstances. Fourth, the overlap of persistent symptoms, physical recovery, and surgical preparation during the transition from NAC to surgery revealed gaps in transitional support that were not adequately addressed by generic health education. Conclusions Self-management needs differed across NAC stages and during the transition to surgery. These findings suggest a need for continuous and individualized self-management support aligned with patients' understanding, symptom burden, and treatment stage.