Barriers and facilitators of patient activation among older adults with cancer in China: a descriptive qualitative study based on ecological systems theory

Abstract

Background Older adults with cancer face significant treatment and care challenges. Patient activation determines patients' awareness, knowledge, ability, and confidence in self-management. However, older adults with cancer generally demonstrate insufficient patient activation. This study employed a qualitative approach to investigate the multidimensional influencing factors and underlying mechanisms of patient activation among older adults with cancer, addressing the research gap concerning their subjective experiences and interactive processes from a socioecological perspective. Methods A qualitative descriptive design was used, following the COREQ guidelines within the EQUATOR network. A purposive sample of older adults with cancer was recruited from August 15 to September 30, 2025. Data were collected through individual interviews using a semistructured guide. Theoretical and data-driven approaches were used for coding and theme generation. Results Six themes—individual psychological strengths (microsystem), emotional empowerment through social support (mesosystem), institutional safeguards (macrosystem), individual-level functional and psychological barriers (microsystem), dysfunction within family systems (mesosystem), and barriers in health care and information services (macrosystem)—and 15 subthemes emerged from the data analysis. Conclusion This study revealed that patient activation among older adults with cancer is shaped by multi-system factors, including patients, caregivers, medical staff, and policymakers. Coordinated interventions at each ecological system level are necessary to optimize patients' active participation in health management.