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Financial toxicity (FT) is the economic burden of medical care that negatively affects patients' well-being and quality of life. FT disproportionately impacts surgical patients. Although prior studies have quantified FT, few have explored patient-identified interventions to mitigate it. This study explores solutions to FT through qualitative interviews with surgical patients. A multicenter prospective study was conducted to characterize FT in adult surgical trauma patients across three tertiary care centers in India. A total of 854 patients were surveyed. Semi-structured interviews were conducted amongst a randomized subset of these patients within 1 year of surgery. Interviews were recorded, transcribed, translated, and coded. Recurring themes were identified using a qualitative thematic analysis with a deductive approach. A total of 39 patients were interviewed, with a median age of 37.7 years (SD 14.6). Almost all reported needing to borrow money or sell assets to cope with FT resulting from surgical care, leading to long-term social distress. Themes for patient-proposed solutions emerged: (1) addressing insurance deficits, (2) providing direct non-medical cost support, (3) increasing social support schemes, and (4) infrastructure for acute financial assistance. Surgical trauma patients in India face substantial postoperative FT, necessitating contextualized solutions. Increasing awareness and use of existing government schemes is crucial. Patients facing FT should be identified upon admission and educated about financial options. Comprehensive support strategies such as governmental resources, monetary support systems, and social services are essential. Implementing patient-reported solutions to mitigate FT is vital to improving patient outcomes after surgery.

Longer treatment engagement is associated with improved recovery outcomes in alcohol use disorder (AUD), making patient retention a critical determinant of reduced return to drinking. This study aimed to identify factors predicting outpatient treatment engagement, operationalized as the number of follow-up visits, among individuals with AUD following inpatient care. We applied a five-step analytic framework integrating random forest modelling (RFM) and Least Absolute Shrinkage and Selection Operator (LASSO) regression to identify predictors of outpatient visit frequency. Clinical, psychological and physiological variables (n = 177 per participant) collected during inpatient treatment prior to discharge were included. RFM ranked variables associated with follow-up visits, with LASSO used for validation and complementary selection. Over a 5-year period, 119 treatment-seeking patients with AUD (mean age = 45.8) returned for outpatient care, averaging 5.14 visits, following a medical treatment inpatient stay. Positive urgency (VIP = 44.31) and positive life events (VIP = 41.19) emerged as the strongest predictors; both inversely associated with visit frequency. LASSO confirmed positive urgency as a significant predictor (coefficient: -0.03296). Greater alcohol use severity and higher haemoglobin levels were also associated with fewer outpatient visits, whereas higher depressive symptom severity predicted increased follow-up engagement. Using complementary machine learning and regression approaches, this study identified affective traits, alcohol use severity and physiological factors as key determinants of outpatient engagement following inpatient AUD treatment. Interestingly, positive urgency and positive life events, often considered markers of recovery or resilience, were linked to reduced outpatient attendance, suggesting that certain personality or motivational factors may diminish perceived need for continued care. These findings highlight the importance of integrating psychological and motivational variables into postdischarge planning to enhance retention and improve early recovery outcomes.

To assess the association between personal temperature exposure and oxygen saturation (SpO2) during sleep in chronic obstructive pulmonary disease (COPD) patients, to analyze potential susceptibility factors and to provide a scientific basis for the adoption of effective measures to safeguard the health of susceptible populations. In this prospective panel study, 96 stable COPD patients were recruited. From March 2021 to September 2023 in Beijing, all participants completed 202 nights (from 20:00 to 08:00) of dynamic real-time SpO2 monitoring during sleep, simultaneously monitoring personal exposure level to temperature, alongside environmental humidity and other key air pollutant data. Based on previous clinical studies, SpO2 < 90% was defined as desaturation to assess the risk of hypoxic events occurring during sleep. Linear mixed-effects models and generalized linear mixed-effects models were used to analyze the association between personal temperature exposure and SpO2 during sleep, as well as the risk of oxygen desaturation. Interaction models were constructed to evaluate susceptibility factors. During the study, the average personal temperature exposure was (27.5&#xb1; 2.6) &#x2103;, with a temperature range from 16.5 &#x2103; to 40.0 &#x2103;. Short-term exposure to personal temperature was associated with a decline in SpO2 and an increased risk of oxygen desaturation during sleep in the COPD patients. The effect of temperature exposure was strongest at lag 0-30 min, with a 0.24% (95%CI: -0.28%, -0.20%) decrease in SpO2, and with an odds ratio (OR) of oxygen desaturation was 1.26 (95% CI: 1.12, 1.42) for each interquartile range (IQR, 6.0 &#x2103;) increase in temperature. Besides, the patients exposed to medium and high humidity levels were more likely to be affected by temperature exposure compared with the patients exposed to low humidity levels. Personal temperature exposure had a stronger effect on SpO2 during sleep in the patients with global initiative for chronic obstructive lung disease (GOLD) &#x2162;-&#x2163; compared with the patients with GOLD &#x2160;-&#x2161; (Pinteraction < 0.05). From 16.5 &#x2103; to 40.0 &#x2103;, personal temperature exposure is associated with SpO2 decline during sleep in COPD patients. There was a significant synergistic amplification between temperature and humidity, patients were more susceptible to damage under high temperature and high humidity conditions. Moreover, patients with poorer lung function are more significantly affected by temperature.

To systematically evaluate the association between anticoagulant therapy and long-term outcomes (all-cause mortality, stroke recurrence, and hemorrhage events) in elderly patients with cardiogenic stroke, thereby providing evidence for clinical decision-making. A retrospective cohort study design was adopted. A total of 567 elderly patients with cardiogenic stroke from Liang-xiang Hospital in Fangshan District, Beijing, were followed up for 4 years. The primary outcomes included all-cause mortality, stroke recurrence, and hemorrhage events (including intracranial hemorrhage, gastrointestinal bleeding, urinary system bleeding, gingival bleeding, and skin and mucosal hemorrhage). Multivariable Logistic regression was used to analyze the association between anticoagulant therapy and each outcome. All statistical analyses were performed using R software (version 4.2.2). A total of 567 elderly patients were included in this study, with a mean age of (73.92&#xb1;9.70) years and 49.74% being male. Among them, 142 patients (25.04%) received anticoagulant therapy. During the follow-up period, 266 deaths occurred (crude mortality rate: 46.91%), 107 patients had stroke recurrence (cumulative recurrence incidence: 18.87%), and 28 patients experienced bleeding events (cumulative hemorrhage incidence: 4.94%). Multivariable Logistic regression showed that elderly patients with cardiogenic stroke who received anticoagulant therapy had a significantly lower risk of death (OR=0.22, 95%CI: 0.12, 0.41, P < 0.001). No significant association was found between anticoagulant therapy and the risk of stroke recurrence or hemorrhage (P>0.05). Anticoagulant therapy is beneficial in reducing the risk of all-cause mortality in elderly patients with cardiogenic stroke, and no evidence was found that anticoagulant therapy increases the risk of stroke recurrence or hemorrhage. The study supports considering anticoagulant therapy to improve long-term survival in elderly patients with cardiogenic stroke, and larger prospective studies are still needed to further validate the findings.

To systematically evaluate the association between perioperative hyperglycemia and postoperative prognosis in esophageal squamous cell carcinoma (ESCC) patients using large-scale, multicenter real-world data. A total of 5 952 patients with ESCC who underwent radical esophagectomy were consecutively included in this retrospective cohort study from the Anyang Cancer Hospital in Anyang, Henan Province (January 2012 to December 2017) and the Cancer Hospital of Shantou University Medical College in Shantou, Guangdong Province (August 2009 to December 2018). Perioperative fasting glucose data were obtained from the hospital information system. The perioperative period was divided into preoperative and postoperative phases: Preoperative hyperglycemia was defined as a mean fasting glucose level &#x2265;7.0 mmol/L from day 14 to day 2 before surgery, and postoperative hyperglycemia was defined as a mean fasting glucose level &#x2265;7.0 mmol/L from day 2 to day 14 after surgery. The primary outcome was overall survival (OS), and secondary outcomes included 30 d/90 d postoperative mortality and in-hospital complications. Multivariable Cox proportional hazards models were used to assess the association between perioperative hyperglycemia and OS, with adjusted hazard ratios (HR) and 95% confidence intervals (CI) calculated. The maximum follow-up period was 12 years. The prevalence of preoperative and postoperative hyperglycemia was 6.7% and 18.3%, respectively. Patients with preoperative hyperglycemia had a lower 5-year OS rate than those without (57.3% vs. 65.0%), with an adjusted HR of 1.41 (95%CI: 1.19-1.68). The patients with postoperative hyperglycemia also had reduced 5-year survival (61.8% vs. 66.4%), with an adjusted HR of 1.39 (95%CI: 1.22-1.58). Joint analysis showed that compared with patients without hyperglycemia, those with hyperglycemia in either the preoperative or postoperative phase alone had an elevated mortality risk (HR=1.24, 95%CI: 1.07-1.43), while the patients with hyperglycemia in both phases had the highest mortality risk (HR=1.86, 95%CI: 1.49-2.32). Stratified analysis revealed that BMI significantly modified the association between hyperglycemia and adverse prognosis (Pinteraction=0.010), with the association being particularly pronounced in patients with BMI &#x2265;24.0 kg/m2. Additionally, perioperative hyperglycemia was associated with poorer short-term postoperative outcomes. Perioperative hyperglycemia is an independent risk factor for long-term survival in ESCC patients undergoing curative esophagectomy. These findings suggest that enhanced routine glucose monitoring and control during perioperative management of ESCC may help improve long-term patient outcomes.

This study focused on the correlations of lipoprotein-associated phospholipase A2 (Lp-PLA2) and angiotensin II (Ang II) levels with the severity of coronary artery stenosis (CAS) in elderly patients with suspected coronary heart disease (CHD). This retrospective case-control study was conducted on 228 elderly patients suspected of CHD. Their clinical data were collected. Patients were grouped by CHD diagnosis and by CAS severity. Correlation analyses were performed between Lp-PLA2, Ang II, lipid profiles, and the atherogenic index of plasma (AIP). Influencing factors for moderate-to-severe CAS in elderly patients were identified by univariate/multivariate logistic regression models. Receiver operating characteristic curves were used to analyze diagnostic performance for the severity of CAS in elderly patients. Lp-PLA2 and Ang II levels were notably elevated in patients with CHD and were positively associated with the severity of CAS. Lp-PLA2 level correlated with lipid levels. Both Lp-PLA2 and Ang II were correlated with AIP. Elevated levels of Lp-PLA2 and Ang II were independent risk factors for moderate-to-severe CAS in elderly patients. Both Lp-PLA2 and Ang II demonstrated certain diagnostic value for identifying moderate-to-severe CAS in this population. The combination of Lp-PLA2 and Ang II demonstrated diagnostic performance comparable to AIP and superior to either marker alone for identifying moderate-to-severe CAS. Lp-PLA2 and Ang II are closely associated with AIP in elderly patients with CHD, are independent risk factors for moderate-to-severe CAS, and may serve as valuable biomarkers for diagnosis and risk stratification.

Azithromycin is a key drug in the treatment of most non-tuberculous mycobacterial (NTM) diseases. Its exposure may be decreased by rifampicin co-administration, but to what extent is largely unknown. We measured azithromycin exposure in an NTM disease patient population and quantified the effect of rifampicin co-administration. We retrospectively collected plasma azithromycin area-under-the-curve from 0 to 6&#x2005;hours after administration in mg/L*hours (AUC0-6h), peak (Cmax), and trough (Cmin) concentrations from the TDM service at Radboudumc, The Netherlands. Azithromycin exposure measures were compared between patients with and without concurrent rifampicin use, and within patients who had rifampicin stopped during treatment. We analysed data of 130 patients, of whom 59% had NTM pulmonary disease. The azithromycin geometric mean of AUC0-6h in patients with (n&#x200a;=&#x200a;48) and without (n&#x200a;=&#x200a;82) rifampicin were 0.90 versus 1.83&#x2005;mg/L*h, Cmax 0.22 versus 0.46&#x2005;mg/L, and Cmin 0.043 versus 0.13&#x2005;mg/L, respectively. A within-patient comparison in 14 subjects showed geometric means of AUC0-6h, Cmax, and Cmin (90%-CI) with rifampicin were 62% (45%-74%), 58% (38%-72%) and 66% (48%-77%) lower than without rifampicin. Interventions based on TDM enabled a strong increase in exposure to azithromycin. No association between azithromycin exposure and disease outcomes was shown, but the number of patients in these analyses was small. This study provides new population exposure data for TDM of azithromycin in NTM disease. Rifampicin co-administration reduces azithromycin exposure by at least half, underscoring the need for upfront azithromycin dose adjustment, application of TDM, or considering alternative drugs for rifampicin, also considering controversy around its effectiveness and adverse effects.

To examine the impact of effective health information acquisition on hemophilia-related health literacy among adult caregivers of children and adolescents with hemophilia in China, and to provide evidence-based recommendations for improving adult caregivers' hemophilia-related health literacy. Data were derived from the 2024 nationwide multicenter cross-sectional survey, "Health Literacy Survey of Hemophilia Patients in China". A total of 856 adult caregivers of children and adolescents with hemophilia were recruited through convenience sampling. To explore the differences in hemophilia-related health literacy and effective health information acquisition levels among caregivers across different demographic characteristics, univariate ANOVA and independent-samples t test were adopted for statistical analysis. The bootstrap method was employed to test the mediating role of effective health information acquisition in the relationship between hemophilia-related health literacy and its influencing factors. The overall level of hemophilia-related health literacy among caregivers of minor patients with hemophilia was relatively low, with an average score of 11.87&#xb1;2.92. Only 20.68% of the caregivers for underage patients with hemophilia had acquired hemophilia-related health literacy. Univariate ANOVA analysis indicated that marital status, educational attainment, annual household income, registered residence location, and employment status significantly influenced adult caregivers ' hemophilia-related health literacy (P < 0.05). The utilization rate of various health information channels by caregivers of underage hemophilia patients exceeded 70%. Over 95% of the caregivers reported obtaining hemophilia-related health information from medical staff and hemophilia patient organizations. While, the caregivers demonstrated relatively low overall effective health information acquisition (34.43&#xb1;16.50). The level of effective health information acquisition was related to educational attainment, place of household registration and employment status. Caregivers with higher educational attainment, urban household registration and full-time employment had a higher level of effective health information acquisition, and the differences were statistically significant (P < 0.05). The mediation analysis showed that the level of effective health information acquisition was positively correlated with hemophilia health literacy (P < 0.01), and effective health information acquisition played a partial mediating role between "education attainment" and "hemophilia health literacy", "employment status" and "hemophilia health literacy", and "place of household registration" and "hemophilia health literacy" (P < 0.05). Higher educational attainment and favorable employment status not only directly improved health literacy, but also indirectly enhanced it by promoting effective information acquisition. Compared with urban household registration, rural household registration had a negative impact on health literacy in patients with hemophilia. Meanwhile, effective information acquisition also exerted a partial mediating effect between registered residence location and health literacy. The hemophilia-related health literacy among caregivers of underage hemophilia patients is relatively low. Enhancing adult caregivers' effective health information acquisition of health information will improve their hemophilia-related health literacy. Tailored strategies to optimize effective health information acquisition for adult caregivers with varying sociodemographic characteristics could indirectly contribute to improved health literacy outcomes.

To explore expectations and experiences of nurses and physicians with remote care monitoring for breast cancer patients within the Norwegian specialist health service. Qualitative exploratory study. Individual semi-structured interviews were conducted with nine nurses and physicians before and after the implementation of remote patient monitoring. The data were analysed using reflexive thematic analysis. Three key themes were developed: (1) 'Navigating patient empowerment: Reassurance, misinterpretation and guidance in remote patient monitoring communication'; (2) 'Digital care impacts the workflow: Efficiency gains and hidden burdens'; and (3) 'Clinical judgement in a digital context: Balancing standardisation and clinical discretion'. While remote patient monitoring increased flexibility and targeted follow-up, it also reshaped roles and workloads and introduced new interpretive demands that often lack formal delegation, highlighting the need for clearer task allocation and organisational support. Remote patient monitoring expands nurses' roles in symptom assessment and digital follow-up. As such, clear role boundaries and support for clinical judgement are essential for its successful implementation. The results are relevant for management in healthcare services, nurses and other healthcare professionals implementing remote patient monitoring. The study followed CORQ guidelines. Four user representatives with lived experience of breast cancer contributed to the design of the study and gave input regarding the interview guide.

Increasing physician turnover poses challenges to healthcare institutions worldwide. Patient-centered communication (PCC), which increases patient-physician communication quality and physician work experiences, is considered a potential solution. Nonetheless, little is known about its actual effects and underlying mechanisms on healthcare providers themselves. Drawing on an integrated framework based on affective event theory and affect theory of social exchange, this study proposes and tests a pathway model linking PCC and physician turnover intention. Analyzing survey data collected from Chinese physicians (N&#x2009;=&#x2009;600) with the structural equation model technique, the findings show that PCC is negatively associated with turnover intention. Particularly, this association is sequentially mediated by 1) receipt of patient gratitude, positive affect after consultations and positive work rumination (&#x3b2;&#x2009;=&#x2009;-.002, 95%CI[-.006, -.0002]), 2) receipt of patient gratitude, positive affect after consultations and negative work rumination (&#x3b2;&#x2009;=&#x2009;-.003, 95%CI[-.007, -.0004]), 3) receipt of patient gratitude, negative affect after consultations and positive work rumination (&#x3b2;&#x2009;=&#x2009;-.003, 95%CI[-.007, -.0004]), and 4) receipt of patient gratitude, negative affect after consultations and negative work rumination (&#x3b2;&#x2009;=&#x2009;-.002, 95%CI[-.006, -.0002]). On this basis, this study contributes to the literature by elucidating how PCC benefits physicians through their active elicitation of positive affective events.

This study was to explore the correlation between macroscopic and microscopic sleep architectures and early neurological improvement (ENI) in acute ischemic stroke by utilizing polysomnography (PSG) for sleep monitoring. Acute ischemic stroke patients were recruited to the Department of Neurology Inpatients of the Second Hospital affiliated with Soochow University from November 2015 and October 2021. PSG data were collected from all enrolled patients after admission, and sleep spindles and slow oscillations (SOs) were extracted and analyzed. Stroke patients were then divided into ENI and non-ENI groups based on the percentage difference between the National Institutes of Health Stroke Scale (NIHSS) score at admission and discharge, then clinical features, macro and micro sleep structure were compared between the two groups. Logistic regression analysis was used to explore the factors affecting the early improvement of neurological function in stroke patients. In multivariable analysis, specific sleep architecture features were independent predictors of ENI. Higher sleep efficiency (p&#x2009;=&#x2009;0.002) and stronger SO-spindle coupling (p&#x2009;=&#x2009;0.011) were independently associated with increased odds of ENI, while higher spindle frequency (p&#x2009;=&#x2009;0.023) and higher SO frequency (p&#x2009;=&#x2009;0.012) were independently associated with reduced odds. A higher level of non-high density lipoprotein cholesterol (p&#x2009;=&#x2009;0.009) and thalamic (p&#x2009;=&#x2009;0.006) and other cortical and subcortical infarctions (p&#x2009;=&#x2009;0.035) were also independently associated with lower ENI odds. Macroscopical and microscopical sleep structures influence early recovery from stroke, and the precise coupling of SO and sleep spindle is independently associated with favorable neurological outcomes in stroke patients.

Patients with cardiovascular disease undergoing surgery commonly experience psychological distress, including anxiety, depression, and fear of mortality, which may negatively influence surgical outcomes and recovery. However, mental health support for patients with cardiovascular disease remains unprioritized in many healthcare systems, particularly in middle-income countries such as Kazakhstan, where mental health services are still fragmented and underdeveloped. This study aims to explore and describe the mental health promotion strategies employed by nurses when caring for preoperative patients with cardiovascular disease. This study employed an exploratory-descriptive qualitative design. Data were collected through semistructured interviews with 13 nurses working in cardiac surgery units in Kazakhstan from February 3 to April 10, 2025. The interview data were analyzed using thematic analysis. The study was conducted in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Initially, 96 codes were generated from the data. These codes were subsequently organized into 19 subthemes and further synthesized into four major themes: "Patient Emotional Support Needs," "Mental Health Implementation Strategies," "Challenges to Mental Health Promotion," and "Influencing Factors in Mental Health Promotion." Nurses play a pivotal role in promoting the mental health and psychological well-being of patients with cardiovascular disease, with therapeutic communication and professional presence serving as fundamental components of holistic care. In Kazakhstan, this responsibility also requires adapting nursing management strategies to culturally grounded perspectives on mental health, thereby ensuring the delivery of compassionate, culturally sensitive, and comprehensive care that extends beyond physical recovery.

Although immune checkpoint inhibitors (ICIs) have revolutionized the treatment of nasopharyngeal carcinoma (NPC), reliable predictive biomarkers need to be further explored. This study aimed to investigate the predictive ability of inflammatory markers for poor prognosis in NPC patients treated with ICIs. In this multicenter retrospective study, a total of NPC patients treated with at least two cycles of ICIs from May 2019 to December 2022 at three independent medical centers in China were included. In this study, we collected the multiple hematological parameters from patients prior to treatment to calculate serum inflammatory markers, and we performed the multivariate COX analysis to identify independent prognostic factors for constructing columnar plots. Then the ROC survival curves, calibration curves, and clinical curve analysis were used to assess the predictive performance of the model. A total of 170 patients were included in the training group with a median follow-up of 26&#x2009;months. Univariate and multivariate Cox regression analyses showed that Hb, Prognostic Nutritional Index (PNI), and the number of metastases were independent prognostic factors for overall survival (OS). A nomogram was constructed based on these three factors to predict the prognosis of NPC patients after ICI treatment. The nomogram achieved a C-index of 0.733 in the training cohort and 0.743 in the validation cohort, indicating good discriminative ability. Time-dependent ROC curves demonstrated favorable predictive accuracy, with area under the curve (AUC) values for 1-, 2-, and 3-year OS of 0.701, 0.756, and 0.760 in the training set, and 0.773, 0.784, and 0.777 in the validation set. The model was further validated using calibration plots and decision curve analysis (DCA), and patients were categorized into high- and low-risk groups, with the validation cohort also showing consistent survival differentiation. The combination of serum inflammatory markers and clinicopathological factors may serve as a practical prognostic tool to predict NPC patients who may benefit from ICIs.

Forensic psychiatric patients experience high rates of preventable physical illness. Integrating primary care within forensic settings may help address this gap, yet little is known about how patients experience such services. To explore how forensic psychiatric patients experienced an on-ward general practitioner (GP) service and how these experiences shaped engagement with integrated care. We conducted a qualitative interview study with 14 patients from two Danish medium-secure forensic psychiatric wards. Semi-structured interviews were analyzed using reflexive thematic analysis to identify key patterns of meaning. Patients generally perceived the GP service as relevant and valued its distinct somatic focus, which countered perceptions that physical symptoms were overlooked by psychiatric staff. The GP's proximity and accessibility encouraged consultations, and the outsider role provided a less custodial relationship. However, engagement was conditional and barriers were experienced, such as limited continuity, perceptions of redundancy due to existing services, and discomfort during intimate examinations, especially when staff were present or of the opposite sex. While broadly welcomed, GP engagement remained reactive and dependent on trust and privacy. These findings suggest that future integrated care models may benefit from considering relational continuity, sensitive examination practices, and structures supporting preventive somatic care.

Antidepressants (ADs) are an essential depression treatment option, but may cause side effects that affect treatment outcome, patient function, and quality of life. AD side effect assessment may be insufficient in both clinical trials and practice, potentially distorting the understanding of their prevalence and tolerability. We examined AD self-reported side effects (SRSEs) in psychiatric settings. We evaluated AD SRSEs in 128 psychiatric out- and inpatients from the Pharmacoepidemiology and Pharmacogenetics of Antidepressant Treatment for Depressive Disorders (PEGAD) study at baseline, two- and eight weeks, using the Antidepressant Side-Effect Checklist (ASEC), and the Frequency, Intensity, and Burden of Side Effects Rating (FIBSER) scale. Predominantly mild to moderate SRSEs with a low burden on daily activities were reported by over 90% at each evaluation, and 45% of study completers reported occasional severe side effects. Nonetheless, only 6.5% of study completers consequently discontinued their AD, and symptom attribution to the ADs varied, indicating different perceived reasons for SRSEs. Depression severity was the main predictor of SRSEs, and higher depression, anxiety, and age predicted functional impairment. When systematically evaluated, most antidepressant-treated patients with depression report multiple perceived side effects, some rated severe, that rarely result in discontinuation of their pharmacotherapy. Patients often attribute potential side effects to factors other than pharmacotherapy, and SRSEs affect overall functioning less than depression itself. Our findings highlight the difficulty of reliably ascertaining causes of perceived side effects in the absence of mechanistic biomarkers.

Advanced ovarian cancer patients face profound psychosocial challenges in maintaining hope amidst terminal illness and treatment uncertainty. Understanding mechanisms supporting adaptive hope could inform psychosocial interventions. Phenomenological qualitative study of 16 women with advanced ovarian cancer receiving platinum-based and/or targeted therapies at a tertiary center in southern China. Semi-structured interviews conducted across 11-month observation period; thematic analysis guided by Leventhal's Common-Sense Model (CSM). Participants demonstrated a triphasic psychosocial adjustment process organized around three interdependent themes: (1) Cognitive Reappraisal of Chronicity: Patients progressively reconceptualized ovarian cancer from acute crisis to manageable chronic condition, anchored in biomedical evidence (stable disease scans) and analogized to familiar chronic illnesses (diabetes). This cognitive restructuring enabled milestone-based temporal orientation replacing survival countdown framing; (2) Therapeutic Alliance as Hope Anchor: Quality of patient-clinician relationships functioned as relational scaffolding enabling cognitive reappraisal through shared decision-making, emotional attunement, continuity of care, and hope-framed honest prognostic communication. Family members facilitated this process through co-construction of illness identity, milestone tracking, and selective information mediation (81.3% of participants); (3) Strategic Information Management: Patients actively regulated illness-related information engagement, prioritizing actionable biomarkers over distressing epidemiological statistics, protecting the chronic illness cognitive framework while maintaining decision-making capacity. The triphasic trajectory progressed from Phase 1 Crisis Cognition (0-3 months) through Phase 2 Cognitive Negotiation (4-10 months) to Phase 3 Adaptive Integration (11+ months). Platinum-resistant cases reverted to Phase 1, indicating dynamic rather than stable cognitive achievement. All themes directly mapped onto CSM regulatory dimensions (identity, timeline, consequences, controllability, emotional representation), demonstrating empirical alignment between data-derived constructs and established theoretical architecture. Hope maintenance in advanced ovarian cancer depends on integrated cognitive reappraisal, relational security, and behavioral information management-mechanisms actionable through targeted psychosocial intervention. Family-centered communication and milestone-based temporal scaffolding warrant clinical implementation pending prospective validation.