A Qualitative Study on the Knowledge, Experiences, and Influencing Factors of Specialist Nurses Regarding the Use of Non-Pharmacological Intervention Schemes for Managing Cachexia in Pancreatic Cancer Patients: Based on the Theory of Planned Behavior

Pancreatic cancer is a relentless disease, known for its rapid progression and the severe weight loss it causes in its victims. This wasting condition, called cachexia, is not simply a matter of not eating enough; it is a complex metabolic breakdown where the body consumes its own muscle and organs, leaving patients weak, tired, and often unable to tolerate standard treatments. While doctors have long relied on medicines to fight the cancer itself, there is a growing recognition that non-drug approaches—such as tailored nutrition, gentle exercise, and psychological support—are vital for keeping patients as strong and comfortable as possible. However, these supportive measures are not always easy to put into practice. They require time, specific skills, and a coordinated effort that often falls to specialist nurses, the medical professionals who spend the most time at the patient's bedside. The question facing the medical community is not just whether these methods work, but why they are sometimes used and other times left aside by the very people tasked with delivering them.

To understand this gap between knowledge and action, a team of researchers at the Second Affiliated Hospital of Dalian Medical University in China set out to listen directly to the nurses who care for these patients. They focused on thirteen specialist nurses, all women with years of experience in oncology, ranging from twenty-eight to fifty years old. These were not general ward nurses, but professionals with advanced training in specific areas like nutrition, pain management, or palliative care. The researchers conducted one-on-one interviews, asking the nurses to describe their thoughts, feelings, and daily realities when trying to help pancreatic cancer patients manage their wasting. The goal was to map out the mental and practical landscape these nurses navigate, looking at what they believe about these treatments, who influences their decisions, and what obstacles stand in their way.

The nurses spoke with a clear conviction about the value of non-drug interventions. They described how nutritional guidance, such as providing high-energy, easy-to-digest foods or specific supplements, could help slow down weight loss. They also highlighted the importance of gentle movement, like slow walking or breathing exercises, to maintain muscle strength, and the role of psychological care in reducing the anxiety and despair that often accompany such a difficult diagnosis. Many nurses viewed these efforts as a profound expression of their professional worth. One nurse recalled a patient who had been crying and withdrawn, only to later greet her with a smile after receiving consistent emotional support. For these professionals, helping a patient maintain their dignity and quality of life, even when a cure is out of reach, was a deeply fulfilling experience that validated their role in the medical team.

Yet, this positive view was shadowed by a deep sense of frustration. The nurses explained that while they wanted to help, the reality of pancreatic cancer often made their job feel like a losing battle. Because the disease progresses so quickly, patients often reach a stage where their condition is irreversible. When nurses spent hours guiding a patient through a diet plan or an exercise routine, only to see the patient's condition worsen without noticeable improvement, they felt a heavy sense of helplessness. They worried that their efforts were pointless, and they feared the disappointment of patients and families who expected a miracle that medicine could not deliver. This emotional toll was compounded by the physical reality of their work; these interventions added significant time to an already crushing workload, with no extra staff to share the burden.

The researchers found that the nurses' ability to provide this care was heavily influenced by the people around them. The attitudes of patients and their families were a major factor. Sometimes, families would reject the idea of exercise or special diets, believing the patient was too weak or that the effort was unnecessary. In other cases, families would force patients to eat more than they could handle, contradicting the nurses' advice. The nurses also felt the weight of their colleagues' opinions. If a nurse was the only one trying to implement these programs, she often felt isolated and unsupported. However, when department leaders actively supported these initiatives—by sending nurses for training or creating dedicated nutrition wards—the nurses felt empowered to act. Conversely, the lack of clear, standardized guidelines left them feeling uncertain. They noted that while general guidelines existed, they often lacked specific instructions on how to exercise safely with a wasting patient or how to assess the specific needs of cachexia, leaving the nurses to guess or rely on their own limited experience.

Perhaps the most significant barriers were the practical constraints of the hospital environment. The nurses described a lack of resources that made their work nearly impossible at times. There were no dedicated spaces for patients to exercise, and the equipment needed for rehabilitation was often missing. They spoke of the financial burden placed on families, who had to pay out of pocket for nutritional supplements that were not covered by insurance, leading many to skip these essential treatments. Furthermore, the nurses felt they lacked the right tools to assess the patients properly. They relied on basic scales to check weight or simple tests for muscle strength, but these did not capture the full picture of the patient's decline in function or mental state. Without a comprehensive assessment tool, they struggled to tailor their interventions effectively.

The study concludes that while specialist nurses are eager and willing to use non-drug strategies to help pancreatic cancer patients, they are often held back by a system that does not fully support them. The nurses possess the knowledge and the desire to provide holistic care, but they face a wall of obstacles: insufficient staffing, a lack of standardized protocols, financial barriers for patients, and the emotional strain of watching patients deteriorate despite their best efforts. The researchers suggest that to change this, hospitals need to build better structures. This includes creating clear, step-by-step guides for managing these patients, training nurses in a wider range of skills so they can work as a team, and providing the necessary space and equipment. Most importantly, the system needs to recognize the emotional weight these nurses carry and offer them support, ensuring they do not feel alone in their struggle to improve the lives of patients facing one of the most challenging diseases in modern medicine.