The results indicate that breast cancer survivors have a greater focus on attractive and indifferent quality in terms of their home care service demands, accounting for a total of 16 services (48.48%). Additionally, 13 services (43.33%) were identified as one-dimensional needs, while only one service (3.3%) fell under the must-be quality category. This outcome can be attributed to two possible factors. Firstly, it may be because breast cancer survivors generally have better physical functioning and are capable of self-care, resulting in a lower demand for home care services. Previous research has highlighted the significance of self-care ability in determining patient care needs [27]. In this study, the majority of the sample consisted of middle-aged survivors, with 74.92% belonging to stage II or stage I. Furthermore, 74.2% of the survivors had been diagnosed for more than six months. These factors suggest that the participants possessed a certain level of understanding regarding their health condition, had a favorable prognosis, and exhibited a strong sense of self-care, thereby reducing their dependence on home care services.
Additionally, the limited supply of home care services specifically tailored for cancer patients in existing medical institutions could also contribute to the observed results. This inadequate provision may lead to breast cancer survivors having a limited understanding and awareness of home care services, resulting in a lack of experience with such services. Most research in the field of home care services has predominantly focused on the elderly, disabled individuals, and chronic disease patients, with relatively fewer studies investigating the specific demand for home care services among cancer patients[28–30].
As medical technology continues to advance, an increasing number of breast cancer survivors, approximately 90%, express a preference for home-based treatment. Consequently, their demand for home care services is substantial; however, it often remains unmet. Currently, home care for cancer patients is relatively underdeveloped and fragmented, with nurses lacking standardized service capabilities and a lack of standardized home care models [31]. These factors collectively impact the survivors' perception and understanding of home care services, resulting in a higher concentration of demands in the areas of one-dimensional needs, attractive needs, or indifferent needs, while must-be needs receive less attention.
In the future, it is crucial to collaborate with families, communities, and hospitals to conduct public awareness campaigns and educational lectures. Large-scale publicity efforts through various media channels such as television, the internet, WeChat, and microblogs should be employed to improve survivors' understanding and recognition of home care services. This will enable breast cancer survivors, both in urban and rural areas, to access nearby medical resources, which, in turn, will promote the availability of medical resources in these regions and alleviate the challenges associated with receiving adequate medical treatment.
Must-be services
It is essential to prioritize the must-be service for breast cancer survivors in home care. Must-be service refers to the fundamental demands of survivors in rehabilitation, and without these services being provided, survivors may not show interest in other services[21]. The research findings highlight that the body image management service is the only must-be demand among breast cancer survivors at home. This indicates that survivors have an urgent need for self-image management services. For women, breasts hold special significance, serving as a symbol of physical health and female identity. When breast cancer survivors undergo breast removal, it signifies a complete disruption of their physiological integrity and sexual characteristics. The impact of these changes in body image on survivors is immense and long-lasting [32]. Studies have revealed that physical changes such as breast loss, hair loss, skin scars, pigmentation, and limb dysfunction can lead survivors to question their feminine identity and attractiveness. This, in turn, can result in a decrease in sexual interest, a strong sense of stigma, and the experience of negative emotions such as anxiety, depression, inferiority, and fear[33–35]. Given these findings, it is crucial to prioritize the provision of body image management services for breast cancer survivors. These services may include the selection or wearing of artificial breasts, the use of breast reconstruction materials and products, hair loss care, surgical scar care, and skin pigmentation care, among others. By addressing survivors' body image concerns, these services can help them establish their own role identity, reconstruct their sense of self, and facilitate their integration into their new lives.
One-dimensional services
Focusing on one-dimensional services is crucial for improving patient satisfaction. The provision of these services leads to an increase in satisfaction, while their absence results in decreased satisfaction[21]. The analysis revealed that there were 13 (43.33%) one-dimensional services identified by breast cancer survivors. Based on the Better-Worse coefficient results, the following services were highly expected by survivors: social medical security services, symptom response guidance, health consulting services, follow-up management services, drug delivery services, emergency services, examination guidance, family visit services, pain relief guidance, medication safety guidance, specialized nursing service, exercise guidance, and health file management. These one-dimensional services primarily revolve around social medical support, health management, and health guidance. This result indicates that survivors have a strong desire to receive economic assistance and continuous health services at home. The prolonged treatment duration and the extensive use of medications often prevent patients from resuming work, leading to significant financial burdens and economic toxicity[36]. The study findings highlighted that the social medical security service had the highest Better value and |Worse| value, indicating that breast cancer survivors have the highest expectations and consider this service to be of utmost importance. In light of these results, it is crucial to prioritize the provision of social medical services during home care. This may involve providing survivors with information on major disease reimbursement coverage, the reimbursement process in different regions, and related insurance schemes. By addressing survivors' economic concerns and providing comprehensive health management and guidance, we can enhance their satisfaction and alleviate the financial burdens associated with their treatment.
Absolutely, promoting the use of online services provided by internet hospitals is an effective strategy to reduce transportation costs and alleviate the economic pressure on breast cancer survivors. Online consultations, follow-ups, and medication management can be conducted through virtual platforms, allowing survivors to access healthcare services conveniently from their homes. In addition, studies have found that breast cancer survivors are accompanied by adverse symptom during home, such as cardiovascular disease, abnormal bone metabolism, osteoporosis, and drug adverse, which lead to multiple symptom clusters at the same time. Health problems are prominent affect survival[37]. To address these challenges, health management and guidance services play a vital role. Establishing comprehensive health records for survivors and implementing regular follow-ups can help monitor their health status and detect any potential problems. By providing targeted health guidance and interventions based on individual needs, such as symptom response guidance, medication safety guidance, pain management, and risk factor assessments, we can improve the quality of life for breast cancer survivors. This holistic approach to health management not only addresses the immediate physical symptoms but also promotes overall well-being and supports survivors in navigating the challenges they face during their recovery journey.
Attractive services
Indeed, providing attractive demand services is crucial to enhancing the satisfaction of breast cancer survivors during home care. Attractive services are those that patients may not have anticipated but can greatly improve their experience and satisfaction when provided. Neglecting these services may not lead to a decrease in satisfaction, but offering them can have a significant positive impact. The study results revealed that there were 7 (23.33%) attractive services identified by breast cancer survivors. Based on the Better-Worse coefficient analysis, these services include door-to-door health services, communication guidance, internet medical services, emotional management guidance, medical accompanying services, emotional disclosure services, and basic nursing services. These services primarily focus on social communication and telemedicine. Breast cancer survivors often experience challenges in social communication, with a tendency to avoid interactions and higher levels of distress compared to healthy individuals in China [38]. They may struggle to communicate their inner feelings with their families and experience emotional distress [39]. Therefore, providing platforms for social communication, such as organizing doctor-patient communication meetings or encouraging communication with families and other patients, can help survivors release their negative emotions and foster a supportive environment. Furthermore, door-to-door health services, internet medical services, and accompanying/assisting medical services can provide convenience for remote or elderly patients[40]. By offering these services, survivors can access healthcare resources more easily and receive necessary support without the burden of travel or additional challenges.
Indifferent services
Pay dynamic attention to the demand for indifferent services in home care for breast cancer survivors. The demand for indifferent services that whether or not the service is provided will not affect patient satisfaction[21]. The study results indicated that there were 9 (30%) indifferent services identified by breast cancer survivors. According to the Better-Worse coefficient analysis, these services include stress response methods, palliative care services, psychological distress assessment and guidance, social assistance services, psychological support for caregivers or families, health risk factors assessment, social interaction activities, daily life care services, and returning to work. These services primarily focus on psycho-social demands, with the lowest better coefficient associated with the demand for returning to work. This result may be attributed to the treatment stage of the survivors. The study sample consisted mostly of survivors within 3 years after diagnosis, undergoing radiotherapy and chemotherapy, with only 17.1% having received treatment for over 3 years. During this stage, survivors often experience pronounced physical symptoms that can hinder their ability to return to work. Their primary focus is on disease rehabilitation and health management services, resulting in a lower need for palliative care and psycho-social support. Maslow's Hierarchy of Needs Theory emphasizes that when physiological and safety needs are met, individuals can progress to more advanced and socialized needs such as love/belonging, esteem, and self-actualization [41]. Returning to work is an important aspect of self-actualization, but it may not be a necessary demand for survivors if their other needs are not adequately met. However, it is essential to recognize that the demand categories in the Kano model change over time, and indifferent demands may shift towards attractive, must-be, or one-dimensional demands[42]. Therefore, it is crucial to pay attention to the treatment stage of breast cancer survivors and dynamically monitor changes in their home care service needs. As their treatment progresses and their priorities shift, the demand for different types of services may evolve. Flexibility and adaptability in the home care model are necessary to address the changing needs of survivors and ensure their satisfaction throughout their care journey.