Abstract
<title>Abstract</title> <p>Objective To explore how patients with cancer interpret and experience refusal of intensive care unit (ICU) readmission following prior ICU admission, and to develop an understanding of autonomy-related decision-making interpreted using Psychological Reactance Theory as a sensitising framework Methods A phenomenologically informed qualitative study was conducted in a tertiary cancer hospital in China (June–December 2024). Fifteen patients with cancer who had experienced ICU admission and subsequently refused ICU readmission were recruited purposively. Semi-structured interviews were analysed using Colaizzi’s phenomenological method. An abductive approach integrated inductive thematic analysis with Psychological Reactance Theory as an interpretive framework. Reporting followed COREQ and SRQR guidelines. Results Four interrelated themes were identified: (1) ICU care as embodied loss of autonomy; (2) ICU readmission as a perceived threat to freedom; (3) psychological reactance manifested as anger, avoidance, and refusal; and (4) reconstruction of autonomy through treatment boundaries, information seeking, and surrogate decision-making. ICU readmission refusal was understood as a dynamic process of autonomy restoration rather than simple treatment rejection. Conclusions Refusal of ICU readmission among patients with cancer may reflect efforts to restore autonomy shaped by prior ICU experiences. Recognising refusal as a potential signal of perceived autonomy threat may support more sensitive communication and shared decision-making in critical care. Implications for Practice: Nurses should interpret refusal as a cue for values exploration, clarify treatment boundaries, provide patient-centred explanations of ICU experiences, consider time-limited ICU trials, and support early surrogate alignment. Clinical trial registration Not applicable. This was a qualitative interview study and did not involve a clinical trial.</p>