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

<title>Abstract</title> <p> <bold>Background:</bold> Pancreatic cancer cachexia is a complex metabolic syndrome characterized by progressive weight loss, skeletal muscle wasting, and multi-organ functional decline, significantly compromising patients' quality of life and treatment tolerance. Non-pharmacological interventions—including nutritional support, exercise rehabilitation, and psychological care—are essential components of cachexia management, yet their clinical implementation remains inconsistent. Specialist nurses are uniquely positioned to deliver these interventions; however, little is known about the factors shaping their clinical decision-making and practice behaviours in this context. <bold>Aim:</bold> This study aimed to explore specialist nurses' knowledge, experiences, and the factors influencing their use of non-pharmacological intervention schemes for managing cachexia in pancreatic cancer patients, drawing on the Theory of Planned Behavior as an analytical framework. <bold>Design:</bold> A qualitative descriptive study employing semi-structured interviews and directed content analysis. <bold>Setting and Participants:</bold> Thirteen specialist nurses were purposively recruited from the medical oncology department of a tertiary hospital in Dalian, China, between March and April 2026. <bold>Methods:</bold> Data were collected through individual, face-to-face, semi-structured interviews guided by the Theory of Planned Behavior. Directed content analysis was performed following the approach described by Hsieh and Shannon , with the Theory of Planned Behavior serving as the initial coding framework. Findings were organized around the three core constructs: behavioural attitudes (cognitive and affective), subjective norms, and perceived behavioural control. <bold>Result:</bold> Nurses acknowledged the clinical value of nutritional support, exercise rehabilitation, psychological care, and Traditional Chinese Medicine adjunctive therapies, but also experienced frustration when patients' symptoms failed to improve and stress from increased workloads. Salient subjective norms emerged from patient and family expectations, colleague attitudes, and organizational culture. Facilitators included multidisciplinary collaboration and professional training; barriers included a lack of standardized protocols, insufficient staffing of specialist nurses, heavy routine workloads, inadequate reimbursement support, and the absence of cachexia-specific assessment tools. <bold>Conclusions:</bold> Specialist nurses hold generally favorable attitudes toward non-pharmacological interventions but face multiple barriers to their consistent delivery. Establishing standardized protocols, strengthening multidisciplinary collaboration, increasing staffing and training resources, improving policy and reimbursement support, and developing cachexia-specific assessment tools may facilitate the sustained implementation of non-pharmacological interventions. </p>