Exploring Patients' Care Needs in Digital Free-Text Messages During Cancer Treatment: Qualitative Analysis Guided by the Fundamentals of Care Framework.

AIM: To describe the content of patients' free-text messages submitted within a digital symptom-monitoring system during cancer treatment, and to explore how these messages reflect relational, integrated, and contextual care needs as conceptualised in the Fundamentals of Care Framework, and to generate implications for the future development of digitally mediated cancer care.

DESIGN: Exploratory qualitative study using inductive and deductive content analysis.

METHOD: Free-text messages (n = 2097) from 180 patients receiving treatment for breast, prostate, or pancreatic cancer were analysed. These messages were collected between 2013 and 2017 within three clinical trials, in which intervention-group participants used a symptom-reporting app and could submit free-text messages alongside their reports. Summative counts and inductive qualitative content analysis were conducted first, followed by a deductive interpretation using the Fundamentals of Care Framework to examine how communication reflected relational, integrated, and contextual care needs.

RESULTS: Three interconnected categories were identified: navigating uncertainty and taking an active role, reassurance and confirmation, and going beyond predefined symptom ratings. These formed the overarching theme of expressing experiences and negotiating shared care. Patients used free-text messages to seek clarification, describe symptoms and contextual factors, articulate self-care efforts, set boundaries for communication, and maintain relational continuity with nurses. Deductive interpretation suggested that patients actively contributed to sustaining therapeutic relationships, integrating symptoms with everyday life experiences, and managing substantial self-care responsibilities.

CONCLUSION: Free-text communication enabled patients to articulate needs not captured in structured symptom questionnaires, supporting more person-centred and contextually informed assessment. Implications for the profession and patient care: Future digitally mediated cancer care should not only monitor symptoms but also support relational continuity, preserve integrated patient narratives, and facilitate collaborative sense-making around self-care and symptom management. WHAT PROBLEM DID THE STUDY ADDRESS?: Structured questionnaires do not fully capture patients' experiences or care needs or the relational and contextual dimensions of care during cancer treatment. WHAT WERE THE MAIN FINDINGS?: Patients used free-text messages to negotiate shared care, contextualise symptoms, maintain relational contact with nurses, and support self-care decision-making during cancer treatment.

IMPACT: Findings inform the future development of digitally mediated cancer care by highlighting the importance of supporting patients' relational work, preserving integrated patient narratives, and enabling collaborative sense-making around self-care.

NO PATIENT OR PUBLIC INVOLVEMENT: This study did not include patient or public involvement in its design, conduct, or reporting.

REPORTING METHOD: The Standards for Reporting Qualitative Research (SRQR).

TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02479607; NCT02477137.