Abstract: Objective: To explore and describe the barriers affecting adherence to Comprehensive Decongestive Treatment in patients with Breast Cancer-Related Lymphedema (BCRL), providing evidence for the development of effective clinical interventions. Methods: A descriptive qualitative research method was employed, with purposive sampling used to recruit 15 patients with BCRL, 3 lymphedema therapists, and 3 physicians in a tertiary hospital in Hainan province from October 2023 to March 2024. Data were collected through focus group interviews and analyzed using qualitative content analysis, integrating deductive and inductive approaches to identify recurring themes. Results: A total of 12 themes spanning 3 levels of the social-ecological system. At the microsystem level, barriers included inadequate risk perception, lack of confidence in treatment efficacy, low self-efficacy, the burden of comorbidities, and changes in body image and comfort. At the mesosystem level, role conflict, inadequate dichotomous support for coping, limited interpersonal interactions, and inadequate social support were identified. At the macrosystem level, limited healthcare resources, insufficient institutional support, and a lack of standardized professional training were noted as key challenges. Conclusion: Adherence to Comprehensive Decongestive Therapy in patients with BCRL is hampered by a complex interplay of factors across multiple systematic levels. Addressing these barriers through targeted interventions informed by the identified themes may improve adherence and enhance patient nursing quality.

Key words: breast cancer; lymphedema; Comprehensive Decongestive Therapy; qualitative research