Influencing factors of continuance intention of online consultation among cancer survivors: Grounded theory study (Preprint)

BACKGROUND Online consultation platforms have become an important component of cancer survivorship care, particularly in contexts where survivors require long-term follow-up and reassurance. While adoption increased during the COVID-19 pandemic, evidence on the factors influencing continued utilization among cancer survivors remains limited, especially in China. OBJECTIVE This study aimed to explore the influencing factors of continued utilization of online consultation among cancer survivors in Southwest China and to develop a grounded theoretical model explaining continuance intention. METHODS A grounded theory qualitative design was employed. Twenty-six cancer survivors with diverse cancer types, treatment stages, and demographic characteristics were recruited from the Sichuan Cancer Hospital & Institute and affiliated institutions. Semi-structured telephone interviews were conducted, transcribed verbatim, and analyzed through open, axial, and selective coding. Data collection continued until theoretical saturation was achieved. RESULTS Six interrelated domains influenced survivors’ continued use of online consultation platforms: platform quality, physician competence, user perception, individual condition, external context, and privacy concerns. User perception mediated the impact of platform quality and physician competence, while individual condition and external context exerted both direct and indirect influences. Privacy concerns acted as a moderator, as survivors weighed perceived benefits against risks of disclosure. The final theoretical model positioned continuance intention at the center of these interconnected domains, reflecting survivors’ negotiation between technological features, relational care, personal health status, family involvement, and privacy considerations. CONCLUSIONS Cancer survivors’ willingness to continue using online consultation depends on multiple interrelated factors beyond technological usability. Sustained engagement is shaped by survivors’ perceptions of usefulness and trust, physician empathy and timeliness, family encouragement, and acceptance of privacy trade-offs. The theoretical model advances understanding of digital health continuance in oncology and offers practical guidance for developing survivor-centered online consultation services.