A decisional conflict model of adherence to early mobilization after thoracic surgery: A qualitative interview study

This study aimed to develop a conceptual model of how patients experience and negotiate adherence to early mobilization after thoracic surgery.

A qualitative study using constructivist grounded theory was conducted. Fifteen patients aged 15-79 years, between postoperative days 1 and 5 after video-assisted thoracoscopic surgery, were recruited from a tertiary hospital in China between May and July 2025. In-depth, semi-structured interviews were analyzed using initial and focused coding.

The analysis generated a Decisional Conflict Model. Patients faced two competing asymmetrical threats: an immediate-certainty threat (pain and symptoms) and a long-term-probabilistic threat (complications and delayed recovery), which produced competing avoidance and approach motives. The dominance of these motives was shaped by regulatory factors including trust in clinicians, family support, specific fears, practical constraints, preoperative preparation, and self-assessment. The intensity of this motivational conflict ranged from minimal hesitation to active deliberation. Accounts from participants at different postoperative time points suggested a shift in the balance between the two threats over the recovery course, with timing varying across patients.

Postoperative adherence is a continuously negotiated process in which patients balance the unequal experiential weight of the immediate-certainty threat against the long-term-probabilistic threat. Apparent nonadherence may in part reflect active deliberation under competing threats rather than solely deficient understanding.

Mobilization support should be matched to the temporal phase of recovery and relational context. Early support should prioritize symptom management and acknowledgment of pain rather than emphasizing distant complications. Family members can be incorporated as supportive partners.