Factors influencing patient activation among patients with cancer: A scoping review

Cancer care increasingly relies on long-term self-management, making patient activation an important determinant of health outcomes. However, evidence on the factors influencing patient activation among patients with cancer remains fragmented. Guided by social ecosystem theory, this scoping review synthesized multilevel factors associated with patient activation to inform future research and intervention development.

This review was conducted following Arksey and O'Malley's framework and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) extension for scoping reviews. Twelve databases, including PubMed, Web of Science, Embase, Cochrane Library, Scopus, CINAHL, ProQuest, PsycINFO, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), China Science and Technology Journal Database (VIP Database), and Wanfang, were searched from inception to March 29, 2025. Basic qualitative content analysis was performed in NVivo 15 using deductive coding.

Twenty-six studies were included. Factors influencing patient activation were mapped to three levels of the social ecosystem: (1) the microsystem, including social factors, psychological factors (illness perceptions, motivation, emotional factors, psychological resources, and self-management cognition and ability), and physiological factors (disease course and treatment, cancer-related adverse effects, and health status); (2) the mesosystem, involving family, other social groups, and professional groups, particularly the quality and experience of medical interactions; and (3) the macrosystem, including culture, institutions, and community, which was the least frequently examined level. These factors may interact across levels, although evidence for cross-system pathways remains limited. Differences in influencing factors may also exist across phases of the cancer trajectory.

This scoping review integrates evidence on factors influencing patient activation among patients with cancer through the lens of social ecosystem theory, addressing prior fragmentation in the literature. The findings provide a theoretical basis that may inform for future longitudinal studies, cross-cultural comparisons, and tailored intervention development.