Factors Influencing Continuance Intention for Online Consultations Among Survivors of Cancer: Grounded Theory Study.

BACKGROUND: Online consultation platforms have become an important component of survivorship care for patients with cancer, offering flexible access to oncology expertise between scheduled visits. However, evidence on what drives the willingness of survivors of cancer to continue using online consultations after initial adoption remains limited in China. A better understanding of continuance intention is needed to inform survivor-centered digital health strategies. OBJECTIVE: This study aimed to explore the influencing factors of continued use of online consultations among survivors of cancer in southwest China and develop a grounded theoretical model explaining continuance intention. METHODS: A grounded theory qualitative design was used. A total of 26 adult survivors of cancer with diverse demographic and clinical characteristics were purposively recruited from a tertiary cancer center in southwest China. All participants had used online consultations at least once in the preceding year. Semistructured telephone interviews were audio recorded; transcribed verbatim; and analyzed using open, axial, and selective coding with constant comparison until theoretical saturation was reached. During selective coding, categories and their relationships were integrated and iteratively refined to construct a grounded theoretical model of continuance intention. 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. Platform quality and physician competence influenced user perception of usefulness, reassurance, and trust, which functioned as a mediator of continued use. Individual condition, including health status, health literacy, and psychological needs, influenced both perceived usefulness and reliance on online consultations. External context, especially family encouragement, peer recommendations, and availability of local oncology services, directly facilitated or constrained continued use. Privacy concerns moderated how survivors balanced perceived benefits against risks of data misuse, stigma, and unwanted disclosure of cancer history. Survivors described online consultations as offering rapid guidance and emotional support that complemented hospital-based care but reported discontinuation when interactions were delayed or impersonal or when perceived privacy risks outweighed the benefits. CONCLUSIONS: The willingness of survivors of cancer to continue using online consultation platforms depends on multiple interrelated factors beyond traditional 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.