Cancer Patient Advocacy in the Postoperative Intensive Care Unit: The Experience of Nurses and the Voice of Older Adult Patients

Background/Objectives: Older adults with cancer in the postoperative environment face complex vulnerability, exacerbated by the frailty of ageing and the aggressiveness of surgical treatment. In this highly demanding context, nurses play a crucial role as patient advocates. However, there is a knowledge gap regarding how advocacy is perceived and experienced by the nurse-patient dyad. This qualitative study aims to explain the practice of advocacy by comparing the perspectives of nurses and patients in order to construct part of a substantive theory on the subject. Methods: The Grounded Theory methodological approach was adopted. The sample included 6 specialist nurses and 10 older cancer patients from the ICU. Data collection consisted of participant observation and semi-structured interviews with both groups of participants. The analysis followed the constant comparison method, using MAXQDA software (version 24.10.0; VERBI Software; Berlin, Germany), allowing for the systematic and comparative identification of codes and categories from the two data sources. Results: The core process, defined as The Advocacy-Adjustment Dyad, reveals how older adult cancer patients navigate critical care through a symbiotic interplay of coping and support. Patients autonomously deploy Internal Adjustment mechanisms namely, Shielding the Emotional Self, to mitigate disease stress. Concurrently, the nurse operationalizes the Dynamic Expert Nurse Advocacy Cycle through a Therapeutic Alliance that prioritizes the patient’s best interest, integrates the Family as an anchor, and ensures a meaningful understanding of information. This dyadic interaction transforms the ICU from a purely technological setting into a therapeutic space, ensuring the Preservation of Personhood and the safeguarding of the patient’s self-determination. Conclusions: This study is pioneering in integrating the patient’s voice into the construction of a theory on advocacy in critical care, demonstrating that its effectiveness is a process of mutual interaction and not merely a unilateral function of the nurse. The findings emphasise the need to actively include the patient’s perspective in training and policy, offering valuable implications for optimizing older adult-centered care.