Optimizing radiation dermatitis management in nasopharyngeal carcinoma patients undergoing radiotherapy: a qualitative study based on patient journey mapping

Background Radiation dermatitis is a common and distressing complication of radiotherapy for nasopharyngeal carcinoma (NPC), affecting over 90% of patients. Its clinical management has been widely studied, but patients' evolving needs across the radiotherapy trajectory remain poorly understood. Patient journey mapping can visualize the patient experience and identify care gaps, yet its use in radiation dermatitis management is limited. Methods A descriptive qualitative study used semi-structured interviews with 25 NPC patients undergoing radiotherapy at a tertiary oncology center in China. Purposeful sampling covered four phases: pre-radiotherapy preparation, early radiotherapy, peak radiotherapy, and post-radiotherapy recovery. Data were analyzed using Colaizzi's seven-step method. A patient journey map was developed to visualize tasks, emotions, and pain points at each phase. Results Sixteen themes emerged across four phases, grouped into tasks, emotions, and pain points. Pre-radiotherapy patients reported anticipatory anxiety, information asymmetry, and fragmented preparation. During early radiotherapy, delayed symptom recognition due to wishful thinking led to missed early intervention. Peak radiotherapy was the nadir, marked by severe wound care difficulties, multidimensional symptom distress (pain, pruritus, sleep disturbance), body image collapse, and social withdrawal. Recovery involved transitional care fragmentation, uncertainty about skin changes, and long-term hyperpigmentation and scarring concerns. The map suggested a “rollercoaster” emotional pattern, with greatest distress at weeks 4–6. Because sampling was cross-sectional across phases, this pattern is an interpretive synthesis, not a demonstrated individual longitudinal trajectory. Conclusions This study presents one of the first patient journey maps specifically focused on radiation dermatitis management in NPC patients undergoing radiotherapy. It reveals dynamic, phase-specific needs and critical care gaps, including missed opportunities in proactive skin assessment, structured patient education, practical wound care training, and transitional care coordination. The map offers a visual tool to anticipate needs, optimize intervention timing, and design whole-course nursing interventions. Prospective longitudinal studies are needed to validate and refine it for clinical implementation.