Women's lived experiences with nurse-supported digital rehabilitation after gynaecological cancer: A phenomenological hermeneutic study

Abstract

Gynaecological cancer survivors face various post-treatment challenges, including physical, psychological, social and existential difficulties. Despite existing follow-up, many women experience unmet needs and lack of rehabilitation services. In the present study, we aimed to gain a comprehensive understanding of how participation in Gynea, a nurse-supported digital rehabilitation program, is experienced after gynaecological cancer treatment. Through in-depth interviews with 20 women, four main themes emerged from a phenomenological hermeneutic analysis. The theme Vital but demanding work described participation as beneficial but emotionally demanding. The theme Normalisation leading to self-compassion and acceptance showed that shared experiences helped women normalise and accept changes. The theme It takes time to digest described the need for individual time processing the cancer experience. The last theme Nursing support as essential in digital rehabilitation, described nursing support as providing safety, guidance and motivation. Overall, participation helped alleviate some of the existential distress following illness and treatment, with nursing support crucial for engagement and completement of the programme. We used the consolidated criteria for reporting qualitative research (COREQ) to support the research process and ensure transparency in our work.

Trial Registration:

The Gynea project is registered as a clinical trial, ID: NCT 04414436, https://clinicaltrials.gov/show/NCT04414436.

Introduction

After being diagnosed and undergoing treatment for gynaecological cancer, women experience a range of challenges and consequences that impair their quality of life. These include bodily, psychological, social and existential aspects of life, including anxiety, fear of recurrence and sexual difficulties.^1–3 The three most common types of gynaecological cancer are endometrial, ovarian and cervix cancer, with less common types including vulvar, vaginal and rare uterine sarcomas. ⁴ In Europe, endometrial cancer is the fourth most common cancer in women, while ovarian and cervix cancer rank 8th and 12th. ⁵ In 2023, 1727 Norwegian women were diagnosed with gynaecological cancer with a median age of 47 years for cervical cancer, 69 years for uterine cancer and 69 years for ovarian cancer. ⁴

In addition to the side effects and challenges common to most cancers, gynaecological cancer treatment involves an induced menopause in pre-menopausal women, whose symptoms are reported to be more severe and last longer than a normal menopause. ⁶ Despite close follow-up from the healthcare service during treatment, there seem to be limitations in follow-up that address women's challenges after cancer treatment.^2,7 Many gynaecological cancer survivors experience unmet rehabilitation needs,^1,3,8 which are also associated with reduced quality of life. ⁹ To address these rehabilitation needs, both the World Health Organization ¹⁰ and national recommendations such as Norway`s Directorate for eHealth ¹¹ recognise e-health as a prerequisite for making universal health coverage achievable.

Nursing care plays an important role in supporting cancer survivors, yet there is limited research on how digital rehabilitation is experienced by gynaecological cancer survivors. Systematic reviews of digital interventions designed to improve the quality of life in cancer survivors have found that participation resulted in positive behavioural and/or health-related outcomes.^12–16 The main content of these interventions generally included education, life management and coping skills ¹² and focuses on physical activity, mindfulness, stress management and cognitive therapy.^13–16

However, research is inconclusive about the effect of symptom distress, social support, psychological distress and sexual well-being in digital interventions designed for women with gynaecological cancer. ¹⁷ The findings drawn from single studies have shown that women value knowledge sharing and support from peers after gynaecological cancer,^18–21 as well as being reassured through symptom monitoring. ²²

Notwithstanding the positive results from quantitative studies, there seems to be a lack of qualitative studies that provide an in-depth understanding of digital interventions in gynaecological cancer rehabilitation. Previous research advocates for a holistic, person-centred approach, recognising the diverse and individual rehabilitation needs across cancer types.^2,23,24 Conversely, digital interventions are typically designed for larger groups. Holter et al. ²⁵ argue for exploring user perspectives to understand the working mechanisms of digital health interventions, beyond measuring effectiveness, usability and technological functionalities. This research is important for nursing practise, as registered nurses (RNs) play a key role in patient care, including digital health. Understanding the impact of digital rehabilitation is vital for shaping future care. Hence, the present study aimed to gain a comprehensive understanding of how informants experienced nurse-supported digital rehabilitation after gynaecological cancer treatment.

Methods

Design

We chose to use a phenomenological hermeneutic design that explored the phenomenon of participating in a digital rehabilitation program after gynaecological cancer treatment. Phenomenology seeks to understand how individuals undergo and give meaning to lived experiences based on their own descriptions. ²⁶ Hermeneutical interpretation aims to unfold the essential meaning of lived experiences. ²⁶ Data were collected through semi structured in-depth interviews conducted via video conferencing. Data analysis followed a phenomenological hermeneutic method by Lindseth and Norberg. ²⁷ We used the consolidated criteria for reporting qualitative research (COREQ) to ensure rigour and transparency. ²⁸

Study context

The digital rehabilitation program used in this study (Gynea) was developed following the UK Medical Research Council`s framework for complex interventions ²⁹ and the development has been described in detail in a previous study. ³⁰ The program consisted of a 6-week digital course incorporating psycho-educative elements, such as educational content and mindfulness exercises in weekly thematic modules covering life after gynaecological cancer treatment. These themes were named everyday life after illness, a changed female body, sexual health, fatigue, fear of recurrence and a summary. After each module, women were followed up by RN support via telephone to clarify thematic content, assist with tasks and address technical issues. The women's engagement in the course was encouraged through different assignments, such as writing their own cancer stories and performing mindfulness exercises focusing on presence and self-compassion. The nurse read the participants’ written work before the telephone conversation, which lasted a few minutes to up to half an hour. All of the RNs involved in the program had a background in cancer care, had received relevant training and followed guidelines for telephone follow-up.

Recruitment and sampling

The informants in this study were 20 women who took part in the Gynea digital rehabilitation program between four and 15 months after completing primary treatment for gynaecological cancer. A purposive sampling ³¹ approach was used, as informants were recruited to the study by a short message service (SMS) text sent by a RN after they had completed the digital program. Prior to participation in Gynea, informants had to meet the following inclusion criteria: (1) completed primary treatment for gynaecological cancer; (2) aged over 18 years; and (3) fluency in Norwegian. Exclusion criteria were: (1) known cancer recurrence; (2) severe mental health disorders; (3) insufficient cognitive or Norwegian language skills; and (4) no curative intent of the treatment.

In total, 22 women agreed to participate in the interviews, but two withdrew their consent before the interviews started due to deteriorating health.

Data collection

Data were collected through individual semi-structured in-depth interviews conducted face-to-face via video conferencing, except two respondents who requested a telephone interview as they found it easier to speak about the cancer experience without being face-to-face. The first researcher conducted the interviews between January 2021 and February 2022 after the informants completed Gynea. Although NJNR's guidelines recommend data no older than 3 years, the findings from this study remains highly relevant in 2025. The phenomenological hermeneutic design with in-depth experiences, remain valuable for understanding how digital rehabilitation after gynaecological cancer treatment is experienced. Given the limited availability of comparable programs and research in this field, these insights continue to provide an important contribution to clinical nursing practice and future research. The interviews lasted between 60 and 150 min and were audio recorded for transcription. The interviewer had a clinical background as a nurse in gynaecological care and had no contact with the informants before the study.

The interview guide included the following main questions: “How did you experience your participation in Gynea?”, “What was it like to work with the different modules?” and “How did you experience the nurse support?” The interview guide was developed in collaboration with the team that developed Gynea which included clinicians, researchers and user representatives. Additionally, the guide was based on a phenomenological hermeneutic methodology to ensure that the questions helped gather rich descriptions of the informants’ experiences. The interviewer asked exploratory and affirmative follow-up questions to help informants probe deeper into the phenomenon.

Data analysis

The transcribed interviews were analysed according to the Lindseth and Norberg ²⁷ phenomenological hermeneutical method, an inductive approach where themes and subthemes emerged from the data. The method comprises of three steps that form a hermeneutical circle aimed at opening a universal meaning of the phenomenon, namely naïve understanding, structural analysis and comprehensive understanding. In the first step, we conducted a naïve understanding. This is described as an immediate interpretation of the text in which one refrains from a natural attitude with judgments and presupposed understanding, trying to read the text with a phenomenological attitude. ²⁷ Due to the complexity of each participant's experience, we wrote one individual and unique naïve understanding for each interview and thereafter an overall integrated naïve understanding for all interviews.

In the second step, the naïve understanding was validated by structural analysis. This is important to avoid one-sided views or opinions and prejudices. ²⁷ Structural analysis consists of a conscientious and thorough interpretation and analysis of the text. The meaning units extracted from the text were structured into a table and condensed to present a precise expression of their meaning. In this part of the analysis, the themes and subthemes were discussed among the researchers and reflected upon. Furthermore, they were interwoven to create an objective understanding ³² with all its variations backed by citations. A dialectic process of rewriting and reformulating the themes and repositioning the meaning content was undertaken until there was a coherent relationship between the naïve understanding and the structural analysis. The first researcher conducted the analysis, while the second and fifth researchers reviewed and discussed the emerging themes. The third and fourth researchers provided feedback and helped finalise the analysis.

In the third and last step of the analysis, comprehensive understanding, we reflected critically on and discussed the findings on the basis of previous research and theory that could contribute to a universal meaning of the phenomena as a way of participating in life. ²⁷ Open discussions between the researchers and the analysis prevented the single researcher's view and values from dominating the findings. In this article, the comprehensive understanding is presented in the discussion.

Rigour

Trustworthiness was maintained through several strategies. First, initial concepts were shared with informants, allowing them to confirm, challenge or add insights to ensure the accuracy of our understanding. The first researcher used a reflective diary to gain a conscious awareness of the preunderstandings to ensure the phenomenon to be authentically described. Informant’s quotes were used throughout the findings to ensure their voices were represented. Finally, member checking was conducted, where four informants reviewed the drafted manuscript, confirming its accuracy and resonance with their lived experiences, ensuring the study's confirmability.

Ethical considerations

The Gynea project was approved by the National Research Ethics Committee in 2019 and assigned reference number 2019/491. In addition, this study was assessed by the National Centre for Research Data and assigned reference number 446602. The Gynea project is registered as a clinical trial in a public clinical trial registry, with the following ID: NCT 04414436, https://clinicaltrials.gov/show/NCT04414436. Audiotaped recordings and transcribed interviews were stored on the research server of (name of the researcher's institution), and data were anonymised. Informed consent was obtained from all informants, to ensure that they were fully aware of the study's purpose, procedures, and their right to withdraw at any time without consequences. Information about the study was provided both verbally and in writing, and the informants gave their informed consent twice: first upon enrolment in the digital program and again when consenting to the in-depth interview. This process was in line with the ethical principles from the Declaration of Helsinki, ³³ ensuring the informants’ rights and confidentiality were protected. To maintain anonymity, all names used in the findings chapter are fictitious.

Results

The informants in this study had a median age of 53 years, with a wide range of cancer types, stages and treatments represented. All informants were employed at the time of diagnosis, except one retired woman. Among the 20 informants, 15 held positions that required a university degree, while the remaining five held positions requiring a high school diploma. Five informants were childless, one due to cancer, while the majority (n = 15), were married or in a relationship. Additionally, two informants had a non-Norwegian background.

Naïve understanding

Participation in digital rehabilitation following gynaecological cancer was, for some women, experienced as a life-changing process crucial for shaping their future perspectives, while, for others, it was less meaningful. The program helped the informants understand how illness and treatment had led to changes and challenges in their lives.

After cancer treatment, limited information and follow-up from healthcare providers often led to anxiety and fear of recurrence, especially with unanticipated bodily changes. Through Gynea, they were introduced to and informed about the consequences of cancer for the first time. Taking part in the program was demanding work that challenged the women to undergo their cancer experiences anew, which they found emotionally painful and difficult. However, it was described as important work because it enabled an understanding of and a sense of normalisation of the changes following cancer, which led the cancer experience to become less dominant. Normalisation also contributed to an experienced acceptance of oneself and one's changed body, leading to an awareness of self-care as an important aspect of life. The RNs support was described as necessary security for the women, as a form of support and understanding needed to engage fully in the emotionally challenging aspects of the rehabilitation process.

Structural analysis

The structural analysis could be understood from four themes describing the experiences of participating in the digital rehabilitation program after gynaecological cancer treatment. These themes were: Vital but demanding work, Normalisation leading to acceptance and self-compassion, It takes time to digest and Nursing support as essential to digital rehabilitation.

Vital but demanding work

In the first theme, Vital but demanding work, the informants described that their participation in Gynea was experienced as emotionally demanding. After reading or listening to the narratives in the first module, women were invited to write their own cancer stories. Many women described this as the most emotionally demanding task, while it offered great relief verbalise their thoughts. Frida (50) explained, “When I had it on paper, it was there and no longer in my head. I can’t forget it, but if I want to, I can just read it instead of thinking about it all the time”. Several women used the expression “processing work” when describing their emotional journey through the program. While the processing was unique for all informants, what was similar for all of them was that it started when they felt a sense of recognition through the content of the program, especially through the narrative stories. For many, recognition triggered strong bodily reactions. Olivia (65) described it this way: “My entire cancer experience came back to me when I listened to the characters’ stories. It was as if it was me that they were talking about”. Revisiting one's own illness experience was described as particularly demanding because it required informants to recall emotions that were painful and frightening. Several respondents said that they had ‘avoided’ the cancer experience because of the emotional distress it caused. Pia (50) found reading other stories difficult, because of their similarity to her own. She stated the following: “I had put it away, and now it came back … things I had put a lid on, … and I had to go through it again, with reactions linked to bodily changes, through everything that had happened. I was so sad because I had lost so much of my former self. I was changed”. Through the stories and information in Gynea, the women learned words and concepts to convey incomprehensible, wordless experiences. Cecilie (50) stated she now could organise thoughts that she could not verbalise earlier. She explained it like this: “Fear of recurrence was like something murky in my subconscious that I was able to put into words. I would not have come up with the words, even if I had experienced them. I did not know that there was a term for what I had experienced”. Cecilie explained how this provided relief: “When I recognised myself, I cried and I cried and I cried. But for each concept in Gynea that I could relate to my own experience, the painful emotion inside me diminished a little”. Several women said that working with the exercises and revisiting their cancer experience triggered a range of emotions – from sadness and crying over what had happened to joy and relief that they had gained a new self-understanding.

Normalisation leading to self-compassion and acceptance

In the second theme, Normalisation leading to self-compassion and acceptance, the informants described one of the most important benefits from participation was learning that their struggles could be understood in the context of their diagnosis and treatment. This confirmation that their experiences were normal was decisive for processing what they had endured. After treatment, most women experienced that information about life after cancer treatment was absent. In turn, this led to an association between unexpected physical changes and cancer recurrence. Reading about other women with similar experiences helped normalising their feelings. Vera (50) described this as follows: “I had been through a year when I was very afraid of relapse. But when I read about others experiencing things similar to what I had experienced, I realised that this was normal and not a sign of relapse”. Jane (50) also shared her fear of the cancer recurring and explained that she had struggled with thoughts that led her into a “dark hole” of self-pity and gloomy thoughts about the future. After gaining new understanding and knowledge about the disease's sequelae and what could help her, she changed how she thought about her life: “I used to think that I was lucky if I were to live a few more months. Now, I think I will live for many years to come”.

After treatment, several informants experienced challenges with concentration, memory and work capacity, and several felt they could not resume the same work as before. Expressions such as “not managing”, “feeling lazy” and “my brain doesn’t work” were linked to feelings of defeat. When informants learned about the experiences of other cancer survivors through Gynea, it led to a sense of normality, releasing them from feeling personally responsible for their symptoms. This contributed to a process toward acceptance of their situation. Ursula (50) stated: “After treatment, I felt that my body and psyche were completely changed. But I did not have the opportunity to take it into consideration because I had to go back to work. It was horrible because I did not manage it. The doctor said to me that I had ‘only’ had surgery and that made me feel lazy. … But when I went through the program, I thought to myself that there were others who had the same experience as I had, meaning that what I experienced is normal; I am not lazy”.

In line with the theme of normalisation leading to self-compassion and acceptance, the informants described experiencing compassion for the narrative characters, which eventually evolved into self-compassion. Elisabeth (30), for example, felt particularly empathetic toward one character and her experiences and explained it by, “Because I know what it's like”. Another informant reported that when she read about women who received support from their partners, it increased her loneliness but also compassion for herself, living without a partner.

By gaining self-awareness, the informants experienced growing acceptance and compassion toward themselves, living with the cancer experience. This helped them take better care of themselves and their bodies. Olivia (65) described it this way: ‘It gave me the confirmation that it is not just me … and my experience is normal. With the acceptance of the changes, the pieces of the puzzle fell into place. This is something I must go through. I just have to listen to myself, to my body”. Informants indicated that they had shared the gained knowledge with their family and partners and explained the need to look after themselves. Some informants printed texts from the program for their close relatives to increase their awareness and understanding.

It takes time to digest

In the theme, It takes time to digest, the informants described how processing their cancer experience took time, and, while some felt the duration of the program was sufficient, others wished for more time to reflect. The program lasted six weeks. Some informants wanted more time because there were many feelings and important matters that needed reflection. Diana (40) formulated it this way: “For my part, it could have lasted longer, because these issues need maturing. At least for me, they do”. Those who had not finished the program explained that they downloaded audio files and printed text from the program so they could continue to work on it. Informants reported spending most time on topics they felt were specific to their situation and passed on topics they did not need or did not feel “ready” for.

Informants who experienced less benefit from the program linked this to the fact that they had received good information and follow-up from health personnel during and after their treatment. One informant stated that she chose not to be open about her cancer experience and ignored the program exercises because she wanted to “put the cancer away”. Another stated that, although she had benefited little from the digital program due to a lack of recognition in the program, she did benefit from the conversations with the RN.

Nursing support as essential for digital rehabilitation

In the theme Nursing support as essential for digital rehabilitation, informants highlighted the important role of nursing support in enabling them to fully benefit from the digital program. Nursing support provided through the telephone was described as decisive for gaining full benefit from the digital program. To complete the program without professional support was described as “half-finished work”. The informants described that, without the RNs’ telephone conversations, they would have struggled to complete the program. Others said that they would have dropped out within the first week because it was emotionally challenging to confront their own cancer experience, fearing that they could not cope with the anxiety that might be evoked. The informants emphasised that it would have felt risky to enter such a deep personal process without a skilled mentor. Sarah (60) described it this way: “Without the phone call with the nurse, I would have dropped out, because these are very tough topics that deal with my life. I thought that if I am going to go into it, I have to be able to share it with someone afterwards”. The RN provided a sense of security, empowering women to work through these challenges.

Contact with the RN helped to verbalise the women's unspoken cancer experiences. Cecilie (50) stated the following: “The nurse asked questions I hadn’t thought of myself. I had an answer but had never been able to pose the question”. Cecilie explained that it was through these conversations and reflections that she could mature existentially. Informants believed the nurse's knowledge and experience with other cancer survivors enabled her to confirm that their experiences were normal concerning what they had endured. Interpersonal and professional contact with the nurse was described as a value beyond the digital program, alone. Ingeborg (70) described the importance of the nurse being present when she discussed difficult aspects of life after cancer: “At the hospital, I was told that I had finished treatment, I was healthy and should be happy. The nurse in Gynea never said that. She was always present with what I was struggling with. She was my anchor”.

The informants often avoided discussing their cancer experiences with relatives and friends to prevent causing worry. The RNs was described as being understanding by listening to and tolerating what was painful and difficult, yet distant enough to provide support without becoming personally affected. A few informants emphasised that nursing support was the most important part of the program with those conversations, alone being sufficient.

Discussion

Participation in the nurse-supported digital rehabilitation program was described as an important turning point in coping with life after gynaecological cancer. After treatment, life were filled with an existential uncertainty about the physical changes for which they were not prepared and a fear of cancer's recurrence.

Many women struggle with feelings of uncertainty and anxiety long after their illnesses due to a lack of information and guidance about late effects and symptoms from cancer illness and treatment.^3,34,35 Feelings of uncertainty after cancer have also been linked to changed self-knowledge and self-perception. ³⁶ According to Merleau-Ponty's phenomenology of the body, feelings are bodily expressions of how we relate to phenomena. ³⁷ The existential uncertainty relieved when the informants in our study understood that what they experienced was normal due to cancer treatment and illness can be understood as a change in how they related to themselves in their lives after cancer. Hence, we can assume that gaining a new sense of self-knowledge and understanding reduces feelings of uncertainty and existential distress after cancer.

Before participation in Gynea, several informants had avoided delving into their cancer experience, and some informants stated that they had kept their cancer experience at a distance for fear of recalling uncomfortable memories. For many, expressing the cancer experience in writing was the most challenging task as well as existential relieving. These experiences can be explained on the basis of trauma theory, which holds that if a stressful experience, such as having cancer, is not verbalised, the patient will not progress from the experience and their feelings and understandings will not be revealed. ³⁸ Moreover, research on gynaecological cancer survivors revealed that women who deliberately avoided the cancer experience were impeded by their existential growth and felt uncertainty for many years thereafter. ³⁹ By contrast, expressing and processing the cancer experience has been associated with reduced existential stress and a lower fear of recurrence over time in cancer survivors. ⁴⁰ These findings emphasise the importance of expressing the cancer experience as part of the processing work. However, one of our crucial findings was that, for the informants to express their cancer experience, they needed a language to unfold it. According to Merleau-Ponty, ⁴¹ to develop self-understanding, we must express and verbalise our thoughts through writing or articulation. This requires a knowledge of words that can give meaning to the experience. In the present study, the educational content and the three narratives in the program provided informants with words and concepts that enabled them to express their cancer experiences. Accordingly, they embodied a new understanding of themselves. The most important purpose of expressing an experience is to open up a new dimension of understanding and a new way of existing. ³⁷ This refers to the existential growth and maturation that can be experienced through processing a life-altering event.

Although the self-knowledge gained by subjects can be linked to receiving information, our study suggests that their understanding surpasses knowing about the illness. The informants described their new understanding of themselves as a personal endeavour as they processed the cancer experience. Research has also demonstrated that active patient involvement and participation in digital self-management programs are crucial for improving outcomes in cancer survivorship, such as increasing quality of life. ⁴² This corroborates the phenomenological perspective of the body, where intellectual information, alone, does not contribute to self-knowledge as embodied consciousness; this must be achieved through bodily interaction. ³⁷ In the present study, the informants stated that processing the cancer experience started when they recognised their own experiences, especially through the narrative characters, as they gave meaning to their experiences. Research on online peer support interventions have shown that patients have experienced understanding and adaption to their cancer experiences by sharing personal experiences and emotions with others online. ⁴³ Merleau-Ponty ³⁷ notes that achieving understanding through another person can only be realised if the other person's emotional expressions can be compared and identified in one's own expressions, such as bodily feelings. This highlights the advantage of incorporating lived experiences from former gynaecological cancer patients to make the informational content identifiable and recognisable for informants.

The present study highlights the profound impact RNs had in digital rehabilitation, supporting the informants in processing their cancer experience. It is well known that entering experiences with cancer can trigger traumatic stress. ³⁸ Women in studies who addressed challenging and vulnerable topics after gynaecological cancer relied on guidance that made it safe for them to open up about their experiences.^22,44,45 In trauma work, it is emphasised that the success of professional guidance relates to, among other things, the actual presence of professionals, themselves. Listening can give another person the opportunity to tell a story. ³⁸

The informants and the RN in our study never met face to face; however, the informants described the presence of the RN as near and caring. Our understanding is that the value of the shared presence of two or more people does not depend on a physical presence, but on the connection formed between the two. This connection encompasses the ability to feel trust and empathy for one another, the possibility of being open and reflective with the other and the sharing of thoughts and states of mind. ⁴⁶ It may seem that the physical distance between the participant and the nurse turned into existential proximity based on their shared presence.

Strength and weaknesses

The data in the present study offer a nuanced perspective on participation in digital rehabilitation for women in various life situations after gynaecological cancer. The strengths of the study include the use of semi-structured interviews, which provided rich insights into the informants’ experiences, and the application of the comprehensive analytical method of Lindseth and Norberg, ²⁷ which combines both a naïve understanding and a structural framework. This approach, discussed and reviewed by all researchers, contributed to avoid one researcher's preconceptions influence the study. Additionally, the use of direct quotes from informants enhanced transparency and strengthened the study`s trustworthiness.

However, there are several limitations to the study. First the sample was homogenous, with most informants having a high level of digital health literacy and a higher education compared to the general population in Norway. This could reduce the transferability of the finding to women who have lower levels of education and digital health literacy. Additionally, informants from other ethnic- or cultures are minimally represented in the study, which limits our understanding to how such a program impact other groups that are not included in this study. Furthermore, informants were recruited to Gynea through open invitation, which may have introduced selection bias, as women interested in information and rehabilitation were more likely to participate, potentially not fully representing the broader population of gynaecological cancer survivors. This may also affect the study's transferability. Another limitation is that the study only include women who completed the Gynea programme, and so no data reveal the experiences or reasons of those who chose not to participate or who dropped out. This means that the study cannot provide insights into potential barriers to participating in digital rehabilitation after gynaecological cancer.

Implications and conclusions

The present study explored women`s experiences with a nurse-supported digital rehabilitation program after gynaecological cancer treatment.

The implications of the study suggest that digital rehabilitation program supported by RNs can provide necessary support in addressing the ongoing challenges of the cancer experience, especially when face-to-face follow-up is limited. For patients, this program can serve as a valuable tool for processing challenges related to the cancer experience and supporting self-care. In settings where healthcare resources are scarce, nurse-supported digital rehabilitation can offer a cost-efficient alternative. For RNs, the study highlights the importance of providing personalised empathetic care that addresses individual needs of women during digital rehabilitation. For developers, there is a clear need to design programs that effectively engage informants, including cancer specific information in order for women to recognise their own experiences, and include nursing support to enhance women's engagement in self-care. Future research should focus on exploring the experiences of women who did not complete or chose not to participate in such interventions to understand barriers and refine the programs accordingly. It would also be interesting to explore the outcomes of participating in such a programme without nursing support. Furthermore, ensuring easy enrolment is crucial to include women with lower levels of digital literacy.