Background: Childhood, adolescent, and young adult cancer survivors (CAYACS) face significant long-term health risks, yet adherence to long-term follow-up (LTFU) care remains inconsistent. This study explores the concept of akrasia (i.e., acting against one’s better judgment by engaging in behaviors known to be harmful or counterproductive) to understand the psychological, cognitive, and systemic barriers influencing survivor engagement in LTFU. Method: Using an ethical reflection approach based on a literature review, we discussed survivor experiences, behavioral science insights, and ethical principles to identify solutions that balance patient autonomy with supportive interventions. A narrative approach was used to summarize the key points discussed during the ethics reflection group meetings. Results: Our findings highlight key barriers such as trauma, avoidance behaviors, and cognitive constraints that contribute to non-adherence. Strategies such as shared decision-making, digital health tools, and nudge-based interventions are proposed to enhance survivor engagement. Ethical considerations emphasize the need for personalized and flexible care approaches that respect survivor agency while mitigating obstacles to adherence. Conclusions: Addressing akrasia through ethical and behavioral frameworks could improve LTFU adherence, ultimately enhancing survivorship care and long-term health outcomes.
背景：儿童、青少年及年轻成人癌症幸存者面临显著的长期健康风险，然而其对长期随访护理的依从性仍参差不齐。本研究引入"意志薄弱"概念（即明知行为有害或无益却违背理性判断行事），以探讨影响幸存者参与长期随访的心理、认知及系统性障碍。方法：基于文献综述采用伦理反思框架，结合幸存者经历、行为科学洞见与伦理原则，探寻平衡患者自主权与支持性干预的解决方案。通过叙事性方法系统梳理伦理反思小组会议的核心讨论要点。结果：研究发现创伤经历、回避行为及认知局限是导致依从性不足的关键障碍。研究提出共享决策、数字健康工具及助推式干预等策略以提升幸存者参与度。伦理考量强调需建立尊重幸存者自主权的个性化弹性照护模式，同时消解依从性障碍。结论：通过伦理与行为学框架应对意志薄弱现象，可提升长期随访依从性，最终优化幸存者照护体系并改善长期健康结局。
肿瘤(癌症)患者之家