The purpose of this implementation study is to evaluate the application of an evidence-based practice (EBP) program for managing musculoskeletal symptoms in breast cancer patients receiving endocrine therapy, from a multicultural perspective.

The main questions it aims to answer are:

Is the culturally adapted EBP program feasible and acceptable to implement in real-world clinical settings? Does the implementation of this program effectively reduce patients' musculoskeletal symptoms and improve their quality of life? Researchers will compare the group receiving the cross-culturally adapted evidence-based management with a group receiving standard routine care.

During the study:

Healthcare providers will implement the culturally tailored symptom management program.

Participants will receive targeted health education and nursing guidance based on their cultural context.

Researchers will collect data on how well the program is adopted (implementation outcomes), as well as evaluate changes in patients' joint symptoms and overall well-being at designated follow-up times (clinical outcomes).

Inclusion Criteria:

• Pathologically diagnosed Hormone Receptor Positive (HR+) primary breast cancer
• Aged 18 years or older
• Currently receiving Aromatase Inhibitors (AIs) endocrine therapy for at least 6 months
• Self-reported Aromatase Inhibitor-induced Musculoskeletal Symptoms (AIMSS)
• Possess basic communication skills, able to understand the research content, and voluntarily provide written informed consent
• For the qualitative implementation evaluation, practitioners must be substantially involved in the clinical implementation of the AIMSS management program (e.g., patient recruitment, intervention delivery, digital tool guidance, or follow-up)
• For the qualitative implementation evaluation, practitioners must provide informed consent for recorded interviews

Exclusion Criteria:

• History of bone fracture or related orthopedic surgery within the past 6 months
• Previously diagnosed with inflammatory joint diseases (e.g., rheumatoid arthritis, ankylosing spondylitis)
• Received other treatments for AIMSS not included in this study protocol within the past 1 month
• Diagnosed with metastatic breast cancer or other primary malignant tumors
• Concurrent serious dysfunction of vital organs (heart, brain, kidney, etc.) or uncontrolled infectious diseases
• Presence of severe mental illness or cognitive impairment that prevents cooperation with the longitudinal study process

Individual participant data (IPD) will not be shared to protect the privacy and confidentiality of the participants, as the dataset contains sensitive clinical and personal information. Additionally, current institutional policies and agreements across the multiple study sites do not support the public sharing of individual-level data.