Background Patient compliance can influence the effect of auricular acupressure used to manage cancer-related fatigue (CRF). Objective To explore the barriers and facilitators affecting patients’ compliance with treatment. Methods The maximum difference sampling method was used to conduct qualitative interviews with 11 CRF patients undergoing auricular acupressure therapy. The interview data were analyzed by Colaizzi’s seven-step analysis. Results Convenience and acceptability of the therapy, preliminary effects of its implementation, fully believing in the benefits of auricular acupressure and being habituated to the therapy, help and reminder from family members are the facilitating factors to improve patient compliance with auricular acupressure therapy, while the hindering factors include having doubts about the effect of acupressure resulting in interruption, having limited access to medical resources, deterioration of the condition resulting in self-abandonment, and weak family support. Conclusion In clinical nursing practice, attention should be paid to the analysis of the facilitating and hindering factors during the implementation of auricular acupressure therapy as well as the development of targeted intervention measures to improve patient compliance so as to enhance the effectiveness of auricular acupressure.