{"title":"Death Risk Perception and Hospice Care Decisions in Advanced Cancer: A Psychosocial Pathway Analysis of Emotional and Cognitive Mediators.","authors":"Xiaoling Zhang, Jianwei Zheng, Yuchen Lin, Huina Zou, Guojuan Chen, Huimin Xiao","doi":"10.1002/pon.70201","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>This study examines how death risk perception influences hospice care decision-making through psychosocial pathways in advanced cancer, with specific focus on the mediating roles of emotional distress and decision self-efficacy, and the moderating effects of social support and hospice care knowledge.</p><p><strong>Methods: </strong>A multicenter cross-sectional study with 394 advanced cancer patients was conducted between April 2023 and August 2023. Hospice care decision, death risk perception, emotional reactions, decision self-efficacy, social support, and cognition of hospice care were measured. Path analysis with bootstrapping tested sequential mediation and moderation effects. This study conformed to STROBE checklist guidelines.</p><p><strong>Results: </strong>Death risk perception directly predicted decision avoidance (b = -0.19, p < 0.001) and indirectly through emotional reactions and decision self-efficacy pathway (b = -0.29, p < 0.001). A sequential mediating effect of emotional reactions via decision self-efficacy was found, with a mediating effect size of 0.096 (p < 0.001). Moreover, social support and hospice care cognition played moderating roles in the paths from death risk perception to emotional reaction and from decision self-efficacy to hospice care decision, respectively.</p><p><strong>Conclusions: </strong>Our psycho-oncological framework reveals that enhancing death risk communication while concurrently addressing emotional reactions and strengthening social support networks may optimize advance care planning. Clinicians should integrate decision support interventions targeting these modifiable psychosocial factors.</p>","PeriodicalId":20779,"journal":{"name":"Psycho‐Oncology","volume":"34 6","pages":"e70201"},"PeriodicalIF":3.3000,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Psycho‐Oncology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/pon.70201","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}
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Abstract
Objectives: This study examines how death risk perception influences hospice care decision-making through psychosocial pathways in advanced cancer, with specific focus on the mediating roles of emotional distress and decision self-efficacy, and the moderating effects of social support and hospice care knowledge.
Methods: A multicenter cross-sectional study with 394 advanced cancer patients was conducted between April 2023 and August 2023. Hospice care decision, death risk perception, emotional reactions, decision self-efficacy, social support, and cognition of hospice care were measured. Path analysis with bootstrapping tested sequential mediation and moderation effects. This study conformed to STROBE checklist guidelines.
Results: Death risk perception directly predicted decision avoidance (b = -0.19, p < 0.001) and indirectly through emotional reactions and decision self-efficacy pathway (b = -0.29, p < 0.001). A sequential mediating effect of emotional reactions via decision self-efficacy was found, with a mediating effect size of 0.096 (p < 0.001). Moreover, social support and hospice care cognition played moderating roles in the paths from death risk perception to emotional reaction and from decision self-efficacy to hospice care decision, respectively.
Conclusions: Our psycho-oncological framework reveals that enhancing death risk communication while concurrently addressing emotional reactions and strengthening social support networks may optimize advance care planning. Clinicians should integrate decision support interventions targeting these modifiable psychosocial factors.
期刊介绍：
Psycho-Oncology is concerned with the psychological, social, behavioral, and ethical aspects of cancer. This subspeciality addresses the two major psychological dimensions of cancer: the psychological responses of patients to cancer at all stages of the disease, and that of their families and caretakers; and the psychological, behavioral and social factors that may influence the disease process. Psycho-oncology is an area of multi-disciplinary interest and has boundaries with the major specialities in oncology: the clinical disciplines (surgery, medicine, pediatrics, radiotherapy), epidemiology, immunology, endocrinology, biology, pathology, bioethics, palliative care, rehabilitation medicine, clinical trials research and decision making, as well as psychiatry and psychology.
This international journal is published twelve times a year and will consider contributions to research of clinical and theoretical interest. Topics covered are wide-ranging and relate to the psychosocial aspects of cancer and AIDS-related tumors, including: epidemiology, quality of life, palliative and supportive care, psychiatry, psychology, sociology, social work, nursing and educational issues.
Special reviews are offered from time to time. There is a section reviewing recently published books. A society news section is available for the dissemination of information relating to meetings, conferences and other society-related topics. Summary proceedings of important national and international symposia falling within the aims of the journal are presented.
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