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. 2025 May-Jun;48(3):171-179.
doi: 10.1097/NCC.0000000000001350. Epub 2024 Apr 10.

The Potential Mediating Effect of Symptom Burden on Demoralization Through Locus of Control and Coping Strategies in Chinese Patients With Cancer

Xiaoxin Liu  1 , Yanhua Li, Lezhi Li, Juan Li, Jiao Yang, Lirong Huang, Min Yao, Linlin Yang, Qun Yang
Affiliations

The Potential Mediating Effect of Symptom Burden on Demoralization Through Locus of Control and Coping Strategies in Chinese Patients With Cancer

Xiaoxin Liu et al. Cancer Nurs. 2025 May-Jun.

Abstract

Background: Demoralization is a psychological syndrome that is highly prevalent in patients with cancer and detrimental to individuals' physical and mental health. To explore effective intervention, we first determined the relationships between locus of control, coping strategies, symptom burden, and demoralization.

Objective: The aim of this study was to determine the relationship between symptom burden, locus of control, coping strategies, and demoralization in patients with cancer.

Methods: In this descriptive-correlational study, 273 valid patients were selected with convenience sampling method from a hospital in China. Data were collected using the Chinese version of the M.D. Anderson Symptom Inventory, the Chinese version of the Multidimensional Health Locus of Control Scale, the Chinese version of the Medical Coping Modes Questionnaire, and the Mandarin version of the Demoralization Scale. Data were analyzed using descriptive and inferential statistics using SPSS and AMOS.

Results: A total of 115 patients (42.12%) experienced clinical demoralization (Mandarin version of the Demoralization Scale > 30). Symptom burden (β = 0.295, P < .001), confrontation (β = -0.117, P = .028), and resignation (β = 0.456, P < .001) had direct effects on demoralization. Symptom burden also had an indirect effect on demoralization through the mediating role of resignation (β = 0.026, P = .002). Meanwhile, locus of control can affect demoralization entirely through the indirect mediating role of coping strategies (chance locus of control via resignation [β = 0.138, P < .01], powerful locus of control via confrontation [β = -0.017, P < .05]).

Conclusions: Symptom burden affects demoralization not only directly but also indirectly. Coping strategies play an important mediating role between symptom burden, locus of control, and demoralization in patients with cancer.

Implications for practice: It is urgent to screen demoralization and identify patients with high symptom burden, maladaptive locus of control, or coping strategies. For the patients targeted, a more comprehensive and systematic approach to symptom management and more appropriate guidance related to adaptive coping strategies are needed.

Keywords: Cancer; Coping strategies; Demoralization; Locus of control; Structural equation mode; Symptom burden.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure
Figure
A mediation model for the relationships between symptom burden, health locus of control, and coping strategies on demoralization in Chinese cancer patients. Note that standardized path coefficients were presented. All direct path coefficients were statistically significant (P < .05, P < .001).
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