Relationship between uncertainty in illness and fear of progression among lung cancer patients: The chain mediation model

Abstract

Background: Uncertainty in illness (UI) and fear of progression (FoP) are significant psychological challenges for lung cancer patients. Coping styles and social support are critical mediators, influencing patients' ability to manage the emotional and psychological burden of UI and FoP. However, limited research has explored the chain mediation effect of these factors on the relationship between UI and FoP, particularly among Chinese lung cancer patients.

Aim: To investigate the association between UI and FoP among patients with lung cancer.

Methods: Convenience sampling was used to recruit inpatients diagnosed with lung cancer at a tertiary hospital in Changde City between November and December 2023. A total of 320 participants completed the Mishel Uncertainty in Illness Scale, Simplified Coping Style Questionnaire, Mandarin Chinese Version of the Medical Outcomes Study Social Support Survey, and Fear of Progression Questionnaire-Short Form. The chain mediation analysis was performed using the PROCESS macro to examine the relationships between the variables.

Results: The results revealed that UI had a significant direct effect on FoP (effect = 0.224, 95%CI: 0.136-0.408). Additionally, three indirect pathways were identified: (1) Social support (effect = 0.128, 95%CI: 0.045-0.153); (2) Coping style (effect = 0.115, 95%CI: 0.048-0.157); and (3) Chain mediators involving social support and coping style (effect = 0.072, 95%CI: 0.045-0.120). The total indirect effect of the three mediation paths is 31.5%. These results confirm that social support and coping style significantly mediate the relationship between UI and FoP.

Conclusion: Based on cross-sectional data and a chain mediation model, this study explored the mechanisms between UI, social support, coping style, and FOP. Patients with lung cancer have higher levels of FOP, and the results of this study revealed a correlation between these four factors. Social support and coping style partially mediated the effects of UI on FOP, and there was a chain-mediating effect between UI and FOP. Programs designed to strengthen social support networks should also incorporate training to develop adaptive coping strategies, ultimately reducing FOP and improving overall quality of life.

Keywords: Coping style; Fear of progression; Lung cancer; Social support; Uncertainty in illness.

Figure 1

The theoretical model and the chain mediation model of coping style and social support. A: The theoretical framework based on stress coping theory; B: The chain mediation model of coping style and social support in the relationship between uncertainty in illness and fear of progression with standardized beta. ^bP < 0.001.