Yang YL, Zhang XQ, Yang YQ, Li EM, Zhou B, Gong YW. Relationship between uncertainty in illness and fear of progression among lung cancer patients: The chain mediation model. World J Psychiatry 2025; 15(5): 104979 [DOI: 10.5498/wjp.v15.i5.104979]
Corresponding Author of This Article
You-Wen Gong, Department of Nursing, Changde Hospital, Xiangya School of Medicine, Central South University (The First People’s Hospital of Changde City), No. 818 Renmin Road, Changde 415000, Hunan Province, China. 1755144149@qq.com
Research Domain of This Article
Psychiatry
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Psychiatry. May 19, 2025; 15(5): 104979 Published online May 19, 2025. doi: 10.5498/wjp.v15.i5.104979
Relationship between uncertainty in illness and fear of progression among lung cancer patients: The chain mediation model
Yi-Ling Yang, Xue-Qing Zhang, Yong-Qiang Yang, Er-Mao Li, Bo Zhou, You-Wen Gong
Yi-Ling Yang, Er-Mao Li, Hengyang Medical School, University of South China, Hengyang 421001, Hunan Province, China
Xue-Qing Zhang, Yong-Qiang Yang, You-Wen Gong, Department of Nursing, Changde Hospital, Xiangya School of Medicine, Central South University (The First People’s Hospital of Changde City), Changde 415000, Hunan Province, China
Bo Zhou, Department of Cardiovascular Surgery, Changde Hospital, Xiangya School of Medicine, Central South University (The First people’s Hospital of Changde City), Changde 415000, Hunan Province, China
Co-first authors: Yi-Ling Yang and Xue-Qing Zhang.
Co-corresponding authors: Bo Zhou and You-Wen Gong.
Author contributions: Yang YL designed the study; Yang YQ and Li EM performed data analysis; Yang YL and Zhou B drafted the manuscript; Gong YW and Zhang XQ revised the manuscript; All the authors have read and approved the final manuscript. Zhou B and Gong YW wrote and organized the manuscript and eventually published it and contributed equally to this manuscript as co-corresponding authors.
Supported by Hunan Provincial Natural Science Foundation of China, No. 2024JJ9579 and No. 2025JJ80410; and The Science and Technology Innovation Program of Changde City, No. 2023YD23.
Institutional review board statement: This study was approved by the first People’s Hospital of Changde City’s Ethics Committee (Approval No. YX-2023-280-01).
Informed consent statement: All study participants provided informed written consent before enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: The data from this study are available upon reasonable request from the corresponding authors at 1755144149@qq.com.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: You-Wen Gong, Department of Nursing, Changde Hospital, Xiangya School of Medicine, Central South University (The First People’s Hospital of Changde City), No. 818 Renmin Road, Changde 415000, Hunan Province, China. 1755144149@qq.com
Received: January 8, 2025 Revised: February 19, 2025 Accepted: March 12, 2025 Published online: May 19, 2025 Processing time: 112 Days and 17.2 Hours
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.
Core Tip: Fear of progression (FoP) is a prevalent psychological concern among lung cancer patients, closely associated with uncertainty in illness (UI). Social support and coping styles are critical factors that can mitigate the impact of UI on FoP. This study analyzed data from 320 Chinese lung cancer patients to investigate the chain mediation effects of social support and coping styles. The findings highlight that social support and adaptive coping strategies can significantly reduce FoP. This study provides a theoretical foundation for developing psychosocial interventions targeting FoP, emphasizing the importance of strengthening social networks and promoting adaptive coping mechanisms among lung cancer patients.
