Effect of Symptom Burden on Demoralization in Chinese Lung Cancer Patients: The Mediating Roles of Family Function, Resilience, and Coping Behaviors

OBJECTIVE: This study aimed to elucidate the mechanisms by which symptom burden affects demoralization in Chinese lung cancer patients, with a focus on the roles of family functionality, resilience, and coping strategies. The study also explored differences in these pathways between two distinct demoralization categories. METHODS: A cross-sectional survey was conducted among 567 lung cancer patients who completed questionnaires assessing symptom burden, family functioning, resilience, coping strategies, and demoralization. Data were analyzed using partial least squares structural equation modeling (PLS-SEM), with multigroup structural equation modeling (MG-SEM) employed to compare pathways between the psychological distress-subjective incompetence group (PDSIG) and the low demoralization-emotional disturbance group (LDEDG). RESULTS: PLS-SEM analysis demonstrated a good model fit. Symptom burden (β = 0.26), confrontation coping (β = 0.11), and acceptance-resignation coping (β = 0.41) had positive direct effects on demoralization, whereas resilience (β = -0.19) and family function (β = -0.27) had negative direct effects. Additionally, family function, resilience, and acceptance-resignation coping mediated the relationship between symptom burden and demoralization. MG-SEM revealed that, in the PDSIG, symptom burden (β = 0.47) and family function (β = -0.46) had similarly strong impacts on demoralization, with stronger family function associated with lower demoralization. In contrast, resilience (β = -1.02) was the most significant factor in the LDEDG. CONCLUSIONS: These findings highlight the importance of screening for demoralization, particularly among lung cancer patients with a high symptom burden, maladaptive resignation coping, family dysfunction, and low resilience. Effective strategies should focus on symptom management, family support, resilience building, and fostering positive coping mechanisms. Tailored interventions based on demoralization subtypes are essential to improve psychological well-being in this population.