Death Risk Perception and Hospice Care Decisions in Advanced Cancer: A Psychosocial Pathway Analysis of Emotional and Cognitive Mediators

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.