How Uncertainty in Illness Affects Death Anxiety in Patients With Early-Stage Breast Cancer: Based on the Common-Sense Model of Self-Regulation

BACKGROUND: This study examined the mechanism through which uncertainty in illness influences death anxiety in patients with early-stage breast cancer, focusing on the multiple mediating roles of hope and resignation. OBJECTIVE: (1) To examine whether uncertainty in illness predicts death anxiety in patients with early-stage breast cancer; (2) to test the independent mediating roles of hope and resignation; and (3) to test their serial mediation. METHODS: A cross-sectional design was employed to survey 526 patients with early-stage breast cancer from 2 hospitals in Liaoning Province. Measures included the Mishel Uncertainty in Illness Scale, Herth Hope Index, Medical Coping Modes Questionnaire (resignation dimension), and Death Anxiety Scale. Data were analyzed using SPSS 27.0 and PROCESS Model 6; bootstrapping (5000 iterations) in Mplus 8.3 tested mediation significance. RESULTS: (1) Uncertainty in illness, hope, resignation, and death anxiety were significantly correlated in patients with early‑stage breast cancer (P <.05). (2) Uncertainty in illness positively predicted death anxiety. (3) Three mediation pathways were identified: hope and resignation each played an independent mediating role, and hope and resignation together formed a serial mediation pathway. CONCLUSION: Uncertainty in illness not only directly increases death anxiety in patients with early‑stage breast cancer but also indirectly affects death anxiety through independent and serial mediating paths involving hope and resignation. IMPLICATIONS FOR ONCOLOGY NURSING PRACTICE: Significant death anxiety in patients with early-stage breast cancer requires routine screening. Reducing uncertainty, enhancing hope, and reducing resignation are actionable targets, providing an empirical basis for theory-driven interventions.