Perceived social support and death anxiety among patients with advanced lung cancer: potential independent and serial mediating roles of psychological resilience and yielding coping in a Chinese cultural context

Objectives To examine the association between perceived social support and death anxiety among Chinese patients with advanced lung cancer and to explore the potential independent and serial mediating roles of psychological resilience and yielding coping in this relationship. Methods This cross-sectional study recruited 229 patients diagnosed with stage III/IV advanced lung cancer. Validated self-report questionnaires were used to assess perceived social support, psychological resilience, yielding coping and death anxiety. Hayes’ PROCESS macro (model 6) with 5000 bias-corrected bootstrap resamples was applied to test this theory-driven serial mediation model. Results In the regression model, perceived social support was directly and negatively associated with death anxiety (β=−0.308, p<0.001). Two significant independent indirect pathways and one significant serial indirect pathway were identified. The total indirect association accounted for 53.05% of the total association. Conclusions Perceived social support was associated with lower death anxiety among patients with advanced lung cancer. There were significant independent indirect associations via psychological resilience and yielding coping, as well as a statistically significant serial indirect association involving both mediators. Constrained by the cross-sectional design, this study cannot establish variable temporal relationships; the proposed serial-pathway hypothesis and association direction await subsequent empirical testing. Nevertheless, these correlational findings may offer tentative insights for research on potential psychosocial pathways among this patient population within the Chinese cultural context.