The incidence and mortality of lung cancer is at the forefront of the tumor and shows a rising trend. Lung cancer makes patients to develop a variety of negative emotions during the process of the illness easily, while the adverse psychological state of cancer patients causes many negative effects, such as affecting the quality of life and reducing compliance with treatment and satisfaction[1]. These conditions will easily lead to an adverse prognosis. Therefore, improving the psychological state of lung cancer patients is a major focus of current research.
Compared with most cancer patients, there are still a number of patients having maintained levels of psychological well-being[2]. Consol et al. had established that this positive psychological response in cancer patients could be attributed to a high level of psychological resilience[3]. Psychological resilience is defined by the American Psychology Association as “when still have a good adaptation process,” which means the ability to rebound against difficult experiences[4]. Moreover, the trend in the cancer care field has extended to explore the positive resources, psychological resilience has gradually become an essential research topic in cancer patients[5].
After systematic reviewing 52 studies, Stewart et al. pointed out that psychological resilience had a role in promoting the rehabilitation and prognosis of cancer patients[6]. Seiler et al. found that the physiological basis of psychological resilience was the plasticity of the “reward and fear circuit,” for cancer patients, which meant that, psychological resilience could be learned, otherwise it could be modified through some psychological and pharmacologic interventions[7]. Cancer patients with higher psychological resilience tend to have a better mental and physical state. Therefore, for cancer patients, it is very important to explore the path of psychological resilience, which can greatly help enhance their mental health.
The Kumpfer Resilience Framework (KRF) is the model that is often used to describe paths to enhance or diminish the level of psychological resilience[8]. The KRF indicates when individuals face stresses or challenges, their external factors (including family, culture, community, school, and peers) have an interaction with internal factors (including cognitive, emotional, spiritual, physical, and behavioral factors), which raise the changes of their psychological resilience. Risk and protective factors are vital elements of psychological resilience. It has been pointed out that upgrading the protective factors of patients effectively increases the level of psychological resilience and improves disease prognosis to certain degree extent[9]. Ye et al. reported that an increasing number of studies had used the KRF to guide changes in the psychological resilience of cancer patients[5]. In this study, lung cancer is regarded as a source of stress or challenge; self-efficacy is considered to be an internal factor of psychological resilience; and social support is defined as an external protective factor. Perhaps the changes in psychological resilience among cancer patients can be explained.
Self-efficacy refers to the belief that individuals can produce desired outcomes as a result of their own actions using skills and capabilities, and provide confidence that patients can manage the events that affect their lives[10]. After conducting a cross-sectional survey in 182 cancer survivors, Foster et al. stated that self-efficacy effectively predicted health-related behavior in cancer patients[11]. Moreover, self-efficacy was positively correlated with the quality of life of cancer patients and the ability to regulate their disease[12-13]. In summary, self-efficacy is significant for disease management in cancer patients. In addition, Tamura et al. searched articles published from 2014 to 2019 to conduct a systematic literature review[14]. It was reported that self-efficacy was one kind of internal factors, which was related to psychological resilience in cancer patients. Moreover, Schwarzer et al. theorized that self-efficacy could promote psychological resilience[15]. Wu et al. surveyed 253 patients with gastric cancer and reported that self-efficacy was supposed to be positively associated with psychological resilience[16].
Social support refers to the assistance that is provided by family, friends, and others. Social support reflects the perception that one is loved, esteemed, and valued by other people[17]. It has been reported that social support is a vital situational resource that can 1) improve health and fulfill physical and emotional needs for cancer patients, 2) enhance well-being and reduce distress in considerable amount of cancer patients, 3) and be an important factor in optimizing the quality of life of cancer patients[18]. Social support might increase psychological resilience in cancer patients. A systematic review of palliative patients with advanced cancer published in 2021 showed social support might be one of the most important protective factors of psychological resilience in patients who experience stressful events[19]. Celik et al. conducted a cross-sectional survey among 128 patients with breast cancer and found that social support was positively associated with psychological resilience[20]. Additionally, it may be inferred that social support facilitates self-efficacy in cancer patients. A cross-sectional study conducted from 2018 to 2019 showed the patients with breast cancer seemed to have higher self-efficacy[21]. Besides, Anna et al. surveyed 102 patients with the initial onset of non-small cell lung cancer and demonstrated that social support was positively correlated with self-efficacy[22].
Regarding the relationship of the above three variables, social support was positively associated with self-efficacy and positively correlated with psychological resilience, and self-efficacy was positively associated with psychological resilience[16, 20, 22]. According to the KRF, self-efficacy as one kind of internal factors leads to advancing psychological resilience, and social support as one kind of external factors increases the individual’s self-efficacy and psychological resilience. It might be inferred self-efficacy might likely act as a mediator in the relationship between social support and psychological resilience in patients with lung cancer.
Previous studies of psychological resilience in patients with lung cancer have focused on exploring its related factors, without concentration on relationship among those factors. Few studies have deeply investigated the relationship among social support, self-efficacy, and psychological resilience in patients with lung cancer. Considering to provide a theoretical basis for enhancing the psychological resilience in patients with lung cancer in the future, it is meaningful to examine the relationship among those three variables. Therefore, This study aimed to investigate the relationship among social support, self-efficacy, and psychological resilience in patients with lung cancer. We hypothesized that self-efficacy had mediating effect between social support and psychological resilience.