Observational Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Jul 19, 2025; 15(7): 107416
Published online Jul 19, 2025. doi: 10.5498/wjp.v15.i7.107416
Relationship between death anxiety and coping with death competence among Chinese oncology nurses: A chain mediation model
Ying Wen, Qun-Xiang Zhang, Yang Liu, Xiao-Hua He, You-Wen Gong
Ying Wen, Qun-Xiang Zhang, You-Wen Gong, Department of Nursing, Changde Hospital, Xiangya School of Medicine, Central South University, The First People’s Hospital of Changde City, Changde 415000, Hunan Province, China
Yang Liu, School of Nursing, University of South China, Hengyang 421001, Hunan Province, China
Xiao-Hua He, Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China
Co-first authors: Ying Wen and Qun-Xiang Zhang.
Co-corresponding authors: Xiao-Hua He and You-Wen Gong.
Author contributions: Wen Y designed the study; Zhang QX and Liu Y performed data analysis; Wen Y and He XH drafted the manuscript; Gong YW and Zhang QX revised the manuscript; All the authors have read and approved the final manuscript; He XH and Gong YW wrote and organized the manuscript and eventually published it and contributed equally to this manuscript as co-corresponding authors.
Supported by the Hunan Provincial Natural Science Foundation of China, No. 2025JJ80410.
Institutional review board statement: This study was approved by the University of South China’s Ethics Committee (approval No. CS2023527).
Informed consent statement: All study participants provided informed written consent before enrollment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.
Data sharing statement: The data from this study are available upon reasonable request from the corresponding authors.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: You-Wen Gong, MD, Doctor, Department of Nursing, Changde Hospital, Xiangya School of Medicine, Central South University, The First People’s Hospital of Changde City, No. 818 Renmin Road, Changde 415000, Hunan Province, China. 1755144149@qq.com
Received: March 24, 2025
Revised: April 20, 2025
Accepted: June 4, 2025
Published online: July 19, 2025
Processing time: 109 Days and 16 Hours
Abstract
BACKGROUND

Death anxiety (DA) is a prevalent psychological challenge among oncology nurses that affects their emotional well-being and professional competence in coping with death-related situations. Death-related attitudes and resilience are critical factors that may mediate the relationship between DA and coping with death competence (CDC). However, few studies have examined the chain-mediating effect of these factors among Chinese oncology nurses. This study aimed to investigate the association between DA and CDC among Chinese oncology nurses, with a focus on the mediating roles of death attitude and resilience.

AIM

To investigate the association between DA and CDC among Chinese oncology nurses.

METHODS

A national cross-sectional survey was conducted among Chinese oncology nurses using an electronic questionnaire distributed in Wenjuanxing, China. In total, 615 valid responses were obtained. The participants completed the Templer death anxiety scale, death attitude profile-revised, Connor-Davidson resilience scale, and coping with death scale. A chain mediation analysis was performed using the PROCESS macro in SPSS to examine the relationships between these variables.

RESULTS

The findings indicated that DA had a significant direct effect on CDC [effect = 0.201, 95% confidence interval (CI): 0.112-0.322]. In addition to this direct effect, three significant indirect pathways were observed: (1) Death attitude (effect = 0.118, 95%CI: 0.056-0.163); (2) Resilience (effect = 0.108, 95%CI: 0.032-0.176); and (3) A sequential mediation pathway involving both death attitude and resilience (effect = 0.071, 95%CI: 0.042-0.123). The total indirect effects of the three mediation paths accounted for 29.7% of the relationship between DA and CDC.

CONCLUSION

Using a chain mediation model, this study explored the mechanisms linking DA, death attitude, resilience, and CDC among Chinese oncology nurses. These findings highlighted the crucial role of death attitude and resilience in mediating the relationship between DA and CDC. Interventions aimed at fostering adaptive attitudes toward death and enhancing resilience may improve nurses’ ability to cope with death-related stressors, ultimately benefiting their psychological well-being and professional competence.

Keywords: Death anxiety; Death attitude; Resilience; Coping with death competence; Oncology nurses; Chain mediation model

Core Tip: Death anxiety (DA) is a significant psychological challenge for oncology nurses, affecting their ability to cope with death-related stress in clinical practice. This study explored the mediating roles of death attitude and resilience in the relationship between DA and coping with death competence among Chinese oncology nurses. Based on data from a national cross-sectional survey, the findings highlight that resilience and adaptive death attitudes play crucial roles in reducing the negative impact of DA. These results provide valuable insights for developing targeted interventions to enhance nurses’ coping skills, ultimately improving their psychological well-being and quality of end-of-life care.