Associations between prognostic awareness, illness acceptance, shame, social support, and psychosomatic outcomes: a network analysis study in terminally ill cancer patients

Background. Prognostic Awareness (PA) assumes particular importance in promoting appropriate end-of-life care planning and informed decision-making for terminally ill cancer patients. However, studies in the literature showed discordant results regarding the impact of PA on psychological and quality-of-life outcomes. Therefore, several psychological variables could play a relevant role in this context. The present study aimed to investigate the associations between PA, illness acceptance, shame, social support and anxiety, depression, and perceived pain in a sample of terminally ill cancer patients. Methods. The present cross-sectional study recruited 100 terminally ill cancer patients in a hospice care unit. Several self-report questionnaires, including Prognosis and Treatment Perceptions Questionnaire (PTPQ), Peace, Equanimity, and Acceptance in the Cancer Experience (PEACE) scale, Multidimensional Scale of Perceived Social Support (MSPSS), Other As Shamer (OAS) scale, Patient Health Questionnaire (PHQ-4) and Short Form-McGill Pain Questionnaire (SF-MPQ) were administered to patients. Data were analysed using network analysis to visually explore the interrelationships between the variables examined. Results. The results showed that PA was negatively associated with anxiety and shame and positively with illness acceptance and perceived pain. Moreover, illness acceptance was negatively associated with perceived pain and positively with social support. Shame was negatively associated with social support and positively with depression. PA was the variable with the highest centrality index values, demonstrating its influence within the network structure. Conclusion. The present study provides relevant insights regarding PA and its complex associations with several psychosomatic variables, highlighting its pivotal role in the illness experience of terminal cancer patients.