The role of prognostic awareness in the interrelationships between illness acceptance, shame, social support, and psychosomatic outcomes in terminal cancer patients: A network analysis study

Background and aims Prognostic Awareness (PA) is essential for informed end-of-life care planning. However, evidence on the associations of PA with psychosomatic outcomes in terminal cancer patients is discordant, suggesting the role of further variables in influencing these associations. This study examined the interrelationships between illness acceptance, shame, social support, and psychosomatic outcomes (anxiety, depression, perceived pain) in terminal cancer patients aware of their prognosis and those unaware. Method This cross-sectional study enrolled 140 terminal cancer patients (F = 66; Mage = 76.6±10.8) in an Italian hospice (Territorial Ethics Committee ID:53-2023), who completed self-report questionnaires assessing PA, illness acceptance, shame, social support, anxiety, depression, and perceived pain. Data analysis included independent samples t-tests and network analysis. Results Patients aware of their prognosis showed significantly higher anxiety, depression, and perceived pain levels than those unaware. Network analysis revealed that in aware patients, struggle with illness was positively associated with anxiety, depression, and perceived pain, while in unaware patients, illness acceptance was negatively associated with anxiety and depression. Moreover, in aware patients, shame was positively associated with depression and perceived pain. In both aware and unaware patients, social support was negatively associated with shame and perceived pain. Discussion The findings suggest that PA may negatively affect the psychosomatic well-being of terminal cancer patients. Struggling with illness and shame could worsen psychosomatic symptoms, while illness acceptance and social support might mitigate them. Conclusion The study provides insights regarding the role of PA in terminal cancer, suggesting potential clinical implications for healthcare providers in the oncological context.