%0 Journal Article
%T Life Orientation and Advanced Care Planning Engagement among Surrogate Decision-Makers of Patients with Advanced Cancer: A Serial Mediation Analysis
%A Veronica Alvarez
%A Diego Molina
%J Journal of Integrative Nursing and Palliative Care
%@ 3006-5550
%D 2026
%V 7
%N 1
%R 10.51847/OgKJ2zhArA
%P 190-200
%X The objective of this investigation was to determine whether surrogate decision-makers’ (SDMs) life orientation predicts their level of involvement in advance care planning (ACP). Furthermore, we examined whether this relationship is sequentially mediated by perceived social support and illness-related uncertainty regarding the patient’s condition. A cross-sectional survey was administered to a sample of 276 adult SDMs, including patients with advanced-stage cancer, at a medical center in China. Data collection used validated Chinese-language instruments to evaluate life orientation, social support, illness uncertainty, and ACP involvement. A serial mediation framework was employed to assess whether the life orientation of SDMs exerts an indirect effect on ACP involvement via sequential impacts on social support and illness uncertainty, adjusting for pertinent covariates. Analytical procedures, including descriptive statistics, correlation analyses, and structural equation modeling, were conducted using SPSS version 26.0. The findings indicated that highly optimistic SDMs experienced stronger social support networks and lower degrees of illness uncertainty. Mediation modeling confirmed that a more positive life orientation correlated with increased ACP involvement through both direct and indirect pathways: optimism was linked to enhanced perceived social support and minimized illness uncertainty, variables which subsequently correlated with elevated ACP involvement. The comprehensive model accounted for 57.8% of the total variance in ACP involvement. In line with our cross-sectional approach, optimism among SDMs was associated with more proactive involvement in ACP, a relationship partially explained by heightened perceived social support and reduced illness-related uncertainty. Therapeutic strategies aimed at fostering a positive mindset, strengthening social support systems, and clarifying medical information could potentially improve ACP adoption rates. These observations highlight the critical need to translate optimistic psychological dispositions into structured care-planning actions.
%U https://journalinpc.com/article/life-orientation-and-advanced-care-planning-engagement-among-surrogate-decision-makers-of-patients-w-ejpafy17rnggeto