Mechanisms underlying the effect of nurse-led enhanced supportive care for advanced cancer patients: A mediation analysis of randomized controlled trial data

Abstract

Purpose: A nurse-led enhanced supportive care intervention integrating the Bandura's mastery enhancement and the acceptance and commitment therapy approach as an early primary palliative care was effective in improving coping, self-efficacy for coping with cancer, and role functioning. This study examined the mechanisms through which the intervention improved role functioning in patients with advanced cancer, focusing on the mediating roles of coping and self-efficacy for coping with cancer. Methods: A secondary analysis was conducted (N = 182). Active coping, self-efficacy for maintaining activity and independence, and role functioning were measured using the Brief COPE, the Cancer Behavior Inventory 3.0, and the EORTC QLQ-C30. Descriptive, correlation, and mediation analyses were conducted using IBM SPSS 27 and PROCESS macro Models 4 and 6. Results: In the serial mediation analysis, the intervention demonstrated statistically significant total effect on role functioning (effect = 8.89, SE = 3.21, 95% CI [2.54, 15.23]). The direct effect of the intervention remained significant after accounting for active coping and self-efficacy in maintaining activity and independence as mediators (effect = 6.19, SE = 3.08, 95% CI [0.12, 12.27]). The sequential pathway suggested by the conceptual model was statistically significant (effect = 0.78, SE = 0.46, 95% CI [0.11, 1.90]) and explained 8.8% of the total effect. Conclusion: The nurse-led enhanced supportive care improved role functioning via the serial mediation of active coping and self-efficacy for maintaining activity and independence. The results highlight the importance of coping and self-efficacy in enhancing role functioning and provide direction for future palliative care interventions. Trial registration: NCT04407013.