Emotional support receipt and health-related quality of life in cancer: Serial mediation through a cognitive-affective pathway.

BACKGROUND

Emotional support (ES) is a key psychosocial determinant of cancer adjustment. Emotional Support Receipt (ESR) is a nurse-assessable interpersonal resource linked to Health-Related Quality of Life (HRQoL) through a cognitive-affective processes.

OBJECTIVE

To examine whether ESR relates to higher HRQoL through proactive coping strategies and lower emotional distress in adults undergoing cancer treatment.

METHODS

Cross-sectional study at a tertiary hospital in Spain. Adults with cancer (n = 360) completed validated Spanish versions of Brief-COPE (ESR, active coping, informational support, planning, positive reframing, acceptance, humour), HADS (distress), and EORTC QLQ-C30 (global HRQoL), plus sociodemographic/clinical data. Analyses included descriptive statistics, correlations, hierarchical linear regression (Block 1: clinical covariates; Block 2: proactive coping skills; Block 3: distress), and serial mediation (PROCESS Model 6; 10,000 bias-corrected bootstraps; 95% CI).

RESULTS

Positive reframing independently predicted higher HRQoL (Block 2); distress was the strongest negative predictor (Block 3). These variables were included as serial mediators. The total effect of ESR on HRQoL was significant (c = 4.087, p = 0.002), whereas the direct effect was not after including the mediators (c' = 1.713; p = 0.171). The serial processes ESR → positive reframing → emotional distress → HRQoL was significant (B = 1.665; 95% CI [0.980, 2.518]). The model explained 28.3% of HRQoL variance.

CONCLUSIONS

ESR related to better HRQoL via a serial cognitive-affective mechanism. Findings highlight scalable targets for nurse-led stepped care: routine screening of ESR and distress, brief training in cognitive reframing, and reinforcement of support networks, with HRQoL monitored as an outcome.