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Psychooncology. 2018 Aug;27(8):2045-2051. doi: 10.1002/pon.4773. Epub 2018 Jun 14.

Facing death alone or together? Investigating the interdependence of death anxiety, dysfunctional attitudes, and quality of life in patient-caregiver dyads confronting lung cancer.

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Department of Social Work and Social Administration, University of Hong Kong, Hong Kong.



Based on the cognitive theory, anxiety arising from the awareness of death and dying may activate dysfunctional attitudes, which may then reduce quality of life. This study examined the interdependence and the mediating role of dysfunctional attitudes on the relationship between death anxiety and quality of life among patients with lung cancer and their caregivers.


From March 2016 to April 2017, 173 pairs of patients and their caregivers enrolled in a randomized controlled trial of psychosocial support. Using the baseline data, actor-partner interdependence modeling was used to analyze the relationships among death anxiety, dysfunctional attitudes, and quality of life.


In patients, death anxiety was related to dependency (β = .51) and self-control (β = -.37); achievement (β = -.21) and self-control (β = .34) were related to quality of life. Among caregivers, death anxiety was related to all 3 dysfunctional attitudes of their own (βs = .23 to.32); dependency (β = -.22) was associated with quality of life. Caregiver quality of life was also associated with patient self-control (β = .22) and achievement (β = -.18). Patient self-control mediated the links between patient death anxiety with both patient and caregiver quality of life. The relationship between death anxiety and quality of life was mediated by dependency in caregivers.


Death anxiety influences dysfunctional attitudes and quality of life of both patients and caregivers. Our results support the relevance of dysfunctional attitudes in understanding the impact of death anxiety and underscore the need for parallel psychosocial interventions.


cancer; caregiving; death anxiety; dyadic; dysfunctional attitudes; interdependence; lung cancer; oncology; quality of life


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