The impact of death attitude and sense of dignity on the quality of life of patients receiving end-of-life palliative care for cancer:The intermediary role of advance care planning

Objective. To investigate attitudes toward death, sense of dignity, and acceptance of advance care planning (ACP) among terminally ill cancer patients receiving palliative care and to explore their mediating role to provide a scientific basis for optimizing care and improving policies in clinical practice. Methods. A cross-sectional survey was conducted from November 2024 to February 2025 with 120 end-stage cancer palliative care patients in the Palliative Medicine Department of Xinjiang Medical University Affiliated Cancer Hospital. The survey included a general situation questionnaire, a patient ACP acceptance questionnaire, a sense of dignity scale, and a death attitude description scale. Results . The survey analyzed the current status of end-of-life palliative care patients' attitudes toward death and the differences among the different variables. The total death attitude score is 75.48 ± 20.67. By exploring the correlations among death attitudes, self-esteem, and ACP acceptance, it was found that death attitudes were significantly positively correlated with self-esteem and significantly negatively correlated with ACP acceptance. Through stratified regression analysis, factors influencing the death attitudes of cancer patients in end-of-life palliative care were identified. Age, education level, and monthly family income had a significant effect on death attitudes. After a sense of dignity was incorporated, a significant positive impact on death attitudes was observed. By quantifying the mediating effect of ACP acceptance, ACP acceptance was shown to partially mediate the relationship between dignity and death attitudes. Conclusion. Late-stage cancer patients play an important mediating role in preestablished medical plans because of the pain caused by the disease itself, their experience and feelings toward death, and their need for emotional support. Sense of dignity and attitude toward death interact with each other and jointly affect the psychological state and quality of life of patients at the end stage of the disease when they are facing death.