Parallel Mediating Roles of Illness Acceptance Attitudes Between Physical Symptoms and Quality of Life in Patients with Gastrointestinal Cancers

OBJECTIVE: Physical symptoms severely impair quality of life (QoL) in patients with gastrointestinal cancers (GICs). Although illness acceptance is recognized as a key mediator, the distinct rols of its two dimensions-active acceptance and negative acceptance-remain underexplored in the symptom-QoL pathway. This study aimed to explore their parallel mediating roles. METHODS: In this cross-sectional study, 301 inpatients with GICs completed the MD Anderson Symptom Inventory (MDASI), the 12-item Short Form Health Survey (SF-12), the Illness Cognition Questionnaire-Acceptance subscale (ICQ-A, measuring active acceptance), and the Medical Coping Modes Questionnaire (MCMQ, measuring negative acceptance). Parallel mediation analysis was performed using PROCESS Model 4 with bootstrap resampling (5,000 iterations). RESULTS: Symptom severity was negatively correlated with QoL (r = -0.69, P < 0.01) and active acceptance (r = -0.47, P < 0.01), and positively correlated with negative acceptance (r = 0.56, P < 0.01). Active acceptance was positively (r = 0.60) and negative acceptance negatively (r = -0.60) correlated with QoL (both P < 0.01). Mediation analysis revealed two significant indirect pathways: symptoms → reduced active acceptance → lower QoL, accounting for 23.92% of total effect (95% bootstrap CI [-0.068, -0.033]), and symptoms → increased negative acceptance → lower QoL, accounting for 25.36% of total effect (95% bootstrap CI [-0.074, -0.035]). Neither confidence interval contained zero. CONCLUSION: Both active acceptance and negative acceptance independently mediate the relationship between physical symptoms and QoL in patients with GICs. Active acceptance buffers the impact of symptoms, whereas negative acceptance exacerbates it. These findings support integrating psychological interventions that foster active acceptance and mitigate negative acceptance as a core component of symptom management to optimize QoL in this population.