The impact of facilitating patient involvement on decisional conflict among patients undergoing surgical treatment for lung cancer: the serial mediating roles of hope level and social support

BACKGROUND: With the development of new technologies, surgical treatment options for lung cancer have become increasingly diverse, providing patients with more choices before surgery, which may lead to hesitation, uncertainty, and decisional conflict. Decisional conflict can affect psychological well-being and may reduce treatment adherence. Facilitating patient involvement has been proposed as a potential strategy to reduce decisional conflict; however, the underlying mechanisms remain unclear. AIM: This study aimed to examine the association between facilitating patient involvement and decisional conflict among patients undergoing surgical treatment for lung cancer and to explore the mediating and serial mediating roles of hope level and social support. METHODS: A cross-sectional study was conducted among 321 patients undergoing surgical treatment for lung cancer using a convenience sampling method. Data were collected using a self-developed sociodemographic questionnaire, the Facilitating Patient Involvement Scale, the Herth Hope Index, the Perceived Social Support Scale, and the Decisional Conflict Scale. Mediation and serial mediation analyses were performed using Model 6 of the PROCESS macro (version 4.1) for SPSS, with 5,000 bootstrap resamples to estimate indirect effects and their 95% confidence intervals. RESULTS: The median decisional conflict score was 25.00 (IQR:6.25-28.13). Overall, Overall, 51.4% of patients had decisional conflict, and 13.7% reported high levels of conflict. Facilitating patient involvement (r = - 0.394), hope level (r = - 0.504), and social support (r = - 0.677) were all negatively correlated with decisional conflict (all P < 0.05). Facilitating patient involvement was associated with decisional conflict through both direct and indirect pathways. The total effect was - 0.744, with an indirect effect of - 0.337, accounting for 45.3% of the total effect. The serial mediation model involving hope level and social support was statistically significant (indirect effect = - 0.069). CONCLUSION: Facilitating patient involvement was associated with lower levels of decisional conflict through both direct and indirect pathways, including indirect pathways involving hope level and social support. These findings provide new perspectives for the development of multi-level decision-support systems. Clinical nursing practice may benefit from greater attention to the integration of psychological and social resources to better address decisional challenges among patients undergoing treatment for lung cancer.