Self-advocacy: a critical mediator between spousal disease communication and symptom perception in breast cancer patients undergoing chemotherapy

Objective To investigate the mediating role of self-advocacy in the relationship between spousal illness communication and symptom burden in breast cancer patients undergoing chemotherapy.Methods A cross-sectional survey was conducted using convenience sampling to recruit 411 dyads (breast cancer patients undergoing chemotherapy and their spouses) from the Breast Cancer Diagnosis and Treatment Centre at a tertiary teaching hospital in Ganzhou, China, between March and December 2024. Data were collected using the General Information Form, the Female Cancer Survivor Self-Advocacy Scale (FSACS), the Couple’s Cancer Communication Problems Scale, and the Breast Cancer Patient Chemotherapy-Related Symptom Assessment Scale.Results The mean scores for patient self-advocacy and symptom burden were( 60.07 ± 12.79) and (29.45 ± 11.25), respectively. Regarding illness communication problems, patients scored (15.24 ± 6.73), while spouses scored (15.15 ± 5.36). Mediation analysis revealed that self-advocacy played a significant mediating role between patient communication and symptom burden, accounting for 82.8% of the total effect. Additionally, a chain mediation effect was observed from spousal communication to patient symptoms via patient communication and self-advocacy.Conclusion Self-advocacy fully mediates the relationship between illness communication and symptom perception in breast cancer patients undergoing chemotherapy. Clinical interventions facilitating effective couple-based communication are recommended to empower patient self-advocacy, thereby reducing symptom burden.