The Relationship Among Emotional Intelligence, Self-Efficacy, and Attitude Toward Death in Family Caregivers of Patients with Advanced Cancer

The Relationship Among Emotional Intelligence, Self-Efficacy, and Attitude Toward Death in Family Caregivers of Patients with Advanced Cancer | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Relationship Among Emotional Intelligence, Self-Efficacy, and Attitude Toward Death in Family Caregivers of Patients with Advanced Cancer HUIMIN SU, Kuai IN Tam This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9277009/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background As the global incidence of cancer continues to rise, most patients are diagnosed at an advanced stage because early symptoms are often nonspecific or overlooked. In the care of patients with advanced cancer, family caregivers assume the primary caregiving responsibilities. At the same time, they must confront end-of-life and death-related events, which place considerable demands on their emotional and caregiving capacities. However, research examining how family caregivers’ emotional intelligence influences their attitudes toward death through self-efficacy remains very limited. Aims To explore the associations among emotional intelligence, self-efficacy, and attitudes toward death in family caregivers of patients with advanced cancer, and to analyze the mediating role of self-efficacy in these relationships. Methods This quantitative cross-sectional study used convenience sampling to recruit 365 family caregivers of patients with advanced cancer from three hospitals in Hunan Province, China. The Wong and Law Emotional Intelligence Scale (WLEIS), the General Self-Efficacy Scale (GSES), and the Attitude Toward Death Profile-Revised (DAP-R) were used to assess participants. Results Among family caregivers of patients with advanced cancer, emotional intelligence was positively correlated with self-efficacy and with the neutral acceptance dimension of attitudes toward death, and negatively correlated with death fear. Self-efficacy was negatively correlated with death fear and positively correlated with neutral acceptance. Self-efficacy played a partial mediating role in the relationships between emotional intelligence and attitudes toward death. Conclusion This study found significant associations among emotional intelligence, self-efficacy, and attitudes toward death in family caregivers of patients with advanced cancer, with self-efficacy partially mediating these relationships. Emotional intelligence Self efficacy Attitude toward death Cancer Family caregivers Figures Figure 1 Background According to the latest 2022 report from the Global Cancer Observatory (GLOBOCAN), there were approximately 19.97 million new cancer cases and about 9.74 million cancer-related deaths worldwide. China accounted for approximately 24% of global new cases and 26% of global deaths [ 1 ], representing nearly one-quarter of the world's total burden. Moreover, most cancer patients exhibit no obvious symptoms in the early stages, and by the time of diagnosis, they are often already in the middle or advanced stages of the disease. Effective curative treatments are limited in clinical practice, and as the disease progresses, patients rapidly enter the terminal phase of their illness [ 2 , 3 ]. Cancer not only brings immense suffering to patients but also imposes unprecedented physical and emotional strain on family caregivers. According to the American Cancer Society, family caregivers are primarily individuals who live with the patient, provide unpaid assistance with daily living activities, participate in decision-making, and bear primary responsibility for patient care [ 4 , 5 ]. With the advancement of holistic care models that emphasize a "patient-centred" approach, family caregivers are now recognized as playing an indispensable role throughout cancer treatment and long-term adaptation to the illness [ 6 ]. Furthermore, caregivers’ responses and behaviors significantly influence patients' outcomes. Therefore, research that excludes family caregivers may fail to develop comprehensive support systems that are truly effective for patients. When terminal cancer patients approach the end of life, their family caregivers are inevitably confronted with end-of-life realities and topics surrounding death. In traditional Chinese culture, which emphasizes life while shunning death, discussions about death have long been considered taboo. People generally avoid talking about or even encountering death, believing such topics or experiences bring misfortune [ 7 ]. However, death is an inescapable part of life. Within this cultural context, attitudes toward death have emerged as a key area of focus in palliative care research. Death attitudes refer to an individual's emotional responses, psychological tendencies, and evaluations concerning death and the dying process, encompassing their views on both their own death and the death of others [ 8 ]. Research indicates [ 9 , 10 ] that caregivers with positive death attitudes are more proactive in caring for terminally ill patients. Conversely, negative death attitudes among caregivers not only reduce their own quality of life but also compromise the quality of patient care [ 11 , 12 ], ultimately affecting the patients' quality of end-of-life experiences [ 13 ]. Therefore, caregivers' death attitudes constitute a critical factor in end-of-life care. Moreover, family caregivers of terminally ill patients often experience negative emotions such as anxiety and sadness when facing death [ 14 , 15 ]. Previous studies [ 16 ] have shown that more negative perceptions of death are associated with greater difficulty in adapting to life after the patient's passing. Furthermore, caregivers' fear and taboos surrounding death can influence clinical decision-making at the end of life [ 17 ]. Thus, to improve the quality of care and the quality of dying for terminally ill patients, support caregivers' psychological well-being, facilitate their post-loss adaptation, and promote appropriate end-of-life decisions, it is essential to understand caregivers' attitudes toward death. Emotional intelligence refers to an individual's ability to recognize their own emotions and those of others, to discriminate among different emotional states, and to use emotional information to guide thinking and behavior [ 18 ]. Research demonstrates that emotional intelligence significantly predicts caregivers' death attitudes [ 19 ]. Individuals with higher emotional intelligence tend to exhibit less negative and stronger positive attitudes toward death, as well as more adaptive responses to terminal illness events [ 20 ]. Self-efficacy denotes an individual's belief in their capacity to execute specific tasks successfully and achieve desired outcomes [ 21 ]. Higher self-efficacy enables individuals to exert better control over their thoughts about death and is associated with improved psychological and social functioning, as well as enhanced well-being [ 22 , 23 ]. Tzamakos et al. [ 24 ] suggested that self-efficacy constitutes a component of one's death attitude and can be applied within this domain. Similarly, Li et al. [ 25 ] found that individuals with lower self-efficacy tend to hold more negative views on death. The ABC-X model of family stress, proposed by Reuben Hill, the father of family stress theory, in 1949, remains a comprehensive framework for understanding stress [ 26 ]. According to this model, when an individual experiences a stressful event, the combination of the stressor itself, available resources, and cognitive appraisal determines whether the outcome is positive or negative. Grounded in this theoretical framework, this study examines the relationships among emotional intelligence, self-efficacy, and death attitudes within the context of end-of-life caregiving. The study proposes three hypotheses, and the hypothesized model is presented in Fig. 1 . H1: Emotional intelligence is positively correlated with self-efficacy among family caregivers of patients with advanced cancer. H2: Emotional intelligence is correlated with death attitudes among family caregivers of patients with advanced cancer. H3: Self-efficacy mediates the relationship between emotional intelligence and death attitudes. Objectives This study aims to explore the relationships between emotional intelligence, self-efficacy, and death attitudes in family caregivers of advanced cancer patients, and to investigate the mediating role of self-efficacy. Methods Study design A quantitative, cross-sectional study. Study setting and sampling This study employed a convenience sampling method. Between April 2025 and November 2025, a questionnaire survey was conducted among family caregivers of patients with advanced cancer from three tertiary Grade A hospitals in Hunan province. Inclusion Criteria: ① The cared-for patient was clinically and pathologically diagnosed with stage III/IV cancer and had experienced disease progression; ② Aged 18 years or older, and aware of the patient's actual diagnosis; ③ A relative of the patient; ④ Possessed effective communication and comprehension skills; ⑤ Served as the primary caregiver, having provided continuous care for more than four weeks recently. Only one caregiver per patient was enrolled; ⑥ Provided informed consent and voluntarily participated in the study. Exclusion Criteria: ① Presence of a severe physical illness; ② Severe psychological illness A total of 365 questionnaires were ultimately distributed according to the method of MacCallum et al. [ 27 ]. Measures Data were collected using a questionnaire comprising four parts: a demographic information sheet, the Wong and Law Emotional Intelligence Scale (WLEIS), the General Self-Efficacy Scale (GSES), and the Death Attitude Profile-Revised (DAP-R). Demographic information Caregiver data encompassed gender, age, education level, monthly income, marital status, employment status, region, exposure to death education, engagement in death-related discussions, and bereavement history. Patient data included gender, age, year of diagnosis, and awareness of their diagnosis. Wong and Law Emotional Intelligence Scale (WLEIS) The Wong and Law Emotional Intelligence Scale (WLEIS) was originally developed in English by Wong et al. [ 28 ] in 2004 within the Hong Kong, China context as a self-report instrument. In 2010, Wang et al. translated and adapted the scale, creating a Chinese version [ 29 ].The scale consists of 16 items divided into four subscales: Others' Emotion Appraisal, Self-Emotion Appraisal, Use of Emotion, and Regulation of Emotion. Participants rate their agreement on a 7-point Likert scale (from "strongly disagree" to "strongly agree"), yielding item scores of 0–6 and a total score range of 0–96. A higher total score reflects a greater level of emotional intelligence. For the present sample, the scale's Cronbach's α was 0.861. General Self-Efficacy Scale (GSES) The General Self-Efficacy Scale (GSES), developed by German psychologist Schwarzer [ 30 ], is a 10-item instrument that has gained widespread international and domestic application. The Chinese version was translated and validated by Wang et al. [ 31 ]. Responses are recorded on a 4-point Likert scale, anchored at 1 ("Completely incorrect") and 4 ("Exactly correct"). The total score is interpreted such that higher scores reflect stronger self-efficacy. Based on the total score, self-efficacy is classified into three levels: low ( 30). For the present study, the Cronbach's alpha for this scale was 0.948. Attitude toward death profile-revised (DAP-R) The Attitude toward death Profile-Revised (DAP-R) is 32-item measure with five subscales: fear of death (negative), death avoidance (negative), neutral acceptance(positive), approach acceptance (positive), and escape acceptance (positive). Scores for positive or negative dimension are averaged by the number of items, and the scale does not calculate a total score but rather interprets attitudes based on individual dimension scores. Item with scores ranging from 1 (totally disagree) to 5 (totally agree), the total score is the sum of the scores for each attitude subscale, higher scores indicate a stronger tendency towards the attitude represented by each dimension [ 32 ]. Tang et al. [ 33 ] translated DAP-R in China. DAP-R in this study has a Cronbach’s alpha of 0.869. Data collection The survey was administered online via "Wenjuanxing", China's leading e-questionnaire platform. Following explanations of the study and obtained consent from the nursing department directors of three hospitals in Hunan provinces, our research team distributed the questionnaire link to potential participants who met the inclusion criteria. The questionnaire's first page contained a detailed description and an informed consent question; only participants who selected "Yes, I agree to join" were granted access to the subsequent sections. Data analysis Data were analyzed using SPSS version 27.0. Descriptive statistics were used to summarize the participants' characteristics and variables. Stepwise regression analysis was used to investigate the mediating effects, and Pearson correlation coefficients were employed to examine the correlations among variables. The mediation effect of self-efficacy in the relationship between emotional intelligence and death attitudes was tested using the PROCESS macro for SPSS. A bias-corrected percentile bootstrap method with 5,000 resamples was used to generate a 95% confidence interval (CI) for the indirect effect. The mediation effect was considered statistically significant if the 95% CI did not include zero. Ethical consideration The study was approved by the Ethics Committee of Hunan Normal University (with the code 2025469) and adhered to the principles of the Declaration of Helsinki [ 34 ]. We explained the study’s purpose and process in the consent form, as well as the voluntary nature and anonymity. Written informed consent and assent were obtained from all the eligible participants. Lastly, all data were securely stored on a password-protected computer accessible only to team members. Results Participants A total of 365 family caregivers of patients with advanced cancer were invited to participate in the survey. Among these, 355 questionnaires were returned, all of which were valid, yielding an effective response rate of 97.26%. The baseline characteristics are as follows: Among the family caregivers, 151 (42.5%) were male and 204 (57.5%) were female. The majority of caregivers were aged between 18–44 (38.3%) and 45–59 (38.6%). Regarding the patients with advanced cancer, 194 (54.6%) were male and 161 (45.4%) were female, with a mean age of 63.03 ± 12.52 years. Other detailed information is presented in Tables 1 and 2 . Table 1 Caregiver Demographic Information Item Category Number Proportion (%) Gender Male Female 151 204 42.5 57.5 Age 18–44 45–59 60–74 ≥ 75 136 137 49 33 38.3 38.6 13.8 9.3 Relationship with patients Spouse Children Parents Other relatives 138 168 28 21 38.9 47.3 7.9 5.9 Duration of care 1–3 months 4–6 months 7–12 months 1 year or more 158 89 44 64 44.5 25.1 12.4 18.0 Religious beliefs Yes No 40 301 11.3 88.7 Education Below Primary Education Primary School Middle School High School Associate's Degree Bachelor's Degree Master's Degree or Above 12 41 63 81 92 44 22 3.4 11.5 17.7 22.8 25.9 12.4 6.2 Personal monthly income ≤ 1500 1501–3499 3500–5499 5500–7500 ≥ 7500 31 132 135 25 32 8.7 37.2 38.0 7.0 9.0 Receiving death education Yes No 63 292 17.7 82.3 Immediate family bereavement experience Yes No 186 169 52.4 47.6 Chronic disease Yes No 58 297 16.3 83.7 Discussing the topic of death Yes No 163 192 45.9 54.1 Marital status Unmarried Married Divorce 40 286 29 11.3 80.6 8.2 Full-time care Yes No 140 215 39.4 60.6 Table 2 General demographic data of patients Item Category Number Proportion (%) Gender Male Female 194 161 54.6 45.4 Age 63.03 ± 12.52 Medical Payment Methods Urban and Rural Residents' Medical Insurance Urban and rural employee medical insurance Out-of-pocket 232 75 48 65.4 21.1 13.5 Disease recurrence Yes No 171 184 48.2 51.8 Illness awareness Aware Unware 316 39 89 11 Accept palliative care Yes No 34 321 9.6 90.4 Descriptive statistics for variables Negative Attitude Toward Death (39.25 ± 8.25), Positive Attitude Toward Death (61.16 ± 12.54), Fear of Death(23.09 ± 6.14), Death avoidance༈16.16 ± 3.82༉, Approach Acceptance (29.05 ± 7.55), Neutral Acceptance (17.43 ± 4.26), Escape Acceptance (14.67 ± 3.72), Emotional Intelligence (63.72 ± 14.76), Self-Efficacy (29.65 ± 7.48). Other detailed information is presented in Tables 3 . The descriptive statistics for variables are shown in Table 3 . Table 3 Descriptive statistics for variables Variable Dimensions Score range Mean ± SD Attitude Toward Death Negative Attitude Toward Death 12–60 39.25 ± 8.25 Fear of Death 7–35 23.09 ± 6.14 Death avoidance 5–25 16.16 ± 3.82 Positive Attitude Toward Death 20–100 61.16 ± 12.54 Approach Acceptance 10–50 29.05 ± 7.55 Neutral Acceptance 5–25 17.43 ± 4.26 Escape Acceptance 5–25 14.67 ± 3.72 Emotional Intelligence Overall 0–96 63.72 ± 14.76 Regulation of Emotion 0–24 16.73 ± 4.75 Self-Emotion Appraisal 0–24 16.29 ± 5.11 Others' Emotion Appraisal 0–24 16.07 ± 5.17 Use of Emotion 0–24 14.61 ± 5.89 Self-Efficacy Overall 10–40 29.65 ± 7.48 Correlations for variables A correlation analysis was conducted on the five dimension scores of death attitudes, emotional intelligence, and self-efficacy among family caregivers of late-stage cancer patients. The results of the correlation analysis are shown in Table 4 . The analysis revealed that emotional intelligence was significantly positively correlated with self-efficacy (r = 0.598, P < 0.01); fear of death was significantly negatively correlated with both emotional intelligence (r = -0.593, P < 0.01) and self-efficacy (r = -0.564, P < 0.01); and acceptance of natural death was significantly positively correlated with both emotional intelligence (r = 0.570, P < 0.01) and self-efficacy (r = 0.539, P < 0.01). The specific results are presented in Table 8 . The findings of this study indicate: (1) higher total emotional intelligence scores are associated with higher self-efficacy, lower fear of death, and higher neutral acceptance; (2) higher self-efficacy is associated with lower fear of death and higher neutral acceptance. Table 4 Correlation among emotional intelligence, self-efficacy, and attitude toward death 1 1 2 3 4 5 6 7 8 9 10 11 1 2 .331** 3 .028 .287** 4 − .471** − .043 .368** 5 − .032 .220** .604** .331** 6 − .593** − .091 .086 .570** .051 7 − .564** − .038 .064 .539** .077 .598** 8 − .409** − .053 .060 .384** .027 .689** .452** 9 − .472** − .118* .005 .384** − .037 .725** .401** .305** 10 − .413** − .052 .091 .435** .067 .715** .433** .359** .357** 11 − .369** − .025 .098 .411** .098 .690** .406** .300** .300** .359** Note: **: P < 0.01, *: P < 0.05; 1: Fear of death; 2: Death avoidance; 3: Approach acceptance; 4: Neutral acceptance; 5: escape acceptance; 6: emotional intelligence; 7: self-efficacy; 8: Self-Emotion Appraisal; 9: Use of Emotion; 10: Regulation of Emotion; 11: Others' Emotion Appraisal. Regression Analysis of Emotional Intelligence, Self-Efficacy, and Fear of Death Table 5 shows how self-efficacy mediates the relationship between emotional intelligence and fear of death. In step 1, emotional intelligence predicted fear of death ( β =-0.5640, P < 0.001 ). In step 2, emotional intelligence predicted self-efficacy ( β = 0.4852, P < 0.001 ). In step 3, when the mediator self-efficacy was included, the regression coefficient between emotional intelligence and fear of death decreased from ( β =-0.5640) to ( β =-0.3784, P < 0.001 ). Table 5 Regression analysis for emotional intelligence, self efficacy and Fear of Death (n = 355) Dependent variables Independent variables β t F R² P Fear of Death Emotional Intelligence −0.564 −13.882 191.058 0.351 <0.001 Self-Efficacy Emotional Intelligence 0.485 14.035 196.983 0.358 <0.001 Fear of Death Self-Efficacy −0.382 −6.426 127.081 0.419 <0.001 Emotional Intelligence −0.378 −7.842 <0.001 Mediation analysis of emotional intelligence, self-efficacy, and fear of death Table 6 illustrates the path coefficients of the direct (-0.3784) and indirect (-0.1856) impacts of Emotional intelligence on Fear of Death, indicating that a self efficacy has a partially mediate role. Table 6 Mediation analysis of emotional intelligence, self-efficacy, and fear of death Model pathways Estimated effect 95%CI Lower Upper Total effect of X on Y Emotional Intelligence → Fear of Death −0.5640 0.0408 −0.6443 Direct effect Emotional Intelligence → Fear of Death −0.3784 0.0483 −0.4733 Indirect effect Emotional Intelligence → Self-efficacy→Fear of Death −0.1856 0.0303 −0.2448 Regression Analysis of Emotional Intelligence, Self-Efficacy, and Neutral acceptance Table 7 shows how self-efficacy mediates the relationship between emotional intelligence and neutral acceptance. In step 1, emotional intelligence predicted fear of death ( β = 0.5273, P < 0.001). In step 2, emotional intelligence predicted self-efficacy ( β = 0.4852, P < 0.001 ). In step 3, when the mediator self-efficacy was included, the regression coefficient between emotional intelligence and neutral acceptance decreased from ( β = 0.5273) to ( β = 0.3574, P < 0.001 ). Table 7 Regression analysis for emotional intelligence, self efficacy and Neutral acceptance (n = 355) Dependent variables Independent variables β t F R² P Neutral acceptance Emotional Intelligence 0.527 13.049 170.298 0.325 <0.001 Self-Efficacy Emotional Intelligence 0.485 14.035 196.983 0.358 <0.001 Neutral acceptance Self-Efficacy 0.350 5.891 110.635 0.386 <0.001 Emotional Intelligence 0.357 7.416 <0.001 Mediation Analysis of Emotional Intelligence, Self-Efficacy, and Attitudes Toward Death Table 8 illustrates the path coefficients of the direct (0.3574) and indirect (0.1699) impacts of Emotional intelligence on Neutral acceptance, indicating that a self efficacy has a partially mediate role. Table 8 Mediation Analysis of Emotional Intelligence, Self-Efficacy, and Attitudes Toward Death Model pathways Estimated effect 95%CI Lower Upper Total effect of X on Y Emotional Intelligence →Neutral acceptance 0.5273 0.0404 0.4478 Direct effect Emotional Intelligence → Neutral acceptance 0.3574 0.0482 0.2626 Indirect effect Emotional Intelligence→Self-efficacy→Neutral acceptance 0.1699 0.0335 0.1035 Discussion Correlation analysis of emotional intelligence, self-efficacy, and attitude towards death This study contributes to the literature by addressing specific limitations and providing valuable data. This is achieved through conducting the first systematic exploration, which is guided by the ABC-X theory, of the linkages between emotional intelligence, self-efficacy, and death attitudes in family caregivers of advanced cancer patients. The results of this study indicate that emotional intelligence is associated with death attitudes. Specifically, emotional intelligence was negatively correlated with death fear and positively correlated with natural acceptance among caregivers, which aligns with the findings of Li Yuqi et al. [ 20 ]. This suggests that individuals with low emotional intelligence may experience adverse effects on their mental health, including more negative self-evaluations and higher anxiety. Consequently, they may be more prone to fear the unknown, leading to increased fear and anxiety toward death [ 35 ]. Furthermore, individuals with high emotional intelligence possess better emotional regulation and adjustment abilities, enabling them to manage and utilize their emotions more effectively in challenging situations. This contributes to maintaining their mental and emotional stability [ 20 ]. Therefore, caregivers with high emotional intelligence can consistently perceive emotional changes in the cancer patients they care for and respond promptly to provide high-quality care. The emotional intelligence of caregivers of advanced cancer patients showed a significant positive correlation with self-efficacy, which is consistent with the findings of Tzamakos et al. [ 24 ]. Karimi et al. noted [ 36 ] that emotional intelligence serves as a protective factor in an individual’s ability to cope with stress. Individuals with higher emotional intelligence are better equipped to handle emotional stress in caregiving, maintain a positive psychological state, and exhibit greater confidence and determination to overcome difficulties, thereby enhancing their self-efficacy. Additionally, individuals with high emotional intelligence perform better in interactions with patients, gaining more recognition and support. This positive external feedback further strengthens their self-efficacy [ 37 ]. According to Bandura’s self-efficacy theory, self-efficacy represents an individual’s belief in their ability to take action when facing difficulties [ 21 ]. The results of this study indicate that the self-efficacy of caregivers of advanced cancer patients is associated with death attitudes. Specifically, self-efficacy was negatively correlated with death fear and positively correlated with natural acceptance. Liu et al. pointed out [ 38 ] that an individual’s perception of death is influenced by their perception of their own abilities [ 39 ]. Therefore, in death-related contexts, higher self-efficacy typically implies stronger problem-solving and emotional regulation abilities, which help buffer negative attitudes toward death and provide psychological resources for positive death attitudes. The Mediating Role of Self-Efficacy in the Relationship Between Emotional Intelligence and Attitudes Toward Death Existing research indicates that self-efficacy plays a significant role in patients with advanced cancer. It can function not only as a primary predictor or an outcome variable but also as a mediator among various psychological constructs [ 40 ]. Based on this understanding, the present study investigated whether self-efficacy mediates the relationship between emotional intelligence and death attitudes. The results reveal that self-efficacy serves as a partial mediator between emotional intelligence and death attitudes. More specifically, it partially mediates the relationship between emotional intelligence and both death fear and natural acceptance. This finding suggests that an individual's perception of death is influenced by their perception of their own capabilities, which in turn partially shapes the formation of their death attitudes. Family caregivers of cancer patients constitute a distinct group often characterized by frequent exposure to death and a substantial caregiving burden. When confronting the patient's death, these caregivers may experience self-doubt regarding their capabilities, which can subsequently lead to more negative attitudes toward death. The earlier correlation analysis demonstrated significant pairwise relationships among emotional intelligence, self-efficacy, and death attitudes. Subsequent path analysis and mediation testing provided further clarification. Self-efficacy was found to partially mediate the link between emotional intelligence and death fear, accounting for 32.90% of the total effect. Similarly, it partially mediated the relationship between emotional intelligence and natural acceptance, explaining 32.20% of the total effect. These findings indicate that emotional intelligence influences death attitudes through two distinct pathways: a direct effect on death fear and natural acceptance, and an indirect effect mediated through self-efficacy. Given their frequent exposure to death and high caregiving burden, family caregivers of advanced cancer patients are particularly vulnerable to self-doubt in death-related situations, which fosters negative attitudes [ 41 ]. This insight suggests a dual-intervention strategy for healthcare professionals. They can aim to improve caregivers' death attitudes not only by directly enhancing their emotional intelligence but also, by leveraging the mediating role of self-efficacy, indirectly through interventions that boost caregivers' self-efficacy levels. Such an approach may help caregivers face end-of-life events more positively and reduce adverse psychological reactions following bereavement. Self-efficacy is a core concept within social cognitive theory. For family caregivers of advanced cancer patients, it refers to their judgment and confidence in their ability to perform specific caregiving tasks within an end-of-life context. Research has established self-efficacy as a key factor influencing death attitude beliefs, as well as behavioral changes and maintenance, among cancer caregivers [ 24 , 41 ]. Consequently, improving caregivers' self-efficacy levels can effectively enhance their attitudes when confronting end-of-life events. Therefore, it is crucial to focus on enhancing the self-efficacy of these caregivers throughout the prolonged disease trajectory to help them face death-related events more positively and improve their psychological state. This underscores the need for healthcare providers to extend their support beyond direct patient care. They should also assist caregivers in better adapting to the negative changes brought about by the patient's terminal condition. Efforts should be made to strengthen caregivers' confidence in providing end-of-life care and to encourage their active participation in disease management and symptom alleviation. Conclusion This study identified significant associations between emotional intelligence, self-efficacy, and attitudes toward death among family caregivers of patients with advanced cancer. Self-efficacy partially mediated the relationships between emotional intelligence and both death fear and natural acceptance, highlighting self-efficacy as a key psychological pathway through which emotional intelligence shapes caregivers’ responses to death. These findings underscore the importance of developing emotional intelligence–oriented death education (e.g., training in emotional awareness, regulation, and communication) and providing targeted caregiving knowledge and skills training to enhance caregivers’ self-efficacy. Such strategies may help reduce death-related fear, promote more adaptive acceptance of death, and ultimately support caregivers’ psychological well-being. Moreover, these results offer a theoretical and empirical basis for integrating caregiver-focused emotional and efficacy-enhancing interventions into palliative care practice and for guiding future research aimed at improving family-centered end-of-life care. Limitation This study has several limitations. First, the use of a cross-sectional design prevents the establishment of causal relationships and limits the ability to clarify how emotional intelligence and self-efficacy influence attitudes toward death. Second, all participants were recruited from a single province in China, which may restrict the generalizability of the findings to other regions and cultural contexts. Third, although anonymity and confidentiality were assured, talking about death is often considered taboo in Chinese culture, and respondents may have concealed their true thoughts when completing the questionnaires, introducing potential response bias. Therefore, future research could adopt qualitative methods or longitudinal, multicenter designs to further explore the relationships among emotional intelligence, self-efficacy, and attitudes toward death in family caregivers of patients with advanced cancer. Declarations Acknowledgements We would like to express our heartfelt gratitude to all the participants. This study would not have been possible without their contributions. Author contributions H.S: Methodology, Data curation; Formal analysis; Investigation; Methodology; Writing - original draft; Writing - review & editing. K.T: Methodology,Supervision, Resources; Writing - original draft; Review & editing. Funding no funding Data availability The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Ethics approval and consent to participate This study was approved by the Ethics Committee of Hunan Normal University (Approval No.: 2025469). 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Mod Prev Med. 2021;48(18):3448–51. https://doi.org/10.20043/j.cnki.mpm.2021.18.040 . Wen FH, Chou WC, Hou MM, Su PJ, Shen WC, Chen JS, et al. Caregivers' death-preparedness states impact caregiving outcomes and patients' end-of-life care. J Pain Symptom Manage. 2022;63(2):199–209. https://doi.org/10.1016/j.jpainsymman.2021.09.012 . MengJie L, Houxiu Z, Jingci Z. Influencing factors of clinical decision of family members of end of life patients in intensive care unit. Chin Nurs Res. 2016;30(36):4501–5. https://doi.org/10.3969/j.issn.1009-6493.2016.36.007 . Hua Y, Uddin MA, Bhuiyan AJ. Emotional intelligence of nurses in tertiary hospitals in Dali, the People’s Republic of China. Adv Bioscience Bioeng. 2019;7(3). https://doi.org/10.11648/j.abb.20190703.12 . JuYeun K, KyoungHee L. The influence of meaning in life and emotional intelligence of nursing students on attitudes toward death. Korean Association for Learner-Centered. Curriculum Instruction. 2018;18(24):533–51. http://doi.org/10.22251/jlcci.2018.18.24.533 . Yuqi L, Siqi X, Yanan L, Tingting L, Xiaoli P. Analysis of correlation between death attitude and emotional intelligence of nursing undergraduates. Occupation Health. 2019;35(21):2983–7. https://doi.org/10.13329/j.cnki.zyyjk.2019.0758 . Bandura A. Self-efficacy: Toward a unifying theory of behavioral change. Psychol Rev. 1997;84(2):191–215. https://doi.org/10.1037/0033-295X.84.2.191 . Jo KH, Lee HJ. Relationship between self-efficacy, depression, level of satisfaction and death attitude of college students. J Korean Acad Nurs. 2008;38(2):229–37. https://doi.org/10.4040/jkan.2008.38.2.229 . Haomei Z, Zhangyi W, Wei Y, Yajun Z, Jianya Y. A study on status quo of death coping ability and its correlations withdeath attitude and death coping self-efhcacy among internship nursingstudents in Shijiazhuang City. Occupation Health. 2022;38(21):2912–6. https://doi.org/10.13329/j.cnki.zyyjk.20220429.006 . Tzamakos E, Metallinou D, Tigka M, Lykeridou A, Sarantaki A, Nanou C. The associations of perceived self-efficacy with emotional intelligence, personality, resilience, and attitudes towards death among midwives. Healthcare. 2024;12(11):1129. https://doi.org/10.3390/healthcare12111129 . Shuo L, Ning M, Yinyin L, Li S. Correlation between caring ability and emotional self-regulation efficacy, death attitude of clinical nurses. J Nurs Adm. 2023;23(2):133–7. https://doi.org/10.3969/j.issn.1671-315x.2023.02.012 . Schock-Giordano AM. Ethnic Families and Mental Health: Application of the ABC-X Model of Family Stress. SAGE Open. 2013;3(1):93–6. https://doi.org/10.1177/2158244013478015 . MacCallum RC, Widaman KF, Preacher KJ, Hong S. Sample size in factor analysis: The role of model error. Multivar Behav Res. 2001;36(4):611–37. https://doi.org/10.1207/S15327906MBR3604_06 . Law KS, Wong CS, Song LJ. The construct and criterion validity of emotional intelligence and its potential utility for management studies. J Appl Psychol. 2004;89(4):483–96. https://doi.org/10.1037/0021-9010.89.3.483 . Yefei W. Reliability and Validity of Chinese Version of Emotional Intelligence Scale. Central south university. (2010). Schwarze R, Born A. Optimistic self-beliefs: Assessment of general perceived self-efficacy in thirteen cultures. Berlin: Freie Universität Berlin; 1997. Caikang W, Zhongfeng H, Yong L. Reliability and Validity of General Self-efficacy Scale. Chin J Appl Psychol. 2001;1:37–40. Wong PT, Reker GT, Gesser G. Death Attitude Profile—Revised: A multidimensional measure of attitudes toward death. In: Neimeyer RA, editor. Death Anxiety Handbook: Research, Instrumentation, and Application. Washington, DC: Taylor & Francis; 1994. pp. 121–48. Lu T, Ling Z, Yuxiang L, Lingjun Z, Jing C. Validation and reliability of a Chinese version Death Attitude Profile-Revised (DAP-R)for nurses. J Nurs Sci. 2014;29(14):64–6. https://doi.org/10.3870/hlxzz.2014.14.064 . World Medical Association. World medical association declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310:2191–4. https://doi.org/10.1001/jama.2013.281053 . Su H, Tam KI, Li Y. The role of emotional intelligence in end-of-life care: A scoping review of studies involving healthcare professionals. BMC Palliat Care. 2025;24(1):290. https://doi.org/10.1186/s12904-025-01928-7 . Karimi L, Leggat SG, Donohue L, Farrell G, Couper GE. Emotional rescue: The role of emotional intelligence and emotional labour on well-being and job-stress among community nurses. J Adv Nurs. 2014;70(1):176–86. https://doi.org/10.1111/jan.12185 . Feng X, Shengnan M, Shan W. Correlation between nurses' self-efficacy, nurse-patient communication ability and emotional intelligence in emergency department. Psychologies Magazine. 2025;20(19):61–3. https://doi.org/10.19738/j.cnki.psy.2025.19.015 . Liu W, Su YJ, Zhou SJ, Deng WH, Hu HY, Cui Q, et al. Death coping ability, death attitude, and professional quality of life among geriatric nurses: A multicentre cross-sectional study. Death coping ability, death attitude, and professional quality of life among geriatric nurses: a multicentre cross-sectional study. BMC Palliat Care. 2025;24(1):117. https://doi.org/10.1186/s12904-025-01754-x . Xue T, Shixin T, Yaohui L, HongWei X. The Relationship between Medical Students' Attitudes toward Death and Suicide Ideation: The Mediating Role of Self-Efficacy. China J Health Psychol. 2016;24(6):932–5. https://doi.org/doi:10.13342/j.cnki.cjhp.2016.06.037 . Thomas Hebdon MC, Coombs LA, Reed P, Crane TE, Badger TA. Self-efficacy in caregivers of adults diagnosed with cancer: An integrative review. Eur J Oncol Nurs. 2021;52:101933. https://doi.org/10.1016/j.ejon.2021.101933 . Xinyan L. A study on the status of death anxiety and factors affecting family caregivers of patients with advanced cancer. Chengdu University of Traditional Chinese Medicine; 2023. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 06 May, 2026 Editor assigned by journal 09 Apr, 2026 Submission checks completed at journal 08 Apr, 2026 First submitted to journal 07 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9277009","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":635469001,"identity":"088c44ce-8c0c-4497-80a4-d313a3bf03c9","order_by":0,"name":"HUIMIN SU","email":"","orcid":"","institution":"Kiang Wu Nursing College of Macau","correspondingAuthor":false,"prefix":"","firstName":"HUIMIN","middleName":"","lastName":"SU","suffix":""},{"id":635469002,"identity":"f5d95218-000c-4113-8ebe-635b25deae69","order_by":1,"name":"Kuai IN Tam","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5ElEQVRIiWNgGAWjYBACxgYYi70NyjhAnBYDBgaeY0RqgQKgFok0IrUwtzc/e1xQ80ded+azNOmCGgY5vhsJrBs+4HNYzzFz4xnHDAy33U47Jj3jGIOx5I0Etpsz8GmZkWAmzcNmwLjtdnrbbd4GhsQNQC23efBqSf8mzfPPwH7bzeNgLfVEaMkxk+ZtM0jcdoPtGEhLggFBLT1nyqR5+4yTt51JS//Nc0zCcOaZh214/WLY3r5NmuebnO2248eMjXlqbOT5jicfu4EvxAwbUPkSDMgpAiuQxys7CkbBKBgFowAEAKjBT82BVxX2AAAAAElFTkSuQmCC","orcid":"","institution":"Kiang Wu Nursing College of Macau","correspondingAuthor":true,"prefix":"","firstName":"Kuai","middleName":"IN","lastName":"Tam","suffix":""}],"badges":[],"createdAt":"2026-03-31 08:41:00","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9277009/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9277009/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":109331521,"identity":"c30d40eb-3fe2-4a60-b6d9-c31ee7e4c2e7","added_by":"auto","created_at":"2026-05-15 16:09:44","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":108991,"visible":true,"origin":"","legend":"\u003cp\u003eThe hypothesized model\u003c/p\u003e","description":"","filename":"Fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-9277009/v1/df1570b14952363e82bd5cc0.png"},{"id":109405636,"identity":"85ca4665-fb19-4590-bced-116fd07745ae","added_by":"auto","created_at":"2026-05-17 13:19:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":487268,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9277009/v1/941ade7e-a8fb-43ad-9a93-b6c451b96993.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Relationship Among Emotional Intelligence, Self-Efficacy, and Attitude Toward Death in Family Caregivers of Patients with Advanced Cancer","fulltext":[{"header":"Background","content":"\u003cp\u003eAccording to the latest 2022 report from the Global Cancer Observatory (GLOBOCAN), there were approximately 19.97\u0026nbsp;million new cancer cases and about 9.74\u0026nbsp;million cancer-related deaths worldwide. China accounted for approximately 24% of global new cases and 26% of global deaths [\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e], representing nearly one-quarter of the world's total burden. Moreover, most cancer patients exhibit no obvious symptoms in the early stages, and by the time of diagnosis, they are often already in the middle or advanced stages of the disease. Effective curative treatments are limited in clinical practice, and as the disease progresses, patients rapidly enter the terminal phase of their illness [\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCancer not only brings immense suffering to patients but also imposes unprecedented physical and emotional strain on family caregivers. According to the American Cancer Society, family caregivers are primarily individuals who live with the patient, provide unpaid assistance with daily living activities, participate in decision-making, and bear primary responsibility for patient care [\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e]. With the advancement of holistic care models that emphasize a \"patient-centred\" approach, family caregivers are now recognized as playing an indispensable role throughout cancer treatment and long-term adaptation to the illness [\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e]. Furthermore, caregivers’ responses and behaviors significantly influence patients' outcomes. Therefore, research that excludes family caregivers may fail to develop comprehensive support systems that are truly effective for patients.\u003c/p\u003e \u003cp\u003eWhen terminal cancer patients approach the end of life, their family caregivers are inevitably confronted with end-of-life realities and topics surrounding death. In traditional Chinese culture, which emphasizes life while shunning death, discussions about death have long been considered taboo. People generally avoid talking about or even encountering death, believing such topics or experiences bring misfortune [\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e]. However, death is an inescapable part of life. Within this cultural context, attitudes toward death have emerged as a key area of focus in palliative care research. Death attitudes refer to an individual's emotional responses, psychological tendencies, and evaluations concerning death and the dying process, encompassing their views on both their own death and the death of others [\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e]. Research indicates [\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e] that caregivers with positive death attitudes are more proactive in caring for terminally ill patients. Conversely, negative death attitudes among caregivers not only reduce their own quality of life but also compromise the quality of patient care [\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e], ultimately affecting the patients' quality of end-of-life experiences [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e]. Therefore, caregivers' death attitudes constitute a critical factor in end-of-life care.\u003c/p\u003e \u003cp\u003eMoreover, family caregivers of terminally ill patients often experience negative emotions such as anxiety and sadness when facing death [\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e]. Previous studies [\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e] have shown that more negative perceptions of death are associated with greater difficulty in adapting to life after the patient's passing. Furthermore, caregivers' fear and taboos surrounding death can influence clinical decision-making at the end of life [\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e]. Thus, to improve the quality of care and the quality of dying for terminally ill patients, support caregivers' psychological well-being, facilitate their post-loss adaptation, and promote appropriate end-of-life decisions, it is essential to understand caregivers' attitudes toward death.\u003c/p\u003e \u003cp\u003eEmotional intelligence refers to an individual's ability to recognize their own emotions and those of others, to discriminate among different emotional states, and to use emotional information to guide thinking and behavior [\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e]. Research demonstrates that emotional intelligence significantly predicts caregivers' death attitudes [\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e]. Individuals with higher emotional intelligence tend to exhibit less negative and stronger positive attitudes toward death, as well as more adaptive responses to terminal illness events [\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSelf-efficacy denotes an individual's belief in their capacity to execute specific tasks successfully and achieve desired outcomes [\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e]. Higher self-efficacy enables individuals to exert better control over their thoughts about death and is associated with improved psychological and social functioning, as well as enhanced well-being [\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e]. Tzamakos et al. [\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e] suggested that self-efficacy constitutes a component of one's death attitude and can be applied within this domain. Similarly, Li et al. [\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e] found that individuals with lower self-efficacy tend to hold more negative views on death.\u003c/p\u003e \u003cp\u003eThe ABC-X model of family stress, proposed by Reuben Hill, the father of family stress theory, in 1949, remains a comprehensive framework for understanding stress [\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e]. According to this model, when an individual experiences a stressful event, the combination of the stressor itself, available resources, and cognitive appraisal determines whether the outcome is positive or negative. Grounded in this theoretical framework, this study examines the relationships among emotional intelligence, self-efficacy, and death attitudes within the context of end-of-life caregiving. The study proposes three hypotheses, and the hypothesized model is presented in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eH1: Emotional intelligence is positively correlated with self-efficacy among family caregivers of patients with advanced cancer.\u003c/p\u003e \u003cp\u003eH2: Emotional intelligence is correlated with death attitudes among family caregivers of patients with advanced cancer.\u003c/p\u003e \u003cp\u003eH3: Self-efficacy mediates the relationship between emotional intelligence and death attitudes.\u003c/p\u003e\n\u003ch3\u003eObjectives\u003c/h3\u003e\n\u003cp\u003eThis study aims to explore the relationships between emotional intelligence, self-efficacy, and death attitudes in family caregivers of advanced cancer patients, and to investigate the mediating role of self-efficacy.\u003c/p\u003e "},{"header":"Methods","content":"\u003ch2\u003eStudy design\u003c/h2\u003e\u003cp\u003eA quantitative, cross-sectional study.\u003c/p\u003e\u003ch3\u003eStudy setting and sampling\u003c/h3\u003e\u003cp\u003eThis study employed a convenience sampling method. Between April 2025 and November 2025, a questionnaire survey was conducted among family caregivers of patients with advanced cancer from three tertiary Grade A hospitals in Hunan province.\u003c/p\u003e\u003ch3\u003eInclusion Criteria:\u003c/h3\u003e\u003cp\u003e① The cared-for patient was clinically and pathologically diagnosed with stage III/IV cancer and had experienced disease progression;\u003c/p\u003e\u003cp\u003e② Aged 18 years or older, and aware of the patient's actual diagnosis;\u003c/p\u003e\u003cp\u003e③ A relative of the patient;\u003c/p\u003e\u003cp\u003e④ Possessed effective communication and comprehension skills;\u003c/p\u003e\u003cp\u003e⑤ Served as the primary caregiver, having provided continuous care for more than four weeks recently. Only one caregiver per patient was enrolled;\u003c/p\u003e\u003cp\u003e⑥ Provided informed consent and voluntarily participated in the study.\u003c/p\u003e\u003ch3\u003eExclusion Criteria:\u003c/h3\u003e\u003cp\u003e① Presence of a severe physical illness;\u003c/p\u003e\u003cp\u003e② Severe psychological illness\u003c/p\u003e\u003cp\u003eA total of 365 questionnaires were ultimately distributed according to the method of MacCallum et al. [\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\u003ch2\u003eMeasures\u003c/h2\u003e\u003cp\u003eData were collected using a questionnaire comprising four parts: a demographic information sheet, the Wong and Law Emotional Intelligence Scale (WLEIS), the General Self-Efficacy Scale (GSES), and the Death Attitude Profile-Revised (DAP-R).\u003c/p\u003e\u003ch3\u003eDemographic information\u003c/h3\u003e\u003cp\u003eCaregiver data encompassed gender, age, education level, monthly income, marital status, employment status, region, exposure to death education, engagement in death-related discussions, and bereavement history. Patient data included gender, age, year of diagnosis, and awareness of their diagnosis.\u003c/p\u003e\u003cb\u003eWong and Law Emotional Intelligence Scale (WLEIS)\u003c/b\u003e\u003cp\u003eThe Wong and Law Emotional Intelligence Scale (WLEIS) was originally developed in English by Wong et al. [\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e] in 2004 within the Hong Kong, China context as a self-report instrument. In 2010, Wang et al. translated and adapted the scale, creating a Chinese version [\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e].The scale consists of 16 items divided into four subscales: Others' Emotion Appraisal, Self-Emotion Appraisal, Use of Emotion, and Regulation of Emotion. Participants rate their agreement on a 7-point Likert scale (from \"strongly disagree\" to \"strongly agree\"), yielding item scores of 0–6 and a total score range of 0–96. A higher total score reflects a greater level of emotional intelligence. For the present sample, the scale's Cronbach's α was 0.861.\u003c/p\u003e\u003ch2\u003eGeneral Self-Efficacy Scale (GSES)\u003c/h2\u003e\u003cp\u003eThe General Self-Efficacy Scale (GSES), developed by German psychologist Schwarzer [\u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e], is a 10-item instrument that has gained widespread international and domestic application. The Chinese version was translated and validated by Wang et al. [\u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e]. Responses are recorded on a 4-point Likert scale, anchored at 1 (\"Completely incorrect\") and 4 (\"Exactly correct\"). The total score is interpreted such that higher scores reflect stronger self-efficacy. Based on the total score, self-efficacy is classified into three levels: low (\u0026lt; 20), moderate (20–30), and high (\u0026gt; 30). For the present study, the Cronbach's alpha for this scale was 0.948.\u003c/p\u003e\u003ch2\u003eAttitude toward death profile-revised (DAP-R)\u003c/h2\u003e\u003cp\u003eThe Attitude toward death Profile-Revised (DAP-R) is 32-item measure with five subscales: fear of death (negative), death avoidance (negative), neutral acceptance(positive), approach acceptance (positive), and escape acceptance (positive). Scores for positive or negative dimension are averaged by the number of items, and the scale does not calculate a total score but rather interprets attitudes based on individual dimension scores. Item with scores ranging from 1 (totally disagree) to 5 (totally agree), the total score is the sum of the scores for each attitude subscale, higher scores indicate a stronger tendency towards the attitude represented by each dimension [\u003cspan class=\"CitationRef\"\u003e32\u003c/span\u003e]. Tang et al. [\u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e] translated DAP-R in China. DAP-R in this study has a Cronbach’s alpha of 0.869.\u003c/p\u003e\u003ch2\u003eData collection\u003c/h2\u003e\u003cp\u003eThe survey was administered online via \"Wenjuanxing\", China's leading e-questionnaire platform. Following explanations of the study and obtained consent from the nursing department directors of three hospitals in Hunan provinces, our research team distributed the questionnaire link to potential participants who met the inclusion criteria. The questionnaire's first page contained a detailed description and an informed consent question; only participants who selected \"Yes, I agree to join\" were granted access to the subsequent sections.\u003c/p\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eData were analyzed using SPSS version 27.0. Descriptive statistics were used to summarize the participants' characteristics and variables. Stepwise regression analysis was used to investigate the mediating effects, and Pearson correlation coefficients were employed to examine the correlations among variables. The mediation effect of self-efficacy in the relationship between emotional intelligence and death attitudes was tested using the PROCESS macro for SPSS. A bias-corrected percentile bootstrap method with 5,000 resamples was used to generate a 95% confidence interval (CI) for the indirect effect. The mediation effect was considered statistically significant if the 95% CI did not include zero.\u003c/p\u003e\u003ch2\u003eEthical consideration\u003c/h2\u003e\u003cp\u003eThe study was approved by the Ethics Committee of Hunan Normal University (with the code 2025469) and adhered to the principles of the Declaration of Helsinki [\u003cspan class=\"CitationRef\"\u003e34\u003c/span\u003e]. We explained the study’s purpose and process in the consent form, as well as the voluntary nature and anonymity. Written informed consent and assent were obtained from all the eligible participants. Lastly, all data were securely stored on a password-protected computer accessible only to team members.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eA total of 365 family caregivers of patients with advanced cancer were invited to participate in the survey. Among these, 355 questionnaires were returned, all of which were valid, yielding an effective response rate of 97.26%. The baseline characteristics are as follows: Among the family caregivers, 151 (42.5%) were male and 204 (57.5%) were female. The majority of caregivers were aged between 18\u0026ndash;44 (38.3%) and 45\u0026ndash;59 (38.6%). Regarding the patients with advanced cancer, 194 (54.6%) were male and 161 (45.4%) were female, with a mean age of 63.03\u0026thinsp;\u0026plusmn;\u0026thinsp;12.52 years. Other detailed information is presented in Tables\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCaregiver Demographic Information\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eProportion (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e151\u003c/p\u003e \u003cp\u003e204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.5\u003c/p\u003e \u003cp\u003e57.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026ndash;44\u003c/p\u003e \u003cp\u003e45\u0026ndash;59\u003c/p\u003e \u003cp\u003e60\u0026ndash;74\u003c/p\u003e \u003cp\u003e\u0026ge;\u0026thinsp;75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e136\u003c/p\u003e \u003cp\u003e137\u003c/p\u003e \u003cp\u003e49\u003c/p\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38.3\u003c/p\u003e \u003cp\u003e38.6\u003c/p\u003e \u003cp\u003e13.8\u003c/p\u003e \u003cp\u003e9.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRelationship with patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpouse\u003c/p\u003e \u003cp\u003eChildren\u003c/p\u003e \u003cp\u003eParents\u003c/p\u003e \u003cp\u003eOther relatives\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e138\u003c/p\u003e \u003cp\u003e168\u003c/p\u003e \u003cp\u003e28\u003c/p\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38.9\u003c/p\u003e \u003cp\u003e47.3\u003c/p\u003e \u003cp\u003e7.9\u003c/p\u003e \u003cp\u003e5.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;3 months\u003c/p\u003e \u003cp\u003e4\u0026ndash;6 months\u003c/p\u003e \u003cp\u003e7\u0026ndash;12 months\u003c/p\u003e \u003cp\u003e1 year or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e158\u003c/p\u003e \u003cp\u003e89\u003c/p\u003e \u003cp\u003e44\u003c/p\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44.5\u003c/p\u003e \u003cp\u003e25.1\u003c/p\u003e \u003cp\u003e12.4\u003c/p\u003e \u003cp\u003e18.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReligious beliefs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003cp\u003e301\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.3\u003c/p\u003e \u003cp\u003e88.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBelow Primary Education\u003c/p\u003e \u003cp\u003ePrimary School\u003c/p\u003e \u003cp\u003eMiddle School\u003c/p\u003e \u003cp\u003eHigh School\u003c/p\u003e \u003cp\u003eAssociate's Degree\u003c/p\u003e \u003cp\u003eBachelor's Degree\u003c/p\u003e \u003cp\u003eMaster's Degree or Above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003cp\u003e41\u003c/p\u003e \u003cp\u003e63\u003c/p\u003e \u003cp\u003e81\u003c/p\u003e \u003cp\u003e92\u003c/p\u003e \u003cp\u003e44\u003c/p\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.4\u003c/p\u003e \u003cp\u003e11.5\u003c/p\u003e \u003cp\u003e17.7\u003c/p\u003e \u003cp\u003e22.8\u003c/p\u003e \u003cp\u003e25.9\u003c/p\u003e \u003cp\u003e12.4\u003c/p\u003e \u003cp\u003e6.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePersonal monthly income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;1500\u003c/p\u003e \u003cp\u003e1501\u0026ndash;3499\u003c/p\u003e \u003cp\u003e3500\u0026ndash;5499\u003c/p\u003e \u003cp\u003e5500\u0026ndash;7500\u003c/p\u003e \u003cp\u003e\u0026ge;\u0026thinsp;7500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003cp\u003e132\u003c/p\u003e \u003cp\u003e135\u003c/p\u003e \u003cp\u003e25\u003c/p\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.7\u003c/p\u003e \u003cp\u003e37.2\u003c/p\u003e \u003cp\u003e38.0\u003c/p\u003e \u003cp\u003e7.0\u003c/p\u003e \u003cp\u003e9.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReceiving death education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003cp\u003e292\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.7\u003c/p\u003e \u003cp\u003e82.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImmediate family bereavement experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e186\u003c/p\u003e \u003cp\u003e169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52.4\u003c/p\u003e \u003cp\u003e47.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58\u003c/p\u003e \u003cp\u003e297\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.3\u003c/p\u003e \u003cp\u003e83.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiscussing the topic of death\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e163\u003c/p\u003e \u003cp\u003e192\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45.9\u003c/p\u003e \u003cp\u003e54.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnmarried\u003c/p\u003e \u003cp\u003eMarried\u003c/p\u003e \u003cp\u003eDivorce\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003cp\u003e286\u003c/p\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.3\u003c/p\u003e \u003cp\u003e80.6\u003c/p\u003e \u003cp\u003e8.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFull-time care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e140\u003c/p\u003e \u003cp\u003e215\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39.4\u003c/p\u003e \u003cp\u003e60.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGeneral demographic data of patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eProportion (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e194\u003c/p\u003e \u003cp\u003e161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54.6\u003c/p\u003e \u003cp\u003e45.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63.03\u0026thinsp;\u0026plusmn;\u0026thinsp;12.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedical Payment Methods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban and Rural Residents' Medical Insurance\u003c/p\u003e \u003cp\u003eUrban and rural employee medical insurance\u003c/p\u003e \u003cp\u003eOut-of-pocket\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e232\u003c/p\u003e \u003cp\u003e75\u003c/p\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65.4\u003c/p\u003e \u003cp\u003e21.1\u003c/p\u003e \u003cp\u003e13.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisease recurrence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e171\u003c/p\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48.2\u003c/p\u003e \u003cp\u003e51.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIllness awareness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAware\u003c/p\u003e \u003cp\u003eUnware\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e316\u003c/p\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e89\u003c/p\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAccept palliative care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003cp\u003e321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.6\u003c/p\u003e \u003cp\u003e90.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eDescriptive statistics for variables\u003c/h2\u003e \u003cp\u003eNegative Attitude Toward Death (39.25\u0026thinsp;\u0026plusmn;\u0026thinsp;8.25), Positive Attitude Toward Death (61.16\u0026thinsp;\u0026plusmn;\u0026thinsp;12.54), Fear of Death(23.09\u0026thinsp;\u0026plusmn;\u0026thinsp;6.14), Death avoidance༈16.16\u0026thinsp;\u0026plusmn;\u0026thinsp;3.82༉, Approach Acceptance (29.05\u0026thinsp;\u0026plusmn;\u0026thinsp;7.55), Neutral Acceptance (17.43\u0026thinsp;\u0026plusmn;\u0026thinsp;4.26), Escape Acceptance (14.67\u0026thinsp;\u0026plusmn;\u0026thinsp;3.72), Emotional Intelligence (63.72\u0026thinsp;\u0026plusmn;\u0026thinsp;14.76), Self-Efficacy (29.65\u0026thinsp;\u0026plusmn;\u0026thinsp;7.48). Other detailed information is presented in Tables\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The descriptive statistics for variables are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescriptive statistics for variables\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDimensions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eScore range\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAttitude Toward Death\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNegative Attitude Toward Death\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u0026ndash;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e39.25\u0026thinsp;\u0026plusmn;\u0026thinsp;8.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFear of Death\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u0026ndash;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e23.09\u0026thinsp;\u0026plusmn;\u0026thinsp;6.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDeath avoidance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u0026ndash;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e16.16\u0026thinsp;\u0026plusmn;\u0026thinsp;3.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePositive Attitude Toward Death\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u0026ndash;100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e61.16\u0026thinsp;\u0026plusmn;\u0026thinsp;12.54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eApproach Acceptance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u0026ndash;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e29.05\u0026thinsp;\u0026plusmn;\u0026thinsp;7.55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeutral Acceptance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u0026ndash;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e17.43\u0026thinsp;\u0026plusmn;\u0026thinsp;4.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEscape Acceptance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u0026ndash;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e14.67\u0026thinsp;\u0026plusmn;\u0026thinsp;3.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmotional Intelligence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u0026ndash;96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e63.72\u0026thinsp;\u0026plusmn;\u0026thinsp;14.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRegulation of Emotion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e16.73\u0026thinsp;\u0026plusmn;\u0026thinsp;4.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelf-Emotion Appraisal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e16.29\u0026thinsp;\u0026plusmn;\u0026thinsp;5.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers' Emotion Appraisal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e16.07\u0026thinsp;\u0026plusmn;\u0026thinsp;5.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUse of Emotion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e14.61\u0026thinsp;\u0026plusmn;\u0026thinsp;5.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-Efficacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e29.65\u0026thinsp;\u0026plusmn;\u0026thinsp;7.48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eCorrelations for variables\u003c/h2\u003e \u003cp\u003eA correlation analysis was conducted on the five dimension scores of death attitudes, emotional intelligence, and self-efficacy among family caregivers of late-stage cancer patients. The results of the correlation analysis are shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. The analysis revealed that emotional intelligence was significantly positively correlated with self-efficacy (r\u0026thinsp;=\u0026thinsp;0.598, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01); fear of death was significantly negatively correlated with both emotional intelligence (r = -0.593, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and self-efficacy (r = -0.564, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01); and acceptance of natural death was significantly positively correlated with both emotional intelligence (r\u0026thinsp;=\u0026thinsp;0.570, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and self-efficacy (r\u0026thinsp;=\u0026thinsp;0.539, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). The specific results are presented in Table\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e8\u003c/span\u003e. The findings of this study indicate: (1) higher total emotional intelligence scores are associated with higher self-efficacy, lower fear of death, and higher neutral acceptance; (2) higher self-efficacy is associated with lower fear of death and higher neutral acceptance.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation among emotional intelligence, self-efficacy, and attitude toward death\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"12\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.331**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.287**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.471**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.368**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.220**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.604**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.331**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.593**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.091\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.086\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.570**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.051\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.564**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.038\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.064\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.539**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.077\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.598**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.409**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.060\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.384**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.689**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.452**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.472**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.118*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.384**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.037\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.725**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.401**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.305**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.413**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.052\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.091\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.435**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.067\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.715**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.433**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.359**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.357**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.369**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.411**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.690**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.406**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.300**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.300**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.359**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"12\"\u003eNote: **: P\u0026thinsp;\u0026lt;\u0026thinsp;0.01, *: P\u0026thinsp;\u0026lt;\u0026thinsp;0.05; 1: Fear of death; 2: Death avoidance; 3: Approach acceptance; 4: Neutral acceptance; 5: escape acceptance; 6: emotional intelligence; 7: self-efficacy; 8: Self-Emotion Appraisal; 9: Use of Emotion; 10: Regulation of Emotion; 11: Others' Emotion Appraisal.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eRegression Analysis of Emotional Intelligence, Self-Efficacy, and Fear of Death\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e shows how self-efficacy mediates the relationship between emotional intelligence and fear of death. In step 1, emotional intelligence predicted fear of death (\u003cem\u003eβ\u003c/em\u003e=-0.5640, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001 ). In step 2, emotional intelligence predicted self-efficacy (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.4852, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001 ). In step 3, when the mediator self-efficacy was included, the regression coefficient between emotional intelligence and fear of death decreased from (\u003cem\u003eβ\u003c/em\u003e=-0.5640) to (\u003cem\u003eβ\u003c/em\u003e=-0.3784, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001 ).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRegression analysis for emotional intelligence, self efficacy and Fear of Death (n\u0026thinsp;=\u0026thinsp;355)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDependent variables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIndependent variables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eR\u0026sup2;\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFear of Death\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmotional Intelligence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;0.564\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;13.882\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e191.058\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.351\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-Efficacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmotional Intelligence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.485\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e196.983\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.358\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFear of Death\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelf-Efficacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;0.382\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;6.426\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e127.081\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.419\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmotional Intelligence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;0.378\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;7.842\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eMediation analysis of emotional intelligence, self-efficacy, and fear of death\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e illustrates the path coefficients of the direct (-0.3784) and indirect (-0.1856) impacts of Emotional intelligence on Fear of Death, indicating that a self efficacy has a partially mediate role.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMediation analysis of emotional intelligence, self-efficacy, and fear of death\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eModel pathways\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEstimated effect\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLower\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUpper\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal effect of X on Y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eEmotional Intelligence \u0026rarr; Fear of Death\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.5640\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0408\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;0.6443\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDirect effect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eEmotional Intelligence \u0026rarr; Fear of Death\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.3784\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0483\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;0.4733\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndirect effect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eEmotional Intelligence \u0026rarr; Self-efficacy\u0026rarr;Fear of Death\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.1856\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0303\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;0.2448\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eRegression Analysis of Emotional Intelligence, Self-Efficacy, and Neutral acceptance\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e shows how self-efficacy mediates the relationship between emotional intelligence and neutral acceptance. In step 1, emotional intelligence predicted fear of death (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.5273, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In step 2, emotional intelligence predicted self-efficacy (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.4852, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001 ). In step 3, when the mediator self-efficacy was included, the regression coefficient between emotional intelligence and neutral acceptance decreased from (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.5273) to (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.3574, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001 ).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRegression analysis for emotional intelligence, self efficacy and Neutral acceptance (n\u0026thinsp;=\u0026thinsp;355)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDependent variables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIndependent variables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eR\u0026sup2;\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeutral acceptance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmotional Intelligence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.527\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e170.298\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-Efficacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmotional Intelligence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.485\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e196.983\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.358\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeutral acceptance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelf-Efficacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.350\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.891\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e110.635\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.386\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmotional Intelligence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.357\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.416\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eMediation Analysis of Emotional Intelligence, Self-Efficacy, and Attitudes Toward Death\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e8\u003c/span\u003e illustrates the path coefficients of the direct (0.3574) and indirect (0.1699) impacts of Emotional intelligence on Neutral acceptance, indicating that a self efficacy has a partially mediate role.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMediation Analysis of Emotional Intelligence, Self-Efficacy, and Attitudes Toward Death\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eModel pathways\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEstimated effect\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLower\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUpper\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal effect of X on Y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eEmotional Intelligence \u0026rarr;Neutral acceptance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5273\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0404\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.4478\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDirect effect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eEmotional Intelligence \u0026rarr; Neutral acceptance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.3574\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0482\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.2626\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndirect effect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eEmotional Intelligence\u0026rarr;Self-efficacy\u0026rarr;Neutral acceptance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.1699\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0335\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.1035\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec25\" class=\"Section2\"\u003e \u003ch2\u003eCorrelation analysis of emotional intelligence, self-efficacy, and attitude towards death\u003c/h2\u003e \u003cp\u003eThis study contributes to the literature by addressing specific limitations and providing valuable data. This is achieved through conducting the first systematic exploration, which is guided by the ABC-X theory, of the linkages between emotional intelligence, self-efficacy, and death attitudes in family caregivers of advanced cancer patients.\u003c/p\u003e \u003cp\u003eThe results of this study indicate that emotional intelligence is associated with death attitudes. Specifically, emotional intelligence was negatively correlated with death fear and positively correlated with natural acceptance among caregivers, which aligns with the findings of Li Yuqi et al. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. This suggests that individuals with low emotional intelligence may experience adverse effects on their mental health, including more negative self-evaluations and higher anxiety. Consequently, they may be more prone to fear the unknown, leading to increased fear and anxiety toward death [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Furthermore, individuals with high emotional intelligence possess better emotional regulation and adjustment abilities, enabling them to manage and utilize their emotions more effectively in challenging situations. This contributes to maintaining their mental and emotional stability [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Therefore, caregivers with high emotional intelligence can consistently perceive emotional changes in the cancer patients they care for and respond promptly to provide high-quality care.\u003c/p\u003e \u003cp\u003eThe emotional intelligence of caregivers of advanced cancer patients showed a significant positive correlation with self-efficacy, which is consistent with the findings of Tzamakos et al. [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Karimi et al. noted [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] that emotional intelligence serves as a protective factor in an individual\u0026rsquo;s ability to cope with stress. Individuals with higher emotional intelligence are better equipped to handle emotional stress in caregiving, maintain a positive psychological state, and exhibit greater confidence and determination to overcome difficulties, thereby enhancing their self-efficacy. Additionally, individuals with high emotional intelligence perform better in interactions with patients, gaining more recognition and support. This positive external feedback further strengthens their self-efficacy [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAccording to Bandura\u0026rsquo;s self-efficacy theory, self-efficacy represents an individual\u0026rsquo;s belief in their ability to take action when facing difficulties [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The results of this study indicate that the self-efficacy of caregivers of advanced cancer patients is associated with death attitudes. Specifically, self-efficacy was negatively correlated with death fear and positively correlated with natural acceptance. Liu et al. pointed out [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e] that an individual\u0026rsquo;s perception of death is influenced by their perception of their own abilities [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Therefore, in death-related contexts, higher self-efficacy typically implies stronger problem-solving and emotional regulation abilities, which help buffer negative attitudes toward death and provide psychological resources for positive death attitudes.\u003c/p\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003eThe Mediating Role of Self-Efficacy in the Relationship Between Emotional Intelligence and Attitudes Toward Death\u003c/h2\u003e \u003cp\u003eExisting research indicates that self-efficacy plays a significant role in patients with advanced cancer. It can function not only as a primary predictor or an outcome variable but also as a mediator among various psychological constructs [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Based on this understanding, the present study investigated whether self-efficacy mediates the relationship between emotional intelligence and death attitudes.\u003c/p\u003e \u003cp\u003eThe results reveal that self-efficacy serves as a partial mediator between emotional intelligence and death attitudes. More specifically, it partially mediates the relationship between emotional intelligence and both death fear and natural acceptance. This finding suggests that an individual's perception of death is influenced by their perception of their own capabilities, which in turn partially shapes the formation of their death attitudes. Family caregivers of cancer patients constitute a distinct group often characterized by frequent exposure to death and a substantial caregiving burden. When confronting the patient's death, these caregivers may experience self-doubt regarding their capabilities, which can subsequently lead to more negative attitudes toward death.\u003c/p\u003e \u003cp\u003eThe earlier correlation analysis demonstrated significant pairwise relationships among emotional intelligence, self-efficacy, and death attitudes. Subsequent path analysis and mediation testing provided further clarification. Self-efficacy was found to partially mediate the link between emotional intelligence and death fear, accounting for 32.90% of the total effect. Similarly, it partially mediated the relationship between emotional intelligence and natural acceptance, explaining 32.20% of the total effect. These findings indicate that emotional intelligence influences death attitudes through two distinct pathways: a direct effect on death fear and natural acceptance, and an indirect effect mediated through self-efficacy. Given their frequent exposure to death and high caregiving burden, family caregivers of advanced cancer patients are particularly vulnerable to self-doubt in death-related situations, which fosters negative attitudes [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. This insight suggests a dual-intervention strategy for healthcare professionals. They can aim to improve caregivers' death attitudes not only by directly enhancing their emotional intelligence but also, by leveraging the mediating role of self-efficacy, indirectly through interventions that boost caregivers' self-efficacy levels. Such an approach may help caregivers face end-of-life events more positively and reduce adverse psychological reactions following bereavement.\u003c/p\u003e \u003cp\u003eSelf-efficacy is a core concept within social cognitive theory. For family caregivers of advanced cancer patients, it refers to their judgment and confidence in their ability to perform specific caregiving tasks within an end-of-life context. Research has established self-efficacy as a key factor influencing death attitude beliefs, as well as behavioral changes and maintenance, among cancer caregivers [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Consequently, improving caregivers' self-efficacy levels can effectively enhance their attitudes when confronting end-of-life events. Therefore, it is crucial to focus on enhancing the self-efficacy of these caregivers throughout the prolonged disease trajectory to help them face death-related events more positively and improve their psychological state.\u003c/p\u003e \u003cp\u003eThis underscores the need for healthcare providers to extend their support beyond direct patient care. They should also assist caregivers in better adapting to the negative changes brought about by the patient's terminal condition. Efforts should be made to strengthen caregivers' confidence in providing end-of-life care and to encourage their active participation in disease management and symptom alleviation.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study identified significant associations between emotional intelligence, self-efficacy, and attitudes toward death among family caregivers of patients with advanced cancer. Self-efficacy partially mediated the relationships between emotional intelligence and both death fear and natural acceptance, highlighting self-efficacy as a key psychological pathway through which emotional intelligence shapes caregivers\u0026rsquo; responses to death. These findings underscore the importance of developing emotional intelligence\u0026ndash;oriented death education (e.g., training in emotional awareness, regulation, and communication) and providing targeted caregiving knowledge and skills training to enhance caregivers\u0026rsquo; self-efficacy. Such strategies may help reduce death-related fear, promote more adaptive acceptance of death, and ultimately support caregivers\u0026rsquo; psychological well-being. Moreover, these results offer a theoretical and empirical basis for integrating caregiver-focused emotional and efficacy-enhancing interventions into palliative care practice and for guiding future research aimed at improving family-centered end-of-life care.\u003c/p\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003eLimitation\u003c/h2\u003e \u003cp\u003eThis study has several limitations. First, the use of a cross-sectional design prevents the establishment of causal relationships and limits the ability to clarify how emotional intelligence and self-efficacy influence attitudes toward death. Second, all participants were recruited from a single province in China, which may restrict the generalizability of the findings to other regions and cultural contexts. Third, although anonymity and confidentiality were assured, talking about death is often considered taboo in Chinese culture, and respondents may have concealed their true thoughts when completing the questionnaires, introducing potential response bias. Therefore, future research could adopt qualitative methods or longitudinal, multicenter designs to further explore the relationships among emotional intelligence, self-efficacy, and attitudes toward death in family caregivers of patients with advanced cancer.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to express our heartfelt gratitude to all the participants. This study would not have been possible without their contributions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eH.S: Methodology, Data curation; Formal analysis; Investigation; Methodology; Writing - original draft; Writing - review \u0026amp; editing.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eK.T: Methodology,Supervision, Resources; Writing - original draft; Review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eno funding\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of Hunan Normal University (Approval No.: 2025469). All procedures performed in this study involving human participants were in accordance with the ethical standards of the Ethics Committee of Hunan Normal University and with\u0026nbsp;the Declaration of Helsinki [34]. Informed consent was obtained from all individual participants included in the study. Participants were informed that they could withdraw at any time without consequence. Anonymity and confidentiality were guaranteed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, Jemal A. 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Chengdu University of Traditional Chinese Medicine; 2023.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-palliative-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pcar","sideBox":"Learn more about [BMC Palliative Care](http://bmcpalliatcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pcar/default.aspx","title":"BMC Palliative Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Emotional intelligence, Self efficacy, Attitude toward death, Cancer, Family caregivers","lastPublishedDoi":"10.21203/rs.3.rs-9277009/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9277009/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e \u003cb\u003eBackground\u003c/b\u003e As the global incidence of cancer continues to rise, most patients are diagnosed at an advanced stage because early symptoms are often nonspecific or overlooked. In the care of patients with advanced cancer, family caregivers assume the primary caregiving responsibilities. At the same time, they must confront end-of-life and death-related events, which place considerable demands on their emotional and caregiving capacities. However, research examining how family caregivers\u0026rsquo; emotional intelligence influences their attitudes toward death through self-efficacy remains very limited.\u003c/p\u003e \u003cp\u003e \u003cb\u003eAims\u003c/b\u003e To explore the associations among emotional intelligence, self-efficacy, and attitudes toward death in family caregivers of patients with advanced cancer, and to analyze the mediating role of self-efficacy in these relationships.\u003c/p\u003e \u003cp\u003e \u003cb\u003eMethods\u003c/b\u003e This quantitative cross-sectional study used convenience sampling to recruit 365 family caregivers of patients with advanced cancer from three hospitals in Hunan Province, China. The Wong and Law Emotional Intelligence Scale (WLEIS), the General Self-Efficacy Scale (GSES), and the Attitude Toward Death Profile-Revised (DAP-R) were used to assess participants.\u003c/p\u003e \u003cp\u003e \u003cb\u003eResults\u003c/b\u003e Among family caregivers of patients with advanced cancer, emotional intelligence was positively correlated with self-efficacy and with the neutral acceptance dimension of attitudes toward death, and negatively correlated with death fear. Self-efficacy was negatively correlated with death fear and positively correlated with neutral acceptance. Self-efficacy played a partial mediating role in the relationships between emotional intelligence and attitudes toward death.\u003c/p\u003e \u003cp\u003e \u003cb\u003eConclusion\u003c/b\u003e This study found significant associations among emotional intelligence, self-efficacy, and attitudes toward death in family caregivers of patients with advanced cancer, with self-efficacy partially mediating these relationships.\u003c/p\u003e","manuscriptTitle":"The Relationship Among Emotional Intelligence, Self-Efficacy, and Attitude Toward Death in Family Caregivers of Patients with Advanced Cancer","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-15 16:08:48","doi":"10.21203/rs.3.rs-9277009/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-05-06T11:37:49+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-09T16:23:01+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-08T04:13:28+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Palliative Care","date":"2026-04-08T03:54:24+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-palliative-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pcar","sideBox":"Learn more about [BMC Palliative Care](http://bmcpalliatcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pcar/default.aspx","title":"BMC Palliative Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"05c45580-0c20-4e9f-ad51-df87a7b2a860","owner":[],"postedDate":"May 15th, 2026","published":true,"recentEditorialEvents":[{"type":"reviewersInvited","content":"3","date":"2026-05-06T11:37:49+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-15T16:08:55+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-15 16:08:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9277009","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9277009","identity":"rs-9277009","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}