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

The impact of death attitude and sense of dignity on the quality of life of patients receiving end-of-life palliative care for cancer:The intermediary role of advance care planning | 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 impact of death attitude and sense of dignity on the quality of life of patients receiving end-of-life palliative care for cancer:The intermediary role of advance care planning Juan Wang, Ling Chen, Xue Li, Yuan Xia, Yan Sun, Mengru Yang, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7328545/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective. To investigate attitudes toward death, sense of dignity, and acceptance of advance care planning (ACP) among terminally ill cancer patients receiving palliative care and to explore their mediating role to provide a scientific basis for optimizing care and improving policies in clinical practice. Methods. A cross-sectional survey was conducted from November 2024 to February 2025 with 120 end-stage cancer palliative care patients in the Palliative Medicine Department of Xinjiang Medical University Affiliated Cancer Hospital. The survey included a general situation questionnaire, a patient ACP acceptance questionnaire, a sense of dignity scale, and a death attitude description scale. Results . The survey analyzed the current status of end-of-life palliative care patients' attitudes toward death and the differences among the different variables. The total death attitude score is 75.48 ± 20.67. By exploring the correlations among death attitudes, self-esteem, and ACP acceptance, it was found that death attitudes were significantly positively correlated with self-esteem and significantly negatively correlated with ACP acceptance. Through stratified regression analysis, factors influencing the death attitudes of cancer patients in end-of-life palliative care were identified. Age, education level, and monthly family income had a significant effect on death attitudes. After a sense of dignity was incorporated, a significant positive impact on death attitudes was observed. By quantifying the mediating effect of ACP acceptance, ACP acceptance was shown to partially mediate the relationship between dignity and death attitudes. Conclusion. Late-stage cancer patients play an important mediating role in preestablished medical plans because of the pain caused by the disease itself, their experience and feelings toward death, and their need for emotional support. Sense of dignity and attitude toward death interact with each other and jointly affect the psychological state and quality of life of patients at the end stage of the disease when they are facing death. Terminal Cancer Patients Palliative Care Attitude towards Death Sense of Dignity Advance Care Planning Figures Figure 1 1. Introduction The incidence and mortality rates of cancer, a major public health problem worldwide, is increasing annually. The "2022 National Cancer Report" released by the National Cancer Center of China is mainly based on national tumor registration and follow-up monitoring data. According to the latest statistical data on the incidence rate and mortality of new cancers in China in 2022, the number of new cancer cases in China is expected to be 4.8247 million, including 2.5339 million men and 2.2908 million women. The estimated number of cancer deaths in China in 2022 was 2.5742 million. The number of deaths among cancer patients has been increasing annually, with a clear trend toward a younger age [ 2 – 3 ]. Research shows that end-stage cancer patients experience great physical and mental pressure and a sense of dignity, with various responsibilities and burdens involving family, work, and society. With the progression of the disease, patients, especially in the late stage of cancer, are susceptible to impacts of the disease, such as the inability to accept death, fear of death, loss of dignity due to treatment cycles and economic pressures, a lack of understanding and acceptance of preestablished medical plans, and the ineffective expression of self, all of which affect the quality of life of cancer patients [ 9 ]. Palliative care is a comprehensive care model provided for terminally ill patients aimed at improving their quality of life and helping them pass away comfortably, peacefully, and with dignity. However, despite the widespread use of palliative care in developed countries, only 14% of terminally ill patients worldwide have received palliative care services, and the proportion is even lower in developing countries [ 11 ]. In China, the "Healthy China 2023" plan proposes vigorously developing palliative care services. Research shows that providing death education to patients and their families through palliative care helps them understand and accept death, reduce fear and misunderstandings about death, and face the end of life with a peaceful mindset. Death attitudes refer to an individual's relatively stable cognitive, emotional, and behavioral tendencies toward the objective phenomenon of death. Attitudes toward death are influenced by various factors, including personal growth experience, cultural background, education level, and current living conditions. Different attitudes toward death can affect individuals' psychological adjustment and behavioral choices when facing death and play important roles in their perceptions of the quality and meaning of life. There are also different views on the understanding of the essence of death, the inevitability of death, and the uncertainty of the time of death. Some patients may show helplessness and passivity when facing death, worry about the pain of the death process, and even express a more negative attitude and avoid discussing death. Some patients are able to view death with a peaceful mindset, seeing it as a part of life and accepting its inevitability. A sense of dignity usually refers to a patient's recognition of self-worth, exercise of autonomy, need for respect, and physical and psychological integrity. The sense of dignity of cancer patients is a complex and important topic that involves multiple aspects of the patient's disease diagnosis, treatment, and rehabilitation process. Terminal patients may experience a loss of dignity due to disease progression, a loss of physical functions, or dependence on others, such as feeling helpless, ashamed, or burdened. Advance care planning (ACP) is an important component of palliative care and one of the core indicators of high-quality palliative care. ACP refers to the process in which adults of any age or stage of health actively communicate and discuss their future health care preferences with their families and health care professionals before their cognitive and communication abilities are lost. Through ACP, patients and their families can clarify patients’ medical preferences while they have decision-making abilities and guide medical decisions once patients lose decision-making ability, thereby improving patients’ quality of life and reducing overtreatment [ 14 ]. From the perspective of disease and age, ACP has a higher application value for middle-aged and young cancer patients [ 15 ]. In summary, although most end-stage cancer palliative care patients consider ACP necessary, the actual acceptance rate is still low. The poor quality of life of patients and their negative attitudes toward death may be important factors affecting their acceptance of ACP. Although previous studies have reported the relationships among death attitudes, a sense of dignity, and preconceived medical plans, the mediating effect of preconceived medical plans on the relationship between death attitudes and a sense of dignity in end-stage cancer patients receiving palliative care has not been clearly validated. Preestablished medical plans may be seen as a key mediating factor influencing the quality of life of end-stage cancer patients. For end-stage cancer patients receiving palliative care, it is necessary to guide them to have a correct understanding of death, resolve their fear of death, and help them face the disease with a positive and optimistic attitude, which is highly important for improving their quality of life. On the basis of the above literature, we hypothesize that preestablished medical plans are an important factor in improving the quality of life of end-stage cancer patients receiving palliative care. Given the above empirical research and different cultural backgrounds and conditions, this study aims to verify the following three hypotheses among Chinese end-stage cancer patients receiving palliative care: 1) A sense of dignity has a significant positive effect on attitudes toward death; 2) ACP acceptance has a significant negative effect on attitudes toward death; and 3) ACP acceptance plays a mediating role in the association between dignity and attitudes toward death. 2 Object and Method 2.1 Research Object A convenience sampling method was used to survey 120 hospitalized terminal cancer patients in the Palliative Medicine Department of Xinjiang Medical University Affiliated Cancer Hospital from January 2024 to February 2025. The inclusion criteria were as follows: ① Age over 18 years old; ② diagnosed with cancer through histopathological examination; ③ aware of their condition; and ④ clear consciousness, no language communication barriers, and independent decision-making ability. The exclusion criteria for patients were as follows: ① other serious physical illnesses; ② past or present mental or cognitive disorders; and ③ in the acute phase of the disease in critical condition; and ④ previous researchers involved in palliative care and preestablished medical plans. All survey participants provided informed consent and voluntarily participated in this study. 2.2 Research Tools 2.2.1 General Information Survey Form The self-designed demographic survey consists of two parts: the patient's social demographic information and disease-related information. The specific items include sex, age, marital status, education level, place of residence, occupation, economic status, medical payment method, primary caregiver, family situation, cancer type, disease stage, duration of illness, and number of hospitalizations, etc. 2.2.2 Patient ACP Acceptance Questionnaire The scale was developed by Ren Xiaojing [ 16 ] and includes three dimensions (attitudes toward ACP, feelings toward ACP, and plans for ACP), with a total of 19 items, each ranging from 1 to 5 points. The total score is positively correlated with the acceptance of ACP. Each item is scored using a Likert 5-point rating system: 1–5 points represent "strongly disagree" to "strongly agree", and the total score of the questionnaire is 19–95 points. The higher the total score is, the greater the respondents' understanding and acceptance of ACP. The content validity is 0.923, and the total Cronbach's alpha coefficient of the questionnaire is 0.856. The overall Cronbach's alpha coefficient of this study is 0.869, and the Cronbach's alpha coefficients for different dimensions range from 0.716 to 0.885. 2.2.3 Dignity Scale This scale was developed by Canadian scholars Chochinov et al. in 2008 [ 17 ] and was developed by Jiao Yanchao in 2012. It is mainly used to screen for the dignity status of advanced cancer patients and terminally ill patients with an expected survival period of less than 6 months. This scale is divided into 5 dimensions with a total of 25 items, and the 5-point Likert scoring method is used. Each item is scored on a scale of 1–5, corresponding to "no distress", "mild distress", "moderate distress", "severe distress", and "very severe distress". The higher the score is, the worse the patient's sense of dignity, with a threshold of 50 points. A total score greater than 50 points indicates a loss of dignity. In 2016, Ge Guojing et al. [ 16 ] revised the Chinese version of the Patient Dignity Inventory (PDI) on the basis of previous studies, with an overall Cronbach's alpha coefficient of 0.924 and a half-point reliability of 0.885. 2.2.4 Death Attitude Scale This scale was developed by Wong et al. in 1994 [ 18 ] and adapted into Chinese by Tang Lu et al. The scale has five dimensions (death fear, death avoidance, natural acceptance, approach acceptance, and escape acceptance), with a total of 32 items, each ranging from 1 to 5 points. The options for each item are "strongly disagree, disagree, uncertain, agree, " and " strongly agree" and are scored from 1 to 5 points. A score below 2.5 indicates low agreement, 2.5 to 3.5 indicates moderate agreement, and a score above 3.5 indicates high agreement. According to the evaluation of the reliability and validity of the Chinese version of the scale by Wang Qiongqiong et al., the Cronbach's alpha coefficient was 0.868, and the Spearman Brown halving coefficient was 0.835. The Pearson correlation coefficient between each item and its dimension is 0.554–0.828. 2.3 Research Methods Five hospice nursing specialists were selected to establish an investigation team, and five investigators were trained by psychology teachers. After one-on-one simulation training, 10 patients were selected for preinvestigation, and the research design was modified and improved. From November 2024 to May 2025, the researcher distributed questionnaires to the departments where the research subjects were located, explaining the research purpose and significance to them. After the informed consent forms were signed, the questionnaires were distributed on site, verified on site, and collected. A total of 120 questionnaires were distributed, and 120 valid questionnaires were obtained, for an effective response rate of 100%. 2.4 Statistical Methods SPSS 27.0 was used to analyze the data. The measurement data are presented as the means ± standard deviations, while the count data are presented as frequencies and percentages. If the scores of the ACP acceptance, dignity scale, and death attitude scale of patients follow a normal distribution when comparing groups, a t-test was used, otherwise, a rank sum test was used. Based on demographic and clinical groups, we used t-tests and one-way ANOVA to test for intergroup differences. Pearson correlation analysis was used to explore the correlations between attitudes toward death, sense of dignity, and preconceived medical plans. Stratified multiple regression analysis was conducted to explore the potential mediating role of preestablished medical plans in the association between death attitudes and dignity. The asymptotic method and resampling strategy were adopted to test whether social support plays a mediating role in the associations among death attitudes, sense of dignity, and preconceived medical plans. The selection of control variables is based on the statistical significance of univariate analysis. The total scores of death attitude, dignity, and preestablished medical plans were standardized by subtracting the mean and dividing by the standard deviation to eliminate the influence of differences in scale scores. The overall effect ("c-path"), direct effect ("c-path"), and indirect effect ("ab path") are presented. The bias-corrected acceleration 95% confidence interval (BCa 95% CI) was calculated for each ab product. If the BCa 95% CI does not include 0, it indicates the presence of significant mediating effects. 3. Results 3.1 Common Method Deviation Testing Using Harman single factor analysis, exploratory factor analysis was conducted on 76 items, with the results revealing 9 factors with eigenvalues greater than 1. The variance contribution rate of the first factor was 13.26%, which was less than the critical value of 40%, indicating there was no significant common method bias in this study. 3.2 General Information Characteristics of End-Stage Cancer Patients Receiving Palliative Care The basic demographic and clinical characteristics of patients receiving end-of-life palliative care for cancer are presented. The sample included 120 patients, with males accounting for 41.67% and females accounting for 58.33%. The age distribution was mainly between 41 and 50 years (49.17%), and the majority of patients were married (86.67%). In terms of education, a majority of patients had a college diploma or above (57.50%). Most of the residents were urban (94.17%), and the main occupation type was workers (86.67%). Patients with a monthly family income exceeding 5000 yuan represented 57.5%, and 68.33% of patients had a family financial situation in which they could fully afford the treatment costs. The main payment method for medical expenses was urban medical insurance (93.33%). Among the main types of caregivers during hospitalization, parents/children accounted for the highest proportion (54.17%). The main types of diseases were colorectal cancer (30.00%) and breast cancer (23.33%). The main disease stage was stage IV (95.00%). The number of hospitalizations ranged from 510 (48.33%). 3.3 Analysis of the Current Status and Differences in the Death Attitudes of End-Stage Cancer Patients Receiving Palliative Care The current status of end-of-life palliative care patients' attitudes toward death and their differences in different variables were analyzed. The total death attitude was 75.48 ± 20.67. The results revealed that age group (p < 0.01), education level (p < 0.01), monthly family income (p < 0.01), and type of primary caregiver during hospitalization (p = 0.010) had significant effects on attitudes toward death. Specifically, the death attitude score of patients over 50 years old was significantly higher than that of other age groups. Patients with an education level of junior high school or below scored higher than did the other groups. Patients with a monthly family income of less than 3000 yuan scored the highest. Patients who were taken care of by parents/children scored higher. 3.4 Correlation Analysis of the Death Attitudes of End-Stage Cancer Patients Receiving Palliative Care The correlations among attitudes toward death, self-esteem, and ACP acceptance were explored. Attitudes toward death were significantly positively correlated with self-esteem (r = 0.618, p < 0.001) and significantly negatively correlated with ACP acceptance (r=-0.530, p < 0.001). Additionally, self-esteem was significantly negatively correlated with ACP acceptance (r=-0.600, p < 0.001). 3.5 Analysis of Factors Influencing Stratified Attitudes Toward Death among End-Stage Cancer Patients Receiving Palliative Care The factors influencing the attitudes toward death of end-of-life palliative care patients with cancer were analyzed through stratified regression analysis. Model 1 shows that age, education level, and monthly household income have a significant effect on attitudes toward death (p < 0.05). After adding a sense of dignity to Model 2, there was a significant positive impact of dignity on attitudes toward death (β = 0.359, p < 0.001). Model 3 further incorporated ACP acceptance, which revealed a significant negative effect on attitudes toward death (β=-0.240, p = 0.004). The adjusted R² values of the three models are 0.424, 0.536, and 0.566, respectively, indicating a gradual increase in explanatory power. 3.6 Analysis of the Mediating Role of Preestablished Medical Plans The mediating effect of ACP acceptance was quantified. The total effect is 0.540, of which the direct effect is 0.410 (75.92%) and the indirect effect is 0.130 (24.08%). The 95% confidence interval shows a significant indirect effect (0.066–0.192), indicating that ACP acceptance partially mediates the relationship between dignity and death attitudes, as shown in Table 5 . By demonstrating the mediating role of ACP acceptance in the relationship between dignity and attitudes toward death. The standardized coefficients and significance levels (p < 0.001) of each path are labeled in Fig. 1 , which visually presents the direct and indirect relationships between variables. Table 1 General Information of Palliative Care Patients (n = 120) Variable N Constituent Ratio(%) Sex Male 50 41.67 Female 70 58.33 Age 30–40 16 13.33 41–50 59 49.17 >50 45 37.50 Marriage Unmarried/Widowed 16 13.33 Married 104 86.67 Educational Level Middle School and Below 42 35.00 High School/Vocational School 9 7.50 College Degree Or Above 69 57.50 Habitation City 113 94.17 Countryside 7 5.83 Career Worker 104 86.67 Farmer 7 5.83 Other Career 9 7.50 Family Income of Average Month ¥5000 69 57.50 The Tolerance of Disease Burden Barely Possible/Quite Difficult 38 31.67 Absolutely 82 68.33 Payment Method for Medical Expenses Resident Medical Insurance 112 93.33 New Rural Cooperative Medical Insurance 8 6.67 Family Residence Type Live Alone 3 2.50 Couples Live 98 81.67 Living With Children/Parents 19 15.83 Main Types of Caregivers During Hospitalization Parents/Children 65 54.17 Spouse 43 35.83 Other Caregivers 12 10.00 Disease Type Lung Cancer 15 12.50 Liver Cancer 13 10.83 Colorectal Cancer 36 30.00 Breast Cancer 28 23.33 Gastric Cancer 28 23.33 Stages of Disease Phase Ⅲ 6 5.00 Phase Ⅳ 114 95.00 Number of Hospital Stays 10 43 35.83 Table 2 Differential Analysis of End-Of-Life Cancer Patients' Attitudes Towards Palliative Care and Death (n = 120) Variable N (%) Total Score for Death Attitude, Mean ± SD Statistic P Sex t=-0.69 0.489 Male 50 (41.67 74.02 ± 16.25 Female 70 (58.33 76.53 ± 23.38 Age F = 11.88 50 45 (37.50 86.40 ± 26.40 Marriage t = 1.31 0.194 Unmarried/Widowed 16 (13.33 81.75 ± 23.24 Married 104 (86.67 74.52 ± 20.20 Educational Level F = 7.96 < .001 Middle School and Below 42 (35.00 85.17 ± 26.27 High School/Vocational School 9 (7.50 68.56 ± 9.71 College Degree Or Above 69 (57.50 70.49 ± 15.20 Habitation t=-0.37 0.713 City 113 (94.17 75.31 ± 21.01 Countryside 7 (5.83 78.29 ± 15.03 Career F = 0.04 0.959 Worker 104 (86.67 75.64 ± 21.82 Farmer 7 (5.83 73.29 ± 10.21 Other Career 9 (7.50 75.33 ± 12.04 Family Income of Average Month F = 40.45 < .001 ¥5000 69 (57.50 70.81 ± 13.56 The Tolerance of Disease Burden t=-0.54 0.588 Barely Possible/Quite Difficult 38 (31.67 73.97 ± 19.76 Absolutely 82 (68.33 76.18 ± 21.16 Payment Method for Medical Expenses t = 1.17 0.245 Resident Medical Insurance 112 (93.33 76.07 ± 21.15 New Rural Cooperative Medical Insurance 8 (6.67 67.25 ± 9.22 Family Residence Type F = 2.08 0.129 Live Alone 3 (2.50 69.33 ± 3.21 Couples Live 98 (81.67 77.29 ± 22.08 Living With Children/Parents 19 (15.83 67.16 ± 9.93 Main Types of Caregivers During Hospitalization F = 4.83 0.010 Parents/Children 65 (54.17 76.57 ± 21.42 Spouse 43 (35.83 69.86 ± 17.37 Other Caregivers 12 (10.00 89.75 ± 21.19 Disease Type F = 1.74 0.147 Lung Cancer 15 (12.50 77.67 ± 13.09 Liver Cancer 13 (10.83 70.31 ± 28.81 Colorectal Cancer 36 (30.00 71.08 ± 20.92 Breast Cancer 28 (23.33 83.39 ± 23.10 Gastric Cancer 28 (23.33 74.46 ± 14.74 Stages of Disease t=-0.60 0.547 Phase Ⅲ 6 (5.00 70.50 ± 10.37 Phase Ⅳ 114 (95.00 75.75 ± 21.07 Number of Hospital Stays F = 1.60 0.207 10 43 (35.83 74.28 ± 15.47 Table 3 Correlation Analysis of Death Attitudes of Palliative Care Patients Variable Mean ± SD Death Attitude Self-Respect ACP Acceptance Death Attitude 75.48 ± 20.67 1 Self-Respect 71.57 ± 23.65 0.618*** 1 ACP Acceptance 51.40 ± 20.14 -0.530*** -0.600*** 1 Note: ** p < 0.001 Table 4 Analysis of Influencing Factors on Death Attitudes of Palliative Care Patients Variable Step1 Step2 Step3 β p β p β p (Constant) 115.095 < 0.001 76.843 < 0.001 103.236 < 0.001 Age 5.69 0.017 2.982 0.170 1.533 0.476 Educational Level -4.503 0.008 -3.988 0.009 -4.081 0.006 Family Income of Average Month -15.317 < 0.001 -11.457 < 0.001 -11.677 < 0.001 Main Types of Caregivers During Hospitalization_Parents/Children -1.117 0.834 6.88 0.172 5.964 0.222 Main Types of Caregivers During Hospitalization_Spouse -12.122 0.040 -1.802 0.748 -2.064 0.703 Self-Respect 0.359 < 0.001 0.247 0.001 ACP Acceptance -0.240 0.004 F, p 18.484 < 0.001 23.916 < 0.001 23.139 < 0.001 R² 0.448 0.559 0.592 AdjR² 0.424 0.536 0.566 Table 5 Analysis of the Mediating Role of Advance Care Planning Item Effect Value Standard Error 95%Ci Effect Ratio (%) Total Effect 0.540 0.063 (0.415–0.666 100% Direct Effect 0.410 0.077 (0.285–0.562 75.92% Indirect Effect 0.130 0.032 (0.066–0.192 24.08% 4 Discussion Our findings indicate that by analyzing the current status of end-of-life palliative care, patients' attitudes toward death and their differences across different variables can be determined. The total death attitude score is 75.48 ± 20.67. Age group, education level, monthly family income, and primary caregiver type during hospitalization significantly affected attitudes toward death. Specifically, the death attitude score of patients over 50 years old was significantly higher than that of other age groups. Patients with an education level of junior high school or below scored higher than did the other groups. Patients with a monthly family income of less than 3000 yuan scored the highest. Patients who were taken care of by parents/children scored higher. As society has progressed, people's concept of survival for late-stage patients has changed, with the hope that patients can pass away peacefully and no longer undergo invasive medical treatment. Kyota's research analysis revealed five themes in patients' experiences managing anxiety and depression when facing death, including "I must accept that I have cancer", "I must accept that I will inevitably die", "I must accept that I need help", "I must accept this unsatisfactory situation", and "I must accept that this is the result of my fate and life". S Bigi et al.'s research revealed that accepting death is a fundamental prerequisite for palliative care, which helps in the process of caring for terminally ill individuals and emphasizes the need to evaluate different cultural perspectives on death. In fact, patients receiving end-of-life palliative care for cancer have a need for emotional support due to the pain caused by the disease itself, their experience and feelings toward death, and their need for emotional support. In fact, the experience and feelings of attitudes toward death include fear, proximity, psychological gap, psychological burden, and the feeling of being forced to accept it, which seriously affect the quality of life and indirectly affect patients' attitudes toward death, prompting them to crave more pain relief and a peaceful death through palliative care. We explored the correlations among death attitudes, self-esteem, and ACP acceptance in this study. The attitude toward death was significantly positively correlated with self-esteem and significantly negatively correlated with ACP acceptance. Additionally, self-esteem is significantly negatively correlated with ACP acceptance. Moreover, we conducted a stratified regression analysis to investigate the factors influencing the mortality attitudes of patients receiving end-of-life palliative care for cancer. Age, education level, and monthly family income significantly affect attitudes toward death. When a sense of dignity is added, it has a significant positive effect on attitudes toward death. Further incorporation of ACP acceptance revealed a significant negative effect on attitudes toward death. Currently, domestic and international research on the sense of dignity among cancer patients is increasing. Niveau et al. reported that self-esteem is an important psychological resource and that low self-esteem is a real risk factor for the development of depression. The rationality of self-esteem should be considered in the context of cancer-related psychological care. Moreover, research has shown that cancer significantly increases the risk of developing depression and anxiety symptoms [ 18 ]. Research by Xiao J has shown that the meaning of life in different disease scenarios can improve patients' self-esteem and subjective well-being, which has reference value for improving the quality of life of cancer patients in the terminal stage [ 19 ]. ACP is designed to enable end-stage palliative care patients to clearly express their attitudes and preferences toward various medical measures, such as whether to accept life-sustaining treatments, such as cardiopulmonary resuscitation, mechanical ventilation, and nasogastric feeding, as well as their preferences for palliative care. Moreover, patients can elaborate on their definition and expectations of quality of life, as well as which factors are crucial for their quality of life, helping medical teams and agents better consider the overall needs of patients when making decisions [ 20 ]. Therefore, it is necessary to further explore the important experiences, values, and meaning of life of terminal cancer patients so that they can feel the value and dignity of their lives. In addition, we quantified the mediating effect of ACP acceptance. The total effect is 0.540, with a direct effect of 0.410 and an indirect effect of 0.130. The 95% confidence interval shows significant indirect effects, indicating that ACP acceptance partially mediates the relationship between dignity and attitudes toward death. Preestablished medical plans allow patients to plan their choices for end-of-life care in advance, clearly expressing their medical wishes and values. When these wishes are respected and implemented, patients feel that they have a certain degree of control over medical decisions, thereby enhancing their sense of dignity. For example, patients explicitly state in their preestablished medical plan that they wish to avoid excessively invasive treatments toward the end of their lives and maintain their physical integrity and comfort. When the medical team provides care according to their wishes, patients feel that they are treated with dignity. At the same time, by participating in preestablished medical plans, patients have the opportunity to reflect more deeply on their views and expectations toward death, which helps them better prepare psychologically to face death. When patients are able to arrange medical care according to their own wishes, they may feel more in control of the process of death, thereby reducing their fear and anxiety about death and forming a more positive attitude toward death [ 23 ]. However, preestablished medical plans may affect patients' sense of dignity, thereby influencing their attitudes toward death. Specifically, preestablished medical plans first enhance patients' sense of dignity, and patients with a greater sense of dignity are often more likely to accept their condition and impending death, holding a more peaceful and positive attitude toward death. However, attitudes toward death may also play a mediating role between preestablished medical plans and a sense of dignity. A positive attitude toward death may make patients more willing to participate in preestablished medical plans and better understand and accept the results of the plan during the participation process, thereby enhancing their sense of dignity. In summary, a sense of dignity and attitudes toward death play important mediating roles in preestablished medical plans. They interact with each other and jointly affect the psychological state and quality of life of patients when facing the end stages of illness and death. Our research has several limitations. First, this study adopts a cross-sectional design, and these research results cannot be used to construct formal causal relationships. These results need to be validated through longitudinal studies. Second, individuals with a lifespan greater than 6 months or long-term cancer survivors may not have been investigated. Additionally, we recruited end-stage cancer patients receiving palliative care from only one hospital in Xinjiang, northern China. Owing to cultural differences between northern and southern China, the applicability of the research results in other regions may be limited. Third, our study utilized validated death attitudes, a sense of dignity, and preconceived medical plan scales among Chinese participants in an attempt to minimize this bias. Finally, our study focused only on the relationships among attitudes toward death, a sense of dignity, and preconceived medical plans. Further research is needed to explore other social, psychological, and emotional background predictive factors that affect the acceptance level of medical plans among end-stage cancer patients, such as sociocultural, family communication, and environmental factors. 5 Conclusion In summary, palliative care is not a treatment measure but rather a service concept that is distinct from traditional medicine. It regards death as a normal process and does not aim to intentionally prolong life or accelerate death. Compared with traditional medicine, palliative care provides people with the option to allow death to occur naturally. Facing death and normalizing it naturally has not become mainstream in our culture, and the attitude toward death in Chinese culture is still mostly avoidance. Preestablished medical plans have a positive impact on the sense of dignity and attitudes toward the death of terminally ill patients. By participating in preestablished medical plans, patients have the opportunity to delve deeper into death-related issues, including how they wish to spend their final moments and their expectations for the process of death. This process of thinking and planning can help patients gradually accept the inevitability of death psychologically, alleviate their fear and anxiety about death, and thus face death with a more peaceful mindset. The process of participating in preestablished medical plans may prompt patients to review their lives and reflect on their life experiences, achievements, and the significance of their lives. This helps patients view their lives and impending death from a more macro perspective, discover the value of life, and, thus, accept death with a more positive attitude, viewing it as a natural stage of life. Therefore, in future research, we must address the social determinants of death, the end-of-life, and grief emotions. Accepting the process of dying is not just a simple physiological change but also a process of connecting interpersonal relationships and changing inner spiritual attitudes. Even interpersonal connections and empathetic relationships should be prioritized to improve the network of relationships, including patient families, broader community members, and professionals, to guide support for terminally ill individuals, caregivers, and grieving individuals; encourage the normalization of conversations and story sharing about death, dying, and grief to facilitate broader public dialog, debate, and action; and recognize and truly understand the value of death. All humans are fragile; it is death that connects us together. We can construct models that are suitable for each region on the basis of their differences, which can organically integrate various forces, such as the public, communities, media, and health care. The era of high-quality palliative care for Chinese citizens is approaching, with multiparty collaboration and each fulfilling their respective duties. By providing the necessary human, material, and financial resources for palliative care through the regular medical security system, terminally ill individuals receive the care and attention they deserve in their final stages of life, and everyone in the future benefits. This will lead to the formation of a virtuous cycle of palliative care. Declarations Acknowledgements We gratefully appreciate all participators and all research members for their help during data collection and/or data interpretation and synthesis. Author contributions J W: Writing: original draft, Visualization, Software, Project administration, Methodology, Formal analysis, Data curation, Conceptualization. L C: Data curation, Resources, Investigation. X L: Data curation, Software, Investigation. Y X: Writing – review & editing, Software, Investigation, Data curation. Y S: Resources, Software, Investigation. MR Y : Data curation, Software, Investigation. Y Z: Validation, Supervision, Resources, Project administration, Conceptualization. Funding 1. Tianshan Talent Medical and Health High Level Talent Training Program of the Health Commission of Xinjiang Uygur Autonomous Region (TSYC202401B131); 2. Xinjiang Uygur Autonomous Region Health Care Research Special Project (BH202527) 3. Basic Research Funds for Autonomous Region Universities, Education Department of Xinjiang Uygur Autonomous Region (XJEDU2024P053). Data availability Data can be made available upon reasonable request from the corresponding author. Ethics approval and consent to participate Our research has been reviewed and approved by the Ethics Committee of The Affiliated Cancer Hospital of Xinjiang Medical University, with approval number (K-2024204). Participants were provided with written material regarding the purpose of the study, level of involvement and their right not to participate. All the survey data were anonymous and participants were assured about their confidentiality and privacy.All principles of research ethics indicated in the Declaration of Helsinki were followed. Consent for publication Not applicable. Competing interests The authors declare no competing interests. References Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA. 2024;74(3):229–63. Cao W, Chen HD, Yu YW et al. Changing profiles of cancer burden worldwide and in China:a secondary analysis of the global cancer statistics 2020J. Chin Med J(Engl) 2021,134 (7):783–91. Miller KD, Fidler-Benaoudia M, Keegan TH et al. Cancer statistics for adolescents and young adults,2020J.CA Cancer J Clin,2020,70(6):443–59. C1l Gall TL. Relatonwhip with Cod and the quality of life of prostate cancer survivors0J. Qul Life Res 2004,13(8),1357–68. Bright CJ, Reulen. RC,Winter DLiet al, Risk of subsequent primary neoplasms in survivors of adolescent and young adult cane er(Teenage and Young Adult Cancet Survivot Study')ia popalation-based.cohort studyJd. Lancet Oncol. 2019;20(4):531–45. You L, LvZ,Li C. etal. Worldwide cancer statistics of adolescents and young adults in 2019:a syslematic analysis of the global burden of discase study 2019J.ESMO Open,2021,6(5):100255. Senkus E. lacko A. Over-treatment in metastatic breast. cancer J Breast. 2017;31:309–17. Rao J. Fu Q,Wu Q,etal. Comparison of the treatments of patients with cancer in their last 6 monts between ICU and cancer centerJ. Am JHosp Palliat Care. 2016;33(3):245–51. Wang XR, Sheng Y. Advance in application of pre-established medical care program in patients with cancerJ. Chin I Nurs. 2019;54(2):306–10. RI ETJ E NS J A C, SU DOR E R L,CONNOLLY, M, et al. Definition and recommendations for advance care planning:an international consensus supported by the European Association for. Palliat Care J Lancet Oncol. 2017;18(9):e543–551. Sudore RL, Lum HD, You JJ et al. Definingadvancecare plan-ning for adults: aconsensusdefinitionfrom a multidisciplinary Delphi panel [J].J Pain SymptomManage, 2017, 53(5):821–e8321. Rodi H, Detering K, Sellars MExploring advancecare plan-ning awareness, experiences, and preferences of people with cancer and support people: an Australian online cross-sectional study [J].Support Care Cancer, Deng ZJ, Chen XY, Yang L et al. The experience of cancer patientsand their relatives in advancecare planning: ameta-synthesisof qualitativeresearch [J].Chin J Nurs, 2020, 55(12):1864–1870. CHOCHINOV H M.HASSARD T.MCCLEMENT, S. et al. The Patient Dignity Inventory: a novel was of measuring dignity related distress in palliative careJ.,Journal of pain and symptom management,2008.36(6):559–71. Wong PTP. Reker GT,Gesser G.Death attitude profile-revi-Sed:a multidimensional measure of attitude toward deathM.Death anxiety handbook:research, instrumention, and application, 1994, 121–148. Paley CA, Paley AT, Ziegler LE, et al. Narrative review: what constitutes contemporary, high-quality end-of-life care and can lessons be learned from medieval history?J. Annals Palliat Med. 2024;13(3):13. Wang YF, Zhang X, Zhong Y. .Blaming illegal aliens for crisis? Cultural worldview defenses in effects of death and economic threats on anti-undocumented immigrant attitudesJ. Int J Intercultural Relations, 2025, 106. Kyota A, Kanda K. How to come to terms with facing death: A qualitative study examining the experiences of patients with terminal CancerJ. Bmc Palliat Care, 2019, 18(1). Niveau N, New B, Beaudoin M. .How Should Self-Esteem Be Considered in Cancer Patients?J.Frontiers in psychology, 2021, 12:763900. Xiao J, Ng MSN, Yan T et al. How patients with cancer experience dignity: An integrative reviewJ.Psycho-Oncology. Zhao S, Birchley G, Huxtable R. Translation of bioethics across cultural borders: exploring the adoption of the four-principles approach in palliative care provision on the Chinese mainlandJ. BMC Palliat Care. 2025;24(1):1–15. Huang CL, Hsu CHNR, Hsu SF, D H R, et al. Dignity, Resilience, and Quality of Life in Patients With Cardiac DiseaseJ. J Cardiovasc Nurs. 2025;40(2):9. Ghirotto L, Paci E, Bricci C, et al. Self-blaming as a barrier to lung cancer screening and smoking cessation programs in Italy. Volume 20. A qualitative studyJ.PLoS ONE; 2025. 3. Jain NR, Alwazzan L. What's your experience? A duoethnographic dialogue to advance disability inclusion in medical educationJ. Med Educ, 2025, 59(1). Lam CK. Contrast-Invariant Edge Detection: A Methodological Advance in Medical Image AnalysisJ.Applied Sciences, 2025, 15. Additional Declarations No competing interests reported. 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Introduction","content":"\u003cp\u003eThe incidence and mortality rates of cancer, a major public health problem worldwide, is increasing annually. The \"2022 National Cancer Report\" released by the National Cancer Center of China is mainly based on national tumor registration and follow-up monitoring data. According to the latest statistical data on the incidence rate and mortality of new cancers in China in 2022, the number of new cancer cases in China is expected to be 4.8247\u0026nbsp;million, including 2.5339\u0026nbsp;million men and 2.2908\u0026nbsp;million women. The estimated number of cancer deaths in China in 2022 was 2.5742\u0026nbsp;million. The number of deaths among cancer patients has been increasing annually, with a clear trend toward a younger age [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Research shows that end-stage cancer patients experience great physical and mental pressure and a sense of dignity, with various responsibilities and burdens involving family, work, and society. With the progression of the disease, patients, especially in the late stage of cancer, are susceptible to impacts of the disease, such as the inability to accept death, fear of death, loss of dignity due to treatment cycles and economic pressures, a lack of understanding and acceptance of preestablished medical plans, and the ineffective expression of self, all of which affect the quality of life of cancer patients [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Palliative care is a comprehensive care model provided for terminally ill patients aimed at improving their quality of life and helping them pass away comfortably, peacefully, and with dignity. However, despite the widespread use of palliative care in developed countries, only 14% of terminally ill patients worldwide have received palliative care services, and the proportion is even lower in developing countries [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In China, the \"Healthy China 2023\" plan proposes vigorously developing palliative care services. Research shows that providing death education to patients and their families through palliative care helps them understand and accept death, reduce fear and misunderstandings about death, and face the end of life with a peaceful mindset.\u003c/p\u003e\u003cp\u003eDeath attitudes refer to an individual's relatively stable cognitive, emotional, and behavioral tendencies toward the objective phenomenon of death. Attitudes toward death are influenced by various factors, including personal growth experience, cultural background, education level, and current living conditions. Different attitudes toward death can affect individuals' psychological adjustment and behavioral choices when facing death and play important roles in their perceptions of the quality and meaning of life. There are also different views on the understanding of the essence of death, the inevitability of death, and the uncertainty of the time of death. Some patients may show helplessness and passivity when facing death, worry about the pain of the death process, and even express a more negative attitude and avoid discussing death. Some patients are able to view death with a peaceful mindset, seeing it as a part of life and accepting its inevitability.\u003c/p\u003e\u003cp\u003eA sense of dignity usually refers to a patient's recognition of self-worth, exercise of autonomy, need for respect, and physical and psychological integrity. The sense of dignity of cancer patients is a complex and important topic that involves multiple aspects of the patient's disease diagnosis, treatment, and rehabilitation process. Terminal patients may experience a loss of dignity due to disease progression, a loss of physical functions, or dependence on others, such as feeling helpless, ashamed, or burdened.\u003c/p\u003e\u003cp\u003eAdvance care planning (ACP) is an important component of palliative care and one of the core indicators of high-quality palliative care. ACP refers to the process in which adults of any age or stage of health actively communicate and discuss their future health care preferences with their families and health care professionals before their cognitive and communication abilities are lost. Through ACP, patients and their families can clarify patients\u0026rsquo; medical preferences while they have decision-making abilities and guide medical decisions once patients lose decision-making ability, thereby improving patients\u0026rsquo; quality of life and reducing overtreatment [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. From the perspective of disease and age, ACP has a higher application value for middle-aged and young cancer patients [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn summary, although most end-stage cancer palliative care patients consider ACP necessary, the actual acceptance rate is still low. The poor quality of life of patients and their negative attitudes toward death may be important factors affecting their acceptance of ACP. Although previous studies have reported the relationships among death attitudes, a sense of dignity, and preconceived medical plans, the mediating effect of preconceived medical plans on the relationship between death attitudes and a sense of dignity in end-stage cancer patients receiving palliative care has not been clearly validated. Preestablished medical plans may be seen as a key mediating factor influencing the quality of life of end-stage cancer patients. For end-stage cancer patients receiving palliative care, it is necessary to guide them to have a correct understanding of death, resolve their fear of death, and help them face the disease with a positive and optimistic attitude, which is highly important for improving their quality of life.\u003c/p\u003e\u003cp\u003eOn the basis of the above literature, we hypothesize that preestablished medical plans are an important factor in improving the quality of life of end-stage cancer patients receiving palliative care. Given the above empirical research and different cultural backgrounds and conditions, this study aims to verify the following three hypotheses among Chinese end-stage cancer patients receiving palliative care: 1) A sense of dignity has a significant positive effect on attitudes toward death; 2) ACP acceptance has a significant negative effect on attitudes toward death; and 3) ACP acceptance plays a mediating role in the association between dignity and attitudes toward death.\u003c/p\u003e"},{"header":"2 Object and Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Research Object\u003c/h2\u003e\u003cp\u003eA convenience sampling method was used to survey 120 hospitalized terminal cancer patients in the Palliative Medicine Department of Xinjiang Medical University Affiliated Cancer Hospital from January 2024 to February 2025. The inclusion criteria were as follows: ① Age over 18 years old; ② diagnosed with cancer through histopathological examination; ③ aware of their condition; and ④ clear consciousness, no language communication barriers, and independent decision-making ability. The exclusion criteria for patients were as follows: ① other serious physical illnesses; ② past or present mental or cognitive disorders; and ③ in the acute phase of the disease in critical condition; and ④ previous researchers involved in palliative care and preestablished medical plans. All survey participants provided informed consent and voluntarily participated in this study.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Research Tools\u003c/h2\u003e\u003cdiv id=\"Sec5\" class=\"Section3\"\u003e\u003ch2\u003e2.2.1 General Information Survey Form\u003c/h2\u003e\u003cp\u003eThe self-designed demographic survey consists of two parts: the patient's social demographic information and disease-related information. The specific items include sex, age, marital status, education level, place of residence, occupation, economic status, medical payment method, primary caregiver, family situation, cancer type, disease stage, duration of illness, and number of hospitalizations, etc.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section3\"\u003e\u003ch2\u003e2.2.2 Patient ACP Acceptance Questionnaire\u003c/h2\u003e\u003cp\u003eThe scale was developed by Ren Xiaojing [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e16\u003c/span\u003e] and includes three dimensions (attitudes toward ACP, feelings toward ACP, and plans for ACP), with a total of 19 items, each ranging from 1 to 5 points. The total score is positively correlated with the acceptance of ACP. Each item is scored using a Likert 5-point rating system: 1\u0026ndash;5 points represent \"strongly disagree\" to \"strongly agree\", and the total score of the questionnaire is 19\u0026ndash;95 points. The higher the total score is, the greater the respondents' understanding and acceptance of ACP. The content validity is 0.923, and the total Cronbach's alpha coefficient of the questionnaire is 0.856. The overall Cronbach's alpha coefficient of this study is 0.869, and the Cronbach's alpha coefficients for different dimensions range from 0.716 to 0.885.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section3\"\u003e\u003ch2\u003e2.2.3 Dignity Scale\u003c/h2\u003e\u003cp\u003eThis scale was developed by Canadian scholars Chochinov et al. in 2008 [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e17\u003c/span\u003e] and was developed by Jiao Yanchao in 2012. It is mainly used to screen for the dignity status of advanced cancer patients and terminally ill patients with an expected survival period of less than 6 months. This scale is divided into 5 dimensions with a total of 25 items, and the 5-point Likert scoring method is used. Each item is scored on a scale of 1\u0026ndash;5, corresponding to \"no distress\", \"mild distress\", \"moderate distress\", \"severe distress\", and \"very severe distress\". The higher the score is, the worse the patient's sense of dignity, with a threshold of 50 points. A total score greater than 50 points indicates a loss of dignity. In 2016, Ge Guojing et al. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e16\u003c/span\u003e] revised the Chinese version of the Patient Dignity Inventory (PDI) on the basis of previous studies, with an overall Cronbach's alpha coefficient of 0.924 and a half-point reliability of 0.885.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section3\"\u003e\u003ch2\u003e2.2.4 Death Attitude Scale\u003c/h2\u003e\u003cp\u003eThis scale was developed by Wong et al. in 1994 [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e18\u003c/span\u003e] and adapted into Chinese by Tang Lu et al. The scale has five dimensions (death fear, death avoidance, natural acceptance, approach acceptance, and escape acceptance), with a total of 32 items, each ranging from 1 to 5 points. The options for each item are \"strongly disagree, disagree, uncertain, agree, \" and \" strongly agree\" and are scored from 1 to 5 points. A score below 2.5 indicates low agreement, 2.5 to 3.5 indicates moderate agreement, and a score above 3.5 indicates high agreement. According to the evaluation of the reliability and validity of the Chinese version of the scale by Wang Qiongqiong et al., the Cronbach's alpha coefficient was 0.868, and the Spearman Brown halving coefficient was 0.835. The Pearson correlation coefficient between each item and its dimension is 0.554\u0026ndash;0.828.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Research Methods\u003c/h2\u003e\u003cp\u003eFive hospice nursing specialists were selected to establish an investigation team, and five investigators were trained by psychology teachers. After one-on-one simulation training, 10 patients were selected for preinvestigation, and the research design was modified and improved. From November 2024 to May 2025, the researcher distributed questionnaires to the departments where the research subjects were located, explaining the research purpose and significance to them. After the informed consent forms were signed, the questionnaires were distributed on site, verified on site, and collected. A total of 120 questionnaires were distributed, and 120 valid questionnaires were obtained, for an effective response rate of 100%.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e2.4 Statistical Methods\u003c/h2\u003e\u003cp\u003eSPSS 27.0 was used to analyze the data. The measurement data are presented as the means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations, while the count data are presented as frequencies and percentages. If the scores of the ACP acceptance, dignity scale, and death attitude scale of patients follow a normal distribution when comparing groups, a t-test was used, otherwise, a rank sum test was used. Based on demographic and clinical groups, we used t-tests and one-way ANOVA to test for intergroup differences. Pearson correlation analysis was used to explore the correlations between attitudes toward death, sense of dignity, and preconceived medical plans. Stratified multiple regression analysis was conducted to explore the potential mediating role of preestablished medical plans in the association between death attitudes and dignity. The asymptotic method and resampling strategy were adopted to test whether social support plays a mediating role in the associations among death attitudes, sense of dignity, and preconceived medical plans. The selection of control variables is based on the statistical significance of univariate analysis. The total scores of death attitude, dignity, and preestablished medical plans were standardized by subtracting the mean and dividing by the standard deviation to eliminate the influence of differences in scale scores. The overall effect (\"c-path\"), direct effect (\"c-path\"), and indirect effect (\"ab path\") are presented. The bias-corrected acceleration 95% confidence interval (BCa 95% CI) was calculated for each ab product. If the BCa 95% CI does not include 0, it indicates the presence of significant mediating effects.\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Common Method Deviation Testing\u003c/h2\u003e\u003cp\u003eUsing Harman single factor analysis, exploratory factor analysis was conducted on 76 items, with the results revealing 9 factors with eigenvalues greater than 1. The variance contribution rate of the first factor was 13.26%, which was less than the critical value of 40%, indicating there was no significant common method bias in this study.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e3.2 General Information Characteristics of End-Stage Cancer Patients Receiving Palliative Care\u003c/h2\u003e\u003cp\u003eThe basic demographic and clinical characteristics of patients receiving end-of-life palliative care for cancer are presented. The sample included 120 patients, with males accounting for 41.67% and females accounting for 58.33%. The age distribution was mainly between 41 and 50 years (49.17%), and the majority of patients were married (86.67%). In terms of education, a majority of patients had a college diploma or above (57.50%). Most of the residents were urban (94.17%), and the main occupation type was workers (86.67%). Patients with a monthly family income exceeding 5000 yuan represented 57.5%, and 68.33% of patients had a family financial situation in which they could fully afford the treatment costs. The main payment method for medical expenses was urban medical insurance (93.33%). Among the main types of caregivers during hospitalization, parents/children accounted for the highest proportion (54.17%). The main types of diseases were colorectal cancer (30.00%) and breast cancer (23.33%). The main disease stage was stage IV (95.00%). The number of hospitalizations ranged from 510 (48.33%).\u003c/p\u003e\u003cp\u003e\u003cb\u003e3.3 Analysis of the Current Status and Differences in the Death Attitudes of End-Stage Cancer Patients Receiving Palliative Care\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe current status of end-of-life palliative care patients' attitudes toward death and their differences in different variables were analyzed. The total death attitude was 75.48\u0026thinsp;\u0026plusmn;\u0026thinsp;20.67. The results revealed that age group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), education level (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), monthly family income (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), and type of primary caregiver during hospitalization (p\u0026thinsp;=\u0026thinsp;0.010) had significant effects on attitudes toward death. Specifically, the death attitude score of patients over 50 years old was significantly higher than that of other age groups. Patients with an education level of junior high school or below scored higher than did the other groups. Patients with a monthly family income of less than 3000 yuan scored the highest. Patients who were taken care of by parents/children scored higher.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003e3.4 Correlation Analysis of the Death Attitudes of End-Stage Cancer Patients Receiving Palliative Care\u003c/h2\u003e\u003cp\u003eThe correlations among attitudes toward death, self-esteem, and ACP acceptance were explored. Attitudes toward death were significantly positively correlated with self-esteem (r\u0026thinsp;=\u0026thinsp;0.618, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and significantly negatively correlated with ACP acceptance (r=-0.530, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Additionally, self-esteem was significantly negatively correlated with ACP acceptance (r=-0.600, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003e3.5 Analysis of Factors Influencing Stratified Attitudes Toward Death among End-Stage Cancer Patients Receiving Palliative Care\u003c/h2\u003e\u003cp\u003eThe factors influencing the attitudes toward death of end-of-life palliative care patients with cancer were analyzed through stratified regression analysis. Model 1 shows that age, education level, and monthly household income have a significant effect on attitudes toward death (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). After adding a sense of dignity to Model 2, there was a significant positive impact of dignity on attitudes toward death (β\u0026thinsp;=\u0026thinsp;0.359, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Model 3 further incorporated ACP acceptance, which revealed a significant negative effect on attitudes toward death (β=-0.240, p\u0026thinsp;=\u0026thinsp;0.004). The adjusted R\u0026sup2; values of the three models are 0.424, 0.536, and 0.566, respectively, indicating a gradual increase in explanatory power.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003e3.6 Analysis of the Mediating Role of Preestablished Medical Plans\u003c/h2\u003e\u003cp\u003eThe mediating effect of ACP acceptance was quantified. The total effect is 0.540, of which the direct effect is 0.410 (75.92%) and the indirect effect is 0.130 (24.08%). The 95% confidence interval shows a significant indirect effect (0.066\u0026ndash;0.192), indicating that ACP acceptance partially mediates the relationship between dignity and death attitudes, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. By demonstrating the mediating role of ACP acceptance in the relationship between dignity and attitudes toward death. The standardized coefficients and significance levels (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) of each path are labeled in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, which visually presents the direct and indirect relationships between variables.\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\u003eGeneral Information of Palliative Care Patients (n\u0026thinsp;=\u0026thinsp;120)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\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\u003eN\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eConstituent Ratio(%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e41.67\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e58.33\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\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e30\u0026ndash;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13.33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e41\u0026ndash;50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e49.17\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e37.50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarriage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnmarried/Widowed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13.33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e104\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e86.67\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducational Level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMiddle School and Below\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e35.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh School/Vocational School\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7.50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCollege Degree Or Above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e57.50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHabitation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e113\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e94.17\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCountryside\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.83\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCareer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWorker\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e104\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e86.67\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFarmer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.83\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther Career\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7.50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFamily Income of Average Month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026yen;3000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13.33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026yen;3000-\u0026yen;5000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e29.17\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026yen;5000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e57.50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe Tolerance of Disease Burden\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBarely Possible/Quite Difficult\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e31.67\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbsolutely\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e68.33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePayment Method for Medical Expenses\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eResident Medical Insurance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e112\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e93.33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNew Rural Cooperative Medical Insurance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6.67\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFamily Residence Type\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLive Alone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCouples Live\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e81.67\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLiving With Children/Parents\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15.83\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMain Types of Caregivers During Hospitalization\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParents/Children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e54.17\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpouse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e35.83\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther Caregivers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDisease Type\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLung Cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12.50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLiver Cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10.83\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eColorectal Cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e30.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBreast Cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e23.33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGastric Cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e23.33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStages of Disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhase Ⅲ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhase Ⅳ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e114\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e95.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of Hospital Stays\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15.83\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u0026ndash;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e48.33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e35.83\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\u003eDifferential Analysis of End-Of-Life Cancer Patients' Attitudes Towards Palliative Care and Death (n\u0026thinsp;=\u0026thinsp;120)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" 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=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\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\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTotal Score for Death Attitude, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eStatistic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\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\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et=-0.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.489\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e50 (41.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e74.02\u0026thinsp;\u0026plusmn;\u0026thinsp;16.25\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e70 (58.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e76.53\u0026thinsp;\u0026plusmn;\u0026thinsp;23.38\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\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\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;11.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e30\u0026ndash;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16 (13.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e69.06\u0026thinsp;\u0026plusmn;\u0026thinsp;12.53\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e41\u0026ndash;50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e59 (49.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e68.90\u0026thinsp;\u0026plusmn;\u0026thinsp;12.63\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e45 (37.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e86.40\u0026thinsp;\u0026plusmn;\u0026thinsp;26.40\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarriage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;1.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.194\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnmarried/Widowed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16 (13.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e81.75\u0026thinsp;\u0026plusmn;\u0026thinsp;23.24\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e104 (86.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e74.52\u0026thinsp;\u0026plusmn;\u0026thinsp;20.20\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducational Level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;7.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMiddle School and Below\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e42 (35.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e85.17\u0026thinsp;\u0026plusmn;\u0026thinsp;26.27\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh School/Vocational School\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9 (7.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e68.56\u0026thinsp;\u0026plusmn;\u0026thinsp;9.71\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCollege Degree Or Above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e69 (57.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e70.49\u0026thinsp;\u0026plusmn;\u0026thinsp;15.20\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHabitation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et=-0.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.713\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e113 (94.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e75.31\u0026thinsp;\u0026plusmn;\u0026thinsp;21.01\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCountryside\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7 (5.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e78.29\u0026thinsp;\u0026plusmn;\u0026thinsp;15.03\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCareer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.959\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWorker\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e104 (86.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e75.64\u0026thinsp;\u0026plusmn;\u0026thinsp;21.82\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFarmer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7 (5.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e73.29\u0026thinsp;\u0026plusmn;\u0026thinsp;10.21\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther Career\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9 (7.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e75.33\u0026thinsp;\u0026plusmn;\u0026thinsp;12.04\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFamily Income of Average Month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;40.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026yen;3000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16 (13.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e109.00\u0026thinsp;\u0026plusmn;\u0026thinsp;31.72\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026yen;3000-\u0026yen;5000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e35 (29.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e69.37\u0026thinsp;\u0026plusmn;\u0026thinsp;8.50\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026yen;5000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e69 (57.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e70.81\u0026thinsp;\u0026plusmn;\u0026thinsp;13.56\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe Tolerance of Disease Burden\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et=-0.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.588\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBarely Possible/Quite Difficult\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e38 (31.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e73.97\u0026thinsp;\u0026plusmn;\u0026thinsp;19.76\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbsolutely\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e82 (68.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e76.18\u0026thinsp;\u0026plusmn;\u0026thinsp;21.16\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePayment Method for Medical Expenses\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;1.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.245\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eResident Medical Insurance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e112 (93.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e76.07\u0026thinsp;\u0026plusmn;\u0026thinsp;21.15\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNew Rural Cooperative Medical Insurance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8 (6.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e67.25\u0026thinsp;\u0026plusmn;\u0026thinsp;9.22\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFamily Residence Type\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;2.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.129\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLive Alone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3 (2.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e69.33\u0026thinsp;\u0026plusmn;\u0026thinsp;3.21\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCouples Live\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e98 (81.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e77.29\u0026thinsp;\u0026plusmn;\u0026thinsp;22.08\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLiving With Children/Parents\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e19 (15.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e67.16\u0026thinsp;\u0026plusmn;\u0026thinsp;9.93\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMain Types of Caregivers During Hospitalization\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;4.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.010\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParents/Children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e65 (54.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e76.57\u0026thinsp;\u0026plusmn;\u0026thinsp;21.42\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpouse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e43 (35.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e69.86\u0026thinsp;\u0026plusmn;\u0026thinsp;17.37\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther Caregivers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12 (10.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e89.75\u0026thinsp;\u0026plusmn;\u0026thinsp;21.19\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDisease Type\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;1.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.147\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLung Cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15 (12.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e77.67\u0026thinsp;\u0026plusmn;\u0026thinsp;13.09\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLiver Cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e13 (10.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e70.31\u0026thinsp;\u0026plusmn;\u0026thinsp;28.81\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eColorectal Cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e36 (30.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e71.08\u0026thinsp;\u0026plusmn;\u0026thinsp;20.92\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBreast Cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e28 (23.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e83.39\u0026thinsp;\u0026plusmn;\u0026thinsp;23.10\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGastric Cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e28 (23.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e74.46\u0026thinsp;\u0026plusmn;\u0026thinsp;14.74\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStages of Disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et=-0.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.547\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhase Ⅲ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6 (5.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e70.50\u0026thinsp;\u0026plusmn;\u0026thinsp;10.37\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhase Ⅳ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e114 (95.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e75.75\u0026thinsp;\u0026plusmn;\u0026thinsp;21.07\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of Hospital Stays\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;1.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.207\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e19 (15.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e69.11\u0026thinsp;\u0026plusmn;\u0026thinsp;8.52\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u0026ndash;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e58 (48.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e78.47\u0026thinsp;\u0026plusmn;\u0026thinsp;25.87\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e43 (35.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e74.28\u0026thinsp;\u0026plusmn;\u0026thinsp;15.47\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\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=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCorrelation Analysis of Death Attitudes of Palliative Care Patients\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" 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=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\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\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDeath Attitude\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSelf-Respect\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eACP Acceptance\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDeath Attitude\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e75.48\u0026thinsp;\u0026plusmn;\u0026thinsp;20.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSelf-Respect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e71.57\u0026thinsp;\u0026plusmn;\u0026thinsp;23.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.618***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eACP Acceptance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e51.40\u0026thinsp;\u0026plusmn;\u0026thinsp;20.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.530***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.600***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eNote: **\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\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\u003eAnalysis of Influencing Factors on Death Attitudes of Palliative Care Patients\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=\"char\" char=\".\" 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\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eStep1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eStep2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003eStep3\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eβ\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eβ\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eβ\u003c/em\u003e\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\u003e(Constant)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e115.095\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e76.843\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e103.236\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\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=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.017\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.982\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.170\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.533\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.476\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducational Level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-4.503\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.008\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-3.988\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.009\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-4.081\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.006\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFamily Income of Average Month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-15.317\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-11.457\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-11.677\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMain Types of Caregivers During Hospitalization_Parents/Children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-1.117\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.834\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.172\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e5.964\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.222\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMain Types of Caregivers During Hospitalization_Spouse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-12.122\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.040\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-1.802\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.748\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-2.064\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.703\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSelf-Respect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.359\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.247\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eACP Acceptance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\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=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-0.240\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eF, p\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18.484\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e23.916\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e23.139\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eR\u0026sup2;\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.448\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.559\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.592\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eAdjR\u0026sup2;\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.424\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.536\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.566\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\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=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAnalysis of the Mediating Role of Advance Care Planning\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" 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=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\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\u003eEffect Value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStandard Error\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95%Ci\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eEffect Ratio (%)\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\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.540\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.063\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e(0.415\u0026ndash;0.666\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e100%\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=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.410\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.077\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e(0.285\u0026ndash;0.562\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e75.92%\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=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.130\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.032\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e(0.066\u0026ndash;0.192\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e24.08%\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\u003c/p\u003e\u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eOur findings indicate that by analyzing the current status of end-of-life palliative care, patients' attitudes toward death and their differences across different variables can be determined. The total death attitude score is 75.48\u0026thinsp;\u0026plusmn;\u0026thinsp;20.67. Age group, education level, monthly family income, and primary caregiver type during hospitalization significantly affected attitudes toward death. Specifically, the death attitude score of patients over 50 years old was significantly higher than that of other age groups. Patients with an education level of junior high school or below scored higher than did the other groups. Patients with a monthly family income of less than 3000 yuan scored the highest. Patients who were taken care of by parents/children scored higher. As society has progressed, people's concept of survival for late-stage patients has changed, with the hope that patients can pass away peacefully and no longer undergo invasive medical treatment. Kyota's research analysis revealed five themes in patients' experiences managing anxiety and depression when facing death, including \"I must accept that I have cancer\", \"I must accept that I will inevitably die\", \"I must accept that I need help\", \"I must accept this unsatisfactory situation\", and \"I must accept that this is the result of my fate and life\". S Bigi et al.'s research revealed that accepting death is a fundamental prerequisite for palliative care, which helps in the process of caring for terminally ill individuals and emphasizes the need to evaluate different cultural perspectives on death. In fact, patients receiving end-of-life palliative care for cancer have a need for emotional support due to the pain caused by the disease itself, their experience and feelings toward death, and their need for emotional support. In fact, the experience and feelings of attitudes toward death include fear, proximity, psychological gap, psychological burden, and the feeling of being forced to accept it, which seriously affect the quality of life and indirectly affect patients' attitudes toward death, prompting them to crave more pain relief and a peaceful death through palliative care.\u003c/p\u003e\u003cp\u003eWe explored the correlations among death attitudes, self-esteem, and ACP acceptance in this study. The attitude toward death was significantly positively correlated with self-esteem and significantly negatively correlated with ACP acceptance. Additionally, self-esteem is significantly negatively correlated with ACP acceptance. Moreover, we conducted a stratified regression analysis to investigate the factors influencing the mortality attitudes of patients receiving end-of-life palliative care for cancer. Age, education level, and monthly family income significantly affect attitudes toward death. When a sense of dignity is added, it has a significant positive effect on attitudes toward death. Further incorporation of ACP acceptance revealed a significant negative effect on attitudes toward death. Currently, domestic and international research on the sense of dignity among cancer patients is increasing. Niveau et al. reported that self-esteem is an important psychological resource and that low self-esteem is a real risk factor for the development of depression. The rationality of self-esteem should be considered in the context of cancer-related psychological care. Moreover, research has shown that cancer significantly increases the risk of developing depression and anxiety symptoms [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Research by Xiao J has shown that the meaning of life in different disease scenarios can improve patients' self-esteem and subjective well-being, which has reference value for improving the quality of life of cancer patients in the terminal stage [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. ACP is designed to enable end-stage palliative care patients to clearly express their attitudes and preferences toward various medical measures, such as whether to accept life-sustaining treatments, such as cardiopulmonary resuscitation, mechanical ventilation, and nasogastric feeding, as well as their preferences for palliative care. Moreover, patients can elaborate on their definition and expectations of quality of life, as well as which factors are crucial for their quality of life, helping medical teams and agents better consider the overall needs of patients when making decisions [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Therefore, it is necessary to further explore the important experiences, values, and meaning of life of terminal cancer patients so that they can feel the value and dignity of their lives.\u003c/p\u003e\u003cp\u003eIn addition, we quantified the mediating effect of ACP acceptance. The total effect is 0.540, with a direct effect of 0.410 and an indirect effect of 0.130. The 95% confidence interval shows significant indirect effects, indicating that ACP acceptance partially mediates the relationship between dignity and attitudes toward death. Preestablished medical plans allow patients to plan their choices for end-of-life care in advance, clearly expressing their medical wishes and values. When these wishes are respected and implemented, patients feel that they have a certain degree of control over medical decisions, thereby enhancing their sense of dignity. For example, patients explicitly state in their preestablished medical plan that they wish to avoid excessively invasive treatments toward the end of their lives and maintain their physical integrity and comfort. When the medical team provides care according to their wishes, patients feel that they are treated with dignity. At the same time, by participating in preestablished medical plans, patients have the opportunity to reflect more deeply on their views and expectations toward death, which helps them better prepare psychologically to face death. When patients are able to arrange medical care according to their own wishes, they may feel more in control of the process of death, thereby reducing their fear and anxiety about death and forming a more positive attitude toward death [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. However, preestablished medical plans may affect patients' sense of dignity, thereby influencing their attitudes toward death. Specifically, preestablished medical plans first enhance patients' sense of dignity, and patients with a greater sense of dignity are often more likely to accept their condition and impending death, holding a more peaceful and positive attitude toward death. However, attitudes toward death may also play a mediating role between preestablished medical plans and a sense of dignity. A positive attitude toward death may make patients more willing to participate in preestablished medical plans and better understand and accept the results of the plan during the participation process, thereby enhancing their sense of dignity. In summary, a sense of dignity and attitudes toward death play important mediating roles in preestablished medical plans. They interact with each other and jointly affect the psychological state and quality of life of patients when facing the end stages of illness and death.\u003c/p\u003e\u003cp\u003eOur research has several limitations. First, this study adopts a cross-sectional design, and these research results cannot be used to construct formal causal relationships. These results need to be validated through longitudinal studies. Second, individuals with a lifespan greater than 6 months or long-term cancer survivors may not have been investigated. Additionally, we recruited end-stage cancer patients receiving palliative care from only one hospital in Xinjiang, northern China. Owing to cultural differences between northern and southern China, the applicability of the research results in other regions may be limited. Third, our study utilized validated death attitudes, a sense of dignity, and preconceived medical plan scales among Chinese participants in an attempt to minimize this bias. Finally, our study focused only on the relationships among attitudes toward death, a sense of dignity, and preconceived medical plans. Further research is needed to explore other social, psychological, and emotional background predictive factors that affect the acceptance level of medical plans among end-stage cancer patients, such as sociocultural, family communication, and environmental factors.\u003c/p\u003e"},{"header":"5 Conclusion","content":"\u003cp\u003eIn summary, palliative care is not a treatment measure but rather a service concept that is distinct from traditional medicine. It regards death as a normal process and does not aim to intentionally prolong life or accelerate death. Compared with traditional medicine, palliative care provides people with the option to allow death to occur naturally. Facing death and normalizing it naturally has not become mainstream in our culture, and the attitude toward death in Chinese culture is still mostly avoidance. Preestablished medical plans have a positive impact on the sense of dignity and attitudes toward the death of terminally ill patients. By participating in preestablished medical plans, patients have the opportunity to delve deeper into death-related issues, including how they wish to spend their final moments and their expectations for the process of death. This process of thinking and planning can help patients gradually accept the inevitability of death psychologically, alleviate their fear and anxiety about death, and thus face death with a more peaceful mindset. The process of participating in preestablished medical plans may prompt patients to review their lives and reflect on their life experiences, achievements, and the significance of their lives. This helps patients view their lives and impending death from a more macro perspective, discover the value of life, and, thus, accept death with a more positive attitude, viewing it as a natural stage of life. Therefore, in future research, we must address the social determinants of death, the end-of-life, and grief emotions. Accepting the process of dying is not just a simple physiological change but also a process of connecting interpersonal relationships and changing inner spiritual attitudes. Even interpersonal connections and empathetic relationships should be prioritized to improve the network of relationships, including patient families, broader community members, and professionals, to guide support for terminally ill individuals, caregivers, and grieving individuals; encourage the normalization of conversations and story sharing about death, dying, and grief to facilitate broader public dialog, debate, and action; and recognize and truly understand the value of death. All humans are fragile; it is death that connects us together. We can construct models that are suitable for each region on the basis of their differences, which can organically integrate various forces, such as the public, communities, media, and health care. The era of high-quality palliative care for Chinese citizens is approaching, with multiparty collaboration and each fulfilling their respective duties. By providing the necessary human, material, and financial resources for palliative care through the regular medical security system, terminally ill individuals receive the care and attention they deserve in their final stages of life, and everyone in the future benefits. This will lead to the formation of a virtuous cycle of palliative care.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe gratefully appreciate all participators and all research members for their help during data collection and/or data interpretation and synthesis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eJ W:\u0026nbsp;\u003c/strong\u003eWriting: original draft, Visualization, Software, Project administration, Methodology, Formal analysis, Data curation, Conceptualization. \u003cstrong\u003eL C:\u0026nbsp;\u003c/strong\u003eData curation, Resources, Investigation. \u003cstrong\u003eX L:\u0026nbsp;\u003c/strong\u003eData curation, Software, Investigation. \u003cstrong\u003eY X:\u003c/strong\u003e Writing \u0026ndash; review \u0026amp; editing, Software, Investigation, Data curation.\u003cstrong\u003e\u0026nbsp;Y S:\u0026nbsp;\u003c/strong\u003eResources, Software, Investigation. \u003cstrong\u003eMR Y\u003c/strong\u003e: Data curation, Software, Investigation.\u003cstrong\u003e\u0026nbsp;Y Z:\u0026nbsp;\u003c/strong\u003eValidation, Supervision, Resources, Project administration, Conceptualization.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1. Tianshan Talent Medical and Health High Level Talent Training Program of the Health Commission of Xinjiang Uygur Autonomous Region (TSYC202401B131);\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2. Xinjiang Uygur Autonomous Region Health Care Research Special Project (BH202527)\u003c/p\u003e\n\u003cp\u003e3. Basic Research Funds for Autonomous Region Universities, Education Department of Xinjiang Uygur Autonomous Region (XJEDU2024P053).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData can be made available upon reasonable request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur research has been reviewed and approved by the Ethics Committee of The Affiliated Cancer Hospital of Xinjiang Medical University, with approval number (K-2024204). Participants were provided with written material regarding the purpose of the study, level of involvement and their right not to participate. All the survey data were anonymous and participants were assured about their confidentiality and privacy.All principles of research ethics indicated in the Declaration of Helsinki were followed.\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, et al. Global cancer statistics 2022:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA. 2024;74(3):229\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCao W, Chen HD, Yu YW et al. Changing profiles of cancer burden worldwide and in China:a secondary analysis of the global cancer statistics 2020J. Chin Med J(Engl) 2021,134 (7):783\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMiller KD, Fidler-Benaoudia M, Keegan TH et al. Cancer statistics for adolescents and young adults,2020J.CA Cancer J Clin,2020,70(6):443\u0026ndash;59.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eC1l Gall TL. Relatonwhip with Cod and the quality of life of prostate cancer survivors0J. Qul Life Res 2004,13(8),1357\u0026ndash;68.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBright CJ, Reulen. RC,Winter DLiet al, Risk of subsequent primary neoplasms in survivors of adolescent and young adult cane er(Teenage and Young Adult Cancet Survivot Study')ia popalation-based.cohort studyJd. Lancet Oncol. 2019;20(4):531\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYou L, LvZ,Li C. etal. Worldwide cancer statistics of adolescents and young adults in 2019:a syslematic analysis of the global burden of discase study 2019J.ESMO Open,2021,6(5):100255.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSenkus E. lacko A. Over-treatment in metastatic breast. cancer J Breast. 2017;31:309\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRao J. Fu Q,Wu Q,etal. Comparison of the treatments of patients with cancer in their last 6 monts between ICU and cancer centerJ. Am JHosp Palliat Care. 2016;33(3):245\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang XR, Sheng Y. Advance in application of pre-established medical care program in patients with cancerJ. Chin I Nurs. 2019;54(2):306\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRI ETJ E NS J A C, SU DOR E R L,CONNOLLY, M, et al. Definition and recommendations for advance care planning:an international consensus supported by the European Association for. Palliat Care J Lancet Oncol. 2017;18(9):e543\u0026ndash;551.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSudore RL, Lum HD, You JJ et al. Definingadvancecare plan-ning for adults: aconsensusdefinitionfrom a multidisciplinary Delphi panel [J].J Pain SymptomManage, 2017, 53(5):821\u0026ndash;e8321.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRodi H, Detering K, Sellars MExploring advancecare plan-ning awareness, experiences, and preferences of people with cancer and support people: an Australian online cross-sectional study [J].Support Care Cancer, Deng ZJ, Chen XY, Yang L et al. The experience of cancer patientsand their relatives in advancecare planning: ameta-synthesisof qualitativeresearch [J].Chin J Nurs, 2020, 55(12):1864\u0026ndash;1870.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCHOCHINOV H M.HASSARD T.MCCLEMENT, S. et al. The Patient Dignity Inventory: a novel was of measuring dignity related distress in palliative careJ.,Journal of pain and symptom management,2008.36(6):559\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWong PTP. Reker GT,Gesser G.Death attitude profile-revi-Sed:a multidimensional measure of attitude toward deathM.Death anxiety handbook:research, instrumention, and application, 1994, 121\u0026ndash;148.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePaley CA, Paley AT, Ziegler LE, et al. Narrative review: what constitutes contemporary, high-quality end-of-life care and can lessons be learned from medieval history?J. Annals Palliat Med. 2024;13(3):13.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang YF, Zhang X, Zhong Y. .Blaming illegal aliens for crisis? Cultural worldview defenses in effects of death and economic threats on anti-undocumented immigrant attitudesJ. Int J Intercultural Relations, 2025, 106.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKyota A, Kanda K. How to come to terms with facing death: A qualitative study examining the experiences of patients with terminal CancerJ. Bmc Palliat Care, 2019, 18(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNiveau N, New B, Beaudoin M. .How Should Self-Esteem Be Considered in Cancer Patients?J.Frontiers in psychology, 2021, 12:763900.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eXiao J, Ng MSN, Yan T et al. How patients with cancer experience dignity: An integrative reviewJ.Psycho-Oncology.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhao S, Birchley G, Huxtable R. Translation of bioethics across cultural borders: exploring the adoption of the four-principles approach in palliative care provision on the Chinese mainlandJ. BMC Palliat Care. 2025;24(1):1\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHuang CL, Hsu CHNR, Hsu SF, D H R, et al. Dignity, Resilience, and Quality of Life in Patients With Cardiac DiseaseJ. J Cardiovasc Nurs. 2025;40(2):9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGhirotto L, Paci E, Bricci C, et al. Self-blaming as a barrier to lung cancer screening and smoking cessation programs in Italy. Volume 20. A qualitative studyJ.PLoS ONE; 2025. 3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJain NR, Alwazzan L. What's your experience? A duoethnographic dialogue to advance disability inclusion in medical educationJ. Med Educ, 2025, 59(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLam CK. Contrast-Invariant Edge Detection: A Methodological Advance in Medical Image AnalysisJ.Applied Sciences, 2025, 15.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"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":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Terminal Cancer Patients, Palliative Care, Attitude towards Death, Sense of Dignity, Advance Care Planning","lastPublishedDoi":"10.21203/rs.3.rs-7328545/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7328545/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo investigate attitudes toward death, sense of dignity, and acceptance of advance care planning (ACP) among terminally ill cancer patients receiving palliative care and to explore their mediating role to provide a scientific basis for optimizing care and improving policies in clinical practice.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods.\u003c/strong\u003e A cross-sectional survey was conducted from November 2024 to February 2025 with 120 end-stage cancer palliative care patients in the Palliative Medicine Department of Xinjiang Medical University Affiliated Cancer Hospital. The survey included a general situation questionnaire, a patient ACP acceptance questionnaire, a sense of dignity scale, and a death attitude description scale.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e. The survey analyzed the current status of end-of-life palliative care patients' attitudes toward death and the differences among the different variables. The total death attitude score is 75.48 ± 20.67. By exploring the correlations among death attitudes, self-esteem, and ACP acceptance, it was found that death attitudes were significantly positively correlated with self-esteem and significantly negatively correlated with ACP acceptance. Through stratified regression analysis, factors influencing the death attitudes of cancer patients in end-of-life palliative care were identified. Age, education level, and monthly family income had a significant effect on death attitudes. After a sense of dignity was incorporated, a significant positive impact on death attitudes was observed. By quantifying the mediating effect of ACP acceptance, ACP acceptance was shown to partially mediate the relationship between dignity and death attitudes.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion.\u003c/strong\u003e Late-stage cancer patients play an important mediating role in preestablished medical plans because of the pain caused by the disease itself, their experience and feelings toward death, and their need for emotional support. Sense of dignity and attitude toward death interact with each other and jointly affect the psychological state and quality of life of patients at the end stage of the disease when they are facing death.\u003c/p\u003e","manuscriptTitle":"The impact of death attitude and sense of dignity on the quality of life of patients receiving end-of-life palliative care for cancer:The intermediary role of advance care planning","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-01 09:36:02","doi":"10.21203/rs.3.rs-7328545/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"905131f0-40e4-4a8b-8f63-6da9eb5c462d","owner":[],"postedDate":"September 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-28T22:09:34+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-01 09:36:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7328545","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7328545","identity":"rs-7328545","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}