Self-compassion in patients with lung cancer- A Structural Equation Modeling

Self-compassion in patients with lung cancer- A Structural Equation Modeling | 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 Self-compassion in patients with lung cancer- A Structural Equation Modeling NingXin Sun, Manli Wang, Jinlei Zhang, Junjie Shi, Danyang Li, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9267151/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background Self-compassion plays a crucial role in the psychological well-being of cancer patients, yet the interplay of factors influencing self-compassion in lung cancer patients remains underexplored. This study aimed to examine the relationships among social support, resilience, self-compassion, illness perception, and positive coping in lung cancer patients. Methods A cross-sectional survey was conducted with 309 lung cancer patients from two tertiary hospitals in Shandong, China, using simple random sampling. Data were collected via validated scales, including the Connor-Davidson Resilience Scale, Self-Compassion Scale, Perceived Social Support Scale, Simplified Coping Style Questionnaire, and Brief Illness Perception Questionnaire. Results Patients’ mean total self-compassion score was 80.81 ± 11.50. The fit indices for the model indicated a good fit. Social support had multiple effects on self-compassion; specifically, it had direct and indirect effects through the mediating role of resilience, illness perception and positive coping. Resilience had an indirect effect on self-compassion through illness perception and positive coping. Conclusions Social support, resilience, illness perception, and positive coping are interrelated factors significantly associated with self-compassion in lung cancer patients. These findings highlight the need for multifaceted interventions targeting these factors to enhance psychological well-being. Clinicians should integrate self-compassion training, peer support programs, and resilience-building strategies into patient care to foster adaptive coping and improve quality of life. Lung cancer Self compassion Influencing factors Structural equation modeling Figures Figure 1 Figure 2 1 Background According to the latest cancer statistics released by IARC, in 2022, there will be 2.48 million new cases of lung cancer and 1.81 million deaths due to lung cancer globally, which is characterized by a high incidence and mortality rate [ 1 ]. Research has shown that due to the side effects of surgery and drug treatment, lung cancer patients may experience physical symptoms such as fatigue, pain, nausea, and vomiting, as well as negative emotions such as anxiety and depression [ 2 – 4 ]. These negative emotions seriously affect the therapeutic effects and prognostic status of lung cancer patients. In recent years, with the rapid development of positive psychology, researchers have begun to focus on and explore the positive psychological states of cancer patients. self-compassion has emerged as a new perspective of positive psychology in the field of psychological research [ 5 – 7 ]. Self-compassion is defined as the ability to understand one’s own suffering, to be kind and forgiving towards one’s own flaws and shortcomings, and to view one’s pain as part of the human experience rather than isolating oneself from society and becoming excessively immersed in it [ 8 ]. Some scholars have pointed out that self-compassion is an effective emotion regulation strategy that can significantly improve mental health and reduce the generation of negative emotions [ 9 , 10 ]. According to Lazarus’s [ 11 ] stress and coping model, when an individual is faced with a stressful event, the individual will first respond to the stressful event according to existing information and experience, as well as the individual’s cognitive and perceptual process of perceiving the situation, and then coping with the stressful event to solve the problem or alleviate the emotion (generate self-compassion). In this process, the individual’s internal resources such as mental toughness plays an important role, patients with high mental toughness can correctly view the disease, and take positive coping methods, so as to maintain a good physiological and psychological state; when the individual faces a stressful event, good social support as an available external resource can buffer and prevent the negative impact caused by the event, which is then manifested as a good adaptation. As a resilience-enhancing resource, social support fosters adaptive cognitive restructuring under stress, bolsters self-esteem, and attenuates cancer-related adverse outcomes, ultimately functioning as a key mediator of self-compassion cultivation [ 12 ]. In addition, resilience is a positive psychological characteristic exhibited in the face of difficulties and challenges. Resilience is an important determinant of psychological adaptation when coping with cancer [ 13 ]. A previous study showed that breast cancer patients with higher resilience had higher levels of self-compassion [ 14 ]. Thus, resilience and social support may also influence self-compassion in lung cancer patients; the relationship between factors influencing self-compassion should be considered. Specifically, social support may have a direct effect on resilience or an indirect effect through resilience. Illness perception refers to people’s knowledge and understanding of their condition and the presence of disease. Cancer treatment can be lengthy and produce a range of physical and psychological stresses and distress. Negative perceptions can have a negative impact on patients’ quality of life and are a risk factor for poor self-compassion in cancer patients [ 15 ]. A previous study investigating the level of illness perception in breast cancer patients 5 years after surgery reported that illness perception may have a direct effect on resilience and an indirect effect through coping styles [ 16 ]. Although self-compassion plays an important role in regulating the relationship between psychological stress and mental health, and factors such as perceived social support, resilience, illness perception, and coping styles significantly influence self-compassion, the mechanisms of interaction between these factors are not yet clear. Therefore, we have developed a hypothetical model is depicted in Fig. 1 , and will use structural equation modeling (SEM) to test this model, to elucidate the relationships among these factors in lung cancer patients and provide the necessary information for the development of targeted intervention measures. 2 Methods 2.1 Study Population This study employed a cross-sectional descriptive correlational survey. We recruited lung cancer patients from two tertiary hospitals in Shandong, China using convenience sampling method. Inclusion criteria: (1) Patients diagnosed with lung cancer [ 17 ] who stayed in a hospital and received relevant treatment; (2) Patients who provide informed consent and voluntarily participate in the study; (3) aged ≥ 18 years, without cognitive or communication disorders. Exclusion criteria: (1) Patients with severe cognitive impairment who are unable to cooperate or refuse to participate in the study; (2) Patients with concomitant other malignant tumors. According to the Kendall sample estimation method, the sample size should be at least 5–10 times the number of predictor variables [ 18 ]. In addition, structural equation modeling (SEM) was implemented in this study. According to methodological guidelines, SEM analysis necessitates a minimum sample size of 200 participants to ensure statistical adequacy [ 19 ]. This study has a total of 30 predictor variables. Therefore, the estimated sample size for this study is 150–300 cases. Taking into account a 20% attrition rate, the final sample size for this study is determined to be 309 cases. 2.2 Measures In this study, data were collected using the following instruments: The general information questionnaire, the Self-Compassion Scale, Perceived Social Support Scale, The Connor-Davidson Resilience Scale, the Simplified Coping Style Questionnaire, and Brief Illness Perception Questionnaire. 2.2.1 The general information questionnaire The general information questionnaire was based on the purpose and content of this study, the researchers designed a section that includes 11 items for general demographic information. These items cover age, gender, religious, education level, marital status, monthly household income, residence, clinical stage, metastasis, comorbidity, and current treatment. 2.2.2 The Self-Compassion Scale (SCS) The Self-Compassion Scale (SCS), originally developed by Neff [ 20 ] and later translated into Chinese by Chen [ 21 ], consists of 26 items categorized into 6 dimensions: self-kindness (items 5, 12, 19, 23, 26), self-judgment (items 1, 8, 11, 16, 21), common humanity (items 3, 7, 10, 15), isolation (items 4, 13, 18, 25), mindfulness (items 9, 14, 17, 22), and over-identification (items 2, 6, 20, 24). The total score ranges from 26 to 130 points, with responses scored from 1 to 5 for “never” to “almost always.” The Cronbach’s ɑ of the scale in this study was 0.827. 2.2.3 Perceived Social Support Scale (PSSS) The scale was originally developed by Zimet et al. [ 22 ] and subsequently adapted into Chinese by Huang Li et al. [ 23 ]. It comprises 12 items across three dimensions: family support (4 items), friend support (4 items), and other support (4 items). Responses are measured using a 7-point Likert scale ranging from 1 (‘strongly disagree’) to 7 (‘strongly agree’), yielding a total score between 12 and 84. Higher scores indicate greater perceived social support. The Cronbach’s ɑ coefficient for the total scale is 0.88, and in this study, the Cronbach’s α coefficient was calculated to be 0.853. 2.2.4 The Connor-Davidson Resilience Scale (CD-RISC) The scale used in this study was developed by Connor [ 24 ]. In 2003 and later translated into Chinese by Yu [ 25 ]. The scale consists of 25 items and is structured into three main dimensions: resilience, optimism, and strength. The resilience dimension includes items 11–23, reflecting an individual’s resilience and adaptability in facing challenges and adversity. The optimism dimension includes items 2, 3, 4, and 6, focusing on an individual’s optimistic emotions and attitudes. The strength dimension comprises items 1, 5, 7–10, 24, 25, highlighting the strength and fortitude displayed when confronting difficulties. The scale has a Cronbach’s ɑ coefficient of 0.911, indicating good reliability and validity. 2.2.5 Simplified Coping Style Questionnaire (SCSQ) The scale used in this study was developed by Chinese scholar Xie [ 26 ]. It is primarily designed to reflect the coping strategies and responses individuals adopt when facing stress. Items 1–12 represent positive coping strategies, while items 13–20 measure negative coping strategies. A higher score on positive coping indicates a more proactive approach to coping. Each item is scored from 0 to 3, with response options ranging from “never” to “often.” In this study, the Cronbach’s ɑ coefficient was calculated to be 0.881, indicating good reliability and validity. 2.2.6 Brief Illness Perception Questionnaire (BIPQ) The Brief Illness Perception Questionnaire was developed by the Broadbent [ 27 ], and later translated into Chinese by Sun [ 28 ]. The scale consists of 9 items that cover various aspects such as individual’s cognitive perception of health issues, the level of attention to health behaviors, perceived disease risk, and intentions towards health behaviors. The first 8 items are scored from 0 to 10, with items 3, 4, and 7 reverse-scored. The total score ranges from 0 to 80, with higher scores indicating a stronger perception of the threat posed by the disease. The Cronbach's α coefficient for this scale is 0.861, indicating good reliability and validity. 2.3 Data Collection Lung cancer inpatients from two tertiary hospitals in Shandong, China, were recruited from January 2024 to August 2024. Two researchers explained the purpose and significance of the study to the participants. Subsequently, they introduced the questionnaire content to the participants and explained how to complete the questionnaire. After completing the questionnaire, the researchers collected them directly. 2.4 Analysis All data were entered into Excel and analyzed using SPSS 26.0 statistical software. Continuous data were described using mean ± standard deviation if normally distributed, or median and interquartile range if not normally distributed. Categorical data were described using rates and proportions. Depending on the distribution and homogeneity of variance, comparisons between groups were conducted using independent sample t-tests, one-way analysis of variance (ANOVA), or non-parametric tests. Pearson or Spearman correlation analysis was used to explore relationships between variables. Multiple linear regression analysis was employed to identify factors influencing self-compassion levels in lung cancer patients. The AMOS 24.0 software was used to construct a model, and the model was modified based on modification indices and fit indices. The Bootstrap method was utilized to test for mediating effects. 2.5 Ethical Approval This study has been approved by the Institutional Review Board of Shandong Second Medical University. All eligible participants were provided with written informed consent before completing the questionnaire. They were informed of their research rights, including the right to withdraw from the study at any time. 3 Results 3.1 Sample Characteristics and Variable Scores in the Model In this study, a total of 320 questionnaires were distributed, and 309 valid questionnaires were collected. The demographic characteristics of the final participants are shown in Table 1. 3.2 SC and Other Measured Variables and Their Relationships The mean total scores among participants with lung cancer for SCS, PSSS, CD-RISC, SCSQand BIPQ were 80.81±11.50, 58.39±8.05, 55.63±14.35, 31.44±5.09 and 51.32±6.09, respectively. The statistics are summarized in Table 2. The self-compassion of lung cancer patients is negatively correlated with their illness Perception. It is significantly positively correlated with positive coping style in the coping style scales, social support, and resilience, while showing no correlation with negative coping style in the coping style scales (Table 3). Table 1 Demographic and other characteristics of the sample (n=309) Characteristics Categories N % Gender Male 228 73.8 Female 81 26.2 Age ≤40 20 6.5 41-59 76 24.6 ≥60 213 68.9 Religion Yes 19 6.1 No 290 93.9 Education level Below primary school 116 37.5 Primary school 102 33.0 High school 71 23.0 University or higher 20 6.5 Marital status Married 294 95.1 Unmarried 5 1.6 Desertion 10 3.2 Residence Rural 145 46.9 Urban 164 53.1 Monthly household income ≤2000 CNY 44 14.2 2001-5000 CNY 139 45.0 5001-10000 CNY 83 26.9 ＞10000 CNY 43 13.9 Clinical stage Ⅰ 33 10.7 Ⅱ 68 22.0 Ⅲ 130 42.1 Ⅳ 78 25.2 Metastasis Yes 142 46.0 No 167 54.0 Comorbidity Yes 187 60.5 Continued Characteristics Categories N % No 122 39.5 Current treatment Surgery 147 47.6 Chemotherapy or radiotherapy 56 18.1 Chemotherapy and radiotherapy 70 22.6 Others 36 11.7 3.3 Measurement model Initially, the model displayed an unsatisfactory fit. Then, according to the modification indices, we modified the model. We removed paths in which the standardized path coefficients had small effects (absolute values＜0.10). Social support to illness perception, and illness perception to positive coping. Based on the modification indices provided by the model, establish a covariance relationship between e10 and e11, as well as between e11 and e12. After the modifications, all indicators of the model met the standards and showed improvement. The modified model is shown in Figure 2 and the model fit comparison for the modified and hypothetical models is shown in Table 4. The results revealed that social support had the largest effect on self-compassion (total effect of 0.610), with a direct effect of 0.321. The indirect effects through resilience, positive coping, resilience-illness perception, and positive coping were 0.101, 0.070, 0.062, and 0.056, respectively. Resilience followed as the next significant factor (total effect of 0.562), with a direct effect of 0.243. The indirect effects through positive coping and illness perception were 0.150 and 0.169, respectively. Positive coping had a direct effect on self-compassion with a value of 0.264. Illness perception had a direct negative effect on self-compassion with a value of -0.311. The total, standardized direct, and indirect effects of each variable are displayed in Table 5. Table 2 Descriptive statistics of the measured variables(n=309) Characteristics Range Entry Mean SD Family Support 4~28 4 22.39 2.63 Friend Support 4~28 4 17.31 4.34 Other Support 4~28 4 18.69 4.21 PSSS 12~84 12 58.39 8.05 Self-Kindness 5~25 5 17.19 3.14 Self-Judgment 5~25 5 13.00 3.12 Isolation 4~20 4 9.86 2.32 Common Humanity 4~20 4 13.34 2.39 Mindfulness 4~20 4 14.27 2.43 Over-Identification 4~20 4 13.15 2.21 SCS 26~130 26 80.81 11.50 Tenacity 0~52 13 28.24 8.49 Optimism 0~16 4 8.26 2.54 Strength 0~32 8 19.13 5.65 CD-RISC 0~100 25 55.63 14.35 Positive coping 0~36 12 20.91 3.31 Negative coping 0~24 8 10.53 1.66 SCSQ 0~60 20 31.44 5.09 BIPQ 0~80 9 51.32 6.09 Table 3 Correlations Among the Measured Variables (n = 309) Characteristics SCS CD-RISC PSSS Positive coping Negative coping BIPQ SCS 1.000 — — — — — CD-RISC 0.558** 1.000 — — — — PSSS 0.602** 0.492** 1.000 — — — Positive coping 0.544** 0.374** 0.331** 1.000 — — Negative coping 0.023 0.053 0.036 0.067 1.000 BIPQ -0.537** -0.454** -0.255** -0.260** 0.084 1.000 ** P ＜.01 Table 4 Comparison of Model Fit for the Modified Model to the Hypothetical Model Fitness index Reference value Hypothetical Modified NC( c 2 /df ) 1＜NC＜3 3.280 1.986 GFI ＞0.90 0.881 0.933 RMSEA ＜0.08 0.102 0.067 NFI ＞0.90 0.889 0.942 RFI ＞0.90 0.853 0.911 IFI ＞0.90 0.920 0.971 TLI ＞0.90 0.893 0.954 CFI ＞0.90 0.919 0.970 Abbreviations: CFI, comparative of fit index; df, degree of freedom; GFI, goodness-of-fit index; IFI, incremental fit index; NFI, normed fit index; RMSEA, root mean square error of approximation. Table 5 Factor efect breakdown of self-compassion Characteristics Direct Efects Indirect Efects（95%CI） Total Efects Social support 0.321 A→B→E: 0.101（0.025-0.199） 0.610 A→B→D→E: 0.070（0.038-0.122） A→B→C→E: 0.062（0.027-0.119） A→D→E: 0.056（0.016-0.120） Resilience 0.243 B→C→E: 0.169（0.103-0.256） 0.562 B→D→E: 0.150（0.071-0.265） Illness perception -0.311 —— -0.311 Positive coping 0.264 —— 0.264 A=Social support; B=Resilience; C=Illness perception; D=Positive coping; E=Self-Compassion 4 Discussion This study explored the relationships among self-compassion and social support, resilience, illness perception and positive coping among patients with lung cancer in China. The model construction further explored the path relationships and mechanisms with self-compassion. This provides a theoretical basis for the development of intervention methods in the future. Participants’ mean level of self-compassion in this study was significantly lower than the level of other patients with cancer in China and much lower than that of patients with breast cancer in the United States [29, 30].This indicates that research and intervention targeting self-compassion in lung cancer patients are critically necessary.Due to its high incidence rate and relatively low survival rate, it remains a severe global health burden [31]. Therefore, patients with lung cancer may have a wide range of physiological, psychological, and social problems during the treatment stage.The study demonstrates that increasing self-compassion can effectively alleviate negative psychological emotions in lung cancer patients and improve their quality of life [32]. Therefore, understanding the influencing factors and underlying mechanisms of self-compassion becomes particularly important. Our model found that positive coping have a direct positive effect on self-compassion. Munroe [33] conducted a survey on the self-compassion levels of 111 American and Canadian youth who had experienced trauma and found that positive coping can better promote positive recovery from traumatic events by reducing self-criticism, thereby enhancing their self-compassion levels. Zhu [34] conducted a study on self-compassion and coping strategies in breast cancer survivors and found that positive coping strategies played a mediating role between self-compassion and body image issues. Encouraging patients to adopt positive coping strategies can reduce interference with body image and increase their self-compassion levels. We found that patients adept at employing positive coping strategies tend to adopt a proactive mindset toward treatment and postoperative recovery. They actively seek support from family members and healthcare providers while learning methods and techniques to manage their illness. This approach helps alleviate cancer-related anxiety and fear, reduces psychological burdens, and enhances patients' acceptance and understanding of their condition. Consequently, it diminishes self-criticism and feelings of isolation, thereby improving patients' self-care levels. Illness perception has a direct negative effect on self-compassion. The study [16] conducted a survey on illness perception among 106 breast cancer patients five years post-surgery and found that providing sufficient information to women with cancer can positively improve their understanding of cancer, reduce body image disturbances, and increase their levels of self-compassion and mindfulness. For lung cancer patients, a lack of understanding about their disease and heightened negative perceptions may severely impact their mindset and recovery. This can lead to resistance toward treatment, diminish self-confidence in recovery, foster doubts about treatment efficacy, reduce treatment adherence, and ultimately hinder the development of self-compassion. Moreover, when patients perceive the harm caused by the disease as less severe, they tend to adopt more proactive coping strategies, learn effective self-management techniques, and adjust their mindset to better confront the challenges of the illness. Therefore, clinical healthcare providers should develop personalized health education plans and provide more comprehensive disease knowledge guidance. This enables patients to truly understand treatment, nursing, and rehabilitation measures, thereby reducing negative cognition. Path analysis revealed that psychological resilience not only has a direct effect on self-compassion but also indirectly influences self-compassion through illness perception or positive coping, with path coefficients of 0.169 and 0.150, respectively, which is consistent with the results of Perez-Aranda [35]. Psychological resilience enhances adaptive functioning, sustains favorable mental health status, and improves quality of life in patients with lung cancer [36]. Psychological resilience, as a positive psychological trait, holds significant importance for patients' treatment and recovery processes. Patients with higher psychological resilience demonstrate greater self-efficacy and self-regulation abilities, enabling them to effectively maintain and manage their emotions. They believe in their capacity to overcome illness, adopt proactive coping strategies, and thereby enhance their level of self-compassion [40]. Research indicates that psychological resilience is not a fixed trait; it can be enhanced through interventions such as mindfulness-based supportive psychotherapy and self-compassion training [41, 42]. Therefore, we should actively monitor the psychological resilience of lung cancer patients. By engaging in psychological communication, listening to their concerns, and understanding their emotions and needs, we can elevate their resilience levels and foster the development of self-compassion. Our model found that social support can directly influence self-compassion. Additionally, social support also affects self-compassion through four mediating pathways. The first pathway is “Social Support → Psychological Resilience → Self-Compassion” (β=0.101); The second pathway is "Social Support → Psychological Resilience →Positive Coping → Self-Compassion" (β=0.070); The third path was “Social Support → Psychological Resilience → Illness Perception → Self-Compassion” (β=0.062); The fourth path was “Social Support → Positive Coping → Self-Compassion” (β=0.056). Research indicates that individuals with broader social support resources gain more substantial material assistance, healthcare services, and informational support, enabling them to better understand and manage their illnesses. This enhanced capacity for disease management, in turn, makes them more likely to adopt a self-compassionate perspective toward their predicament rather than succumb to self-blame and denial [37]. When individuals perceive support and care from others, it enhances their capacity to cope with adversity and challenges, enabling them to confront problems with greater optimism and positivity. This proactive mindset and coping approach strengthens psychological resilience, allowing individuals to recover more swiftly from difficult situations and fostering greater self-compassion. [38]. Poreba-Chabros [39] found that social support can help individuals better cope with negative emotions and stress triggered by disease cognition, thereby alleviating anxiety and fear stemming from their perception of illness. Consequently, social support provides emotional assistance and mood regulation, aiding individuals in better managing their disease perception and enhancing their level of self-compassion. Therefore, clinical nurses should pay more attention to the self-compassion levels of lung cancer patients and work on enhancing patients’ self-compassion levels through factors such as social support, illness perception, positive coping, and resilience. Regularly assessing patients’ levels of social support, increasing patients’ correct understanding of the disease, guiding patients to adopt positive ways of coping with the disease, and strengthening patients’ resilience can all contribute to enhancing patients’ self-compassion levels. There are several limitations in this paper. First, the participants were potentially eligible patients recruited from two hospitals using convenience sampling methods, so the population was not well represented. Second, the data analyzed were cross-sectional and self-reported. Therefore, without conclusions can be drawn about causation. In the future, longitudinal studies can be designed to explore the causal relationships and synergistic effects among these variables. Certainly, many variables are being studied, including social support, illness perception, positive coping, and resilience associated with SC of cancer. This is the strength of this research. What’s more, we have established the relationship between these variables for the first time, which can provide theoretical basis and intervention ideas for us to better improve the quality of life of cancer patients. 5 Conclusion In summary, the resiliency among patients with lung cancer was relatively low in this study. The model suggests that positive coping and illness perception can directly predict self-compassion levels. Resilience can directly or through multiple mediating pathways involving illness perception and positive coping, influence self-compassion levels. Social support can directly or indirectly enhance self-compassion levels through psychological resilience, positive coping, and illness perception. It is important to help patients identify and utilize their social support systems, enhance their resilience, have a correct understanding of the disease, and actively face it to improve their self-compassion levels and enhance their quality of life. Abbreviations CFI, comparative of fit index; df, degree of freedom; GFI, goodness-of-fit index; IFI, incremental fit index; NFI, normed fit index; RMSEA, root mean square error of approximation Declarations Ethics approval and Consent to Pa rticipate All methods were carried out in accordance with the Declaration of Helsinki. This study was approved by the Ethics Committee of the Affiliated Hospital of Weifang Medical University (wyfy-2025-ky-016). All participants provided written informed consent before the study commenced and were fully informed about the purpose, procedures, and voluntary nature of participation. The participants’ personal information was kept strictly confidential throughout the study, ensuring privacy protection. The participants were free to withdraw their consent at any stage without any consequences for their subsequent treatment or care. Availability of data and materials The results generated during the study are not publicly available due to ethical considerations but are available from the corresponding author on reasonable request. Consent for publication All participants consented to the publication of data. Funding This work was supported by the Shandong Provincial Natural Science Foundation General Program[ZR2022MH184] and Postgraduate Ideological. The funder did not have any influence on any aspects of the study (i.e., design, data collection, analyses, interpretations, or writing of the manuscript). Authors’ contributions Ningxin Sun was responsible for the research design, data collection, data analysis, and the drafting of the manuscript. Manli Wang assisted with the research design, data analysis, and contributed to manuscript writing and revisions. Jinlei Zhang assisted with the interpretation of the results and provided guidance on the theoretical framework of the paper. Haiyang Zhang, Junjie Shi and Danyang Li contributed to the revision and refinement of the manuscript. Chaoqun Ma provided overall guidance for the study and was responsible for the final approval and revisions of the manuscript. Acknowledgments The authors thank the individuals who participated in this study. Clinical trial number Not applicable. References Bray F, Laversanne M, Sung H, et al. 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Global burden of lung cancer in 2022 and projections to 2050: Incidence and mortality estimates from GLOBOCAN[J]. Cancer Epidemiol. 2024;93:102693. Faghani F, Choobforoushzadeh A, Sharbafchi MR, et al. Effectiveness of mindfulness-based supportive psychotherapy on posttraumatic growth, resilience, and self-compassion in cancer patients: A pilot study[J]. Wien Klin Wochenschr. 2022;134(15–16):593–601. Munroe M, Al-Refae M, Chan HW, et al. Using self-compassion to grow in the face of trauma: The role of positive reframing and problem-focused coping strategies[J]. Psychol Trauma. 2022;14(S1):S157–64. Zhu F, Liu C, Zhang W et al. The mediating effect of coping styles between self-compassion and body image disturbance in young breast cancer survivors: a cross-sectional study[J]. BMC Nurs, 2023,22(1). Perez-Aranda A, Garcia-Campayo J, Gude F, et al. Impact of mindfulness and self-compassion on anxiety and depression: The mediating role of resilience[J]. Volume 21. INTERNATIONAL JOURNAL OF CLINICAL AND HEALTH PSYCHOLOGY; 2021. 2. Cao J, Li Z, Dou Y, et al. Research progress on psychological resilience in lung cancer patients[J]. Chin Gen Pract Nurs. 2024;22(08):1426–9. Wang J, Wang H, Ma S, et al. The influencing factors and mechanism of self-compassion in young and middle-aged stroke patients[J]. J Nurs Sci. 2025;40(06):91–6. Liu Y, Liu K, Meng A, et al. Self-compassion and related factors in patients with lung cancer[J]. Chin Mental Health J. 2023;37(2):110–5. Poreba-Chabros A, Mamcarz P, Jurek K. Social support as a moderator between the perception of the disease and stress level in lung cancer patients[J]. Ann Agric Environ Med. 2020;27(4):630–5. Asensio-Martinez A, Olivan-Blazquez B, Montero-Marin J, et al. Relation of the Psychological Constructs of Resilience,Mindfulness,and Self-Compassion on the Perception of Physical and Mental Health[J]. Psychol Res Behav Manag. 2019;12:1155–66. Khosrobeigi M, Hafezi F, Naderi F et al. Effectiveness of self-compassion training onhopelessness and resilience in parents of children with cancer[J]. Explore(NY) 2022,18(3):357–61. Faghani F, Choobforoushzadeh A, Sharbafchi MR, et al. Effectiveness of mindfulness-based supportive psychotherapy on posttraumatic growth,resilience, and self-compassion in cancer patients:A pilot study[J]. Wien Klin Wochenschr. 2022;134(15–16):593–601. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 24 Apr, 2026 Editor invited by journal 31 Mar, 2026 Editor assigned by journal 31 Mar, 2026 Submission checks completed at journal 31 Mar, 2026 First submitted to journal 30 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9267151","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":634281656,"identity":"26cd3f94-b124-4f3e-ae99-ba3f7b9b37b8","order_by":0,"name":"NingXin Sun","email":"","orcid":"","institution":"Shandong Provincial Hospital Affiliated to Shandong First Medical University","correspondingAuthor":false,"prefix":"","firstName":"NingXin","middleName":"","lastName":"Sun","suffix":""},{"id":634281657,"identity":"c36f20fb-d69e-4c9f-aeb1-3f716fbe8b17","order_by":1,"name":"Manli Wang","email":"","orcid":"","institution":"Shandong Provincial Hospital Affiliated to Shandong First Medical University","correspondingAuthor":false,"prefix":"","firstName":"Manli","middleName":"","lastName":"Wang","suffix":""},{"id":634281658,"identity":"9ec18438-cbce-47e1-ab87-e14a6a139623","order_by":2,"name":"Jinlei Zhang","email":"","orcid":"","institution":"Shandong Second Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jinlei","middleName":"","lastName":"Zhang","suffix":""},{"id":634281659,"identity":"026c953a-ae93-4abb-ad9b-b60bd7cac7b3","order_by":3,"name":"Junjie Shi","email":"","orcid":"","institution":"Shandong Provincial Hospital Affiliated to Shandong First Medical University","correspondingAuthor":false,"prefix":"","firstName":"Junjie","middleName":"","lastName":"Shi","suffix":""},{"id":634281662,"identity":"6b29764e-cba0-488d-bb91-22544a8776b2","order_by":4,"name":"Danyang Li","email":"","orcid":"","institution":"Affiliated Hospital of Shandong Second Medical University","correspondingAuthor":false,"prefix":"","firstName":"Danyang","middleName":"","lastName":"Li","suffix":""},{"id":634281663,"identity":"de6c63a1-ba5c-4780-b939-e8d6d88e3fec","order_by":5,"name":"Haiyang Zhang","email":"","orcid":"","institution":"Shandong Provincial Hospital Affiliated to Shandong First Medical University","correspondingAuthor":false,"prefix":"","firstName":"Haiyang","middleName":"","lastName":"Zhang","suffix":""},{"id":634281664,"identity":"d6ad9d51-0ba3-4536-bfad-8e50555f0460","order_by":6,"name":"Chaoqun Ma","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyElEQVRIiWNgGAWjYBACxmaG5AcJFTb1/ewNRGphbmd4ZvDhTBrjzJ4DRGph72d8IDmz7TDjhhsJRGrhbWZOMOZtS2OWnPl44w2GGptoglokm9kSHvOcs2Hjl04rtmA4lpbbQEiLYTNPgjFPWRqP5OwcMwnGhsOEtdgf5v8gzcN2WMLg5hkitQADOUFyRtthA4MbPMRrSQMFcoJkD9AvCcT4hbH/ADgqE/jZD2+88aHGhrAWZGAgkUCKcogWUnWMglEwCkbByAAAR25BueLylawAAAAASUVORK5CYII=","orcid":"","institution":"Shandong Provincial Hospital Affiliated to Shandong First Medical University","correspondingAuthor":true,"prefix":"","firstName":"Chaoqun","middleName":"","lastName":"Ma","suffix":""}],"badges":[],"createdAt":"2026-03-30 12:54:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9267151/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9267151/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108838056,"identity":"96c02ddf-bd38-423a-9457-2b024cf2f55b","added_by":"auto","created_at":"2026-05-09 00:20:33","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":82536,"visible":true,"origin":"","legend":"\u003cp\u003eThe hypothetical model\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-9267151/v1/11d98137d44f64ac8804ad2d.png"},{"id":108838057,"identity":"6ff21bad-c579-4813-a755-5247fdaf0ae6","added_by":"auto","created_at":"2026-05-09 00:20:33","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":99796,"visible":true,"origin":"","legend":"\u003cp\u003eThe modified model\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-9267151/v1/c2f27c904864a2e4c5c533f4.png"},{"id":108977131,"identity":"d79c388d-5a93-4820-862c-891167470895","added_by":"auto","created_at":"2026-05-11 11:30:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":574753,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9267151/v1/689d31b7-f3be-4ab2-887e-90d75005609f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Self-compassion in patients with lung cancer- A Structural Equation Modeling","fulltext":[{"header":"1 Background","content":"\u003cp\u003eAccording to the latest cancer statistics released by IARC, in 2022, there will be 2.48\u0026nbsp;million new cases of lung cancer and 1.81\u0026nbsp;million deaths due to lung cancer globally, which is characterized by a high incidence and mortality rate [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Research has shown that due to the side effects of surgery and drug treatment, lung cancer patients may experience physical symptoms such as fatigue, pain, nausea, and vomiting, as well as negative emotions such as anxiety and depression [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. These negative emotions seriously affect the therapeutic effects and prognostic status of lung cancer patients.\u003c/p\u003e \u003cp\u003eIn recent years, with the rapid development of positive psychology, researchers have begun to focus on and explore the positive psychological states of cancer patients. self-compassion has emerged as a new perspective of positive psychology in the field of psychological research [\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Self-compassion is defined as the ability to understand one\u0026rsquo;s own suffering, to be kind and forgiving towards one\u0026rsquo;s own flaws and shortcomings, and to view one\u0026rsquo;s pain as part of the human experience rather than isolating oneself from society and becoming excessively immersed in it [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Some scholars have pointed out that self-compassion is an effective emotion regulation strategy that can significantly improve mental health and reduce the generation of negative emotions [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAccording to Lazarus\u0026rsquo;s [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] stress and coping model, when an individual is faced with a stressful event, the individual will first respond to the stressful event according to existing information and experience, as well as the individual\u0026rsquo;s cognitive and perceptual process of perceiving the situation, and then coping with the stressful event to solve the problem or alleviate the emotion (generate self-compassion). In this process, the individual\u0026rsquo;s internal resources such as mental toughness plays an important role, patients with high mental toughness can correctly view the disease, and take positive coping methods, so as to maintain a good physiological and psychological state; when the individual faces a stressful event, good social support as an available external resource can buffer and prevent the negative impact caused by the event, which is then manifested as a good adaptation.\u003c/p\u003e \u003cp\u003eAs a resilience-enhancing resource, social support fosters adaptive cognitive restructuring under stress, bolsters self-esteem, and attenuates cancer-related adverse outcomes, ultimately functioning as a key mediator of self-compassion cultivation [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In addition, resilience is a positive psychological characteristic exhibited in the face of difficulties and challenges. Resilience is an important determinant of psychological adaptation when coping with cancer [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. A previous study showed that breast cancer patients with higher resilience had higher levels of self-compassion [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Thus, resilience and social support may also influence self-compassion in lung cancer patients; the relationship between factors influencing self-compassion should be considered. Specifically, social support may have a direct effect on resilience or an indirect effect through resilience.\u003c/p\u003e \u003cp\u003eIllness perception refers to people\u0026rsquo;s knowledge and understanding of their condition and the presence of disease. Cancer treatment can be lengthy and produce a range of physical and psychological stresses and distress. Negative perceptions can have a negative impact on patients\u0026rsquo; quality of life and are a risk factor for poor self-compassion in cancer patients [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. A previous study investigating the level of illness perception in breast cancer patients 5 years after surgery reported that illness perception may have a direct effect on resilience and an indirect effect through coping styles [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough self-compassion plays an important role in regulating the relationship between psychological stress and mental health, and factors such as perceived social support, resilience, illness perception, and coping styles significantly influence self-compassion, the mechanisms of interaction between these factors are not yet clear. Therefore, we have developed a hypothetical model is depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, and will use structural equation modeling (SEM) to test this model, to elucidate the relationships among these factors in lung cancer patients and provide the necessary information for the development of targeted intervention measures.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"2 Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study Population\u003c/h2\u003e \u003cp\u003eThis study employed a cross-sectional descriptive correlational survey. We recruited lung cancer patients from two tertiary hospitals in Shandong, China using convenience sampling method. Inclusion criteria: (1) Patients diagnosed with lung cancer [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] who stayed in a hospital and received relevant treatment; (2) Patients who provide informed consent and voluntarily participate in the study; (3) aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years, without cognitive or communication disorders. Exclusion criteria: (1) Patients with severe cognitive impairment who are unable to cooperate or refuse to participate in the study; (2) Patients with concomitant other malignant tumors. According to the Kendall sample estimation method, the sample size should be at least 5\u0026ndash;10 times the number of predictor variables [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In addition, structural equation modeling (SEM) was implemented in this study. According to methodological guidelines, SEM analysis necessitates a minimum sample size of 200 participants to ensure statistical adequacy [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This study has a total of 30 predictor variables. Therefore, the estimated sample size for this study is 150\u0026ndash;300 cases. Taking into account a 20% attrition rate, the final sample size for this study is determined to be 309 cases.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Measures\u003c/h2\u003e \u003cp\u003eIn this study, data were collected using the following instruments: The general information questionnaire, the Self-Compassion Scale, Perceived Social Support Scale, The Connor-Davidson Resilience Scale, the Simplified Coping Style Questionnaire, and Brief Illness Perception Questionnaire.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003e2.2.1 The general information questionnaire\u003c/h2\u003e \u003cp\u003eThe general information questionnaire was based on the purpose and content of this study, the researchers designed a section that includes 11 items for general demographic information. These items cover age, gender, religious, education level, marital status, monthly household income, residence, clinical stage, metastasis, comorbidity, and current treatment.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.2.2 The Self-Compassion Scale (SCS)\u003c/h2\u003e \u003cp\u003eThe Self-Compassion Scale (SCS), originally developed by Neff [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] and later translated into Chinese by Chen [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], consists of 26 items categorized into 6 dimensions: self-kindness (items 5, 12, 19, 23, 26), self-judgment (items 1, 8, 11, 16, 21), common humanity (items 3, 7, 10, 15), isolation (items 4, 13, 18, 25), mindfulness (items 9, 14, 17, 22), and over-identification (items 2, 6, 20, 24). The total score ranges from 26 to 130 points, with responses scored from 1 to 5 for \u0026ldquo;never\u0026rdquo; to \u0026ldquo;almost always.\u0026rdquo; The Cronbach\u0026rsquo;s ɑ of the scale in this study was 0.827.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.2.3 Perceived Social Support Scale (PSSS)\u003c/h2\u003e \u003cp\u003eThe scale was originally developed by Zimet et al. [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] and subsequently adapted into Chinese by Huang Li et al. [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. It comprises 12 items across three dimensions: family support (4 items), friend support (4 items), and other support (4 items). Responses are measured using a 7-point Likert scale ranging from 1 (\u0026lsquo;strongly disagree\u0026rsquo;) to 7 (\u0026lsquo;strongly agree\u0026rsquo;), yielding a total score between 12 and 84. Higher scores indicate greater perceived social support. The Cronbach\u0026rsquo;s ɑ coefficient for the total scale is 0.88, and in this study, the Cronbach\u0026rsquo;s α coefficient was calculated to be 0.853.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003e2.2.4 The Connor-Davidson Resilience Scale (CD-RISC)\u003c/h2\u003e \u003cp\u003eThe scale used in this study was developed by Connor [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. In 2003 and later translated into Chinese by Yu [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The scale consists of 25 items and is structured into three main dimensions: resilience, optimism, and strength. The resilience dimension includes items 11\u0026ndash;23, reflecting an individual\u0026rsquo;s resilience and adaptability in facing challenges and adversity. The optimism dimension includes items 2, 3, 4, and 6, focusing on an individual\u0026rsquo;s optimistic emotions and attitudes. The strength dimension comprises items 1, 5, 7\u0026ndash;10, 24, 25, highlighting the strength and fortitude displayed when confronting difficulties. The scale has a Cronbach\u0026rsquo;s ɑ coefficient of 0.911, indicating good reliability and validity.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003e2.2.5 Simplified Coping Style Questionnaire (SCSQ)\u003c/h2\u003e \u003cp\u003eThe scale used in this study was developed by Chinese scholar Xie [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. It is primarily designed to reflect the coping strategies and responses individuals adopt when facing stress. Items 1\u0026ndash;12 represent positive coping strategies, while items 13\u0026ndash;20 measure negative coping strategies. A higher score on positive coping indicates a more proactive approach to coping. Each item is scored from 0 to 3, with response options ranging from \u0026ldquo;never\u0026rdquo; to \u0026ldquo;often.\u0026rdquo; In this study, the Cronbach\u0026rsquo;s ɑ coefficient was calculated to be 0.881, indicating good reliability and validity.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003e2.2.6 Brief Illness Perception Questionnaire (BIPQ)\u003c/h2\u003e \u003cp\u003eThe Brief Illness Perception Questionnaire was developed by the Broadbent [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], and later translated into Chinese by Sun [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. The scale consists of 9 items that cover various aspects such as individual\u0026rsquo;s cognitive perception of health issues, the level of attention to health behaviors, perceived disease risk, and intentions towards health behaviors. The first 8 items are scored from 0 to 10, with items 3, 4, and 7 reverse-scored. The total score ranges from 0 to 80, with higher scores indicating a stronger perception of the threat posed by the disease. The Cronbach's α coefficient for this scale is 0.861, indicating good reliability and validity.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Data Collection\u003c/h2\u003e \u003cp\u003eLung cancer inpatients from two tertiary hospitals in Shandong, China, were recruited from January 2024 to August 2024. Two researchers explained the purpose and significance of the study to the participants. Subsequently, they introduced the questionnaire content to the participants and explained how to complete the questionnaire. After completing the questionnaire, the researchers collected them directly.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Analysis\u003c/h2\u003e \u003cp\u003eAll data were entered into Excel and analyzed using SPSS 26.0 statistical software. Continuous data were described using mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation if normally distributed, or median and interquartile range if not normally distributed. Categorical data were described using rates and proportions. Depending on the distribution and homogeneity of variance, comparisons between groups were conducted using independent sample t-tests, one-way analysis of variance (ANOVA), or non-parametric tests. Pearson or Spearman correlation analysis was used to explore relationships between variables. Multiple linear regression analysis was employed to identify factors influencing self-compassion levels in lung cancer patients. The AMOS 24.0 software was used to construct a model, and the model was modified based on modification indices and fit indices. The Bootstrap method was utilized to test for mediating effects.\u003c/p\u003e \u003c/div\u003e\u003ch2\u003e2.5 Ethical Approval\u003c/h2\u003e\n\u003cp\u003eThis study has been approved by the Institutional Review Board of Shandong Second Medical University. All eligible participants were provided with written informed consent before completing the questionnaire. They were informed of their research rights, including the right to withdraw from the study at any time.\u003c/p\u003e"},{"header":"3 Results","content":"\u003cp\u003e3.1 Sample Characteristics and Variable Scores in the Model\u003c/p\u003e\n\u003cp\u003eIn this study, a total of 320 questionnaires were distributed, and 309 valid questionnaires were collected. The demographic characteristics of the final participants are shown in Table\u0026nbsp;1.\u003c/p\u003e\n\u003cp\u003e3.2 SC and Other Measured Variables and Their Relationships\u003c/p\u003e\n\u003cp\u003eThe mean total scores among participants with lung cancer for SCS, PSSS, CD-RISC, SCSQand BIPQ were 80.81\u0026plusmn;11.50, 58.39\u0026plusmn;8.05, 55.63\u0026plusmn;14.35, 31.44\u0026plusmn;5.09 and 51.32\u0026plusmn;6.09, respectively. The statistics are summarized in Table 2. The self-compassion of lung cancer patients is negatively correlated with their illness Perception. It is significantly positively correlated with positive coping style in the coping style scales, social support, and resilience, while showing no correlation with negative coping style in the coping style scales (Table 3).\u003c/p\u003e\n\u003cp\u003eTable 1 Demographic and other characteristics of the sample (n=309)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 265px;\"\u003e\n \u003cp\u003eCategories\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 265px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e228\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e73.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 265px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e26.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 265px;\"\u003e\n \u003cp\u003e\u0026le;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 265px;\"\u003e\n \u003cp\u003e41-59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e24.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 265px;\"\u003e\n \u003cp\u003e\u0026ge;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e213\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e68.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003eReligion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 265px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e6.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 265px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e290\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e93.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003eEducation level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 265px;\"\u003e\n \u003cp\u003eBelow primary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e37.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 265px;\"\u003e\n \u003cp\u003ePrimary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e33.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 265px;\"\u003e\n \u003cp\u003eHigh school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e23.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 265px;\"\u003e\n \u003cp\u003eUniversity or higher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 265px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e294\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e95.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 265px;\"\u003e\n \u003cp\u003eUnmarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 265px;\"\u003e\n \u003cp\u003eDesertion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003eResidence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 265px;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e46.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 265px;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e53.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003eMonthly household income\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 265px;\"\u003e\n \u003cp\u003e\u0026le;2000 CNY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e14.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 265px;\"\u003e\n \u003cp\u003e2001-5000 CNY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e139\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e45.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 265px;\"\u003e\n \u003cp\u003e5001-10000 CNY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e26.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 265px;\"\u003e\n \u003cp\u003e＞10000 CNY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e13.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003eClinical stage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 265px;\"\u003e\n \u003cp\u003eⅠ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e10.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 265px;\"\u003e\n \u003cp\u003eⅡ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e22.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 265px;\"\u003e\n \u003cp\u003eⅢ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e42.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 265px;\"\u003e\n \u003cp\u003eⅣ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e25.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003eMetastasis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 265px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e46.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 265px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e54.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003eComorbidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 265px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e60.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eContinued\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"559\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 265px;\"\u003e\n \u003cp\u003eCategories\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 265px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e39.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003eCurrent treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 265px;\"\u003e\n \u003cp\u003eSurgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e47.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 265px;\"\u003e\n \u003cp\u003eChemotherapy or radiotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e18.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 265px;\"\u003e\n \u003cp\u003eChemotherapy and radiotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e22.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 265px;\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e11.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e3.3 Measurement model\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Initially, the model displayed an unsatisfactory fit. Then, according to the modification indices, we modified the model. We removed paths in which the standardized path coefficients had small effects (absolute values＜0.10). Social support to illness perception, and illness perception to positive coping. Based on the modification indices provided by the model, establish a covariance relationship between e10 and e11, as well as between e11 and e12. After the modifications, all indicators of the model met the standards and showed improvement. The modified model is shown in Figure 2 and the model fit comparison for the modified and hypothetical models is shown in Table 4.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe results revealed that social support had the largest effect on self-compassion (total effect of 0.610), with a direct effect of 0.321. The indirect effects through resilience, positive coping, resilience-illness perception, and positive coping were 0.101, 0.070, 0.062, and 0.056, respectively. Resilience followed as the next significant factor (total effect of 0.562), with a direct effect of 0.243. The indirect effects through positive coping and illness perception were 0.150 and 0.169, respectively. Positive coping had a direct effect on self-compassion with a value of 0.264. Illness perception had a direct negative effect on self-compassion with a value of -0.311. The total, standardized direct, and indirect effects of each variable are displayed in Table 5.\u003c/p\u003e\n\u003cp\u003eTable 2 Descriptive statistics of the measured variables(n=309)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003eEntry\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;Mean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u0026nbsp;Family Support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e4~28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e22.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e2.63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003eFriend Support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e4~28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e17.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e4.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003eOther Support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e4~28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e18.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e4.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003ePSSS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e12~84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e58.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e8.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003eSelf-Kindness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e5~25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e17.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e3.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003eSelf-Judgment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e5~25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e13.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e3.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003eIsolation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e4~20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e9.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e2.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003eCommon Humanity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e4~20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e13.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e2.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003eMindfulness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e4~20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e14.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e2.43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003eOver-Identification\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e4~20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e13.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e2.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003eSCS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e26~130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e80.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e11.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003eTenacity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e0~52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e28.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e8.49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003eOptimism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e0~16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e8.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e2.54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003eStrength\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e0~32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e19.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e5.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003eCD-RISC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e0~100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e55.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e14.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u0026nbsp;Positive coping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e0~36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e20.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e3.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u0026nbsp;Negative coping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e0~24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e10.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003eSCSQ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e0~60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e31.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e5.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003eBIPQ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e0~80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e51.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e6.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3 Correlations Among the Measured Variables (n = 309)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"101%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003eSCS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003eCD-RISC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003ePSSS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003ePositive coping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eNegative coping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003eBIPQ\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eSCS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eCD-RISC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.558**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003ePSSS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.602**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.492**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003ePositive coping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.544**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.374**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.331**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eNegative coping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.053\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e0.067\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eBIPQ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e-0.537**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.454**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e-0.255**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e-0.260**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e0.084\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e**\u003cem\u003eP\u003c/em\u003e＜.01\u003c/p\u003e\n\u003cp\u003eTable 4 Comparison of Model Fit for the Modified Model to the Hypothetical Model\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eFitness index\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003eReference value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003eHypothetical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eModified\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eNC(\u003cem\u003ec\u003c/em\u003e\u003cem\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003cem\u003e/df\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e1＜NC＜3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3.280\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1.986\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eGFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e＞0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.881\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.933\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eRMSEA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e＜0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.067\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eNFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e＞0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.889\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.942\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eRFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e＞0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.853\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.911\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eIFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e＞0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.920\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.971\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eTLI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e＞0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.893\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.954\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eCFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e＞0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.919\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.970\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: CFI, comparative of fit index; df, degree of freedom; GFI, goodness-of-fit index; IFI, incremental fit index; NFI, normed fit index; RMSEA, root mean square error of approximation.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable 5 Factor efect breakdown of self-compassion\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eDirect Efects\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 245px;\"\u003e\n \u003cp\u003eIndirect Efects（95%CI）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003eTotal Efects\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003eSocial support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0.321\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 245px;\"\u003e\n \u003cp\u003eA\u0026rarr;B\u0026rarr;E: 0.101（0.025-0.199）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e0.610\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 245px;\"\u003e\n \u003cp\u003eA\u0026rarr;B\u0026rarr;D\u0026rarr;E: 0.070（0.038-0.122）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 245px;\"\u003e\n \u003cp\u003eA\u0026rarr;B\u0026rarr;C\u0026rarr;E: 0.062（0.027-0.119）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 245px;\"\u003e\n \u003cp\u003eA\u0026rarr;D\u0026rarr;E: 0.056（0.016-0.120）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003eResilience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0.243\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 245px;\"\u003e\n \u003cp\u003eB\u0026rarr;C\u0026rarr;E: 0.169（0.103-0.256）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e0.562\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 245px;\"\u003e\n \u003cp\u003eB\u0026rarr;D\u0026rarr;E: 0.150（0.071-0.265）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003eIllness perception\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e-0.311\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 245px;\"\u003e\n \u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e-0.311\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003ePositive coping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0.264\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 245px;\"\u003e\n \u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e0.264\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eA=Social support; B=Resilience; C=Illness perception; D=Positive coping; E=Self-Compassion\u003c/p\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eThis study explored the relationships among self-compassion and social support, resilience, illness perception and positive coping among patients with lung cancer in China. The model construction further explored the path relationships and mechanisms with self-compassion. This provides a theoretical basis for the development of intervention methods in the future.\u003c/p\u003e\n\u003cp\u003eParticipants’ mean level of self-compassion in this study was significantly lower than the level of other patients with cancer in China and much lower than that of patients with breast cancer in the United States [29, 30].This indicates that research and intervention targeting self-compassion in lung cancer patients are critically necessary.Due to its high incidence rate and relatively low survival rate, it remains a severe global health burden [31]. Therefore, patients with lung cancer may have a wide range of physiological, psychological, and social problems during the treatment stage.The study demonstrates that increasing self-compassion can effectively alleviate negative psychological emotions in lung cancer patients and improve their quality of life [32]. Therefore, understanding the influencing factors and underlying mechanisms of self-compassion becomes particularly important.\u003c/p\u003e\n\u003cp\u003eOur model found that positive coping have a direct positive effect on self-compassion. Munroe [33] conducted a survey on the self-compassion levels of 111 American and Canadian youth who had experienced trauma and found that positive coping can better promote positive recovery from traumatic events by reducing self-criticism, thereby enhancing their self-compassion levels. Zhu [34] conducted a study on self-compassion and coping strategies in breast cancer survivors and found that positive coping strategies played a mediating role between self-compassion and body image issues. Encouraging patients to adopt positive coping strategies can reduce interference with body image and increase their self-compassion levels. We found that patients adept at employing positive coping strategies tend to adopt a proactive mindset toward treatment and postoperative recovery. They actively seek support from family members and healthcare providers while learning methods and techniques to manage their illness. This approach helps alleviate cancer-related anxiety and fear, reduces psychological burdens, and enhances patients' acceptance and understanding of their condition. Consequently, it diminishes self-criticism and feelings of isolation, thereby improving patients' self-care levels.\u003c/p\u003e\n\u003cp\u003eIllness perception has a direct negative effect on self-compassion. The study [16] conducted a survey on illness perception among 106 breast cancer patients five years post-surgery and found that providing sufficient information to women with cancer can positively improve their understanding of cancer, reduce body image disturbances, and increase their levels of self-compassion and mindfulness. For lung cancer patients, a lack of understanding about their disease and heightened negative perceptions may severely impact their mindset and recovery. This can lead to resistance toward treatment, diminish self-confidence in recovery, foster doubts about treatment efficacy, reduce treatment adherence, and ultimately hinder the development of self-compassion. Moreover, when patients perceive the harm caused by the disease as less severe, they tend to adopt more proactive coping strategies, learn effective self-management techniques, and adjust their mindset to better confront the challenges of the illness. Therefore, clinical healthcare providers should develop personalized health education plans and provide more comprehensive disease knowledge guidance. This enables patients to truly understand treatment, nursing, and rehabilitation measures, thereby reducing negative cognition.\u003c/p\u003e\n\u003cp\u003ePath analysis revealed that psychological resilience not only has a direct effect on self-compassion but also indirectly influences self-compassion through illness perception or positive coping, with path coefficients of 0.169 and 0.150, respectively, which is consistent with the results of Perez-Aranda [35]. Psychological resilience enhances adaptive functioning, sustains favorable mental health status, and improves quality of life in patients with lung cancer [36].\u0026nbsp;Psychological resilience, as a positive psychological trait, holds significant importance for patients' treatment and recovery processes. Patients with higher psychological resilience demonstrate greater self-efficacy and self-regulation abilities, enabling them to effectively maintain and manage their emotions. They believe in their capacity to overcome illness, adopt proactive coping strategies, and thereby enhance their level of self-compassion [40]. Research indicates that psychological resilience is not a fixed trait; it can be enhanced through interventions such as mindfulness-based supportive psychotherapy and self-compassion training [41, 42]. Therefore, we should actively monitor the psychological resilience of lung cancer patients. By engaging in psychological communication, listening to their concerns, and understanding their emotions and needs, we can elevate their resilience levels and foster the development of self-compassion.\u003c/p\u003e\n\u003cp\u003eOur model found that social support can directly influence self-compassion. Additionally, social support also affects self-compassion through four mediating pathways. The first pathway is “Social Support → Psychological Resilience → Self-Compassion” (β=0.101); The second pathway is \"Social Support → Psychological Resilience →Positive Coping → Self-Compassion\" (β=0.070); The third path was “Social Support → Psychological Resilience → Illness Perception → Self-Compassion” (β=0.062); The fourth path was “Social Support → Positive Coping → Self-Compassion” (β=0.056). Research indicates that individuals with broader social support resources gain more substantial material assistance, healthcare services, and informational support, enabling them to better understand and manage their illnesses. This enhanced capacity for disease management, in turn, makes them more likely to adopt a self-compassionate perspective toward their predicament rather than succumb to self-blame and denial [37]. When individuals perceive support and care from others, it enhances their capacity to cope with adversity and challenges, enabling them to confront problems with greater optimism and positivity. This proactive mindset and coping approach strengthens psychological resilience, allowing individuals to recover more swiftly from difficult situations and fostering greater self-compassion. [38]. Poreba-Chabros [39] found that social support can help individuals better cope with negative emotions and stress triggered by disease cognition, thereby alleviating anxiety and fear stemming from their perception of illness. Consequently, social support provides emotional assistance and mood regulation, aiding individuals in better managing their disease perception and enhancing their level of self-compassion.\u003c/p\u003e\n\u003cp\u003eTherefore, clinical nurses should pay more attention to the self-compassion levels of lung cancer patients and work on enhancing patients’ self-compassion levels through factors such as social support, illness perception, positive coping, and resilience. Regularly assessing patients’ levels of social support, increasing patients’ correct understanding of the disease, guiding patients to adopt positive ways of coping with the disease, and strengthening patients’ resilience can all contribute to enhancing patients’ self-compassion levels.\u003c/p\u003e\n\u003cp\u003eThere are several limitations in this paper. First, the participants were potentially eligible patients recruited from two hospitals using convenience sampling methods, so the population was not well represented. Second, the data analyzed were cross-sectional and self-reported. Therefore, without conclusions can be drawn about causation. In the future, longitudinal studies can be designed to explore the causal relationships and synergistic effects among these variables. Certainly, many variables are being studied, including social support, illness perception, positive coping, and resilience associated with SC of cancer. This is the strength of this research. What’s more, we have established the relationship between these variables for the first time, which can provide theoretical basis and intervention ideas for us to better improve the quality of life of cancer patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e5 Conclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn summary, the resiliency among patients with lung cancer was relatively low in this study. The model suggests that positive coping and illness perception can directly predict self-compassion levels. Resilience can directly or through multiple mediating pathways involving illness perception and positive coping, influence self-compassion levels. Social support can directly or indirectly enhance self-compassion levels through psychological resilience, positive coping, and illness perception. It is important to help patients identify and utilize their social support systems, enhance their resilience, have a correct understanding of the disease, and actively face it to improve their self-compassion levels and enhance their quality of life.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCFI, comparative of fit index;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003edf, degree of freedom;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGFI, goodness-of-fit index;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIFI, incremental fit index;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNFI, normed fit index;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRMSEA, root mean square error of approximation\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eapproval\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eand Consent to Pa\u003c/strong\u003e\u003cstrong\u003erticipate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll methods were carried out in accordance with the Declaration of Helsinki. This study was approved by the Ethics Committee of the Affiliated Hospital of Weifang Medical University (wyfy-2025-ky-016). All participants provided written informed consent before the study commenced and were fully informed about the purpose, procedures, and voluntary nature of participation. The participants’ personal information was kept strictly confidential throughout the study, ensuring privacy protection. The participants were free to withdraw their consent at any stage without any consequences for their subsequent treatment or care.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results generated during the study are not publicly available due to ethical considerations but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants consented to the publication of data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Shandong Provincial Natural Science Foundation General Program[ZR2022MH184] and Postgraduate Ideological. The funder did not have any influence on any aspects of the study (i.e., design, data collection, analyses, interpretations, or writing of the manuscript).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNingxin Sun was responsible for the research design, data collection, data analysis, and the drafting of the manuscript. Manli Wang assisted with the research design, data analysis, and contributed to manuscript writing and revisions. Jinlei Zhang assisted with the interpretation of the results and provided guidance on the theoretical framework of the paper. Haiyang Zhang, Junjie Shi and Danyang Li contributed to the revision and refinement of the manuscript. Chaoqun Ma provided overall guidance for the study and was responsible for the final approval and revisions of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank the individuals who participated in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\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[J]. CA Cancer J Clin. 2024;74(3):229\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaranikas M, Esempidis A, Chasan ZT, et al. Pancreatic Cancer from Molecular Pathways to Treatment Opinion[J]. 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Chin Mental Health J. 2023;37(2):110\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePoreba-Chabros A, Mamcarz P, Jurek K. Social support as a moderator between the perception of the disease and stress level in lung cancer patients[J]. Ann Agric Environ Med. 2020;27(4):630\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAsensio-Martinez A, Olivan-Blazquez B, Montero-Marin J, et al. Relation of the Psychological Constructs of Resilience,Mindfulness,and Self-Compassion on the Perception of Physical and Mental Health[J]. Psychol Res Behav Manag. 2019;12:1155\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhosrobeigi M, Hafezi F, Naderi F et al. Effectiveness of self-compassion training onhopelessness and resilience in parents of children with cancer[J]. Explore(NY) 2022,18(3):357\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFaghani F, Choobforoushzadeh A, Sharbafchi MR, et al. Effectiveness of mindfulness-based supportive psychotherapy on posttraumatic growth,resilience, and self-compassion in cancer patients:A pilot study[J]. Wien Klin Wochenschr. 2022;134(15\u0026ndash;16):593\u0026ndash;601.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcan","sideBox":"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcan/default.aspx","title":"BMC Cancer","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Lung cancer, Self compassion, Influencing factors, Structural equation modeling","lastPublishedDoi":"10.21203/rs.3.rs-9267151/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9267151/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eSelf-compassion plays a crucial role in the psychological well-being of cancer patients, yet the interplay of factors influencing self-compassion in lung cancer patients remains underexplored. This study aimed to examine the relationships among social support, resilience, self-compassion, illness perception, and positive coping in lung cancer patients.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA cross-sectional survey was conducted with 309 lung cancer patients from two tertiary hospitals in Shandong, China, using simple random sampling. Data were collected via validated scales, including the Connor-Davidson Resilience Scale, Self-Compassion Scale, Perceived Social Support Scale, Simplified Coping Style Questionnaire, and Brief Illness Perception Questionnaire.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003ePatients\u0026rsquo; mean total self-compassion score was 80.81\u0026thinsp;\u0026plusmn;\u0026thinsp;11.50. The fit indices for the model indicated a good fit. Social support had multiple effects on self-compassion; specifically, it had direct and indirect effects through the mediating role of resilience, illness perception and positive coping. Resilience had an indirect effect on self-compassion through illness perception and positive coping.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions\u003c/b\u003e\u003c/p\u003e \u003cp\u003eSocial support, resilience, illness perception, and positive coping are interrelated factors significantly associated with self-compassion in lung cancer patients. These findings highlight the need for multifaceted interventions targeting these factors to enhance psychological well-being. Clinicians should integrate self-compassion training, peer support programs, and resilience-building strategies into patient care to foster adaptive coping and improve quality of life.\u003c/p\u003e","manuscriptTitle":"Self-compassion in patients with lung cancer- A Structural Equation Modeling","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-09 00:20:29","doi":"10.21203/rs.3.rs-9267151/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-04-24T16:05:32+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-31T16:56:25+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-31T05:19:16+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-31T05:18:50+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cancer","date":"2026-03-30T12:35:35+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcan","sideBox":"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcan/default.aspx","title":"BMC Cancer","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1fa4a231-465b-4c73-a38b-5c0dcdcec0c2","owner":[],"postedDate":"May 9th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-09T00:20:30+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-09 00:20:29","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9267151","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9267151","identity":"rs-9267151","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}