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Psychological flexibility and coping behaviors in cervical cancer patients: Moderating role of illness perception
Yan-Fei Di, Zhen Zhang, Qian Li, Xue Han, Qin Chen, Xin-Ying He, Peng-Fei Xu, Hai-Xiang Wang
Yan-Fei Di, Qian Li, Department of Nursing, Women’s Hospital of Nanjing Medical University, Nanjing Women and Children’s Healthcare Hospital, Nanjing 210004, Jiangsu Province, China
Zhen Zhang, Department of Oncology, Haian Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nantong 226600, Jiangsu Province, China
Xue Han, Qin Chen, Xin-Ying He, Department of Gynecological Oncology, Women’s Hospital of Nanjing Medical University, Nanjing Women and Children’s Healthcare Hospital, Nanjing 210004, Jiangsu Province, China
Peng-Fei Xu, Department of Nephrology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210000, Jiangsu Province, China
Hai-Xiang Wang, Department of Critical Care Medicine, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi 214023, Jiangsu Province, China
Co-first authors: Yan-Fei Di and Zhen Zhang.
Co-corresponding authors: Xin-Ying He and Peng-Fei Xu.
Author contributions: Chen Q and He XY conceived and designed the study; Wang HX performed the literature search; Di YF acquired data and drafted the manuscript; He XY assisted in revising the manuscript; Chen Q and Zhang Z wrote the original draft; Li Q and Han X wrote, reviewed and edited the manuscript; Wang HX and Xu PF ensured the authenticity of all the raw data. All authors have read and approved the final manuscript. Di YF and Zhang Z contributed equally to this work as co-first authors. We respectfully provide the following rationale for designating two co-corresponding authors in this nursing study. First, the two authors made equal and substantial contributions to the study conception, research design, data collection and interpretation of nursing practice outcomes. Second, this study involves two complementary areas of nursing expertise: One author is a clinical nursing specialist responsible for bedside protocol implementation and patient outcome assessment, while the other is a nursing educator/researcher with advanced expertise in theoretical framework development and statistical analysis. Neither author could independently oversee all aspects of the study without compromising scientific rigor. Third, both co-corresponding authors share equal responsibility for data integrity, ethical oversight (including nursing ethics considerations), and manuscript revisions. Therefore, we believe that co-corresponding authorship accurately reflects their equal leadership roles and adheres to transparency and fairness in nursing scholarship.
Supported by Science and Technology Development Fund Project of Nanjing Medical University, No. NMUB20240252.
Institutional review board statement: The study was reviewed and approved by the Medical Ethics Committee of Nanjing Women and Children’s Healthcare Hospital, No. PJ-2025KY017-001.
Informed consent statement: Informed consent was waived.
Conflict-of-interest statement: The authors have no relevant financial or non-financial interests to disclose.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. All requests relating to data should be addressed to
xinying@njmu.edu.cn.
Corresponding author: Xin-Ying He, Department of Gynecological Oncology, Women’s Hospital of Nanjing Medical University, Nanjing Women and Children’s Healthcare Hospital, No. 123 Mochou Road, Tianfei Lane, Qinhuai District, Nanjing 210004, Jiangsu Province, China.
xinying@njmu.edu.cn
Received: March 9, 2026
Revised: April 10, 2026
Accepted: April 23, 2026
Published online: May 24, 2026
Processing time: 73 Days and 5 Hours
BACKGROUND
Cervical cancer poses significant physical and psychological challenges, often leading to maladaptive coping behaviors that affect treatment adherence and quality of life. While psychological flexibility is known to promote adaptive coping, its relationship with coping behaviors in cervical cancer patients remains underexplored, and the potential moderating role of illness perception in this association has not been established.
AIM
To explore the relationship between psychological flexibility and cancer coping behaviors in patients with cervical cancer, and to analyze the moderating role of illness perception in this relationship.
METHODS
A convenience sampling method was used to select 216 patients with cervical cancer for inclusion in this study. The Multidimensional Psychological Flexibility Inventory-24, Cancer Behavior Scale-3.0, and Brief Illness Perception Questionnaire were used for data collection. SPSS 26.0 software was applied for descriptive statistics, Pearson correlation analysis, and hierarchical regression analysis were also performed.
RESULTS
The total psychological flexibility score in patients with cervical cancer was 65.32 ± 10.25. The score of the positive coping dimension in cancer coping behaviors was 38.67 ± 7.54, and the score of the negative coping dimension was 25.43 ± 6.89. The total illness perception score was 42.15 ± 8.36. Pearson correlation analysis showed that psychological flexibility was significantly positively correlated with positive coping behaviors (r = 0.452, P < 0.05), and significantly negatively correlated with negative coping behaviors (r = -0.387, P < 0.05). Illness perception was significantly positively correlated with negative coping behaviors (r = 0.324, P < 0.05), and significantly negatively correlated with psychological flexibility (r = -0.298, P < 0.05). Hierarchical regression analysis showed that after controlling for demographic variables, psychological flexibility significantly positively predicted positive coping behaviors (β = 0.396, P < 0.05) and significantly negatively predicted negative coping behaviors (β = -0.342, P < 0.05). Illness perception played a significant moderating role in the relationship between psychological flexibility and negative coping behaviors (β = 0.187, P < 0.05), but had no significant moderating effect on the relationship between psychological flexibility and positive coping behaviors (β = 0.093, P > 0.05).
CONCLUSION
Higher levels of psychological flexibility in patients with cervical cancer are associated with a greater tendency to adopt positive coping behaviors. Illness perception enhances the effect of psychological flexibility on negative coping behaviors.
Core Tip: This study examines the relationship between psychological flexibility and coping behaviors in cervical cancer patients, with illness perception as a moderator. Results show that higher psychological flexibility is associated with more positive coping and less negative coping. Illness perception significantly moderates the link between psychological flexibility and negative coping, suggesting that interventions targeting both factors may help reduce maladaptive coping responses in this population.
