Intolerance of uncertainty, experiential avoidance, and trust in physician: a moderated mediation analysis of emotional distress in advanced cancer
Open accessAbstract
We tested whether patients' trust in physician moderated the hypothesized indirect association between intolerance of uncertainty (IU; inability to tolerate the unknown) and emotional distress through the mediator, experiential avoidance (EA; efforts to avoid negative emotions, thoughts, or memories), in patients with advanced cancer. The sample included 108 adults with Stage III or IV cancer (53% female; M age = 63 years) recruited from a metropolitan cancer center. All constructs were measured by standardized self-report instruments. The PROCESS macro for SPSS tested the moderated mediation model. IU evidenced significant direct and indirect relationships with anxiety and depressive symptoms. Trust in physician moderated the indirect relationship between IU and anxiety (not depressive symptoms), albeit in an unexpected direction. Specifically, the indirect relationship between IU and anxiety symptoms through EA was significant for those with moderate to high physician trust but not low trust. Controlling for gender or income did not change the pattern of findings. IU and EA may be key intervention targets, particularly in acceptance-or meaning-based interventions for patients with advanced cancer.
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Experiential avoidance is an important predictor, mediator, and moderator for emotional distress and HRQoL in cancer patients.
“Experiential avoidance is also an important predictor, mediator, and moderator for emotional distress and HRQoL in cancer patients [13–15].”
From Peace, equanimity and acceptance in the cancer experience: validation of the German version (PEACE-G) and associations with mental health, health-related quality of life and psychological constructs (2024) · cites this paper as [14]
The Introduction (Social Cognitive Processing Theory; page unavailable) reports associations between experiential avoidance, distress, and quality of life in cancer populations. The Results (Moderated Mediation; page unavailable) find that experiential avoidance mediates associations with anxiety and depressive symptoms in patients with advanced cancer. But this study identifies trust in physician—not experiential avoidance—as the moderator, and it does not measure HRQoL as an outcome. (LLM, conf=0.88)
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- Authors
- Panjwani, A. A., Applebaum, A. J., Revenson, T. A., Erblich, J., & Rosenfeld, B.
- Affiliations
- University Health Network (CA)
- Memorial Sloan Kettering Cancer Center (US)
- City University of New York (US)
- Corresponding author
- Panjwani, Aliza A.
- Venue
- Journal of Behavioral Medicine
- Published
- 2023-06-07
- Volume
- 47
- Issue
- 1
- Pages
- 71-81
- ISSN
- 0160-7715 (ISSN-L)
- 1573-3521
- PMC
- PMC10942744
- OpenAlex
- W4379599573
- Cited by
- 17
- References
- 68
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 3 · 2023: 1
- FWCI
- 2.06
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- Journal of Behavioral Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (R21-186932)
- Memorial Sloan Kettering Cancer Center Support Grant (P30CA008748)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Keywords
- intolerance of uncertainty, experiential avoidance, trust in physicians, emotional distress, anxiety, depressive symptoms, advanced cancer, moderated mediation, acceptance-based interventions, psychological distress in cancer patients
- MeSH terms
- Psychological Distress, Mediation Analysis, Adult, Anxiety, Depression, Female, Humans, Male, Middle Aged, Neoplasms, Physicians, Uncertainty, Trust
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