Abstract
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; Mage = 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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Data supporting findings from the study may be available upon reasonable request.
Notes
Given that women reported more anxiety than men and lower income was associated with greater EA and emotional distress, study analyses that yielded significant findings—namely, the conditional process analysis for anxiety and simple mediation for depressive symptoms—were recomputed with sex and income as added covariates. There was both a direct and indirect association between IU and anxiety symptoms, even after controlling for income and gender in the conditional process model. Specifically, among patients with high trust in physician, the relationship between IU and anxiety was mediated by EA. No indirect effects were observed at low or average trust in physician. There was a similar direct and indirect association between IU and depressive symptoms, even with the added covariates. As only 78 individuals provided data on income and since the pattern of findings remained the same when gender and income were added to analyses described above, we report data on the full sample in the body of the paper.
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Financial support for this study was received by the National Institutes of Health (NIH; R21:186932, Rosenfeld, PhD) and Memorial Sloan Kettering Cancer Center Grant (P30CA008748, Thompson, MD).
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The primary author, Dr. Panjwani, was responsible for conception of the sub-study, data analysis, original draft preparation and editing. Dr. Rosenfeld acquired funding. Drs. Applebaum and Rosenfeld’s study teams were responsible for data collection. Feedback on earliest versions of the manuscript and data analysis protocols was provided by Drs. Revenson and Erblich. All authors commented on previous versions of the manuscript and approved the final manuscript.
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Panjwani, A.A., Applebaum, A.J., Revenson, T.A. et al. Intolerance of uncertainty, experiential avoidance, and trust in physician: a moderated mediation analysis of emotional distress in advanced cancer. J Behav Med 47, 71–81 (2024). https://doi.org/10.1007/s10865-023-00419-5
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DOI: https://doi.org/10.1007/s10865-023-00419-5