# The impact of death literacy on self-management behaviors in gastric cancer patients: the chain mediating role of psychological adaptation and cognitive reappraisal

## TL;DR

Higher death literacy in gastric cancer patients improves self-management through better psychological adaptation and positive thinking.

## Contribution

This study identifies a chain mediation mechanism linking death literacy to self-management via psychological adaptation and cognitive reappraisal.

## Key findings

- Death literacy was strongly correlated with self-management behaviors (r = 0.495).
- Psychological adaptation and cognitive reappraisal mediated the relationship between death literacy and self-management.
- The sequential mediation pathway explained 59.75% of the total effect.

## Abstract

Death literacy—defined as the knowledge, skills, and attitudes that enable individuals to understand, communicate, and act effectively on issues related to death, dying, and bereavement—plays an important role in cancer patients' psychological regulation and coping behaviors. However, empirical evidence linking death literacy to self-management behaviors in gastric cancer patients remains limited.

This study employed a cross-sectional design and used convenience sampling to recruit 501 gastric cancer patients from three tertiary Grade A hospitals in Zhejiang Province between August and September 2025. All participants completed the Death Literacy Scale, Self-Management Scale, Psychological Adaptation Scale, and Cognitive Reappraisal Scale. Process Model 6 was used to analyze the chain mediating effects of psychological adaptation and cognitive reappraisal.

Death literacy was positively correlated with self-management behaviors (r = 0.495, p < 0.001). Bootstrapping analysis confirmed significant indirect effects via psychological adaptation [β = 0.109, SE = 0.037, 95% CI = (0.036, 0.181)] and cognitive reappraisal [β = 0.106, SE = 0.029, 95% CI = (0.054, 0.170)], as well as a significant sequential mediation pathway [β = 0.068, SE = 0.018, 95% CI = (0.031, 0.102)], jointly explaining 59.75% of the total effect. The results suggest that higher death literacy enhances psychological adaptation and facilitates positive emotion regulation, thereby promoting active and sustained self-management behaviors.

Death literacy functions as a positive psychological resource contributing to adaptive coping and health management among gastric cancer patients. Strengthening patients' understanding and acceptance of death may improve psychological adaptation and cognitive reappraisal, ultimately fostering better self-management and quality of life.