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Peer-reviewedCC BY 4.0BMC Psychology

The relationship between preoperative anxiety, self-efficacy, and positive coping style in lung cancer patients undergoing video-assisted thoracoscopic surgery: a cross-sectional study

  • Shuai Zhang1
  • Liurong Cheng2
  • Honghua Guo3
  • Zi’ping Wang2
  • Yili Li4
  • lu Qiao5
  • Andie Chen5
  • Chuxia Lai3
  • Jiaqi Li2
  • Xing Gao3
  • Zhaohao He2
5 affiliations
  1. 1Nursing Department, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University ), Haikou, Hainan China
  2. 2Department of the Operation room, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University ), Haikou, Hainan China
  3. 3Nursing School, Hainan Medical University, Haikou, Hainan Province China
  4. 4Thoracic Department, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University ), Haikou, Hainan China
  5. 5School of Clinical Medicine, Hainan Medical University, Haikou, Hainan Province China
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Abstract

Background : Patients with lung cancer undergoing video-assisted thoracoscopic surgery (VATS) may experience preoperative anxiety arising from cancer-related uncertainty and surgery-related concerns. Although VATS is less invasive than conventional thoracotomy, patients may still worry about malignancy, prognosis, anaesthesia, postoperative recovery, and long-term health. General self-efficacy and positive coping style are potentially modifiable psychological resources associated with preoperative anxiety, but their interrelationships and the potential indirect role of positive coping style remain insufficiently understood.

Materials and methods: This cross-sectional study recruited patients with lung cancer scheduled for VATS from a large tertiary grade-A general hospital in Hainan Province, China, between April 2023 and October 2024. Preoperative anxiety, general self-efficacy, and positive coping style were assessed using validated questionnaires. A total of 387 valid questionnaires were analysed. Descriptive statistics, group comparisons, Spearman’s correlation analysis, structural equation modelling, and Bootstrap mediation analysis were performed using SPSS 26.0 and AMOS.

Results : A total of 387 valid questionnaires were included in the analysis, yielding a valid response rate of 89.38%. The mean scores of preoperative anxiety, general self-efficacy, and positive coping style were 34.88 ± 13.54 out of 64, 22.21 ± 5.95 out of 40, and 19.57 ± 7.30 out of 36, respectively, with corresponding standardized scores of 54.50%, 55.53%, and 54.36%. Spearman’s correlation analysis showed that preoperative anxiety was negatively correlated with general self-efficacy (r=-0.384, P < 0.01) and positive coping style (r=-0.415, P < 0.01), while general self-efficacy was positively correlated with positive coping style (r = 0.642, P < 0.01). In the structural equation model, general self-efficacy was positively associated with positive coping style (β = 0.795, P < 0.001), and positive coping style was negatively associated with preoperative anxiety (β=-0.294, P = 0.006). The direct path from general self-efficacy to preoperative anxiety was not statistically significant (β=-0.154, P = 0.131).

Conclusion: This cross-sectional study documented preoperative anxiety among patients with lung cancer awaiting VATS, together with relatively low levels of general self-efficacy and positive coping style. The observed indirect-only statistical mediation pattern suggests that general self-efficacy was indirectly associated with lower preoperative anxiety through positive coping style. This pattern extends the understanding of psychological factors associated with preoperative anxiety and may inform combined assessment of anxiety, self-efficacy, and coping responses, as well as targeted preoperative support aimed at strengthening patients’ confidence, improving their understanding of perioperative information, and encouraging positive coping.

Clinical trial number : Not applicable.

Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s40359-026-05324-5.

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Cite

BibTeXRIS
BibTeX
@article{zhang2026relationship,
  title = {{The relationship between preoperative anxiety, self-efficacy, and positive coping style in lung cancer patients undergoing video-assisted thoracoscopic surgery: a cross-sectional study}},
  author = {Shuai Zhang and Liurong Cheng and Honghua Guo and Zi’ping Wang and Yili Li and lu Qiao and Andie Chen and Chuxia Lai and Jiaqi Li and Xing Gao and Zhaohao He},
  journal = {BMC Psychology},
  year = {2026},
  month = aug,
  doi = {10.1186/s40359-026-05324-5},
  url = {https://doi.org/10.1186/s40359-026-05324-5},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - The relationship between preoperative anxiety, self-efficacy, and positive coping style in lung cancer patients undergoing video-assisted thoracoscopic surgery: a cross-sectional study
AU  - Shuai Zhang
AU  - Liurong Cheng
AU  - Honghua Guo
AU  - Zi’ping Wang
AU  - Yili Li
AU  - lu Qiao
AU  - Andie Chen
AU  - Chuxia Lai
AU  - Jiaqi Li
AU  - Xing Gao
AU  - Zhaohao He
PY  - 2026
DA  - 2026/08/10
JO  - BMC Psychology
DO  - 10.1186/s40359-026-05324-5
UR  - https://doi.org/10.1186/s40359-026-05324-5
AB  - Background : Patients with lung cancer undergoing video-assisted thoracoscopic surgery (VATS) may experience preoperative anxiety arising from cancer-related uncertainty and surgery-related concerns. Although VATS is less invasive than conventional thoracotomy, patients may still worry about malignancy, prognosis, anaesthesia, postoperative recovery, and long-term health. General self-efficacy and positive coping style are potentially modifiable psychological resources associated with preoperative anxiety, but their interrelationships and the potential indirect role of positive coping style remain insufficiently understood.  Materials and methods: This cross-sectional study recruited patients with lung cancer scheduled for VATS from a large tertiary grade-A general hospital in Hainan Province, China, between April 2023 and October 2024. Preoperative anxiety, general self-efficacy, and positive coping style were assessed using validated questionnaires. A total of 387 valid questionnaires were analysed. Descriptive statistics, group comparisons, Spearman’s correlation analysis, structural equation modelling, and Bootstrap mediation analysis were performed using SPSS 26.0 and AMOS.  Results : A total of 387 valid questionnaires were included in the analysis, yielding a valid response rate of 89.38%. The mean scores of preoperative anxiety, general self-efficacy, and positive coping style were 34.88 ± 13.54 out of 64, 22.21 ± 5.95 out of 40, and 19.57 ± 7.30 out of 36, respectively, with corresponding standardized scores of 54.50%, 55.53%, and 54.36%. Spearman’s correlation analysis showed that preoperative anxiety was negatively correlated with general self-efficacy (r=-0.384, P < 0.01) and positive coping style (r=-0.415, P < 0.01), while general self-efficacy was positively correlated with positive coping style (r = 0.642, P < 0.01). In the structural equation model, general self-efficacy was positively associated with positive coping style (β = 0.795, P < 0.001), and positive coping style was negatively associated with preoperative anxiety (β=-0.294, P = 0.006). The direct path from general self-efficacy to preoperative anxiety was not statistically significant (β=-0.154, P = 0.131).  Conclusion: This cross-sectional study documented preoperative anxiety among patients with lung cancer awaiting VATS, together with relatively low levels of general self-efficacy and positive coping style. The observed indirect-only statistical mediation pattern suggests that general self-efficacy was indirectly associated with lower preoperative anxiety through positive coping style. This pattern extends the understanding of psychological factors associated with preoperative anxiety and may inform combined assessment of anxiety, self-efficacy, and coping responses, as well as targeted preoperative support aimed at strengthening patients’ confidence, improving their understanding of perioperative information, and encouraging positive coping.  Clinical trial number : Not applicable.  Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s40359-026-05324-5.
SN  - 2050-7283
ER  -