Decision conflict, psychological resilience, and financial toxicity in early-stage non-small-cell lung cancer in China: A latent profile and mediation analysis

AbstractObjective The aim of this study is to investigate the potential profile of decision-making conflicts in early-stage non-small cell lung cancer (NSCLC) patients, and to explore the mediating role of financial toxicity between psychological resilience and decision-making conflicts. Methods A cross-sectional survey was conducted to analyze 310 patients with early-stage NSCLC who visited a tertiary Grade A oncology hospital in Beijing, China from August 2023 to April 2024. General information questionnaires, the Cancer Specific Resilience Scale (RS-SC), the Decision Conflict Scale (DCS), and the COST-PROM were collected. Results Decision conflict among early-stage NSCLC patients was classified into three subgroups: 44.5% of patients exhibited low decision conflict (mean score 10.97 ± 1.73), 30.3% exhibited moderate decision conflict (mean score 18.21 ± 2.89), and 25.2% exhibited high decision conflict (mean score 23.90 ± 3.31). Independent factors associated with decision conflict included lower education level, lower monthly income, unemployment, and participation in the New Rural Cooperative Medical Insurance (all P β = -0.162, P = 0.004), as was the indirect effect through financial toxicity (β = -0.041, P = 0.017). Financial toxicity accounted for 18.1% of the total mediation effect. Conclusions Early-stage NSCLC experience varying degrees of decision conflict. Financial toxicity plays a partial mediating role between psychological resilience and decision conflict. Interventions aimed at reducing financial toxicity may improve psychological resilience and reduce decision conflict in these patients.