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

Abstract

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.