Communication techniques in psychological nursing for thoracic cancer patients: Key to enhanced psychological adaptation
Abstract
This systematic review investigates the critical role of communication techniques in psychological nursing care for thoracic cancer patients and their impact on psychological adaptation. Through comprehensive analysis of literature and health data from PubMed, PsycINFO, and public databases (Surveillance, Epidemiology, and End Results, National Health and Nutrition Examination Survey, Inter-University Consortium for Political and Social Research), we synthesized evidence from nonexperimental clinical observations and cross-sectional studies. The analysis revealed that empathetic communication, information transparency, and nonverbal support significantly improve patient anxiety (reduction: –45.6%, p < 0.001), depression (Hospital Anxiety and Depression Scale [HADS] score improvement: –42.3%, p < 0.001), and treatment adherence (89.5% in high-quality communication groups). Structural equation modeling demonstrated that patient-centered communication strategies enhance psychological resilience, with self-efficacy mediating 42.3% of adaptation outcomes (95% CI: 38.7%–45.9%). Furthermore, culturally sensitive communication and family involvement emerged as key elements in long-term adaptive interventions, with triadic communication patterns showing substantial benefits in reducing family anxiety (mean difference: –2.8 points, p < 0.001). These findings provide evidence-based guidance for optimizing clinical psychological care pathways.
Copyright (c) 2025 Xiaoxia Meng

This work is licensed under a Creative Commons Attribution 4.0 International License.
References
1. Siegel RL, Giaquinto AN, Jemal A. Cancer statistics, 2024. CA: A Cancer Journal for Clinicians. 2024; 74(1): 12–49. doi: 10.3322/caac.21820
2. SEER Cancer Stat Facts: Lung and Bronchus Cancer. National Cancer Institute. Available online: https://seer.cancer.gov/statfacts/
3. html/lungb.html
4. New lung cancer treatments aim to reduce deaths in 2025 and beyond. Available online: https://www.mskcc.org/news/
5. new-lung-cancer-treatments-aim-to-reduce-deaths-in-2025-and-beyond
6. Sanft T, Day A, Ansbaugh S, et al. NCCN guidelines® insights: Survivorship, version 1.2023. Journal of the National Comprehensive Cancer Network. 2023; 21(8): 792–803. doi: 10.6004/jnccn.2023.0041
7. Andersen BL, Goyal NG, Westbrook TD, et al. Trajectories of stress, depressive symptoms, and immunity in cancer survivors: diagnosis to 5 years. Clinical Cancer Research. 2017; 23(1): 52–61. doi: 10.1158/1078-0432.CCR-16-0574
8. Smith AB, Armes J, Richardson A, et al. Psychological distress in cancer survivors: The further development of an item bank. Psychooncology. 2013; 22(2): 308–314. doi: 10.1002/pon.2090
9. Kuczmarski TM, Tramontano AC, Mozessohn L, et al. Mental health disorders and survival among older patients with diffuse large B-cell lymphoma in the USA: A population-based study. Lancet Haematology. 2023; 10(7): e530–e538. doi: 10.1016/S2352-3026(23)00094-7
10. Zebrack B, Burg MA, Vaitones V. Distress screening: An opportunity for enhancing quality cancer care and promoting
11. the oncology social work profession. Journal of Psychosocial Oncology. 2012; 30(6): 615–624. doi: 10.1080/
12. 2012.721485
13. Li M, Kennedy EB, Byrne N, et al. Systematic review and meta-analysis of collaborative care interventions for depression in patients with cancer. Psychooncology. 2017; 26(5): 573–587. doi: 10.1002/pon.4286
14. Moore JX, Andrzejak SE, Bevel MS, et al. Exploring racial disparities on the association between allostatic load and cancer mortality: A retrospective cohort analysis of NHANES, 1988 through 2019. SSM - Population Health. 2022; 19: 101185. doi: 10.1016/j.ssmph.2022.101185
15. Petrova D, Catena A, Rodríguez-Barranco M, et al. Physical comorbidities and depression in recent and long-term adult cancer survivors: NHANES 2007–2018. Cancers. 2021; 13(13): 3368. doi: 10.3390/cancers13133368
16. Lee H, Singh GK. The association between psychological distress and cancer mortality in the United States: Results from the 1997–2014 NHIS-NDI record linkage study. Annals of Behavioral Medicine. 2021; 55(7): 621–640. doi: 10.1093/abm/kaaa111
17. Bu H, Lv M, Wang L, et al. Inverse association of oxidative balance score with depression and specific depressive symptoms among cancer population: Insights from the NHANES (2005–2020). PLoS ONE. 2025; 20(1): e0316819. doi: 10.1371/journal.pone.0316819
18. Yao J, Chen X, Meng F, et al. Combined influence of nutritional and inflammatory status and depressive symptoms on mortality among US cancer survivors: Findings from the NHANES. Brain, Behavior, and Immunity. 2024; 115: 109–117. doi: 10.1016/j.bbi.2023.10.002
19. Von Wagner C, Good A, Whitaker KL, et al. Psychosocial determinants of socioeconomic inequalities in cancer screening participation: A conceptual framework. Epidemiological Review. 2011; 33: 135–147. doi: 10.1093/epirev/mxq018
20. Laidsaar-Powell RC, Butow PN, Bu S, et al. Physician–patient–companion communication and decision-making: A systematic review of triadic medical consultations. Patient Education and Counseling. 2013; 91(1): 3–13. doi: 10.1016/j.pec.2012.11.007
21. Forsythe LP, Kent EE, Weaver KE, et al. Receipt of psychosocial care among cancer survivors in the United States. Journal of Clinical Oncology. 2013; 31(16): 1961–1969. doi: 10.1200/JCO.2012.46.2101
22. Kent EE, Forsythe LP, Yabroff KR, et al. Are survivors who report cancer-related financial problems more likely to forgo or delay medical care?. Cancer. 2013; 119(20): 3710-3117. doi: 10.1002/cncr.28262
23. Palmer NRA, Kent EE, Forsythe LP, et al. Racial and ethnic disparities in patient-provider communication, quality-of-care ratings, and patient activation among long-term cancer survivors. Journal of Clinical Oncology. 2014; 32(36): 4087–4094. doi: 10.1200/JCO.2014.55.5060
24. Yabroff KR, Zhao J, Han X, et al. Prevalence and correlates of medical financial hardship in the USA. Journal of General Internal Medicine. 2019; 34(8): 1494–1502. doi: 10.1007/s11606-019-05002-w
25. Sheard T, Maguire P. The effect of psychological interventions on anxiety and depression in cancer patients: Results of two meta-analyses. British Journal of Cancer. 1999; 80(11): 1770–1780. doi: 10.1038/sj.bjc.6690596
26. Chen M, Huang Y, Zhang J, et al. Impact of preoperative anxiety on postoperative outcomes in patients undergoing minimally invasive thoracoscopic surgery: A prospective cohort study. European Journal of Surgical Oncology. 2024; 50(10): 108605. doi: 10.1016/j.ejso.2024.108605
27. Chen Y, Lin F, Wang B, et al. The development and validation of the psychological needs of cancer patients scale. Frontiers in Psychology. 2021; 12: 658989. doi: 10.3389/fpsyg.2021.658989
28. Cheng X, Wei S, Zhang H, et al. Nurse-led interventions on quality of life for patients with cancer: A meta-analysis. Medicine (Baltimore). 2018; 97(34): e12037. doi: 10.1097/MD.0000000000012037
29. Moore PM, Rivera Mercado S, Grez Artigues M, et al. Communication skills training for healthcare professionals working with people who have cancer. Cochrane Database of Systematic Reviews. 2013; 2013(3): Cd003751. doi: 10.1002/14651858.CD003751.pub3
30. Wolf MS, Chang CH, Davis T, et al. Development and validation of the communication and attitudinal self-efficacy scale for cancer (CASE-cancer). Patient Education and Counseling. 2005; 57(3): 333–341. doi: 10.1016/j.pec.2004.09.005
31. Seyedfatemi N, Ghezeljeh TN, Bolhari J, et al. Effects of family-based dignity intervention and expressive writing on anticipatory grief of family caregivers of patients with cancer: A study protocol for a four-arm randomized controlled trial and a qualitative process evaluation. Trials. 2021; 22(1): 751. doi: 10.1186/s13063-021-05718-3
32. Hu T, Xiao J, Peng J, et al. Relationship between resilience, social support as well as anxiety/depression of lung cancer patients: A cross-sectional observation study. Journal of Cancer Research & Therap. 2018; 14(1): 72–77. doi: 10.4103/jcrt.JCRT_849_17
33. Henoch I, Lövgren M. The influence of symptom clusters and the most distressing concerns regarding quality of life among patients with inoperable lung cancer. European Journal of Oncology Nursing. 2014; 18(3): 236–241. doi: 10.1016/j.ejon.2013.12.001
34. Fujiwara M, Inagaki M, Nakaya N, et al. Association between serious psychological distress and nonparticipation in cancer screening and the modifying effect of socioeconomic status: Analysis of anonymized data from a national cross-sectional survey in Japan. Cancer. 2018; 124(3): 555–562. doi: 10.1002/cncr.31086
35. Bilfinger TV, Albano D, Perwaiz M, et al. Survival outcomes among lung cancer patients treated using a multidisciplinary team approach. Clinical Lung Cancer. 2018; 19(4): 346–351. doi: 10.1016/j.cllc.2018.01.006
36. Zhang X, Meng K, Chen S. Competency framework for specialist critical care nurses: A modified Delphi study. Nursing in Critical Care. 2020; 25(1): 45–52. doi: 10.1111/nicc.12467
37. Gaertner J, Wolf J, Scheicht D, et al. Implementing WHO recommendations for palliative care into routine lung cancer therapy: A feasibility project. Journal of Palliative Medicine. 2010; 13(6): 727–732. doi: 10.1089/jpm.2009.0399
38. Liu N, Zhang L, Liu Y, et al. Relationship between self-psychological adjustment and post-traumatic growth in patients with lung cancer undergoing chemotherapy: A cross-sectional study. BMJ Open. 2024; 14(5): e081940. doi: 10.1136/bmjopen-2023-081940
39. Mirzaei Maghsud A, Abazari F, Miri S, et al. The effectiveness of empathy training on the empathy skills of nurses working in intensive care units. Journal of Research in Nursing. 2020; 25(8): 722–731. doi: 10.1177/1744987120902827
40. Roberts BW, Roberts MB, Yao J, et al. Development and validation of a tool to measure patient assessment of clinical compassion. JAMA Network Open. 2019; 2(5): e193976. doi: 10.1001/jamanetworkopen.2019.3976
41. Ankolekar A, Van Der Heijden B, Dekker A, et al. Clinician perspectives on clinical decision support systems in lung cancer: Implications for shared decision-making. Health Expectations. 2022; 25(4): 1342–1351. doi: 10.1111/hex.13457
42. Sella T, Botser D, Navon R, et al. Preferences for disclosure of disease related information among thoracic cancer patients. Lung Cancer. 2015; 88(1): 100–103. doi: 10.1016/j.lungcan.2015.01.021
43. Lin JJ, Mhango G, Wall MM, et al. Cultural factors associated with racial disparities in lung cancer care. Annals of the American Thoracic Society. 2014; 11(4): 489–495. doi: 10.1513/AnnalsATS.201402-055OC
44. Surbone A. Cultural aspects of communication in cancer care. Support Care Cancer. 2008; 16(3): 235–240. doi: 10.1007/s00520-007-0366-0
45. Kugler C, Tegtbur U, Gottlieb J, et al. Health-related quality of life in long-term survivors after heart and lung transplantation: A prospective cohort study. Transplantation. 2010; 90(4): 451–457. doi: 10.1097/TP.0b013e3181e72863
46. Hoffman KE, Mccarthy EP, Recklitis CJ, et al. Psychological distress in long-term survivors of adult-onset cancer: Results from a national survey. Archives of Internal Medicine. 2009; 169(14): 1274–1281. doi: 10.1001/archinternmed.2009.179
47. Wang G, Antel R, Goldfarb M. The impact of randomized family-centered interventions on family-centered outcomes in the adult intensive care unit: A systematic review. Journal of Intensive Care Medicine. 2023; 38(8): 690–701. doi: 10.1177/08850666231173868
48. Esmaeilzadeh P. The impacts of the perceived transparency of privacy policies and trust in providers for building trust in health information exchange: Empirical study. JMIR Medical Informatics. 2019; 7(4): e14050. doi: 10.2196/14050
49. Kemper KJ, Shaltout HA. Non-verbal communication of compassion: Measuring psychophysiologic effects. BMC Complementary and Alternative Medicine. 2011; 11(1): 132. doi: 10.1186/1472-6882-11-132
50. Abdulghafor R, Turaev S, Ali M a H. Body language analysis in healthcare: An overview. Healthcare (Basel). 2022, 10(7): 1251. doi: 10.3390/healthcare10071251
51. Montes De Oca MK, Wilson LE, Previs RA, et al. Healthcare access dimensions and guideline-concordant ovarian cancer treatment: SEER-medicare analysis of the ORCHiD study. Journal of the National Comprehensive Cancer Network. 2022; 20(11): 1255–1266.e11. doi: 10.6004/jnccn.2022.7055
52. Schumacher RC, Nguyen OK, Deshpande K, et al. Evidence-based medicine and the american thoracic society clinical practice guidelines. JAMA Internal Medicine. 2019; 179(4): 584–586. doi: 10.1001/jamainternmed.2018.7461
53. Gartner JB, Côté A. Optimization of care pathways through technological, clinical, organizational and social innovations:
54. A qualitative study. Health Services Insights. 2023; 16: 11786329231211096. doi: 10.1177/11786329231211096
