Exploring psychological distress, appraisal, and coping during the scan result journey: a qualitative study of young and middle-aged Chinese adults with advanced cancer

Scan-related distress is common in patients with advanced cancer. Young and middle-aged Chinese patients influenced by Confucian culture and identity stages may experience unique psychological distress following the scans. To investigate the psychological distress and coping strategies in young and middle-aged Chinese patients with advanced cancer during the period from the scan result waiting phase to disclosure. A descriptive qualitative method guided by Lazarus and Folkman’s stress and coping theory was used. Nineteen young and middle-aged patients with advanced cancer participated in semi-structured interviews, and data were analyzed using direct content analysis. The scan results journey was perceived as a threat by patients, generating various emotional distress, including “waiting anxiety,” confusion regarding imaging reports, and acute or chronic reactions. Resource assessment involves a tendency toward self-reliance, ambivalence toward family support, and a perception of the internet as an accessible yet untrustworthy resource. Ultimately, both emotion-oriented coping strategies, such as spiritual coping, cognitive reframing, and emotional suppression, and problem-oriented approaches, including seeking explanations and repeated confirmation, deliberately distancing themselves from result disclosure, and surrendering autonomy in scan management, were employed to alleviate psychological distress. Under the influence of Confucian philosophy and social identity, young and middle-aged patients demonstrated self-resilience in the scan results journey. While some coping strategies alleviated emotional distress in the short term, their prolonged use risks suppressing negative emotions and delaying treatment. Future initiatives should prioritize the early identification of scan-related emotional distress and the development of culturally sensitive psychological support interventions.