Introduction

Breast cancer is one of the most common malignant tumors in the world and the main cause of death for women. According to the latest global cancer data released by the International Agency for Research on Cancer (IARC) of the World Health Organization in 2022, there are as many as 2.30 million new cases of breast cancer1. Meanwhile, breast cancer ranks first in the number of new cases and has become the fourth leading cause of death among female cancer in China. The current treatment of breast cancer is based on surgery combined with chemotherapy and radiotherapy and other comprehensive treatment methods. Although the cure technology improvement of breast cancer defend has significantly improved the survival rate of breast cancer patients (5-year survival rate is 90%, 10-year survival rate is 80%)2, which caused patients to experience more physical pain and psychological torture, which seriously affects the quality of life3. Therefore, healthcare practitioners should focus on breast cancer patients’ response to cancer trauma and adaptation, including physical, psychological, and social aspects, which is important to improve the quality of life4,5,6,7.

Research shows that social relationships are an important factor affecting the physical and mental health of patients, and can affect instrumental and emotional support for cancer patients8. Hou WK puts forward the concept of social relational quality based on the social and cultural background of Asian populations9. He believes that Asian people pay more attention to maintaining interpersonal and emotional health and harmonious relationships when coping with stress. Especially for Chinese patients who tend to be collectivist, the quality of social relationships is the core of their family and social life10. As a positive internal support force, ‘hope’ can encourage patients to overcome difficulties, relieve pain and stress. Hope is an important strategy for cancer patients to cope with the disease11. Studies have shown that breast cancer patients with high levels of hope can obtain a higher quality of life and are more satisfied with their social relationships12. In recent years, studies have confirmed that there is a certain correlation between the social relational quality and hope among breast cancer patients13, but the underlying psychological mechanism of them still needs further research.

The occurrence, development and prognosis of breast cancer are the result of physiological, psychological and social factors. The study showed that the psychological risk factor can induce tumors through physiological and immunological mechanisms, thereby reducing the therapeutic effect of cancer patients and affecting the development and prognosis of the disease trajectory14 According to the theoretical model proposed by Temoshok, the mainly important personality factors which can increase the psychological risk factors for breast cancer are emotional depression and compliance with others, that is type C personality, also known as ‘cancer susceptibility personality’15. Previous studies have shown that type C personality as a psychological risk factor can predict the prognosis of breast cancer16.However, the mechanism by which Type C personality as a psychological risk factor in cancer progression remains unclear, and previous studies have presented divergent perspectives. Some research has indicated that among breast cancer patients receiving postoperative chemotherapy, the detection rate of Type C behavior can reach 28%4. Due to physical disability and impaired self-esteem, breast cancer patients are more likely to show type C personality than other cancers17,18.Studies have shown that breast cancer patients with low scores on the Type C personality scale, indicating lower levels of Type C traits, are less likely to develop chemotherapy-related symptoms, and are better able to adapt to the adverse physical and mental effects of postoperative chemotherapy19,20.Conversely, other studies have suggested that there is no direct association between cancer prognosis and personality traits, which may be influenced by factors such as cancer type, treatment phase, and postoperative physical condition21,22.

As early as 1950, Grayson proposed the concept of acceptance of disability. It was further refined by Wright in 1960 depending on accepting the concept of loss, and gradually developed into a theory of individual subjective meaning of loss. It is understood from the following four dimensions that people’s reaction to loss and attitudes, including enlargement of scope of values, transformation from comparative values to asset values, containment of disability effect, and subordination of physique23. During the treatment of breast cancer patients, mastectomy will not only destroy the integrity of the body, but also reduce the unique charm of women and significantly increase the physical and mental burden of the patient3. Studies have shown that psycho-social factors have a significant predictive effect on the acceptance of disability among breast cancer patients, including the social relational quality and medical coping styles6. Therefore, in-depth exploration of the relationship between type C personality and disability acceptance is essential for understanding and determining strategies for the mental health of breast cancer patients.

Medical coping styles mainly include three coping strategies, which are confrontation, avoidance, acceptance-Resignation. Studies have found that confrontation and acceptance-resignation can be used as predictors of the degree of disability adaptation of breast cancer patients6. Previous studies have shown that in the trajectory of breast cancer disease, coping styles have a certain correlation with personality traits24. And the coping style also shows a better predictive effect in the path relationship mediated by the hope, psychological flexibility, acceptance of disability and quality of life of breast cancer patients25,26.

At present, whether medical coping styles serve as a mediating variable between hope and social relational quality, and whether medical coping styles as a mediating pathway for the influence of Type C personality on disability acceptance, have not been verified in the Chinese breast cancer patient population6,13.Therefore, this study aims to clarify the direct and indirect relationship between breast cancer patients’ hope, type C personality, social relational quality, and acceptance of disability, and to explore the mediation mechanism of medical coping styles in breast cancer patients. This study is based on Folkman’s “the stress and coping model”, which highlights the dynamic psychological processes involved in disease adaptation, following the pathway of “cognitive appraisal → coping strategies → adaptation outcomes.” Within this framework, the hop e (as a positive psychological resource) and Type C personality (characterized by emotional suppression and compliance) are used as pre-variables of patients’ cognitive appraisal, with medical coping styles as a mediator. These appraisals may lead to different medical coping styles, which in turn affect patients’ ADS and SRQS27. Based on the existing theoretical frameworks and empirical studies, we hypothesized that an ideal level of hope can improve the social relational quality of breast cancer patients through active coping. While breast cancer patients with a type C personality can adopt acceptance-resignation, thereby weakening the degree of adaptation to physical and functional disability caused by surgery (Fig. 1 for the structural model).

Fig. 1
Fig. 1The alternative text for this image may have been generated using AI.
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A structural model of the impact of hope, type C personality, and medical coping styles on the quality of breast cancer survivors’ social relationships and acceptance of disability. The mediation model with standardized parameter estimates and standard errors in parentheses. Solid lines indicate significant paths at p < 0.05**

Methods

Participants and procedure

According to Kendall 28 sample size estimation method, the sample size is usually 5–10 times the number of variables. A total of 25 variables were included in this study, and the sample size should range from 125–250, which meets the data requirement of at least 100–200 samples for the analysis of intermediary effects proposed by Zhonglin Wen et al.29. In addition, considering the unqualified rate of 20%, the final sample size should be 120–240 samples. We used convenience sampling to recruit 150 breast cancer patients from December 2023 to December 2024 in the breast surgery ward in the affiliated Hospital of Harbin Medical University. In the process of recruiting, clinical nurses in the wards of hospitals were responsible for relatively accurate initial screening of potential eligible participants among breast cancer patients and guided the researchers to establish good interpersonal relationships with breast cancer patients. Then, patients with breast cancer who met the inclusion and exclusion criteria were briefed on the purpose and significance of the survey. Inclusion criteria were: (1) diagnosed pathologically as breast cancer, and is undergoing postoperative chemotherapy for breast cancer, (2) female patients ≥ 18 years of age, (3) ability to read Chinese. Exclusion criteria were: (1) Past history of mental illness, severe mental or cognitive dysfunction, (2) accompanied by severe physical illness or past other malignant tumors and recurrence, (3) type of surgery patients who take breast-conserving conservative treatment. 141 patients of 150 (94%) patients admitted to the hospital were eligible and agreed to participate in the study (9 patients were excluded).

Ethical approval

The study was conducted in accordance with the Declaration of Helsinki guidelines and received approval from the Research Ethics Committee at Harbin Medical University (Approval No: KY2019-0118). Before the survey, the researchers were strictly trained by the systematic course and training for master students, staff and faculty. During the survey, the researchers explained the purpose and significance of the survey to the patients. After obtaining the patient’s informed consent, they used a unified instruction to explain the questionnaire filling method and precautions to the patients.

Measurement

Personal information questionnaire

Designed by the researcher according to the research purpose and the characteristics of the disease, which including age, education, marital status and other demographic and sociological data.

Herth hope index

The Herth hope index (HHI) was compiled by Herth in 199130. The Chinese version of the scale was introduced in 1999 by the translation of Haiping Zhao from China and has been validated in Chinese populations, demonstrated good test–retest reliability (0.92) and construct validity (0.85)31. The 12-item scale has 3 subscales: temporality and future (T), positive readiness and expectancy (P), and interconnectedness (I). Using the Likert 4-level scoring method, each item is rated from 1 (strongly disagree) to 4 (strongly agree) and total score ranges from 12 to 48, with higher score reflecting greater hope. It includes three grades: Low (12 ~ 23), medium (24 ~ 35), and high (36 ~ 48).The Cronbach’s α for HHI was 0.867, indicating good internal consistency.

Type C behavior scale

Designed by Temoshok and introduced to China by Yan Hua et al.S32. There are 16 items of C-type behavior pattern questionnaire, and the score range is 0–16 points. The higher the score, the more obvious the type C personality behavior tendency, and the incidence, recurrence and metastasis rate of cancer are significantly increased. It has been widely used in patients after breast cancer surgery. The Cronbach’s α coefficient of this questionnaire is 0.785 .

Medical coping modes questionnaire

The Medical Coping Modes Questionnaire (MCMQ) compiled by Feifei in 1987 33, the Chinese version was revised by Qianjin Jiang 34. It has been widely used to assess patient coping patterns, including 20 items under the three dimensions of confrontation, avoidance, and acceptance-resignation. Each item is scored using a 4-point Likert rating that ranges from 1(never) to 4 (very much). The higher the cumulative score of each subscale dimension of the patients tend to choose this coping style. On the contrary, lower scores on each subscale dimension indicated that patients were less inclined to this coping style. For our study, the Cronbach’s α of the three subscales in Chinese breast cancer patients are 0.803, 0.723, 0.743, and the corresponding test–retest reliabilities were 0.64, 0.85, and 0.67, indicating acceptable internal consistency and temporal stability. The Chinese version has been validated, demonstrating good content validity34.

Social relational quality scale

The Social Relational Quality Scale (SRQS) was designed by Hou to assess the quality of social relationships in social processes9.. This 17-item scale is scored using a 4-point Likert scale that ranges from 1 = strongly disagree to 4 = strongly agree. It addresses the three dimensions of family intimacy, family commitment, and friendships, with higher scores representing higher levels of social relational quality. In Chinese breast cancer patients, the Cronbach’s α for the scale was 0.855, and the test–retest reliability was 0.90, indicating good internal consistency and temporal stability9.

Acceptance of disability scale

Linkowski compiled the acceptance of disability scale (ADS) based on the theory of loss of acceptance in 1971 in order to describe the individual’s attitude towards disability, and in 2007 it was revised by Darlene. The Chinese version of the scale was revised by Ni Chen et al. 35. The 32-item scale has 4 subscales: enlargement of scope of values, transformation from comparative values to asset values, containment of disability effect, and subordination of physique. The ADS is scored using a 4-point scale ranging from ‘strongly disagree’ (1) to ‘strongly agree’ (4), with higher scores indicating a higher level of ADS. The content validity index (CVI) of the total scale is 0.919, and the Cronbach’s alpha of ADS is 0.905 in our study, indicating good internal consistency and temporal stability35.

Data analysis

Using Epidata 3.1 for single and double data entry can ensure the accuracy of data entry. The SPSS24.0 and AMOS24.0 statistical software packages are used to process and analyze the data. The measurement data is described by the mean and standard deviation (M ± SD) is expressed. Perform descriptive statistics and correlation in SPSS24.0 to identify potential covariates. Examine the relationship between outcome variables (The Social Relational Quality(SRQS) and Acceptance of Disability(ADS)), pre-variables (hope, type C personality), and medical coping styles. Path analyses were conducted using AMOS24.0 with maximum likelihood estimation. Model fit was accessed with the chi-square estimate, normed fit index (NFI), comparative fit index (CFI), Tucker-Lewis index (TLI), and the root mean square error of approximation (RMSEA). Model fit is deemed to be satisfactory if a CFI and TLI greater than 0.95 and an RMSEA less than 0.05 36. Indirect effects were assessed using the bootstrap procedure with bias-corrected 95% CIs.

Results

Participant characteristics

A total of 141 breast cancer patients participated in this study. Table 1 presents the detailed sample characteristics. Among them, 20.57% were under 45 years old, 60.99% were between 45 and 59 years, and 18.44% were 60 years or older.

Table 1 Participant characteristics (n = 141).
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Descriptive statistic and correlations

The score of SRQS of breast cancer patients during chemotherapy was 54.49 (SD = 5.84), and the total mean score of ADS of breast cancer patients during chemotherapy was 82.21 (SD = 11.21), which was at a moderate level. Breast cancer patients’ hope, confrontation and social relational quality are all positively correlated (P < 0.05), type C personality and acceptance-resignation are significantly positively correlated (P < 0.01), and negatively correlated with ADS (P < 0.01), more details are in Table 2. There is no correlation between the avoidance and each variable, so it does not enter the structural equation model.

Table 2 Descriptive statistics and bivariate correlation for the variables of interest.
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Path analysis

Based on the above-mentioned results of the analysis of variables and literature review, the hope and type C personality are used as pre-variables. Confrontation and acceptance-resignation in medical coping styles are used as intermediary variables. The SRQS and ADS are used as outcome variables to build a structural equation model. Before conducting the structural equation modeling analysis, a confirmatory factor analysis (CFA) was first performed to evaluate the measurement model. The results indicated that the standardized factor loadings of all latent variables were greater than 0.50, suggesting that the observed indicators adequately represented their corresponding latent constructs. In addition, the average variance extracted (AVE) values of all constructs exceeded 0.30, and the composite reliability (CR) values were all above 0.80, indicating good convergent validity of the measurement model.During the calculation process, the hypothetical model is corrected and fitted according to the standard correction index. Specifically, a correlated error path was added between the measurement errors of hope and Type C personality, which was theoretically justifiable given that both constructs may be jointly influenced by other underlying emotion regulation patterns. In addition, based on the path coefficient estimates, the non-significant structural path from Type C personality to avoidance coping was removed, while its direct effect on disability acceptance and other significant paths were retained. Results showed that the model had good fitness to the data, χ2 = 8.357, df = 7, P = 0.302, χ2/df = 1.194, GFI = 0.981, CFI = 0.991, TLI = 0.982, RMSEA = 0.037. All the path coefficients were significant.

According to the model results, the total effect of the hope of breast cancer patients and the SRQS (total effect β = 0.630, SE = 0.051, BC 95% CI = 0.526, 0.721) and (direct effect β = 0.604, SE = 0.053, BC 95% CI = 0.500, 0.702) both are significant. At the same time, confrontation as an intermediary factor between hope and SRQS (indirect effect β = 0.025, SE = 0.018, BC 95% CI = 0.001, 0.079). In addition, type C personality of breast cancer patients has a significant negative predictive effect on ADS (total effect β = - 0.378, SE = 0.065, BC 95% CI = - 0.507, -0.256). Among them, the positive predictive effect of type C personality on acceptance-resignation (direct effect β = 0.460, SE = 0.084, BC 95% CI = 0.288, 0.616), was significant. The negative predictive effect of acceptance-resignation on ADS (direct effect β = - 0.238, SE = 0.073, BC 95% CI = - 0.365, - 0.067) was significant. The indirect effect of type C personality on ADS through acceptance-resignation is (indirect effect β = - 0.109, SE = 0.036, BC 95% CI =- 0.188,- 0.044), and the acceptance-resignation as an intermediate factor can explain the effect of 28.9% on ADS. The results show that the medical coping style has a significant mediating effect in the relationship between the hope and the type C personality on the SRQS and ADS (Fig. 1 and Table 3).

Table 3 Total effects, indirect effects, direct effects among Hope, Type C personality, Medical coping modes, Social relational quality, Acceptance of disability.
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Bootstrapping was used to test the mediating effects, with 5,000 resamples. The results showed that in the relationship between hope and social relational quality, the direct effect of hope was 0.604 (95% CI 0.500–0.702), and the indirect effect was 0.025 (95% CI 0.001–0.079). As neither confidence interval included zero, confrontation was identified as a partial mediator. In the relationship between Type C personality and disability acceptance, the direct effect of Type C personality was -0.269 (95% CI -0.417— -0.143), and the indirect effect was –0.109 (95% CI -0.188— -0.044), with confidence intervals not including zero, indicating that acceptance–resignation played a partial mediating role(Table 3).

Discussions

This study investigated the relationship between the hope, type C personality on the SRQS and ADS among breast cancer patients, and the underlying psychological mechanisms. Consistent with our hypothesis, breast cancer patients with higher levels of hope tend to use more optimistic and rational confrontation strategies. These positive coping styles can improve the quality of their social relationships. Breast cancer patients with type C personality can significantly reduce their ability to adapt to physical disability and dysfunction when they adopt helplessness, disheartened and acceptance-resignation coping.

Among the 141 participants in this survey, the HHI total score is 37.11(SD = 4.38), which is at a high level of hope, with the same as the results of Zhang et al.37,38. Enhancing the hope belief of breast cancer patients can effectively reduce negative emotions and improve the quality of life of patients39. The total score of SRQS of breast cancer patients during chemotherapy is 54.49 (SD = 5.84), which is consistent with the studies of Hou in Hong Kong 9. Influenced by cultural factors, cancer patients in Asia—especially in mainland China—rely more on support from family and friends40. In contrast, patients in Western countries tend to focus more on the quality of partner relationships41. The reason may be that many breast cancer patients struggle to accept the physical changes after mastectomy, which can lead to feelings of inferiority. As a result, many women are reluctant to disclose their diagnosis or seek support outside their families. Therefore, most emotional support tends to come primarily from family members42,43.However, this reliance on family may limit patients’ effective use of external social resources, overlooking the potential benefits of support from friends, colleagues, and other social networks, and consequently affecting both SRQS and ADS. More specifically, in a family-centered cultural context, patients may rely more on family members’ support and opinions rather than seeking professional counseling or peer support. This reliance may lead them to adopt more passive medical coping styles, weakening the positive effect of hope on SRQS and potentially amplifying the negative impact of Type C personality on ADS, thereby influencing patients’ overall psychosocial adaptation.

The results showed that type C personality score is 4.40 (SD = 3.22), which is consistent with the research results of Jie Niu44. Data analysis showed that the positive rate for Item 1 of the Type C behavior Scale was as high as 87.2%,which is the highest among all items. This item assesses difficulty in openly expressing emotions, unbearable internal pressure, and frequent feelings of nervousness and anxiety. This pattern indicates prevalent challenges with emotional regulation and a tendency to suppress emotions among these patients. Consistent with the theoretical framework of Type C personality, these individuals may be more vulnerable to severe emotional distress, including hopelessness, pessimism, fear of facing reality, and even committing suicide15.The postoperative ADS of the patients was 82.21 (SD = 11.21), which was at a moderately low level, and the results of the study was consistent with by Jianghua Li et al.45,46. ADS has a positive effect on patients’ physical and mental healing, self-acceptance and social role47. Patients undergoing modified radical mastectomy face both physical challenges—such as arm dysfunction and body image changes—and psychological pressures, including sadness, low self-esteem, pain, and treatment-related shame. Difficulty expressing emotions is a key feature of Type C personality. This emotional suppression can harm mental well-being and increase vulnerability to psychological distress. (e.g., depression, anxiety, hopelessness, helplessness, and suicide)48.. Research showed that the higher the individual’s acceptance of physical disability, the higher the psycho-social adaptation and adjustment ability of breast cancer patients, the better the physical and mental rehabilitation, self-acceptance and social outcome of patients47. In contrary, when a series of physical and psychological changes in a short period of time, the lower the individual’s acceptance of physical disability, some patients may question and deny their own value due to the lack of role experience in social and family activities, and their quality of life gradually declines6. Healthcare practitioners can strengthen the guidance of postoperative rehabilitation of patients, guide patients to pay more attention to rehabilitation exercise and self-care, so as to improve the quality of life.

The hope of breast cancer patients and the SRQS were positively correlated (r = 0.630, p < 0.01). It indicated the higher the hope, the better the SRQS of breast cancer patients. At the same time, the improvement of the SRQS can also promote the level of hope. Further path analysis results showed that the hope has an indirect effect (0.025) on the SRQS. Hope has both a direct positive effect on SRQS and an indirect effect through coping styles. The study, which was conducted by Jie Qin in 100 breast cancer patients, confirmed that the improvement of SRQS can promote the level of hope13. At the same time, a positive and optimistic attitude can promote the quality of ideal social relations. The results showed that a high level of hope among breast cancer patients can properly face the reality of breast loss and maintain an optimistic attitude towards life. With a high level of hope, they actively cope with negative emotions and adverse reactions and seek support and help from family members. The hope of breast cancer patients also can be improved by expanding sources of social support for patients, for example, increasing gatherings with family members, avoiding isolation, engaging in social activities. The findings advise that healthcare practitioners can guide patients to actively face the physical and mental distress caused by diseases.

The type C personality and ADS of breast cancer patients during chemotherapy were significantly negatively correlated (r = -0.432, p < 0.001), indicating that the behavior pattern of breast cancer patients more tend to type C personality, the lower the ADS, this is also the innovation of this research. In previous studies, the studies mainly focus on the negative correlation between type C personality and depression 17,19. This study shows that breast cancer patients often exhibit a Type C personality behavior pattern, which is relatively fragile coping behavior pattern. Blindly enduring, repressing or even denying their own needs and feelings, Such mechanisms tend to foster negative thinking and anxiety, which impair patients’ ability to manage treatment effectively. These psychological barriers can exacerbate physical and mental distress, ultimately hindering recovery4. Therefore, healthcare practitioners can adjust their coping styles by changing the patient’s type C behavior pattern and lifestyle.

In the path analysis results, the total effect of type C personality on ADS is -0.378, and the direct and indirect effects are -0.269 and -0.109, respectively. Specifically, a 1-point increase in level of hope was associated with a 0.604-point increase in SRQS and a 0.197-point increase in ADS. Given the score ranges of SRQS (17–68) and ADS (32–128), these findings indicate that a moderate improvement in hope can positively impact patients’ social relationships and adaptation to disability. Conversely, a 1-point increase in Type C personality score was associated with a 0.269-point decrease in ADS (direct effect) and a 0.378-point decrease in total effect, highlighting the negative impact of Type C traits on disability acceptance. Type C personality not only has a direct negative effect on ADS, but also indirectly affects ADS by influencing acceptance-resignation. And the acceptance-resignation as an intermediary factor can explain the effect of 28.9% on ADS. The current studies show that the acceptance-resignation is significantly negatively correlated with ADS, which is consistent with the research of Zhang6. When breast cancer patients adopt an acceptance–resignation coping style, their ability to adapt to physical disabilities may be weakened. In addition, when they lack understanding of the disease course and prognosis, their subjective initiative is limited, which further reduces their attention to the disease. Resigned patients may avoid or refuse treatment and recovery and the future, refusing to talk about or accept the fact that they are disabled49. Negative coping styles make patients stay in the stress and dilemma after breast cancer surgery and become a marginalized and disadvantaged group in society. The ability to adapt to return to society is gradually weakened, which seriously affects the quality of life of breast cancer patients.

Limitations

The present study has limitations: (1) This study adopted a cross-sectional design and lacked interventional investigation, and some potential confounding variables were not fully controlled. Although the structural equation model identified possible pathways among the study variables, definitive conclusions regarding causal relationships cannot be drawn. Future research should employ longitudinal or experimental designs and incorporate multiple mediation analyses to further verify these causal relationships; (2) The diversity of the study sample was limited, as all participants were Chinese breast cancer patients with a collectivist cultural background.The mediating role of medical coping styles in the relationship between hope and social relational quality in this study is based on the Chinese cultural background, which may limit the applicability of the research results to populations outside Asia, and the scope of promotion will be restricted. Future research could expand the subjects to different ethnic and racial groups to verify its validity; (3) In this study, we examined only the mediating role of acceptance–resignation in the relationship between Type C personality and acceptance of disability. However, acceptance–resignation accounted for only part of the mediating effect. Owing to the limited inclusion of mediators and measurement tools, other unverified variables may exist within the structural equation model. Further research is therefore needed to explore these potential mechanisms and to test the generalizability of the findings among breast cancer patients.

Implications for practice

The study findings suggest that healthcare practitioners should consider the mediating role of coping strategies when formulating interventions to improve social relational quality and acceptance of disability among breast cancer patients during chemotherapy. In clinical practice, patients’ hope levels, coping styles, and social relational quality can be regularly assessed using standardized tools, and targeted nursing intervention measures can be formulated according to the proposed research pathways to provide psychological counseling for breast cancer patients during chemotherapy. For example, interventions such as health belief–based counseling and mindfulness-based programs can enhance patients’ hope and guide them to adopt positive coping strategies, thereby improving the quality of social relationships50,51. In family-centered cultural contexts, emotional expression group counseling and family-centered health education can help regulate behavioral patterns52,53, reduce depressive behaviors and acceptance–resignation coping tendencies, and encourage patients to face and adapt to negative events, enhancing their acceptance of disability. These strategies aim to promote recovery and improve the overall quality of life of breast cancer patients during chemotherapy. In addition, further research will use longitudinal design to study the impact of surgery and treatment types on the mediation model, and explore other potential mediating variables between the hope, type C personality, the social relationship quality and acceptance of disability.

Conclusion

In summary, this study found that the mediating effect model of confrontation and acceptance-resignation coping styles between hope & type C personality and SRQS &ADS for patients with breast cancer. Hope and confrontation can improve the SRQS among breast cancer patients, while the type C personality and acceptance-resignation can reduce the adaptation to physical and functional disabilities of breast cancer patients significantly. When breast cancer patients adopt proactive strategies to cope with the low hope level and cancer-prone type C personality, the SRQS and the ADS are better. Healthcare practitioners should be aware of the coping strategies of breast cancer patients, and psycho-social interventions and supportive care should focus on these cognitive and emotional processes to improve SRQS and ADS for this population. At the same time, it can provide a further understanding of the influence of hope, ADS and SRQS among Chinese breast cancer patients.