The impact of death literacy on self-management behaviors in gastric cancer patients: the chain mediating role of psychological adaptation and cognitive reappraisal

Background: Death literacy-defined as the knowledge, skills, and attitudes that enable individuals to understand, communicate, and act effectively on issues related to death, dying, and bereavement-plays an important role in cancer patients' psychological regulation and coping behaviors. However, empirical evidence linking death literacy to self-management behaviors in gastric cancer patients remains limited. Methods: This study employed a cross-sectional design and used convenience sampling to recruit 501 gastric cancer patients from three tertiary Grade A hospitals in Zhejiang Province between August and September 2025. All participants completed the Death Literacy Scale, Self-Management Scale, Psychological Adaptation Scale, and Cognitive Reappraisal Scale. Process Model 6 was used to analyze the chain mediating effects of psychological adaptation and cognitive reappraisal. Results: < 0.001). Bootstrapping analysis confirmed significant indirect effects via psychological adaptation [β = 0.109, SE = 0.037, 95% CI = (0.036, 0.181)] and cognitive reappraisal [β = 0.106, SE = 0.029, 95% CI = (0.054, 0.170)], as well as a significant sequential mediation pathway [β = 0.068, SE = 0.018, 95% CI = (0.031, 0.102)], jointly explaining 59.75% of the total effect. The results suggest that higher death literacy enhances psychological adaptation and facilitates positive emotion regulation, thereby promoting active and sustained self-management behaviors. Conclusions: Death literacy functions as a positive psychological resource contributing to adaptive coping and health management among gastric cancer patients. Strengthening patients' understanding and acceptance of death may improve psychological adaptation and cognitive reappraisal, ultimately fostering better self-management and quality of life.