{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T16:59:35Z","timestamp":1792083575042,"version":"4.4.0"},"reference-count":37,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"vor","delay-in-days":14,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Psycho-Oncology"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Double awareness, defined as the capacity to engage with life while acknowledging mortality, has been conceptualized primarily within Western cultural contexts. This study aimed to develop a contextually informed interpretive model of double awareness among patients with advanced cancer in China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A constructivist grounded theory approach was adopted. Semi\u2010structured interviews were conducted with 10 patients with stage IV or recurrent\/metastatic cancer recruited from an oncology department and a hospice care facility in China. Data were analyzed iteratively using initial, focused, and theoretical coding, together with constant comparison.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Double awareness was conceptualized as an interpretive model comprising three interrelated experiential domains: Life Engagement, Death Contemplation, and Legacy Continuation. These domains were described as coexisting and interconnected rather than unfolding as a fixed sequence. Psychosomatic Adjustment, encompassing fluctuations in physical symptoms, emotional states, temporal perception, and energy allocation, emerged as a regulatory process that shaped how participants sustained, negotiated, or experienced these domains. In this sample, Legacy Continuation was particularly salient in some participants' accounts, especially in relation to family relationships, intergenerational responsibilities, and the transmission of values.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Among Chinese patients with advanced cancer, double awareness was conceptualized as a multidimensional and contextually situated experience. The model provides a preliminary conceptual framework for generating hypotheses and informing future culturally responsive psychosocial and palliative care research, with further validation needed across diverse populations, care settings, and longitudinal contexts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pon.70623","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T16:30:23Z","timestamp":1792081823000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Developing a Double Awareness Model Among Patients With Advanced Cancer in China: A Constructivist Grounded Theory Study"],"prefix":"10.1002","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-7995-520X","authenticated-orcid":false,"given":"Ruoyi","family":"Xu","sequence":"first","affiliation":[{"name":"School of Nursing Nanjing Medical University  Nanjing Jiangsu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Tianjin Union Medical Center The First Affiliated Hospital of Nankai University  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoxiao","family":"Hu","sequence":"additional","affiliation":[{"name":"School of Nursing Nanjing Medical University  Nanjing Jiangsu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingchun","family":"Geng","sequence":"additional","affiliation":[{"name":"School of Nursing Nanjing Medical University  Nanjing Jiangsu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-3801-9320","authenticated-orcid":false,"given":"Jun","family":"Luo","sequence":"additional","affiliation":[{"name":"School of Nursing Nanjing Medical University  Nanjing Jiangsu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2233-6838","authenticated-orcid":false,"given":"Yaqin","family":"Zhou","sequence":"additional","affiliation":[{"name":"Vanke School of Public Health Tsinghua University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6602-6655","authenticated-orcid":false,"given":"Yanfei","family":"Jin","sequence":"additional","affiliation":[{"name":"School of Nursing Nanjing Medical University  Nanjing Jiangsu China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,15]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.70090"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/s2468\u20102667(21)00157\u20102"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12877\u2010024\u201004788\u20107"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12904\u2010023\u201001259\u20105"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/ecc.13269"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/s2215\u20100366(23)00297\u20103"},{"key":"e_1_2_11_8_1","unstructured":"Central Committee of the Communist Party of China \u201cThe State Council Issued the \u201cHealthy China 2030\u201d Planning Outline \u201d accessed December 6 2025 (2016) http:\/\/www.gov.cn\/gongbao\/content\/2016\/content_5133024.htm."},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2022.995981"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/pon.5030"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1521\/jaap.2008.36.1.181"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1177\/0269216313507757"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/pon.70445"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1017\/s1478951523001669"},{"key":"e_1_2_11_15_1","volume-title":"Preliminary Evaluation of the Double Awareness Scale in Patients With Advanced Cancer Receiving Outpatient Palliative Care","author":"Miljanovski M. A.","year":"2021"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1080\/07481187.2011.553324"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/SPC.0000000000000778"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.13713\/j.cnki.cssci.2015.10.005"},{"key":"e_1_2_11_19_1","first-page":"1259","article-title":"Ethical Conflicts and Countermeasures on Diseases Informing of Malignant Tumor Patients","volume":"30","author":"Tang S. J.","year":"2017","journal-title":"Chinese Medical Ethics"},{"key":"e_1_2_11_20_1","first-page":"1033","article-title":"Research on Hospice Care From the Perspective of Chinese Traditional Culture","volume":"32","author":"Zhang Q. J.","year":"2019","journal-title":"Chinese Medical Ethics"},{"key":"e_1_2_11_21_1","first-page":"98","volume-title":"Views on Life and Death in Traditional Chinese Culture","author":"Chen S. Y.","year":"2024"},{"key":"e_1_2_11_22_1","volume-title":"Constructing Grounded Theory","author":"Charmaz K.","year":"2014"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1080\/14780887.2020.1780357"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/nuf.12661"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1037\/int0000078"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598\u2010024\u201054362\u20109"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejon.2021.102017"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520\u2010020\u201005732\u20102"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.8788"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1080\/07481180802440431"},{"issue":"5","key":"e_1_2_11_31_1","first-page":"21","article-title":"Analysis on the Death Culture Differences Between China and the West From Medical Perspective","volume":"35","author":"Bai N.","year":"2014","journal-title":"Medicine and Philosophy"},{"issue":"2","key":"e_1_2_11_32_1","first-page":"109","article-title":"Shengsheng: The Fundamental Pathway for Confucianism to Transcend Death Anxiety","volume":"39","author":"Gao Z. Q.","year":"2019","journal-title":"Psychological Exploration"},{"issue":"8","key":"e_1_2_11_33_1","first-page":"23","article-title":"On the View of Life and Death in Traditional Chinese Medical Ethics","volume":"31","author":"Pan X. L.","year":"2010","journal-title":"Medicine and Philosophy (Humanistic and Social Medicine Edition)"},{"issue":"2","key":"e_1_2_11_34_1","first-page":"529","article-title":"Implications of Transcending Life\u2010and\u2010Death Ethics in Confucian, Taoist, and Buddhist Cultures for Alleviating Death Anxiety Among Terminally Ill Patients","volume":"35","author":"Huang X. W.","year":"2015","journal-title":"Chinese Journal of Gerontology"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12904\u2010025\u201001801\u20107"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apjon.2025.100796"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2022.07.016"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2022.104273"}],"container-title":["Psycho-Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pon.70623","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/pon.70623","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pon.70623","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T16:30:26Z","timestamp":1792081826000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pon.70623"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":37,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1002\/pon.70623"],"URL":"https:\/\/doi.org\/10.1002\/pon.70623","archive":["Portico"],"relation":{},"ISSN":["1057-9249","1099-1611"],"issn-type":[{"value":"1057-9249","type":"print"},{"value":"1099-1611","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]},"assertion":[{"value":"2026-07-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-03","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-15","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70623"}}