Patient characteristics associated with death literacy in advanced non-small-cell lung cancer: A preliminary single-centre cross-sectional study.

Background: Patients with advanced non-small-cell lung cancer (NSCLC) frequently experience severe symptoms and functional decline, underscoring the need for early end-of-life (EOL) care discussions to improve care quality. Additionally, enhancing patients' death literacy may strengthen these discussions. However, how patient characteristics influence death literacy in this population is largely unknown. Objective: This cross-sectional study explored baseline levels of death literacy and examined associated patient characteristics in advanced NSCLC. Design: A cross-sectional study was conducted. Methods: A total of 103 patients aged ⩾18 years with stage IIIB or higher NSCLC who had completed at least first-line cancer treatment were recruited using convenience sampling. Data were collected between June 2024 and June 2025 using structured questionnaires assessing sociodemographic, medical conditions, prior EOL care experience, and death literacy (using the traditional Chinese version of the Death Literacy Index, score range = 29-145). Descriptive statistics, Pearson's correlation, independent t test, and stepwise regression were used to analyse associations between patient characteristics and death literacy. Result: The mean participant age was 61.62 ± 10.86 years, and the mean Karnofsky Performance Score was 67.57 ± 12.48. Many had prior experience of EOL care provision (58%) and had lost a relative (90%), but few had discussed EOL care with a physician (29%). Overall, death literacy was moderate (94.08 ± 16.45). Higher death literacy was significantly associated with experience of EOL care (β =  13.390, p < 0.001), having had an EOL care discussion with a physician (β =  10.901, p < 0.001), and being a women (β = 8.671, p = 0.001). These factors explained 37.1% of the variance in death literacy (F = 21.030, Adjusted R 2 = 0.371). Conclusion: Healthcare providers should recognize patients' lived experiences as important contributors to fostering open conversations around EOL care preferences. Interventions such as the Life Journey Tea House or broader public health strategies may help stimulate reflection and encourage dialogue.