Factors associated with resilience in spousal caregivers of patients with cancer: An integrative review

Quality of life and appraisal factors of patients with advanced cancer and their family caregivers

PURPOSE

Few existing interventions have effectively improved the quality of life (QOL) for patients with advanced cancer and their caregivers, partly due to limited research on the factors associated with QOL. Guided by an adapted stress-coping model, this study aimed to examine the associations between the QOL of cancer patients and their caregivers and their primary and secondary appraisals. Primary appraisals involve perceptions and evaluations of advanced cancer and related caregiving, while secondary appraisals relate to their available resources and coping capabilities.

METHODS

Using multi-level modeling, we conducted a secondary analysis of the baseline data collected from a randomized clinical trial that examined the effects of a family-based, psychoeducational support program for patients with advanced cancer and their caregivers (N = 362 dyads).

RESULTS

The appraisal variables hypothesized in the adapted stress-coping model explained 74.14% of the variance in the QOL of patients with advanced cancer and their caregivers when controlling for demographics and other disease-related variables. Better QOL in patients and caregivers was associated with less negative appraisals of illness/caregiving, less uncertainty and hopelessness, less avoidant coping strategies, more family support, more health behaviors, higher self-efficacy, and more active coping strategies.

CONCLUSION

Our study highlights the significant impact that advanced cancer has on patients and their caregivers' perceptions, responses to the illness, and QOL. Future interventions may benefit from addressing illness/caregiving appraisals, uncertainty, hopelessness, family support, health behaviors, self-efficacy, and coping strategies. However, further research is needed to determine the effectiveness of interventions specifically targeting these factors.

Changes and predictors of resilience among wife and husband caregivers of patients with advanced cancer: A longitudinal study

BACKGROUND

Resilience as a dynamic process plays a significant role in caregivers' mental health. Little is known about gender differences in the resilience process and predictors of resilience in spousal caregivers.

AIM

To investigate changes in resilience among wives and husbands of patients with advanced cancer over a 6-month posttreatment period, and identify different predictors of resilience between females and males.

DESIGN

This longitudinal, observational study was conducted from January to December 2022.

SETTING/PARTICIPANTS

Spousal caregivers of patients with newly diagnosed advanced cancer were recruited from five regional tertiary hospitals in China. There were three assessment points at 1, 3, and 6 months post-initial treatment. The dependent variable was resilience, and five independent repeated variables were investigated.

RESULTS

Totally, 179 wife caregivers and 133 husband caregivers were included. Resilience in both wife caregivers and husband caregivers increased over time (Wald χ2 = 29.83, p < 0.001) but husbands had higher levels of resilience than wives (Wald χ2 = 35.59, p < 0.001). However, there was no interaction between time and gender (Wald χ2 = 5.25, p > 0.05). Patient functional status, caregiver burden, social support, coping self-efficacy, and mutuality were predictors of resilience for wife caregivers. Meanwhile, patient functional status, caregiver burden and coping self-efficacy could predict resilience for husband caregivers.

CONCLUSIONS

Healthcare providers may develop gender-specific interventions to promote resilience in spousal caregivers of patients with advanced cancer. This would improve mental health for caregivers in the process of palliative care.

Dyadic Coping, Resilience and Post-Traumatic Growth in Young and Middle-Aged Coronary Heart Disease Patients and Their Spousal Caregivers: An Actor-Partner Interdependence Mediation Model

AIMS

This study was to explore the mediating effect of resilience on the relationship between dyadic coping and post-traumatic growth in patient-spousal caregiver dyads living with coronary heart disease (CHD).

DESIGN

A cross-sectional study was conducted from December 2022 to June 2023.

METHODS

Three hundred eighteen young and middle-aged patient-spousal caregiver dyads from a tertiary hospital in China participated. The dyadic participants were evaluated using self-report questionnaires on dyadic coping, resilience and post-traumatic growth.

RESULTS

A significant actor effect was observed, in which dyadic coping in patients was associated with their own post-traumatic growth; this relationship was partially mediated by both the patient's and the partner's resilience. Furthermore, in the examination of partner effects, the association between dyadic coping in spousal caregivers and post-traumatic growth in patients was found to be completely mediated by the resilience of both the patients and the caregivers.

CONCLUSION

The findings suggest that the dyadic coping, resilience and post-traumatic growth of patients and their spousal caregivers display interactive effects. Healthcare providers treating CHD should regard patient-spousal caregiver dyads as a whole and implement interventions that focus on improving positive dyadic coping and resilience to promote post-traumatic growth.

IMPACT

This paper found that the patients with CHD and their spousal caregivers exhibited low levels of post-traumatic growth, with both groups demonstrating mediating and interactive effects via resilience. The findings offer valuable insights to support the early primary identification and implementation of more effective intervention strategies aimed at fostering post-traumatic growth in CHD patient-spousal caregiver dyads.

PATIENT OR PUBLIC CONTRIBUTION

Not applicable.

A Latent Class Analysis of Resilience and Its Relationship With Care Burden and Psychological Distress in Family Caregivers of Older Adults With Disability

Given the challenging circumstances of aging with disability, family caregivers (FGs) face significant strain. Resilience, however, is a crucial protective factor against adverse caregiving outcomes. The study thus aimed to determine the latent classes of resilience among FGs and examine how these classes are related to care burden and psychological distress. This was a cross-sectional descriptive study that included 248 FGs in China. Latent class analysis was conducted to determine the classes of resilience exhibited by FGs. The study revealed four distinct classes of resilience: the high resilience class, high tenacity but moderate strength-optimism class, moderate resilience but low autonomy class, and low resilience class. FGs with secondary caregivers and those who were older were more likely to be part of the high resilience class. Furthermore, caregivers in the high resilience class had significantly lower burdens, less psychological distress, and greater resilience. Therefore, family caregivers' resilience can be classified according to characteristics; more attention should be given to caregivers who are younger and lack the support of secondary caregivers; and targeted interventions should be developed based on resilience classification characteristics.

The Association Between Psychological Resilience and Spiritual Well-Being Among Family Caregivers of Terminally Ill Cancer Patients: A Multicenter Cross-Sectional Study

Purpose: This study was undertaken to determine the nature of the relationship between psychological resilience and spiritual well-being (SWB) among family caregivers (FCs) of patients with terminal cancer. Methods: This multicenter cross-sectional study included 173 FCs from nine inpatient hospice care units. SWB was assessed using the Functional Assessment of Chronic Illness Therapy-Spiritual well-being questionnaire, and various psychosocial variables, including psychological resilience, were also measured. Factors associated with SWB were identified by multivariate regression analysis adjusted for potential covariates. Results: Various factors were found to be associated with the SWB of FCs as determined by total FACIT-Sp-12 scores and the scores of its three domains. FC resilience was significantly associated with SWB as determined by total FACIT-Sp-12 scores and scores of the meaning and peace domains. Conclusion: Assessing FC psychological resilience would help palliative care providers improve their SWB.

Interrelation between dyadic coping and psychological resilience among cervical cancer couples in Northwest China: An Actor-Partner interdependence model

Objective

This study aimed to explore how dyadic coping (DC) influences the psychological resilience (PR) levels of patients with cervical cancer (CC) and their spouses.

Methods

From April to June 2024, this cross-sectional study involved 177 dyads of patients with CC and their spouses from the gynecology and oncology wards of two tertiary hospitals in Xinjiang. Data were collected through questionnaires on demographic information, clinical characteristics, the Resilience Scale, and the Dyadic Coping Inventory, all of which were self-report measures. The results were thoroughly analyzed utilizing the Actor-Partner Interdependence Mediation Model.

Results

The patients had a mean age of 49.94 ​± ​8.05 years (range: 26-64), with the majority being at stage II of CC. Their spouses had a mean age of 51.90 ​± ​8.02 years (range: 27-65). DC scores averaged 105.50 ​± ​23.98 for patients and 103.34 ​± ​22.26 for spouses, while PR scores were 63.51 ​± ​19.68 for patients and 67.44 ​± ​18.97 for spouses. Positive DC, which significantly correlated with higher levels of PR, was observed in patients with CC and their spouses (r ​= ​0.285, P ​< ​0.01; r ​= ​0.697, P ​< ​0.01). Conversely, a negative DC was associated with a lower PR (r ​= ​-0.187, -0.390; P ​< ​0.01). Positive DC by patients with CC and their spouses equally improves both partners' PR. In contrast, negative DC by patients with CC and their spouses affects only their own PR.

Conclusions

Patients with CC and their spouses' PR is significantly influenced by both partners' DC behaviors. When both partners used positive coping strategies, their PR increased. Conversely, negative DC behaviors affected only patients' PR, possibly because of self-concealment and communication barriers, which may explain the lack of a reciprocal impact. Nurses should identify couples at risk for negative DC and implement resilience interventions to encourage both partners' engagement in positive coping.

Quality of Life and Appraisal Factors of Patients with Advanced Cancer and Their Family Caregivers

Purpose

Few existing interventions have effectively improved the quality of life (QOL) for patients with advanced cancer and their caregivers, partly due to limited research on the factors associated with QOL. Guided by an adapted stress-coping model, this study aimed to examine the associations between the QOL of cancer patients and their caregivers and their primary and secondary appraisals. Primary appraisals involve perceptions and evaluations of advanced cancer and related caregiving, while secondary appraisals relate to their available resources and coping capabilities.

Methods

Using multi-level modeling, we conducted a secondary analysis of the baseline data collected from a randomized clinical trial that examined the effects of a family-based, psychoeducational support program for patients with advanced cancer and their caregivers (N = 362 dyads).

Results

The appraisal variables hypothesized in the adapted stress-coping model explained 74.14% of the variance in the QOL of patients with advanced cancer and their caregivers when controlling for demographics and other disease-related variables. Better QOL in patients and caregivers was associated with less negative appraisals of illness/caregiving, less uncertainty and hopelessness, less avoidant coping strategies, more family support, more health behaviors, higher self-efficacy, and more active coping strategies.

Conclusion

Our study highlights the significant impact that advanced cancer has on patients and their caregivers' perceptions, responses to the illness, and QOL. It also highlights that effective interventions may need to target illness/caregiving appraisals, uncertainty, hopelessness, family support, health behaviors, self-efficacy, and coping strategies tailored to patient and caregiver needs.

Change in resilience among spousal caregivers of patients with newly-diagnosed advanced cancer over the first six months posttreatment in China

OBJECTIVE

A longitudinal observational study was conducted and aimed to examine the change in resilience among spousal caregivers of newly-diagnosed advanced cancer patients over the first six months after initial treatment.

METHODS

In total, 312 Chinese spousal caregivers who were taking care of their patients with newly-diagnosed advanced cancer were recruited. The level of resilience was measured using the Connor-Davidson Resilience Scale at the first month post-initial treatment (T1), three-month post-initial treatment (T2), and six-month post-initial treatment (T3). Latent growth modeling analyses were performed to examine changes in resilience using Mplus 8.3.

RESULTS

The mean scores of resilience in spousal caregivers were 54.01 ± 7.68 at T1, 56.20 ± 6.38 at T2, and 57.97 ± 6.70 at T3, respectively. Results of latent growth modeling indicated that spousal caregivers showed a significant increase in their resilience scores over the first six months post-treatment (Mean slope = 1.98, p < 0.001). Furthermore, a significant individual variation in the rate of changes in resilience scores allowed spouses to be categorized into two groups: 42.9% participants with fast growth and 57.1% participants with slight growth.

CONCLUSION

Our findings highlight the importance that new knowledge about change patterns of resilience in the nursing field is beneficial to reveal different psychosomatic health. Acknowledging that resilience is a dynamic process that changes over time, it is crucial for healthcare providers to monitor the psychological adjustment and focus of vulnerable caregivers, particularly spouses.

Effect of a Web-Based Integrative Support Intervention to Improve Family Caregiver Positive Caregiving Experience and Quality of Life: A Randomized Controlled Trial

BACKGROUND

Cancer caregivers experience significant stress due to their multifaceted role. Current support methods are limited by unidimensional assessments.

OBJECTIVE

The aim of this study was to evaluate a Web-based support system aimed at reducing caregiver stress and anxiety, and improving resilience, vigilance, and quality of life, using both subjective and objective measures.

METHODS

A randomized controlled trial with a single-center, 2-arm parallel design and longitudinal assessment was conducted in Taiwan. Caregivers of patients recently diagnosed with cancer were randomly allocated to either a standard care group or an intervention group that received enhanced nurse-led support. Metrics including psychological resilience, caregiver burden, anxiety, quality of life, stress levels, and vigilance were systematically evaluated on a monthly basis over a period of 5 months, starting from the initial baseline measurement.

RESULTS

Following the intervention, participants in the intervention group exhibited statistically significant reductions in caregiver burden and anxiety, alongside a notable improvement in resilience. Objective evaluations revealed a significant reduction in stress levels within this group. However, there were no discernible differences in vigilance and quality of life metrics between the intervention and control groups.

CONCLUSION

The Web-based program effectively reduced caregiver stress and burden, as indicated by multiple metrics.

IMPLICATIONS FOR PRACTICE

This accessible and efficient Web-based support is beneficial for cancer caregivers facing diverse challenges.

The mediation role of hope in the relationship of resilience with depression, anxiety, and stress in caregivers of children and adolescents with cancer

This study aimed to determine the mediation role of hope in the relationship of resilience with depression, anxiety, and stress in caregivers of children and adolescents with cancer. This cross-sectional study was conducted on 200 caregivers of children and adolescents with cancer. Adult Hope Scale, Connor-Davidson Resilience Scale, and Depression, Anxiety and Stress (DAS) scales were used for data collection. The mediator and moderator model was tested using the SPSS macro PROCESS (Model 4, and 5). The mediator model (model 4) indicated that DAS significantly correlated with resilience (β = - 0.54, t-value = - 5.01, p < 0.001), and hope (β = - 0.84, t-value = - 3.45, p = 0.0007). Hope mediated the relationship between resilience and DAS among caregivers of children and adolescents with cancer (Effect = - 0.18, SE = 0.06, 95% CI - 0.33 to - 0.06). The mediator and moderator model (model 5) showed that female caregivers had a stronger correlation between resilience and DAS when compared to their male counterparts (β = - 0.56, t-value = - 3.90, p-value = 0.0001); also, hope mediated the relationship between resilience and DAS among caregivers of children and adolescents with cancer (Effect = - 0.20, SE = 0.08, 95% CI - 0.37 to - 0.04). In conclusion, hope was a mediator, and female caregivers were a moderator in the relationship of resilience with depression, anxiety, and stress, and its promotion might be effective among caregivers of children and adolescents with cancer. It seems that resilience, female caregivers, and hope may provide good protection against depression, anxiety, and stress in caregivers of cancer patients.

Predictors of changes in resilience among spousal caregivers of patients with advanced cancer within the first 6 months after initial treatment

BACKGROUND

While previous research has established that resilience is affected by various factors, these studies have primarily focussed on individual variables associated with resilience, without providing insights into how to influence the rate of change in resilience.

AIM

To examine the trajectory of resilience and identify the factors associated with changes in resilience among spousal caregivers of patients with newly diagnosed advanced cancer receiving treatment during the first 6 months.

DESIGN

An observational longitudinal study.

METHODS

A total of 312 spousal caregivers of patients with newly diagnosed advanced cancer were recruited from January 2022 to December 2022 in Yancheng, China. Three data collection points were established, spanning from the first month to 6 months after initial cancer treatment. A latent growth model was employed to depict the resilience trajectory at various time points. A latent growth model with time-invariant covariates was adopted to determine the factors influencing resilience trajectory. The study adhered to the STROBE checklist for proper reporting.

RESULTS

Throughout the follow-up period, the participants experienced a significant increase in resilience. Gender, family income, the patient's health status, spirituality and belief in familism were significantly associated with the baseline resilience level. Moreover, family income, the patient's health status, spirituality, caregiver burden and belief in familism were significantly associated with the rate of resilience change over time.

CONCLUSIONS

Spousal caregivers demonstrated a linear increase in resilience during the first 6 months after initial treatment. Meanwhile, changes in resilience were influenced by multiple factors during the early phase of cancer treatment. Thus, more attention should be paid to early identification and implementation of targeted interventions.

RELEVANCE TO CLINICAL PRACTICE

Healthcare professionals should understand the change in resilience among spousal caregivers and conduct timely mental health interventions to enhance the resilience of families affected by cancer.

PATIENT OR PUBLIC CONTRIBUTION

The Guidance for Reporting Involvement of Patients and the Public-Short Form reporting checklists were used to improve patient and public involvement.

'A Constant Black Cloud': The Emotional Impact of Informal Caregiving for Someone With a Lower-Grade Glioma

Those closest to people with lower-grade gliomas (LGGs) often assume the role of informal caregiver (IC). The additional responsibilities mean ICs of people with cancer can experience adverse impacts on their own lives. We explored the emotional impact of informal caregiving for people with LGGs. This was a descriptive qualitative study within the multi-method Ways Ahead project. We conducted semi-structured interviews with individuals from the United Kingdom, who currently, or in the past 5 years, informally cared for someone with an LGG. Interviews encompassed experiences of emotional impact as a consequence of caregiving for someone with an LGG. Inductive thematic analysis was undertaken. We interviewed 19 ICs (mean age 54.6 years; 14 females, 5 males). Participants reported substantial emotional impact. Four themes and associated subthemes were generated: Emotional responses to the illness (e.g. feeling helpless), Emotional responses to the unknown (e.g. anxiety about future uncertainty), Emotional consequences of care recipient changes (e.g. challenges of changed relationship dynamics), and Emotional weight of the responsibility (e.g. feeling burnout). Emotional impact in one area often exacerbated impact in another (e.g. future uncertainty impacted feelings of helplessness). Participants detailed the factors that helped them manage the emotional impact (e.g. being resilient). ICs of people with LGGs can experience wide-ranging emotional responses to and impacts of the illness, uncertain prognosis, care recipient changes, and the toll of caregiving. Adjustment and resilience are key protective factors, though further consideration of ways to identify and fulfil the emotional support needs of ICs of people with LGGs is required.

Sleep quality, caregiver burden, and individual resilience among parents of children with epilepsy

PURPOSE

Parents caring for children with epilepsy have poor sleep quality and experience a certain level of caregiving burden. Individual resilience is a crucial psychological variable that contributes to health during extraordinary challenges. This study aimed to determine the relationships among individual resilience, caregiver burden, and sleep quality.

METHODS

This was a descriptive cross-sectional study with a convenience sample, following the STROBE guidelines. One hundred and ninety-one parents of children with epilepsy were invited to participate in the study. Of these, 173 participants completed measures of sleep quality, caregiver burden, and individual resilience. Path analysis was performed to probe the indirect relationship between individual resilience and sleep quality via caregiver burden.

RESULTS

Correlation analysis revealed that individual resilience total scores were significantly and marginally negatively correlated with caregiver burden and sleep quality total scores (r = -0.215, P <.01; r = -0.250, P <.01). Moreover, there was a significant moderate positive correlation between the total caregiver burden scores and total sleep quality scores (r = 0.389, P <.001). The path model showed that individual resilience is indirectly associated with sleep quality via caregiver burden.

CONCLUSION

The higher the level of individual resilience, the less the caregiver burden and the better the sleep quality for parents of children with epilepsy.

Designing a need-based program for relieving psychological distress of family caregivers of leukemia patients: a randomized controlled trial

PURPOSE

The family of leukemia patients, due to their caring role, often feels psychological distress. A practical need-based program carefully considers the set of requirements of nursing service recipients. This paper illustrates the efficacy of a designed family-need-based program on relieving stress, anxiety, and depression of family caregivers of leukemia patients.

METHODS

In this controlled trial, sixty-four family caregivers of leukemia patients referring to a medical center in Iran were recruited by convenience sampling and randomly divided into study and control groups. The study group attended a designed need-based program. The control group did not receive the intervention. Stress, anxiety, and depression of both groups were simultaneously measured and compared in three time-points using the scale of stress, anxiety, and depression (DASS-42). Data were analyzed using descriptive and inferential statistics.

RESULTS

Before the program, the average scores of stress, anxiety, and depression were 31.16 ± 4.14, 21.37 ± 6.31, and 27.56 ± 4.24 for the study group and 31.09 ± 4.48, 20.34 ± 6.56, and 28.78 ± 4.72 for the control group. After the program, the average scores of stress, anxiety, and depression were 10.56 ± 3.37, 6.75 ± 2.99, and 7.37 ± 2.76 for the study group and 34.87 ± 2.51, 23.65 ± 4.96, and 32.56 ± 3.49 for the control group, respectively. Results of the independent t test indicated no considerable difference before the program (P > 0.05) and a significant difference after the program (P < 0.001) between the two groups.

CONCLUSION

This family-need-based program can decrease the level of stress, anxiety, and depression of the family caregivers of leukemia patients and may potentially alleviate the psychological distress of family caregivers over their caring role.

Factors associated with resilience in spousal caregivers of patients with cancer: An integrative review

Aim

To explore resilience and associated factors in spousal caregivers of patients with cancer.

Design

An integrative review.

Methods

This review used the standardized critical appraisal instruments developed by the Joanna Briggs Institute and was conducted by researching the electronic databases of Cochrane, CINAHL, ProQuest, Science Direct, PubMed, Scopus, EBSCO and Google Scholar. The articles were published in English with full text from January 2010 to January 2020.

Results

According to data retrieval, 26 articles were finally selected. From this review, resilience was typically measured by using exact resilience scales (i.e. Connor‐Davidson or Wagnild Resilience Scales) or using other variables to indicate either more positive psychological outcomes or less negative psychological outcomes. For factors associated with resilience, these were classified as individual internal and external factors. Internal factors included caregiver burden, psychological distress, coping strategies and other factors, whereas social support, couple interaction, patient health status and other parameters were considered external factors.

Conclusions

Resilience plays an important role in promoting positive adaptation in spite of adversity among the spousal caregivers of patients with cancer. Due to the uniqueness of resilience among spousal caregivers, ways to assess resilience and identify its associated factors deserve more attention and careful consideration.