Development And Evaluation Of A WeChat-based Family Life Review Program For Chinese Patients With Advanced Cancer

Objectives 1.To develop a We Chat-based family life review program for Chinese patients with advanced cancer.2.To evaluate the effects of a We Chat-based family life review program on the quality of life,family cohesion and adaptability among patients with advanced cancer.3.To evaluate the effects of a We Chat-based family life review program on the quality of life,caregiver burden,family cohesion and adaptability among family caregivers.4.To elicit patients' with advanced cancer and their family caregivers' perceptions of the We Chat-based family life review program.Methods 1.The We Chat-based family life review program was initially developed based on our preliminary study,feedbacks of cancer patients,and suggestions of the experienced facilitators.Then,action research was used to refine this program with the three spiral cycles of "planning-action-observation-reflection".In each cycle,five pairs of advanced cancer patients and family caregivers were selected to validate the program.2.A poilt randomized controlled trial was used to evaluate the program.46 pairs of patients with advanced cancer and their family caregivers were recruited from a general hospital in Fujian,China.The eligible participants were randomly assigned to the experimental group(25 pairs)and the control group(21pairs).The experimental group received the We Chat-based family life review program plus the routine care.The control group received the routine care.The outcomes of patients were measured at the baseline and immediately after the We Chat-based family life review program with QOLC-E,FACES ?-CV.The outcomes of family caregivers were measured at the baseline and immediately after the We Chat-based family life review program with QOLLTI-F,ZBI,FACES ?-CV.3.To elicit patients' and their family caregivers' perceptions of the We Chat-based family life review program,in-depth individual interviews were conducted after the completion of the the We Chat-based family life review program.The qualitative content analysis was performed to analyse the qualitative data.Results 1.The We Chat-based family life review program was implemented by synchronous and asynchronous communication.Synchronous communication was realtime communication,providing an e-life review interview guided by a facilitator online,including the four units of childhood and adolesence,adulthood,disease expereince and life summary.The asynchronous communication was used to interact with patients before and after a life review interview.For patients,it had four modules including Memory Prompts,Review Extraction,Mind Space,and E-legacy products.For family caregivers,it had three modules including Life Review Assitance,Caring Experience and Life Perception,and Connecting You and Me.2.For patients,the experimental group had a significant improvement in the total scores of QOL,overall QOL,value of life,health care,support,family cohesion,and family adaptability of family cohesion and adaptability;and a significant reduction in sense of alienation,existential distress,negative emotions and food-related concerns(P<0.05).For family caregivers,the experimental group had a significant improvement in FQOL,carer's own state,carer's outlook,quality of care,relationships of QOL,family cohesion,and family adaptability of family cohesion and adaptability;and a significant reduction in patients' caregiver burden,individual burden,accountability burden and environment,patient condition of QOL(P<0.05).3.For patients,the four categories identified in the qualitative analysis were:appreciating the We Chat-based family life review program,getting closer with their family caregivers,being grateful for their family caregivers,enhancing emotional support with each other.Regarding family caregivers,the five categories emerged including acceptting and appreciating the We Chat-based family life review program,learning to cherish at present,being grateful for their family caregivers,getting closer with patients,decreasing the burden of care.Conclusions This study is a pioneer study to develop a We Chat-based life review program tailored to patients with advanced cancer and their family caregivers.The program is feasible and effective in improving patients' and caregivers' quality of life,family cohesion and adaptability and decreasing caregivers' burden of care.Additionally,this study could provide a reference for web-based family care and psychological rehabilitation in patients with advanced cancer.