| Objectives:To measure the family resilience levels of colorectal cancer patients and family caregivers under dual perspectives in the same period,to compare the differences in family resilience levels of colorectal cancer patients and family caregivers with different demographic characteristics,and to analyze the factors influencing family resilience of colorectal cancer patients and family caregivers.According to the study’s findings,targeted family resilience intervention strategies were put forth to serve as a theoretical foundation for developing and implementing family resilience interventions for colorectal cancer patients and their carers.Methods:A cross-sectional survey was conducted in this study to facilitate the selection of colorectal cancer patients and their family caregivers who attended the Department of Colorectal Surgery of the Third Affiliated Hospital of Kunming Medical University from March to July 2022 and met the inclusion and exclusion criteria.We used a self-created general demographic questionnaire for patients and family caregivers,a disease-related information questionnaire for patients,and a Chinese version of the Family Resilience Assessment Scale.A total of 700 questionnaires(350 each for patients and family caregivers)were distributed in this study,and 652 valid questionnaires(326 each for patients and family caregivers)were finally returned,with a return rate of 93.1%.Data were processed using Epidata and Statistical Package for Social Science 26.0.The mean ± standard deviation or median and interquartile spacing were chosen to express the measurement data according to whether they satisfied normal distribution.The count data were described by the number of cases and composition ratio(%).In one-way analysis,independent sample t-test,ANOVA or nonparametric test were selected according to whether the variables met normal distribution.In correlation analysis,Pearson correlation analysis or Spearman correlation analysis was chosen according to whether the variables met normal distribution.Multiple linear regression analysis was used for multi-factor analysis.The test level was α=0.05.Results:1.Current status of family resilience among colorectal cancer patients and family caregivers.(1)Family resilience scores of colorectal cancer patients: The total family resilience score of colorectal cancer patients was(140.40±16.06),which was at an intermediate level.According to the standardization rate of scores,each dimension of patients was ranked consistently from high to low as family communication and problem solving,ability to make meaning of adversity,family connectedness,maintaining a positive outlook,utilizing social and economic resources,family spirituality.(2)Family resilience scores of family caregivers: The total family resilience score of family caregivers was(147.08±13.93),which was in the middle to upper range.The mean scores for the six dimensions were ranked from high to low as family communication and problem solving,ability to make meaning of adversity,maintaining a positive outlook,family connectedness,utilizing social and economic resources,family spirituality.(3)Comparison of family resilience scores of colorectal cancer patients and family caregivers: The independent sample t-test showed that the family resilience scores and the scores of "family communication and problem solving","maintaining a positive outlook","utilizing social and economic resources","ability to make meaning of adversity",and "family spirituality" were statistically significantly higher in family caregivers than in patients with colorectal cancer(P < 0.001),while the difference between the scores of "family connectedness" dimension were not statistically significant(P > 0.05).(4)Correlation of family resilience among colorectal cancer patients and family caregivers: According to Pearson’s correlation analysis,colorectal cancer patients’ family resilience scores and scores on "family communication and problem solving","ability to make meaning of adversity","maintaining a positive outlook","family connectedness","utilizing social and economic resources" and "family spirituality" were all positively correlated with the corresponding scores of family caregivers(r=0.466-0.711,P < 0.001).2.Results of the analysis of factors influencing family resilience in colorectal cancer patients(1)Univariate analyses showed that the family resilience scores of patients were statistically different from the presence of enterostomy,age,education level,occupation,long-term residence,number of close relatives who offered help,per capita monthly family income,family history of cancer,whether the family’s primary breadwinner before the illness,the main caregiver,self-care level,method of paying for medical expenses,whether to purchase commercial medical insurance and the degree of understanding of the disease meaning(P < 0.05).Pearson’s correlation analysis showed that the coping style and social support scores of colorectal cancer patients were positively correlated with the family resilience scores and scores on five dimensions which "family communication and problem solving","maintaining a positive outlook","utilizing social and economic resources","ability to make meaning of adversity",and "family connectedness"(r=0.363-0.815,P < 0.001).(2)Multiple linear regression analysis showed that a total of seven variables,including age,occupation,long-term residence,number of relatives who were close and provided help,self-care level,coping style,and social support,entered the final regression equation and together explained 74.4%(F=131.830,P < 0.001)of the total variance in family resilience among colorectal cancer patients.3.Results of the analysis of factors influencing family resilience of family caregivers of colorectal cancer patients(1)Univariate analysis revealed statistically significant differences in family caregivers’ age,education level,occupation,long-term residence,per capita monthly household income,whether they were the primary breadwinner of the family,cumulative hours of care,knowledge of disease care,mastery of caregiving skills,course of the patient’s disease,whether the patient had chemotherapy and other treatments(e.g.,targeted therapy,psychotherapy,immunotherapy,etc.)or not with their family resilience scores(P < 0.05).Spearman’s correlation analysis revealed that family caregivers’ social support scores were positively correlated with family resilience scores and "family communication and problem solving," "maintaining a positive outlook","utilizing social and economic resources","ability to make meaning of adversity" and "family connectedness"(r=0.151-0.474,P < 0.05),while caregiving burden scores were negatively correlated with family resilience scores and the above five dimensions(r=-0.467～-0.195,P < 0.001).(2)Multiple linear regression analysis showed that a total of six variables,family caregiver’s education level,whether they were the main breadwinner of the family,mastery of caregiving skills,social support,caregiving burden,and whether the patient had other treatments,entered the regression equation and together explained 36.5% of the total variance(F=30.541,P < 0.001).Conclusions:1.The family resilience levels of colorectal cancer patients and family caregivers were moderate and upper-moderate,respectively,which needed to be improved and were mutually influenced.It is reminded that we should not only focus on the family resilience levels of colorectal cancer patients and family caregivers unilaterally but also promote their physical and mental health adjustment together from a holistic perspective.2.The factors influencing the family resilience of colorectal cancer patients and family caregivers differed.Patients with colorectal cancer who were younger,in retirement,living in urban areas for a long time,with a better number of relatives who were close and provided help,with better self-care,with more positive coping styles,and with more social support had a higher level of family resilience.Family caregivers who had higher literacy levels,were the primary breadwinner for the family,had greater caregiving skill mastery,more social support,less caregiving burden,and patients who had not received any additional treatments like targeted therapy,psychotherapy,or immunotherapy had a higher level of family resilience.3.The controllable factors affecting the level of family resilience in patients with colorectal cancer and family caregivers should be considered as the key points of intervention.The focus should be placed on the patient’s situation regarding self-care,disease coping style,and social support;on the family caregiver’s situation regarding improvement of caregiving skills,caregiving burden,and social support.In addition,as social support affects both families’ levels of resilience,it should be the focus of attention,and specific strategies should be implemented to increase both sides’ perceptions of social support.4.To increase the level of family resilience,it is advised to jointly promote the entire family’s coping with the illness on many levels,including the individual,the family,and society.At the individual patient level,a multi-team comprehensive assessment and care can be attempted for elderly colorectal cancer patients;based on the concept of accelerated rehabilitation surgery,nursing measures can be optimized to improve patients’ self-care ability;and disease health education can be strengthened to encourage patients to adopt a positive coping style to face the disease.At the level of the individual caregiver,the caregiver’s mastery of illness care skills should be strengthened to enhance their caregiving abilities;attention should be paid to the caregiver’s inner feelings and the caregiving experience.At the family level,family members should be encouraged to face up to cancer and reshape a positive family belief system;effective communication and intra-family support among family members should be promoted;family-centered intervention programs should be implemented to enhance family cohesion and disease-coping ability.At the social level,families should be encouraged to develop social networks and establish a sound social support system,and the government should strengthen the attention of social groups to colorectal cancer and increase investment in medical resource protection. |
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