Family resilience and psychological well-being among Chinese breast cancer survivors and their caregivers
Yuanjing Qiao
Shandong University of Traditional Chinese Medicine School of Nursing, Jinan, China
Search for more papers by this authorShaojie Li
Shandong University of Traditional Chinese Medicine School of Nursing, Jinan, China
Search for more papers by this authorCorresponding Author
Kefang Wang
School of Nursing, Shandong University, Jinan, China
Correspondence
Kefang Wang, School of Nursing, Shandong University, Jinan, China.
Email: [email protected]
Search for more papers by this authorYuanjing Qiao
Shandong University of Traditional Chinese Medicine School of Nursing, Jinan, China
Search for more papers by this authorShaojie Li
Shandong University of Traditional Chinese Medicine School of Nursing, Jinan, China
Search for more papers by this authorCorresponding Author
Kefang Wang
School of Nursing, Shandong University, Jinan, China
Correspondence
Kefang Wang, School of Nursing, Shandong University, Jinan, China.
Email: [email protected]
Search for more papers by this authorFunding information
This study was funded by China Postdoctoral Science Foundation (No. 2017M622213).
Abstract
Walsh's family resilience theory indicated that families could foster resilient outcomes among their members when they are facing changes or crises. However, little is known about family resilience and psychological well-being among Chinese breast cancer survivors and their caregivers. Therefore, this study aimed to examine the direct and indirect relationships between family resilience, breast cancer survivors' post-traumatic growth (PTG), quality of life (QOL), and their principal caregivers' caregiver burden. A total of 108 breast cancer survivors/principal caregivers pairs completed a cross-sectional questionnaire survey in a comprehensive cancer of a public hospital in Shandong Province, China. The structural equation modelling (SEM) results showed that family resilience had direct and indirect effects on QOL and caregiver burden, and it was positively related to the PTG of the survivors. The survivors' PTG was positively related to their QOL, and their QOL was negatively associated with caregiver burden. Therefore, a better understanding of how family resilience contributes to PTG and QOL of the survivors and caregiver burden could help clinicians tailor interventions to enhance interventions aimed at improving both survivors' and caregivers' well-being.
CONFLICT OF INTEREST
The authors declare no conflicts of interest.
REFERENCES
- Ancoli-Israel, S., Liu, L., Rissling, M., Natarajan, L., Neikrug, A. B., Palmer, B. W., … Maglione, J. (2014). Sleep, fatigue, depression, and circadian activity rhythms in women with breast cancer before and after treatment: A 1-year longitudinal study. Supportive Care in Cancer, 22(9), 2535–2545. https://doi.org/10.1007/s00520-014-2204-5
- Arpawong, T. E., Richeimer, S. H., Weinstein, F., Elghamrawy, A., & Milam, J. E. (2013). Posttraumatic growth, quality of life, and treatment symptoms among cancer chemotherapy outpatients. Health Psychology, 32(4), 397–408. https://doi.org/10.1037/a0028223
- Bellizzi, K. M., Smith, A. W., Reeve, B. B., Alfano, C. M., Bernstein, L., Meeske, K., … Ballard-Barbash, R. R. (2010). Posttraumatic growth and health-related quality of life in a racially diverse cohort of breast cancer survivors. Journal of Health Psychology, 15(4), 615–626. https://doi.org/10.1177/1359105309356364
- Cann, A., Calhoun, L. G., Tedeschi, R. G., Taku, K., Vishnevsky, T., Triplett, K. N., & Danhauer, S. C. (2010). A short form of the posttraumatic growth inventory. Anxiety, Stress, & Coping, 23(2), 127–137. https://doi.org/10.1080/10615800903094273
- Casellas-Grau, A., Vives, J., Font, A., & Ochoa, C. (2016). Positive psychological functioning in breast cancer: An integrative review. The Breast, 27, 136–168. https://doi.org/10.1016/j.breast.2016.04.001
- Chiou, C. J., Chang, H. Y., Chen, I. P., & Wang, H. H. (2009). Social support and caregiving circumstances as predictors of caregiver burden in Taiwan. Archives of Gerontology and Geriatrics, 48(3), 419–424. https://doi.org/10.1016/j.archger.2008.04.001
- Cormio, C., Romito, F., Viscanti, G., Turaccio, M., Lorusso, V., & Mattioli, V. (2014). Psychological well-being and posttraumatic growth in caregivers of cancer patients. Frontiers in Psychology, 5, 1342. https://doi.org/10.3389/fpsyg.2014.01342
- Deshields, T. L., Rihanek, A., Potter, P., Zhang, Q., Kuhrik, M., Kuhrik, N., & O’Neill, J. (2012). Psychosocial aspects of caregiving: Perceptions of cancer patients and family caregivers. Supportive Care in Cancer, 20(2), 349–356. https://doi.org/10.1007/s00520-011-1092-1
- Di Giacomo, D., Cannita, K., Ranieri, J., Cocciolone, V., Passafiume, D., & Ficorella, C. (2016). Breast cancer and psychological resilience among young women. Journal of Psychopathology, 3, 9001–9905.
- Fan, L., Strasser-Weippl, K., Li, J. J., St Louis, J., Finkelstein, D. M., Yu, K. D., … Goss, P. E. (2014). Breast cancer in China. The Lancet Oncology, 15(7), e279–e289. https://doi.org/10.1016/S1470-2045(13)70567-9
- Fang, C. Y., Manne, S. L., & Pape, S. J. (2001). Functional impairment, marital quality, and patient psychological distress as predictors of psychological distress among cancer patients' spouses. Health Psychology, 20(6), 452–457. https://doi.org/10.1037/0278-6133.20.6.452
- Govina, O., Kotronoulas, G., Mystakidou, K., Katsaragakis, S., Vlachou, E., & Patiraki, E. (2015). Effects of patient and personal demographic, clinical and psychosocial characteristics on the burden of family members caring for patients with advanced cancer in Greece. European Journal of Oncology Nursing, 19(1), 81–88. https://doi.org/10.1016/j.ejon.2014.06.009
- Hawley, D. R. (2000). Clinical implications of family resilience. American Journal of Family Therapy, 28(2), 101–116. https://doi.org/10.1080/019261800261699
- Hawley, D. R., & DeHaan, L. (1996). Toward a definition of family resilience: Integrating life-span and family perspectives. Family Process, 35(3), 283–298. https://doi.org/10.1111/j.1545-5300.1996.00283.x
- Hayes, A. F. (2009). Beyond Baron and Kenny: Statistical mediation analysis in the new millennium. Communication Monographs, 76(4), 408–420. https://doi.org/10.1080/03637750903310360
- Ho, S. M., Law, L. S., Wang, G. L., Shih, S. M., Hsu, S. H., & Hou, Y. C. (2013). Psychometric analysis of the Chinese version of the posttraumatic growth inventory with cancer patients in Hong Kong and Taiwan. Psycho-Oncology, 22(3), 715–719. https://doi.org/10.1002/pon.3024
- Jang, H. Y., & Yi, M. (2013). Effects of burden and family resilience on the family adaptation of family caregivers of elderly with dementia. Korean Journal of Adult Nursing, 25(6), 725–735. https://doi.org/10.7475/kjan.2012.24.6.725
10.7475/kjan.2012.24.6.725 Google Scholar
- Jansen, L., Hoffmeister, M., Changclaude, J., Brenner, H., & Arndt, V. (2011). Benefit finding and post-traumatic growth in long-term colorectal cancer survivors: Prevalence, determinants, and associations with quality of life. British Journal of Cancer, 105(8), 1158–1165. https://doi.org/10.1038/bjc.2011.335
- Kanani, R., Davies, E. A., Hanchett, N., & Jack, R. H. (2016). The association of mood disorders with breast cancer survival: An investigation of linked cancer registration and hospital admission data for South East England. Psycho-Oncology, 25(1), 19–27. https://doi.org/10.1037/hea0000125
- Ko, K. T., Yip, P. K., Liu, S. I., & Huang, C. R. (2008). Chinese version of the Zarit caregiver Burden Interview: A validation study. The American Journal of Geriatric Psychiatry, 16(6), 513–518. https://doi.org/10.1097/JGP.0b013e318167ae5b
- Li, Y., Zhao, Y., Zhang, J., Lou, F., & Cao, F. (2016). Psychometric properties of the shortened Chinese version of the family resilience assessment scale. Journal of Child and Family Studies, 25(9), 2710–2717. https://doi.org/10.1007/s10826-016-0432-7
- Liu, Y., Li, Y., Chen, L., Li, Y., Qi, W., & Yu, L. (2018). Relationships between family resilience and posttraumatic growth in breast cancer survivors and caregiver burden. Psycho-oncology, 27(4), 1284–1290. https://doi.org/10.1002/pon.4668
- Marcus, A. C., Garrett, K. M., Cella, D., Wenzel, L., Brady, M. J., Fairclough, D., … Flynn, P. J. (2010). Can telephone counseling post-treatment improve psychosocial outcomes among early stage breast cancer survivors? Psycho-oncology, 19(9), 923–932. https://doi.org/10.1002/pon.1653
- Mellon, S., & Northouse, L. L. (2001). Family survivorship and quality of life following a cancer diagnosis. Research in Nursing & Health, 24(6), 446–459. https://doi.org/10.1002/nur.10004
- Molina, Y., Yi, J. C., Martinez-Gutierrez, J., Reding, K. W., Yi-Frazier, J. P., & Rosenberg, A. R. (2014). Resilience among patients across the cancer continuum: Diverse perspectives. Clinical Journal of Oncology Nurssing, 18(1), 93–101. https://doi.org/10.1188/14.cjon.93-101
- Nam, B., Kim, J. Y., DeVylder, J. E., & Song, A. (2016). Family functioning, resilience, and depression among North Korean refugees. Psychiatry Research, 245, 451–457. https://doi.org/10.1016/j.psychres.2016.08.063
- Northouse, L. L., Mood, D., Kershaw, T., Schafenacker, A., Mellon, S., Walker, J., … Decker, V. (2002). Quality of life of women with recurrent breast cancer and their family members. Journal of Clinical Oncology, 20(19), 4050–4064. https://doi.org/10.1200/JCO.2002.02.054
- Palacio, C., Krikorian, A., & Limonero, J. T. (2017). The influence of psychological factors on the burden of caregivers of patients with advanced cancer: Resiliency and caregiver burden. Palliative & Supportive Care, 16(03), 269–277. https://doi.org/10.1017/S1478951517000268
- Ristevska-Dimitrovska, G., Filov, I., Rajchanovska, D., Stefanovski, P., Dejanova, B. (2015). Resilience and quality of life in breast cancer patients. Open Access Macedonian Journal of Medical Sciences, 3(4), 727–731. https://doi.org/10.3889/oamjms.2015.128
- Roick, C., Heider, D., Toumi, M., & Angermeyer, M. C. (2006). The impact of caregivers’ characteristics, patients’ conditions and regional differences on family burden in schizophrenia: A longitudinal analysis. Acta Psychiatrica Scandinavica, 114(5), 363–374. https://doi.org/10.1111/j.1600-0447.2006.00797.x
- Rolland, J. S. (2005). Cancer and the family: An integrative model. Cancer, 104(s11), 2584–2595. https://doi.org/10.1002/cncr.21489
- Shao-hua, H., Jing-fang, H., Xue-feng, Z. U. & Zhi-hua, Z. H. (2016). Effects of family function on quality of life in elderly patients with liver cancer. Chinese Journal of Nursing, 51(10), 1180–1184.
- Sixbey, M. T. (2005). Development of the family resilience assessment scale to identify family resilience constructs (Doctoral dissertation). Gainesville: University of Florida.
- Stenberg, U., Ruland, C. M., & Miaskowski, C. (2010). Review of the literature on the effects of caring for a patient with cancer. Psycho-Oncology, 19(10), 1013–1025. https://doi.org/10.1002/pon.1670
- Tedeschi, R. G., & Calhoun, L. G. (1996). The Posttraumatic Growth Inventory: Measuring the positive legacy of trauma. Journal of Traumatic Stress, 9(3), 455–471. https://doi.org/10.1002/jts.2490090305
- Tedeschi, R. G., & Calhoun, L. G. (2004). Posttraumatic growth: Conceptual foundations and empirical evidence. Psychological Inquiry, 15(1), 1–18. https://doi.org/10.1207/s15327965pli1501_01
- Torre, L. A., Bray, F., Siegel, R. L., Ferlay, J., Lortet-Tieulent, J., & Jemal, A. (2015). Global cancer statistics, 2012. CA- A Cancer Journal of Clinicians, 65(2), 87–108. https://doi.org/10.3322/caac.21262
- Walsh, F. (1996). The concept of family resilience: Crisis and challenge. Family Process, 35(3), 261–281. https://doi.org/10.1111/j.1545-5300.1996.00261.x
- Walsh, F. (2002). A family resilience framework: Innovative practice applications. Family Relations, 51(2), 130–137. https://doi.org/10.1111/j.1741-3729.2002.00130.x
- Walsh, F. (2003). Family resilience: A framework for clinical practice. Family Process, 42(1), 1–18. https://doi.org/10.1111/j.1545-5300.2003.00001.x
- Walsh, F. (2007). Traumatic loss and major disasters: Strengthening family and community resilience. Family Process, 46(2), 207–227. https://doi.org/10.1111/j.1545-5300.2007.00205.x
- Wan, C., Zhang, D., Yang, Z., Tu, X., Tang, W., Feng, C., … Tang, X. (2007). Validation of the simplified Chinese version of the FACT-B for measuring quality of life for patients with breast cancer. Breast Cancer Research and Treatment, 106(3), 413. https://doi.org/10.1007/s10549-007-9511-1
- Zarit, S. H., Reever, K. E., & Bach-Peterson, J. (1980). Relatives of the impaired elderly: Correlates of feelings of burden. The Gerontologist, 20(6), 649–655. https://doi.org/10.1093/geront/20.6.649