The Mechanism Of Resilience And Social Support Influencing Quality Of Life Among Advanced Lung Cancer Patients And Caregivers

Objective:To investigate the status of quality of life(QoL)in patients with advanced lung cancer and their caregivers and to explore the actor and partner effects of resilience and social support on QoL and examine the mediating role of acceptance of illness in this relationship,which could lay an empirical foundation for improving QoL of advanced lung cancer patients and caregivers.Methods:A cross-sectional design was used in this study.304 dyads of advanced lung cancer patients and caregivers were enrolled from three tertiary hospitals in Shandong Province between June 2019 and February 2020.The data were collected with the 10-item Connor-Davidson Resilience Scale(CD-RISC 10),Perceived Social Support Scale(PSSS),the AIS scale,Short Form-8(SF-8)Health Survey,and a self-designed general information questionaire.SPSS 26.0 and Amos 23.0 were used for statistical analysis including descriptive statistics,univariate analysis,Pearson correlation analysis,hierarchical linear regression analysis and actor-partner interdependence mediation analysis.Results:1.Quality of life of patients with advanced lung cancer and caregiversThe mean scores for physical and mental QoL in advanced lung cancer patients were 53.16±23.13 and 57.24±22.99,respectively.The mean scores for physical and mental QoL in advanced lung cancer caregivers were 73.51±18.96 and 69.63±19.66,respectively.There were significant differences in scores for physical and mental QoL between patients and caregivers(t=-12.592,P<0.001;t=-7.942,P<0.001).2.Relationships between general characteristics and QoL in patients with advanced lung cancer and caregivers(1)This study indicated significant differences in physical QoL of advanced lung cancer patients across patient economic situation(F＝4.896,P=0.008),current chemotherapy(t=-3.515,P=0.001),current radiotherapy(t=2.577,P=0.010),current supportive care(t=2.183,P=0.030),Eastern Cooperative Oncology Group(ECOG)performance status(F=16.906,P<0.001).This study indicated significant differences in mental QoL of advanced lung cancer patients among patient economic situation(F=5.521,P=0.004),Tumour-Node-Metastasis(TNM)stage(t=2.234,P=0.026),current chemotherapy(t=-3.200,P=0.002),ECOG performance status(F=12.005,P<0.001).(2)This study indicated significant differences in physical QoL of advanced lung cancer caregivers among age(F=5.631,P=0.004),marital status(t=2.276,P=0.024),education(F=4.233,P=0.002),current work status(F=9.446,P<0.001),economic situation(F=9.404,P<0.001),relationship to patient(F=5.036,P<0.001),whether reside with patient or not(t=-3.377,P=0.001),caregiving hours per day(F=4.968,P=0.008),whether have alternative caregivers or not(t=-3.572,P<0.001),caregiver physical condition(F=30.978,P<0.001).This study indicated significant differences in mental QoL of advanced lung cancer caregivers among current work status(F＝3.355,P=0.036),economic situation(F=8.980,P<0.001),relationship to patient(F=2.790,P=0.018),whether reside with patient or not(t=-2.923,P=0.004),whether have alternative caregivers or not(t=-2.622,P=0.010),caregiver physical condition(F＝12.287,P<0.001).3.Hierarchical linear regression analysis of QoL in patients with advanced lung cancer and caregivers(1)Factors associated with physical QoL among advanced lung cancer patients were patients’ ECOG performance status,acceptance of illness.Factors associated with mental QoL among advanced lung cancer patients were patients’ TNM stage,ECOG performance status,resilience and acceptance of illness.(2)Factors associated with physical QoL among advanced lung cancer caregivers were caregivers’ physical condition.Factors associated with mental QoL among advanced lung cancer caregivers were caregivers’ physical condition,resilience and acceptance of illness.4.Dyadic effects of resilience on QoL in advanced lung cancer patients and caregivers:An actor-partner interdependence mediation model(1)The actor effect of resilience on mental QoL was significant in advanced lung cancer patient-caregiver dyads,however,the actor effect of resilience on physical QoL was not significant in advanced lung cancer patient-caregiver dyads.The partner effect of resilience on physical and mental QoL was not significant in advanced lung cancer patient-caregiver dyads.(2)Advanced lung cancer patients’and caregivers’resilience could improve their mental and physical QoL by improving their own acceptance of illness.(3)Advanced lung cancer caregivers’ resilience could improve patients’ physical and mental QoL by improving acceptance of illness of patients.5.Dyadic effects of social support on QoL in advanced lung cancer patients and caregivers:An actor-partner interdependence mediation model(1)The actor effect of social support on mental QoL was significant in advanced lung cancer patients,however,the actor effect of social support on mental QoL in advanced lung cancer caregivers was not significant.The actor effect of social support on physical QoL was not significant in advanced lung cancer patient-caregiver dyads.The partner effect of social support on physical and mental QoL was not significant in advanced lung cancer patient-caregiver dyads.(2)Advanced lung cancer patients’ and caregivers’ social support could improve their mental and physical QoL by improving their own acceptance of illness.(3)Advanced lung cancer caregivers’ social support could improve patients’physical and mental QoL by improving acceptance of illness of patients.Conclusions:1.The whole QoL of advanced lung cancer patients and caregivers were well,but some dimensions of QoL need to be improved.The physical and mental QoL of patients were poorer than their caregivers.2.Factors associated with physical QoL among advanced lung cancer patients were patients’ ECOG performance status,acceptance of illness.Factors associated with mental QoL among advanced lung cancer patients were patients’ TNM stage,ECOG performance status,resilience and acceptance of illness.3.Factors associated with physical QoL among advanced lung cancer caregivers were caregivers’ physical condition.Factors associated with mental QoL among advanced lung cancer caregivers were caregivers’ physical condition,resilience and acceptance of illness.4.Advanced lung cancer patients’ and caregivers’ resilience and social support could improve their mental and physical QoL by improving their own acceptance of illness.5.Advanced lung cancer caregivers’resilience and social support could improve patients’ physical and mental QoL by improving acceptance of illness of patients.