Associations Of Illness Perception,Mindfulness With Fear Of Cancer Recurrence Among Breast Cancer Patients And Their Spouses:The Mediating Role Of Family Avoidance Of Communication About Cancer

Objectives:To investigate the status of fear of cancer recurrence(FCR)and its related factors in breast cancer patients and their spouses,to explore the actor and partner effects of illness perception and mindfulness on FCR,and to examine the mediating role of family avoidance of communication about cancer based on the actor-partner interdependence mediation models,which could provide empirical evidence for improving FCR in this population.Methods:A convenience sampling of 227 dyads of breast cancer patients and their spouses were recruited from June to November 2021 in a tertiary cancer hospital in Shandong Province.The survey tools included general information questionnaire,Brief Illness Perception Questionnaire,Mindful Attention Awareness Scale-5,Family Avoidance of Communication about Cancer Scale and Fear of Progress Questionnaire-Short Form.SPSS 25.0 and AMOS 24.0 were applied for data analysis,and the main methods included univariate analysis,linear regression analysis,and actor-partner interdependence mediation analysis.Results:1.The scores for FCR in 227 breast cancer patients were(32.83 ± 9.75),of which 46.7%reached clinically significant levels(scores≥ 34),and the scores for FCR in their spouses were(35.00 ± 8.90),of which 59.0%reached clinically significant levels;and the levels of FCR in spouses were significantly higher than patients(t=-3.142,P=0.002).2.Correlation analysis showed that FCR in both breast cancer patients and their spouses was positively associated with their own illness perception and family avoidance of communication about cancer(r=0.373-0.519,Ps<0.001),and negatively associated with their own mindfulness(r=-0.377,-0.326,Ps<0.001).Meanwhile,FCR in both breast cancer patients and their spouses was positively associated with their partners’ illness perception and family avoidance of communication about cancer(r=0.169～0.270,Ps<0.05),and negatively associated with their partners’ mindfulness(r=-0.261,-0.172,Ps<0.01).In addition,patients’FCR,illness perception,mindfulness and family avoidance of communication about cancer were positively associated with their spouses’ corresponding variables,respectively(r=0.253～0.459,Ps<0.001).3.The results of linear regression analysis indicated that breast cancer patients’ illness perception,mindfulness and family avoidance of communication about cancer significantly contributed to patients’FCR(β=0.403,-0.227,0.227;Ps<0.001);and spouses’ illness perception,mindfulness and family avoidance of communication about cancer predicted spouses’ FCR significantly(β=0.392,-0.184,0.236;Ps<0.01).4.The results of actor-partner interdependence mediation analysis demonstrated that both the actor effects of illness perception on FCR were significant in breast cancer patients and their spouses(β=0.435,P<0.001;β=0.428,P<0.001),but neither of the partner effects was significant(β=0.004,P=0.939;(=0.003,P=0.939),and both dyads’ illness perception could influence their own(β=0.051,P<0.001,95%CI=0,024～0.082;β=0.050,P<0.001,95%C以I=0.024～0.082)and each other’s(β=0.022,P=0.040,95%CI=0.001～0.046;β=0.019,P=0.040,95%CI=0.001～0.040)FCR by their own family avoidance of communication about cancer.Besides,both the actor(β=-0.231,P<0.001;β=-0.263,P<0.001)and partner effects(β=-0.101,P=0.031;β=-0.105,P=0.031)of mindfulness on FCR were significant in breast cancer patients and their spouses,and both dyads’mindfulness could impact their own(β=-0.056,P<0.001,95%CI=-0.090～-0.028;β=-0.063,P<0.001,95%CI=-0.103～-0.032)and each other’s(β=-0.020,P=0.048,95%CI=-0.044～-0.0002;β=-0.021,P=0.048,95%CI=-0.044～-0.0003)FCR by their own family avoidance of communication about cancer.Conclusions:1.FCR in breast cancer patients and their spouses was prevalent,which was worthy of concern.2.Factors associated with FCR in both breast cancer patients and their spouses were their own illness perception,mindfulness and family avoidance of communication about cancer.Besides,both patients’ and spouses’mindfulness could predict their partners’ FCR.3.Both breast cancer patients’and spouses’ illness perception and mindfulness could have actor and partner effects on FCR by the mediating role of their family avoidance of communication about cancer.This could provide empirical evidence for improvement of FCR in patient-spouse dyads.