| ObjectiveThe purpose of this study was to investigate the current status of family function among cancer patients and their caregivers,and to analyze influencing factors of family function.This study provides support for medical staff to develop targeted interventions in cancer patients and caregivers to effectively improve family function.MethodsThis study is a mixed-type study and consists of two parts.1.Quantitative research on the current status and influencing factors of family function among cancer patients and their caregivers: This part was a cross-sectional survey.The study selected cancer patients and caregivers hospitalized in three districts of two tertiary A-level general hospitals in Qingdao from August 2020 to July 2021 as the research subjects.Patients and caregivers of the same family were studied as a whole.Questionnaires were conducted using general information questionnaire,Family APGAR Index Scale,Family Hardiness Index,Social Support Rating Scale,Hospital Anxiety and Depression Scale,and Zarit Burden Interview.SPSS25.0(IBM Corp.,Armonk,NY,USA)and Med Calc20.0.4(Ostend,Belgium)were used for statistical analysis and data processing,including descriptive analysis,multivariate logistic regression,decision tree and Delong test.2.Qualitative interview study on the influencing factors of family function among cancer patients and their caregivers: This part was a descriptive qualitative research.The study used the purpose sampling method to select cancer patients and their caregivers who were hospitalized in three districts of two tertiary A-level general hospitals in Qingdao from May 2021 to November 2021.This study conducted one-to-two semi-structured in-depth interviews with families as a unit.Based on content analysis,relevant topics and concepts in patient and caregiver statements were extracted to understand the related feelings and experiences of cancer patients and caregivers’ family function.Results1.Quantitative research results:(1)A total of 260 groups of valid questionnaires were collected in this study.157groups(60.4%)of cancer patients and caregivers’ family function were at a good level,and 103(39.6%)were at a disability level.(2)The family function scores of cancer patients and their caregivers ranged from 3to 10,with an average of(7.47 ± 1.73).The scores of each dimension were fitness(1.62 ±0.42),cooperation(1.49 ± 0.45),and growth(1.43 ± 0.45),emotionality(1.43 ± 0.58),intimacy(1.54 ± 0.42).(3)Multiple Logistic regression results showed that the influencing factors of family function among cancer patients and caregivers mainly included the following aspects:patients level included the number of children(OR = 0.356,95%CI = 0.167-0.759),whether they were accompanied by other chronic diseases(OR = 0.259,95%CI = 0.082-0.813),depressive symptoms(OR = 1.219,95%CI = 1.035-1.436);caregiver level included age(OR = 0.274,95%CI = 0.097-0.774),work status(OR = 0.285,95%CI =0.083-0.976),caregiver burden(OR = 1.046,95%CI = 1.007-1.087);cancer patients and caregivers level included family resilience(OR = 0.735,95%CI = 0.651-0.829)and social support(OR = 0.850,95%CI = 0.750-0.963).(4)The decision tree model had five-layer structures.The first layer was family function and the second layer root node was family resilience,indicating that family resilience was highly correlated with family function.94.2% of families with family resilience score of ≤ 49.5 had family dysfunction,46.0% of families with family resilience score of 49.50-58.50 had family dysfunction,and families with family resilience score of >58.50 had family dysfunction accounted for only 6.2%.In the third tier,50.0% of families had family dysfunction with family resilience score >58.50 and social support score ≤ 34.5.In families with family resilience score ≤ 49.5 and social support score ≤ 40.0,family dysfunction proportion could reach 97.9%.Among the families with family resilience score of 49.50-58.50,the cancer family with 1 child had much higher incidence of family dysfunction(75.0%)than the family with more than 2children(25.9%).The fourth level of the decision tree showed that if the number of children was ≤ 1 and the depressive symptom score was greater than 7 points,the proportion of family dysfunction was 88.2%.In families with more than 2 children,the heavier the burden of caregivers(> 24),the higher the proportion of family dysfunction(53.8%).In the fifth level of decision tree,the younger the patient(< 59 years old),the higher the proportion of family dysfunction(100.0%);the longer the patient’s disease course(< 6 months),the more dysfunctional family(85.7%).(5)The model performance results of multiple logistic regression and decision tree showed that the accuracy,sensitivity,specificity,positive predictive value and negative predictive value of multiple logistic regression analysis were 91.2%,88.3%,93.0%,89.2% and 92.4%,respectively.The accuracy,sensitivity,specificity,positive predictive value,and negative predictive value of the decision tree were 90.0%,82.5%,94.9%,91.4%,and 89.2%,respectively.The area under curve of receiver operating characteristic curve of multiple logistic regression(0.974)was slightly higher than that of decision tree(0.944),and the difference was not statistically significant(P > 0.05).Both models have similar predictive performance.2.Qualitative research results:(1)A total of 17 groups of patients and caregivers were included in this study.The patients included 9 males(52.9%)and 8 females(47.1%),aging from 35 to 68 years old,with an average age of(58.82 ± 8.88)years.Among the caregivers,there were 11 males(64.7%)and 6 females(35.3%),ranging in age from 30 to 65 years,with an average age of(48.47 ± 12.58)years.(2)Based on family system theory and literature review,interviews and summaries of cancer patients and caregivers were conducted.Four themes were extracted in terms of protective factors,including positive emotion,complete family structure,good family relationships,relatives and friends and patients’ support.In terms of risk factors,three themes of negative emotion,family burden,and disease side effects were extracted.Conclusions1.The family function of cancer patients and caregivers is at an upper-middle level,and patients and caregivers whose family function is at the level of disability cannot be ignored.2.The family function of cancer patients and caregivers is affected by the patient’s age,number of children,disease course,whether accompanied by other chronic diseases,depression symptoms;the caregiver’s age,work status,caregiver burden;family resilience and social support of cancer patients and caregivers.There was an interaction between family resilience,social support,patient’s age,number of children,disease duration and depressive symptoms and caregiver burden.Medical staff should comprehensively consider these influencing factors,provide directions for comprehensively improving the family functions of cancer patients and caregivers,and formulate corresponding intervention measures to effectively improve family function of cancer patients and caregivers. |
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