| ObjectiveBased on a dyadic perspective,this study takes patients with advanced cancer and their family caregivers as research subjects,explores their spiritual coping experiences through phenomenological research,analyzes their spiritual coping strategies,similarities,and differences,and their correlation,and preliminarily explores the possible influencing factors and mechanisms.Through a cross-sectional survey,the current situation and influencing factors of spiritual coping were analyzed,and the mechanism of influencing factors on spiritual coping of patients with advanced cancer and family caregivers was revealed through the actor-partner interdependence model.This study will help to deepen the understanding of spiritual coping of patients with advanced cancer and their family caregivers,provide a scientific basis for clarifying their spiritual coping mechanism,and promote the research and practice of spiritual care in cancer families.MethodThis study is divided into two parts:1.Qualitative study of spiritual coping in advanced cancer patients and family caregiversThrough semi-structured interviews with 12 dyads of patients with advanced cancer and their family caregivers,the spiritual coping strategies adopted by advanced cancer patients and family caregivers in the process of coping with cancer were understood,and the possible influencing factors were analyzed,as well as their spiritual coping strategies,similarities and differences,and correlation.2.Investigation of the influencing factors and mechanisms of spiritual coping in patients with advanced cancer and family caregiversBased on previous theoretical research and literature review,and combined with the spiritual coping strategies and influencing factors obtained from qualitative research,appropriate investigation tools are selected.A cross-sectional survey was conducted on 358 dyads of patients with advanced cancer and their family caregivers from tumor-related departments of secondary and tertiary hospitals in Shanghai.The data were collected with the Brief Illness Perception Questionaire(BIPQ),the Caregiver Reaction Assessment(CRA),the Perceived Social Support Scale(PSSS),the Hospital Anxiety and Depression Scale(HADS),the General Self-Efficacy Scale(GSES),the Optimism and Pessimism Scale(OPS),the Herth Hope Scale,the 8-item Short-Form Health Survey(SF-8),and a self-administered general information questionnaire.Descriptive statistics,t-test,variance analysis,Pearson correlation analysis,and multiple linear regression analysis were used to analyze the status quo,influencing factors,and correlation of spiritual coping of patients with advanced cancer and family caregivers,and the actor–partner interdependence model was built to analyze the dyadic effects of each influencing factor on spiritual coping of patients with advanced cancer and family caregivers.Results1.Qualitative results of the spiritual coping experiences of advanced cancer patients and family caregivers(1)Through qualitative interview analysis of 12 dyads of patients with advanced cancer and their family caregivers,five themes of spiritual coping strategies were extracted: "accepting the present","connecting with the outside world","obtaining hope and sustentation","thinking about death" and "exploring the meaning of life";The influencing factors of spiritual coping were divided into four themes,including "demographic factors","disease factors","cognitive factors","family factors" and "social factors".There were common coping strategies between patients with advanced cancer and their family caregivers,including facing reality,letting nature take its course,having hope,putting faith in others,appreciating others,seeking meaning,transcending life and death,and closing to nature.The unique coping strategies of patients include belief support,expressing their values,and talking about death anxiety.And the unique coping strategies of family caregivers include: helping to maintain relationships and experience life.Providing/perceiving love and care are interrelated coping strategies for patients and their family caregivers.(2)Based on the qualitative research results,a hypothesis model of spiritual coping study of patients with advanced cancer and their family caregivers was proposed.Age,marital status,religious belief,therapeutic effect,self-efficacy,family support,and social support were common influencing factors of patients and family caregivers,and directly affected their spiritual coping.The perception of disease severity,attitude towards disease,sense of responsibility to family,sense of social belonging,and external perception of disease were the only factors affecting the spiritual coping of patients with advanced cancer.The financial burden was considered to be the sole factor affecting caregivers’ spiritual coping.Combined with the qualitative research hypothesis model,the theoretical framework of the influencing factors of dyadic spiritual coping for patients with advanced cancer and family caregivers was perfected and supplemented.2.Research results of influencing factors and mechanisms of spiritual coping in patients with advanced cancer and family caregivers(1)Spiritual coping status of advanced cancer patients and family caregiversThe mean score of spiritual coping of patients with advanced cancer was(61.76±11.30),and the mean score of items was(3.63±0.66).The mean score of spiritual coping of family caregivers was(61.04±11.46),and the mean score of items was(3.59±0.67).The total score of spiritual coping of patients and caregivers was above the medium level.The mean scores of all dimensions of spiritual coping in patients with advanced cancer were as follows: the mystical experience was(3.09±1.09),virtue practice was(3.96±0.80),meaning exploration was(3.43±1.00),detachment mentality was(4.13±0.82).The scores from high to low were: transcendent mentality dimension > virtue practice dimension > meaning exploration dimension > mystical experience dimension.The average score of all dimensions of spiritual coping of family caregivers was as follows: the mystical experience was(3.12±1.07),virtue practice was(3.90±0.83),meaning exploration was(3.44±0.90),and detachment mentality was(4.05±0.79).The scores from high to low were: transcendent mentality dimension > virtue practice dimension > meaning exploration dimension > mystical experience dimension.(2)Analysis of influencing factors of spiritual coping in patients with advanced cancer and family caregiversThe spiritual coping level of elderly patients was higher than that of middle-aged patients,and the spiritual coping level of caregivers of elderly patients was higher than that of caregivers of young or middle-aged patients.The spiritual coping level of patients with religious belief was higher than that of patients without religious belief,and the spiritual coping level of caregivers with religious belief was higher than that of caregivers without religious belief.The spiritual coping level of female caregivers was higher than that of male caregivers.Patients who received total care from caregivers for 6-12 months had higher levels of spiritual coping than patients who received care for < 6 months.There was no correlation between the disease perception score of advanced cancer patients and the caregiving burden score of family caregivers and the spiritual coping scores of themselves and caregivers and the scores of each dimension(P>0.05).The spiritual coping of patients with advanced cancer was positively correlated with their social support(r=0.240,P<0.001)and spiritual health(r=0.423,P<0.001),but negatively correlated with their anxiety(r=-0.261,P<0.001)and depression(r=-0.221,P<0.001).There was a negative correlation with caregiver depression(r=-0.172,P<0.001)and a positive correlation with caregiver spiritual health(r=0.188,P<0.001).Family caregivers’ spiritual coping was positively correlated with their self-efficacy(r=0.475,P<0.001)and spiritual health(r=0.400,P<0.001),but negatively correlated with their anxiety(r=-0.381,P<0.001)and depression(r=-0.439,P<0.001).It was negatively correlated with anxiety(r=-0.506,P < 0.001)and depression(r=-0.295,P<0.001),but positively correlated with self-efficacy(r=0.417,P<0.001)and spiritual health(r=0.361,P<0.001).Factors related to spiritual coping in patients with advanced cancer were 45-59 years old,religious beliefs,social support,spiritual health,and total caregiver care duration of6-12 months,which accounted for 30.2% of the variation in spiritual coping in patients with advanced cancer.18-44 years old,45-59 years old,anxiety,depression of patients,and religious belief,female,anxiety,self-efficacy,and spiritual health of caregivers accounted for 90.1% of the variation in family caregiver spiritual coping.(3)Actor and Partner-Independent Model of spiritual coping between advanced cancer patients and family caregiversIn terms of actor effects: Patients’ depression had an actor effect on their spiritual coping(β=-0.172,P=0.001),patients’ spiritual health had an actor effect on their spiritual coping(β=0.285,P=0.001),patients’ social support had an actor effect on their spiritual coping(β=0.168,P=0.001).Caregivers’ anxiety had an actor effect on their spiritual coping(β=-0.337,P=0.002),caregivers’ depression had an actor effect on their spiritual coping(β=-0.141,P=0.005),and caregivers’ self-efficacy had an actor effect on their spiritual coping(β=0.387,P=0.001).In terms of partner effects: Patients’ anxiety had a partner effect on caregivers’ spiritual coping(β=-0.195,P=0.001),patients’ self-efficacy had a partner effect on caregivers’ spiritual coping(β=0.145,P=0.003),and patients’ spiritual health had a partner effect on caregivers’ spiritual coping(β=0.114,P=0.020).Caregivers’ self-efficacy had a partner effect on patients’ spiritual coping(β=-0.171,P=0.009).Conclusions1.Both patients with advanced cancer and family caregivers mostly use positive spiritual coping strategies.They have common coping strategies,including facing reality,letting nature take its course,having hope,placing faith,appreciating others,seeking meaning,transcending life and death,and closing to nature.Supporting beliefs,expressing self-worth,and talking about death anxiety,caregivers’ unique coping strategies include:helping to maintain relationships and understanding life,and the corresponding coping strategies of patients and caregivers are providing/perceiving love and care.2.Advanced cancer patients and family caregivers had above average levels of spiritual coping.Patients’ age classification,religious belief,social support,spiritual health and caregiver’s total care time were the main factors affecting spiritual coping of patients with advanced cancer.Patients’ age classification,anxiety and depression,as well as caregivers’ religious belief,gender,anxiety,self-efficacy and spiritual health were the main influencing factors of family caregivers’ spiritual coping.3.There were interactions among social support,anxiety,depression,self-efficacy,spiritual health,and spiritual coping in patients with advanced cancer and family caregivers.The actor-partner interdependence model showed that in terms of actor effects,patients’ depression could negatively predict their spiritual coping,patients’ spiritual health and social support could positively predict their spiritual coping,caregivers’ anxiety,and depression could negatively predict their spiritual coping,and caregivers’ self-efficacy could positively predict their spiritual coping.In terms of partner effects,patients’ anxiety can negatively predict caregivers’ spiritual coping,patients’ self-efficacy and spiritual health can positively predict caregivers’ spiritual coping,and caregivers’ self-efficacy can negatively predict patients’ spiritual coping. |
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