Liu Jia, Zhang Yuexia, Guan Ting, Wang Xiaomeng, Ma Chunxuan, Northouse Laurel, Song Lixin
The University of Texas Health Science Center at San Antonio School of Nursing, 7703 Floyd Curl Drive, San Antonio, TX, USA.
The University of Texas at San Antonio Alvarez College of Business, San Antonio, TX, USA.
Support Care Cancer. 2025 May 14;33(6):471. doi: 10.1007/s00520-025-09512-8.
Few existing interventions have effectively improved the quality of life (QOL) for patients with advanced cancer and their caregivers, partly due to limited research on the factors associated with QOL. Guided by an adapted stress-coping model, this study aimed to examine the associations between the QOL of cancer patients and their caregivers and their primary and secondary appraisals. Primary appraisals involve perceptions and evaluations of advanced cancer and related caregiving, while secondary appraisals relate to their available resources and coping capabilities.
Using multi-level modeling, we conducted a secondary analysis of the baseline data collected from a randomized clinical trial that examined the effects of a family-based, psychoeducational support program for patients with advanced cancer and their caregivers (N = 362 dyads).
The appraisal variables hypothesized in the adapted stress-coping model explained 74.14% of the variance in the QOL of patients with advanced cancer and their caregivers when controlling for demographics and other disease-related variables. Better QOL in patients and caregivers was associated with less negative appraisals of illness/caregiving, less uncertainty and hopelessness, less avoidant coping strategies, more family support, more health behaviors, higher self-efficacy, and more active coping strategies.
Our study highlights the significant impact that advanced cancer has on patients and their caregivers' perceptions, responses to the illness, and QOL. Future interventions may benefit from addressing illness/caregiving appraisals, uncertainty, hopelessness, family support, health behaviors, self-efficacy, and coping strategies. However, further research is needed to determine the effectiveness of interventions specifically targeting these factors.
现有的干预措施很少能有效改善晚期癌症患者及其照顾者的生活质量（QOL），部分原因是对与生活质量相关因素的研究有限。本研究以一种适应性压力应对模型为指导，旨在探讨癌症患者及其照顾者的生活质量与其初级和次级评估之间的关联。初级评估涉及对晚期癌症及相关护理的认知和评价，而次级评估则涉及他们可用的资源和应对能力。
我们使用多层次模型，对从一项随机临床试验收集的基线数据进行了二次分析，该试验考察了一项针对晚期癌症患者及其照顾者的家庭式心理教育支持项目的效果（N = 362对）。
在控制人口统计学和其他疾病相关变量后，适应性压力应对模型中假设的评估变量解释了晚期癌症患者及其照顾者生活质量差异的74.14%。患者和照顾者更好的生活质量与对疾病/护理的负面评价较少、不确定性和绝望感较少、回避应对策略较少、家庭支持较多、健康行为较多、自我效能感较高以及积极应对策略较多有关。
我们的研究强调了晚期癌症对患者及其照顾者的认知、对疾病的反应和生活质量的重大影响。未来的干预措施可能会受益于解决疾病/护理评估、不确定性、绝望感、家庭支持、健康行为、自我效能感和应对策略等问题。然而，需要进一步的研究来确定专门针对这些因素的干预措施的有效性。
