Family resilience of cancer patients: a concept analysis

Global Cancer Statistics (2022) indicates that there are >19.3 million (19,300,000) new cancer cases reported recently leading to approximately 10 million deaths in 2020 based on the reported data worldwide.¹ And in China, there were about 3.92 million new cases of malignant tumors in 2015.² Cancer, as a crisis, is a persistent challenge to patients and their families. Diagnosis and treatment of cancer not only affect the physical and mental health of patients, but also bring many negative effects on the family.³

In order to promote the treatment of cancer and improve the prognosis, clinicians began to shift from treating patients from an individual perspective to a family centered treatment model with the support of the family system theory, emphasizing the overall advantages and flexibility of the family.⁴ Studies have shown that a high level of family resilience can affect individual psychological resilience, help reduce negative emotions, and improve the well-being and quality of life of patients and family members.^5,6 Due to the complexity of cancer treatment, families have to adjust their role functions and assume corresponding responsibilities. Family perceptions and responses to cancer are very important for cancer patients.

Family resilience is a positive force that helps the whole family adapt successfully to pressure and adversity.⁷ In other words, family resilience affirms the potential of a family to recover and grow from adversity, and evaluates family functions and resources from the perspective of family advantages.

The academic community has not yet unified the concept of family resilience of cancer patients, and this concept also needs to be expanded and updated. However, there is no accurate and unified definition of family resilience of cancer patients at home and abroad. The mature concept has the characteristics of being specific, clear boundaries, and can be directly measured and applied by describing the causes and consequences.

Therefore, this study aims to further summarize and analyze the connotation of this concept. Concept analysis is an effective method to clarify the widely used but ambiguous concepts involving multiple disciplines.⁸ In the process of concept analysis, the general conclusion is constantly summarized and the concept is integrated with strict and careful formulas.

Walker and Avant’s⁹ method was used for this review, which has been widely used in nursing research. In this study, Walker and Avant’s⁹ theory was applied to analyze and discuss family resilience in cancer patients, and the concept was clarified by summarizing the attributes of family resilience. The method is divided into 8 steps: (1) Concept selection, family resilience of adult cancer patients; (2) Determine the purpose of analysis, and give the operational definition of family resilience in cancer patients; (3) Determine the application of the concept in the literature; (4) Define the attributes; (5) Build examples; (6) Construct critical, relevant and opposite cases; (7) Determine the cause and effect; (8) Provide empirical evaluation indicators.

The identification of the model aims to improve the understanding of defining attributes of family resilience and to provide support for antecedents and consequences.

Ms. Wang, 55 years old, has a harmonious relationship with her husband, a son has established a small family. She was diagnosed with meningioma and her doctor suggested surgery. But Wang refused treatment, thinking it was cancer and could not be cured by surgery. Her lover and son encouraged her to have surgery. The doctors and nurses provided the patients’ families with detailed information about the disease and prognosis. She got along well with the patients around and actively learned the methods of postoperative self- management. Now, the patient has recovered well after the operation. She is very grateful for the care and support of her husband and son since her illness, and also cooperate with the follow-up review and treatment. This case is an example containing all the defining attributes of family resilience. Ms. Wang can actively accept the fact, get along well with family members, and get emotional and information support from family members and the outside world.

Walker and Avant⁹ describe antecedents as events or incidents that precede the concept’s occurrence. According to a literature review, family resilience is shown when a family experiences adversity or difficulties. Family itself has resource advantages and development potential, but also needs the strong will of family members to overcome difficulties.

The antecedents of family flexibility of adult cancer patients mainly include: (1) Events related to cancer: including diagnosis of cancer, treatment, method, and course of cancer. When a family member is diagnosed with cancer and knows about it, the balance of family functioning is disrupted. (2) Demographic statistics: including educational background, family economic status, residence, and payment of medical expenses.^15,21,22 (3) Individual characteristics of patients and family members: including the ability to grow after injury, psychological elasticity, sense pressure, trust, and utilize social economic resources.²² (4) Family factors: including family communication and problem-solving, family resilience, and social support. Families have different structures and resources, and are united in their own life paths and ways to assist, actively communicate, and hold an optimistic attitude toward the disease.

Walker and Avant⁹ refer to consequences as events or incidents that follow the family resilience. The consequences are primarily positive changes in the face of cancer by cancer patients and their families, which are mainly to improve the mental and health behavior of patients and family members. There are several consequences.

With the increase of cancer cases year by year, the psychological burden of cancer patients and family members becomes increasingly prominent. Timely detection of their psychological problems and intervention can effectively improve the mood of patients and family members, and ultimately promote their life quality. This is a proposed operational definition of family resilience generated from the current concept analysis: after a family member is diagnosed with cancer, the whole family can actively explore its own unique internal and external resources and advantages, strengthen self-regulation, jointly cope with the crisis by establishing close family relationships, providing mutual support to family members, and interacting with the outside world.

The operational definition of family resilience in adult cancer patients can be used as a theoretical basis for the development, improvement, or selection of measurement tools. According to a literature review, the existing assessment tools for family elasticity of adult cancer patients are mainly based on the family resilience theoretical model proposed by Walsh¹³. Therefore, the definition of adult cancer patients can be combined with the localized family resilience structure model to develop a specific family resilience assessment tool for these patients.²⁵ Researchers can use the operational definition to analyze whether existing family resilience assessment tools contain their defining attributes and determine appropriate assessment tools combined with research purposes, so as to improve the reliability of the results of measuring family resilience of adult cancer patients.

The operational definition of family resilience also provides the basis for the provision of nursing intervention strategies. The suggestion suggests that nurses can improve the outcome of patients from the two aspects of patients themselves and their families, but how to effectively explore the family strength of adult cancer patients and implement nursing intervention to improve family resilience is still difficult. As the implementers of resilient family preparation, the operational definition of family resilience helps nurses to understand family resilience more directly, and encourages nurses to choose appropriate assessment tools to evaluate family resilience of adult cancer patients, so as to identify the families with low resilience early.

In the process of anticancer, a new balance and harmony of family order can be formed to achieve successful disease management.

Improving family resilience of cancer patients can not only help the patients themselves reduce psychological distress, obtain post-traumatic growth, establish a rich social support network, actively cope with cancer, and cooperate with treatment and health care, but also help to reduce the burden of caregivers and protect the mental health of family members.²⁶

A correct understanding of the concept of family elasticity of cancer patients, identification of families with low family elasticity, and appropriate, timely, and reasonable intervention are helpful to improve the quality of life of family members.²⁷

Nurses should pay attention to the resilience level of different families, provide corresponding support according to the uniqueness of the family, assist the family to learn from past challenges and actively cope with cancer, encourage effective communication between family members and reasonable catharsis of emotions,^17,28 guide family members to think positively and give new meaning to cancer, help the family to find their own internal and external resources and develop new resources, and promote self-growth of the family.

Based on the concept analysis of Walker and Avant⁹, this paper further summarizes the family resilience of cancer patients. As a traumatic event in the family, cancer brings certain crises and pressure to the family, and family resilience is an important factor to support the positive response and positive development of their family. However, there are limitations in research on the family resilience of cancer patients in China. First, domestic measurement tools for family resilience of cancer patients were developed by students or families of sick children. Although there have been studies to further verify the adaptability of the scale in cancer groups, the items in the scale are not cancer-specific, and there is no measurement tool for family resilience developed with Chinese culture as the background, and the specific scale can be prepared in the following studies. Second, there are few nursing and intervention studies on family resilience of cancer patients in China, so targeted interventions can be formulated and empirical research can be conducted based on Walsh’s model.