The dyadic coping experience of patients with Percutaneous Transhepatic Biliary Drainage of bile duct stones and their spouses:A qualitative descriptive study

The dyadic coping experience of patients with Percutaneous Transhepatic Biliary Drainage of bile duct stones and their spouses:A qualitative descriptive study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The dyadic coping experience of patients with Percutaneous Transhepatic Biliary Drainage of bile duct stones and their spouses:A qualitative descriptive study Xiaoman Tao, Xiaomei Wang, Huan Yu, Liyun Gong This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7922196/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: As interventional minimally invasive technology develops rapidly, Percutaneous Transhepatic Biliary Drainage (PTBD) has become one of the surgical methods for subsequent stone extraction in patients with bile duct stones because of easy operation, low trauma, fewer complications, and high success rate.However, the need for long-term indwelling drainage tubes after the operation puts the patients and their spouses in different degrees of stress for a long period of their lives, leading to poor dyadic coping. Objectives: this study aimed to explore the dyadic coping experience of patients with PTBD of bile duct stones and their spouses in China and to provide a basis for developing dyadic coping intervention measures. Design: A descriptive qualitative design was used to conduct the study. Results: A total of three themes and ten sub-themes emerged from the analysis.The identified themes include positive coping (Maintenance of a positive and optimistic mindset, actively seeking solutions, and facing challenges together), negative coping (avoiding problems, displaying overprotective behaviour, and bearing the burden alone), difficulties and challenges (high physical and psychological stress,communication disorders and significant financial burden). Discussion and Conclusion: Healthcare professionals should pay increased attention to the stress and challenges faced by both PTBD patients with bile duct stones and their spouses during the period of living with indwelling drainage tubes. Developing couple-centered interventions to mitigate negative emotions in patients and their spouses and facilitate the adoption of positive coping strategies may represent a critical area for future research and clinical practice, ultimately enhancing their joint quality of life. percutaneous transhepatic biliary drainage dyadic coping qualitative research spouses Figures Figure 1 INTRODUCTION Bile duct stones which develop in the intrahepatic or extrahepatic bile ducts due to bile stasis and biliary tract infections[ 1 ], are traditionally rare in Western countries but predominantly observed in the Asia-Pacific region, particularly Hepatolithiasis. Epidemiological studies indicate a high prevalence of 3.1%-21.2% in China, South Korea, and Japan, with 4%-12% of cases complicated by concurrent cholangiocarcinoma[ 2 ]. Notably, recent increases in immigration and shifts in diet have contributed to a rising incidence of bile duct stones in Western populations[ 3 ]. Although classified as a benign condition, bile duct stones demonstrate clinical features typically associated with malignancies, including recurrent biliary obstruction and refractory infections[ 4 ].Traditional open surgery is limited by high residual stone rates and recurrence rates, primarily due to anatomical complexity and incomplete clearance. These therapeutic challenges frequently progress to life-threatening complications such as cholangitis, liver abscesses, and sepsis, making bile duct stones a significant contributor to mortality in benign biliary disorders. PTBD is a minimally invasive procedure performed when biliary obstruction prevents bile from entering the intestines properly, involving percutaneous transhepatic puncture of intrahepatic bile ducts to place a drainage catheter, thereby relieving intrabiliary hypertension above the obstruction level, reducing serum bilirubin, or alleviating biliary inflammation[ 5 , 6 ].For patients with bile duct stones, PTBD catheter retention for 2–4 weeks post-puncture is required, Each stone extraction at monthly intervals, a total of 2–3 times, enabling effective removal of distal biliary stones and correction of biliary strictures, with advantages of minimal invasiveness and rapid recovery[ 4 ].However, the shift in treatment modalities has paradoxically introduced new challenges: patients require PTBD catheter retention for 1–3 months postoperatively, which not only imposes significant lifestyle restrictions and increases the risk of post-discharge catheter-related complications, but may also induce social withdrawal and disease-related stigma due to body image disturbances[ 7 ].For most patients with bile duct stones, treatment and care primarily occur in home settings.The spouse,as the primary caregiver, not only confronts uncertainties regarding disease progression and acquires catheter management skills, but also shoulders main responsibility to take care of family, collectively contributing to a marked decline in their quality of life[ 8 ].Presently, the concept of coping with illness has evolved from an individual perspective to a dual perspective involving the couple.Dyadic coping (DC) refers to the shared decision-making by both partners when faced with stressful events, aiming to enhance the psychosocial adjustment and relationship functioning of both the patient and the spouse, while maining optimal them well-being[ 9 ].The Systemic-transactional Model (STM), initially proposed by Bodenmann in 1995 on the basis of an individual-oriented theory of stress and coping[ 10 ].Among the various DC approaches, the STM has gained the most international recognition and serves as the predominant theoretical model guiding research[ 11 – 13 ].The STM emphasizes the dynamic interplay between partners, positing that stress experienced by one partner invariably affects the other through bidirectional influence pathways. Simultaneously, the coping strategies employed by the other partner serve as relational resources, generating novel synergistic effects that enhance the dyadic coping process. Currently, the STM has been extensively adapted to adress couples coping with severe stressors, particularly in contexts involving critical life events (e.g. the deadth of a child[ 7 ]) or the severe health conditions of a partner (e.g.cancer[ 14 ];strok[ 15 ]). Research indicates that positive dyadic coping enhances patients' self-management abilities and caregivers' caregiving skills[ 16 ],reduces negative emotions in both patients and caregivers[ 17 , 18 ], and improves intimacy between partners[ 19 , 20 ]. Previous researches have predominantly focused on patients' experiences living with indwelling catheter or the prevention and management of complications, lacking a holistic perspective that integrates patients and spouses as a dyadic unit in evaluating their psychophysiological adaptations and quality of life adjustments during stressor events. We hypothesize that couples face shared challenges and unmet needs during catheter retention periods, and these experiences may substantially influence health outcomes for both partners. Guided by the STM, this study aims to explore the lived experiences of disease coping in patients with PTBD bile duct stones and their spouses. The findings of this studying will provide an evidence base for implementing couple-centered DC interventions. METHODS Study Design This qualitative study was based on a qualitative descriptive design to explore the DC experience of patients with PTBD of bile duct stones and their spouses and provide a basis for developing DC intervention measures[ 21 ].From a philosophical point of view, this research method is closely linked to constructivism and critical theory, utilizing interpretive and naturalistic approaches. The use of this method produces a concise summary in everyday language that helps the researcher to understand a particular phenomenon.In this study,the qualitative descriptive approach facilitated a straightforward process to understand the feelings and perspectives of patients with PTBD of bile duct stones and their spouses in coping with the disease.The qualitative descriptive approach facilitated a straightforward process to understand the feelings and perspectives of patients with PTBD choledocholithiasis and their spouses in coping with the disease.The Consolidated Criteria for Reporting Qualitative Research was used for study reporting[ 22 ]. Object of study Purposive sampling was used to recruit participants for this study.Period from December 2024 to February 2025, patients with PTBD bile duct stones and their spouses, enroled after discharge from four cities in China, were asked to participate in the study. Hospital professionals referred participants to the research team, and eligibility screening was conducted by the research team.A total of 15 couples were interviewed.The inclusion and exclusion criteria can be found in Table 1. Insert table 1. Research methodology Defining the outline of the interview Through literature review[ 23 , 24 ],a preliminary interview outline was developed based on the STM ,research group discussion and expert consultation.Prior to the formal interviews, two pairs of patients PTBD bile duct stones and spouses underwent pre-interviews,which helped in refining the final interview outline.The final interview outline is shown in Table 2. Insert table 2. Data collection methods Before the interviews, the first author explained the purpose of the interviews to the participants through phone calls or face-to‐face meetings, obtained their informed consent and scheduled interview times.Then,Separate semi-structured interviews were conducted in a face-to-face or online format.Face-to-face interviews took place in a quiet, private conference room. All interviews were conducted by the first author.During the interviews the first author flexibly utilized the interview outline, used techniques such as listening, responding, clarifying, and following up, and recorded nonverbal information such as the interviewee's facial expressions and body movements.Each interview lasted approximately 30 min.The sample size was determined by data saturation, which means that interviews were stopped after analysing at least 10 interviews, and only when no new data emerged from three consecutive interviews[ 25 ].The interview transcripts were anonymized, and all data, including audio recordings, transcripts, handwritten notes, and consent forms, were securely stored in a locked drawer and password-protected computer files. Methods of information analysis The first author transcribed the audio recordings verbatim within 24 hours post-interview through iterative review processes that annotated nonverbal cues, generating preliminary transcripts which were subsequently cross-verified by an independent researcher, with discrepancies resolved through third-party adjudication to ensure transcription fidelity. Using the thematic analysis[ 26 ],combined with the STM, the interview scripts were read repeatedly by 2 researchers to extract the statements that were relevant and meaningful to the purpose of the study, coded, and codes with common concepts and characteristics were summarized to form themes and subthemes with complete descriptions.The first author who conducted the interviews is a graduate student in Nursing who had undergone comprehensive training and acquired proficiency in qualitative research methods and interviewing techniques. Human Ethics and Consent to Participate declarations The study adhered to the ethical standards outlined in the 1964 Helsinki Declaration and its subsequent amendments. Prior to the interviews, participants provided written informed consent, which was reiterated verbally. Signed informed consent was obtained from all participants. The informed consent form explicitly stated that participant responses would be anonymized following data collection and that participants had the right to withdraw from the study at any point prior to the publication of the data. Ethical approval for this study (EC-SAH-CQMU-2024-66) was granted by the Ethics Committee of the Second Affiliated Hospital of Chongqing Medical University. RESULTS The sample consisted of 30 participants. Through effective coordination and communication between the nurse manager, patients, and their spouses, 15 couples successfully completed the interviews without any dropouts. Table 3 presents the characteristics of each participant. The analysis yielded three main themes and ten sub-themes, as illustrated in Fig. 1.Additional quotes illustrating our findings can be found in the Additional file 1. Insert table 3. Insert Fgure 1. Theme 1: Active coping Maintenance of a positive and optimistic mindset Certain couples stay positive, encourage each other, and promote positive coping styles.For instance,P1 stated,‘I maintained a positive mindset throughout my journey from diagnosis to treatment, with my husband consistently by my side, which helped me sustain emotional stability.’This health challenge has reinforced the importance of prioritizing regular follow-up exams, engaging in physical activity, and adhering to a balanced diet.’S1 mentioned,‘I often reassure her, 'It’s okay. We’re only human—falling ill is part of life.’Similiarly,P2 experessed,‘I have maintained a stable emotional state, supported by my spouse's attentive care. I continue to engage in daily outings and feel no hesitation about others noticing my drainage bag.’As cheerfully recounted by S2,‘ I’ve always believed in her swift recovery and consistently encouraged her to maintain an optimistic mindset. Once the drainage tube is removed, I plan to take her out to enjoy life and celebrate this clinical milestone together.’ Actively seeking solutions During the indwelling tube management phase, particularly in the critical transition from hospital to home care without immediate medical supervision, acute complications may inevitably arise. Proactive problem-solving emerges as a prioritized strategy for many patients.P1 expressed,‘During my time at home, I experienced a sudden episode of pain. I promptly consulted Dr. Wang in our WeChat group, who advised me to take ibuprofen capsules. After two doses, the pain subsided completely!’. Similarly, P2 exclaimed emotionally,‘When I experience significant physical discomfort, I vent my emotions to my spouse, who responds by comforting me and coordinating with doctors to seek medical guidance. This collaborative approach consistently alleviates my distress’. On the other hand,Some spouses actively engage in acquiring disease management knowledge while providing tangible support and advices.As S2 mentioned,‘Upon learning that she would require home care with an indwelling PTBD tube,I proactively acquired comprehensive knowledge on catheter management under the guidance of healthcare professionals prior to discharge. This included recognizing potential complications and developing targeted resolution strategies.’ Simultaneously, some spouses rely on support from other family members to alleviate the burden of caregiving.S5 stated,‘During the post-discharge period, we resided at our daughter’s home. She actively participated in caregiving by assisting with meal preparation, collaboratively studying catheter management protocols, and sharing responsibilities in caring for my husband. This collective engagement resulted in a significantly reduced caregiving burden compared to previous experiences.’ Facing challenges together Many patients reported that mutual empathy, reciprocal support, and effective communication between spouses significantly strengthened intimacy, thereby enhancing their joint capacity to manage illness-related challenges.P1 cheerfully shared,‘Since this illness, I feel our marital relationship has grown stronger. During moments of difficulty, he provided unwavering support, and through navigating these challenges together, we’ve deepened our mutual understanding—this reciprocal dynamic has fostered a positive feedback loop in our relationship.’ Similarly, P3 recunted,‘Since the beginning of my hospitalization, my husband has been caring for me. Every time the doctors and nurses conducted ward rounds, he diligently documented the specific characteristics of my condition and proactively sought guidance from healthcare professionals on catheter care techniques. As a result, I never had to worry about a thing. After returning home, his expertise in caregiving became evident—he attended to me exceptionally well, and my physical recovery progressed rapidly(smiling contentedly) .’ S1 affirmed,‘I’ve come to profoundly understand the saying, ‘In youth, lovers; in age, companions.’ When illness strikes, it is ultimately the spouse who steps into the caregiver role. Our children have work commitments and cannot assist consistently—this is why I took leave to personally care for her.’ Theme 2: Negative coping Losing confidence During home-based tube management, some patients experienced complications such as tube dislodgement and infection, severely impairing their quality of life and leading to considerations of treatment discontinuation. P6 lamented,‘I have had the tube for nearly two months. Previously, the tube dislodged once, requiring a repeat PTBD procedure. However, my current laboratory markers do not meet the criteria for stone removal, necessitating prolonged tube retention. After returning home, I developed bile leakage and persistent pruritus, particularly at night, which severely disrupted my sleep. The physical and emotional toll made me consider abandoning treatment altogether.’Similarly, P14 reported, ‘Following tube placement, purulent discharge developed around the wound site, accompanied by intense itching and pain. Despite adhering to daily wound cleansing as advised by my physician, the condition worsened, resulting in fistula formation. This outcome has left me deeply distressed(sobbing).’ Avoidance of the problem The prolonged retention of catheters forces patients to change their original lifestyles, resulting in a chronic state of stress in the body and mind, such as disorganized self-image and a sense of social detachment, which is accompanied by mood fluctuations, leading to symptoms such as anxiety and depression.Concurrently, spouses experience multifaceted psychological strain—stemming from fears of disease recurrence, self-doubt regarding caregiving competence, and socioeconomic pressures due to income loss. Some couples choose to solve problems through avoidance and refusal to communicate.P15 lamented,‘This disease has been with me for over 10 years, with many surgeries, and I feel numb ,’followed by ensuing silence.likewise, P3 described,‘Since coming home to live with a tube, I've pretty much eliminated all socializing, only going out for walks in the evenings, and I'm worried about people seeing my bag of bile and not wanting to say too much about it.’S4 tearfully disclosed,‘He always says I don't care about him, but then he ignores you every time I try to share knowledge with him about something related to his health condition.(choking).’ Displaying overprotective behaviour Following the transition from hospital to home, patients are in the early stages of physical recovery. For those without prior experience in managing medical tubes at home, some spouses may exhibit overprotective behaviors, such as restricting daily activities. S4 admitted,‘ Sometimes I become overly concerned about him, fearing the tube might dislodge, so I try to prevent him from engaging in any activities.’S7 shared, ‘After returning home, my focus has been entirely on my husband. I rarely let him engage in any activities because he is the primary breadwinner of our family. I desperately want him to recover quickly; otherwise, I truly don’t know how we would cope.(visible tension).’ Bearing the burden alone In addition,some couples attempted to conceal their struggles to alleviate each other’s burdens, bearing pressures and challenges alone. P15 acknowledged,‘Since being discharged with the tube, I have never shared my physical discomfort with my wife. She has already sacrificed tremendously—years ago, I underwent a major surgery that incurred substantial costs, and she has cared for me ever since. I can’t burden her further with my worries.’S11 ststed,‘The medical expenses for this treatment were significant, but I'm afraid to tell her. As her husband, these responsibilities are mine to bear.’ Theme 3: Difficulties and challenges Significant physical and mental stress Throughout the period of living with tubes, both patients and their spouses experienced significant physical and psychological distress. P7 stated,‘The thought of being unable to work as I used to because of the tube makes me feel like a burden.’ P9 shared,‘After returning home, I barely slept for days, terrified of accidentally dislodging the tube. It was utterly exhausting.’S10 expressed,‘Since her illness began, I’ve stayed by her side constantly. Seeing her in pain and being unable to help has left me heartbroken.’Similarly,S12 remarked, ‘Alongside caring for my wife, I also look after our grandchildren. Our children are busy with work and financial obligations—I understand—but the fatigue is overwhelming, and I have no one to talk to.’ Communication disorders Some couples exhibited significant communication barriers during disease management, influenced by personality differences, conflicting perspectives, and emotional strain. P6 complained,‘ Although my husband now handles all household chores and cooking, his efforts are poorly executed. When I try to offer feedback, he either ignores me or outright dismisses my concerns. His indifference fuels my frustration, worsening my emotional state and often leaving me resorting to silent resentment.’ Similarly, P8 exasperatedly stated, ‘Whenever I mention my discomfort, my spouse dismisses it as ‘normal’ and accuses me of overreacting. This inevitably escalates into arguments, followed by days of cold silence.’S6 shared, ‘Since retiring, I’ve dedicated myself to caring for her. Yet, she constantly criticizes my efforts, claiming I’m incompetent. At times, she even snaps, ‘You must be thrilled to see me sick.’ I understand her pain, but such remarks hurt deeply. The exhaustion and emotional toll make me withdraw from conversations altogether.’S13 expressed,‘I’ve repeatedly urged him to reduce alcohol intake and exercise more, especially given his history of pancreatitis. Yet, he neglects follow-up examinations and dismisses my advice. I’ve disengaged from reiterating these concerns—he never listens, and the consequences are his to bear.’ High financial burden Repeated surgeries, prolonged tube management, and potential complications impose substantial financial burdens on patients undergoing PTBD for biliary stones. P3 explained, ‘Each procedure costs tens of thousands of yuan. My husband and I are rural farmers with no stable income, and our children have their own families to support—their financial assistance is limited.’(He shook his head helplessly.) S2 detailed,‘In 2014, hepatic resection surgery depleted our savings. In 2021, we traveled to Southwest Hospital for another stone removal, which alone cost over 10,000 yuan for non-reimbursable albumin infusions. Combined with accommodation and meals, total expenses exceeded 100,000 yuan. This time, transferring from Kai County—where local hospitals lack adequate resources—added another 40,000 yuan." DISCUSSION DC approach for patients with PTBD of bile duct stones and their spouses The findings of this study indicate that both active and passive coping strategies coexist in the DC styles of PTBD patients with biliary stones and their spouses, consistent with the results reported by Tao et al[ 27 ].Notably, our interviews revealed significant gender disparities: female patients and spouses demonstrated higher efficacy in emotional expression during disease management, with significantly stronger desire to share and emotional regulation capabilities compared to males. This may be attributed to societal gender role expectations (e.g., women are often assigned greater responsibility for emotional labor)[ 28 ].Conversely, male patients and spouses tended to minimize their emotional experiences and adopt avoidance strategies when confronting stressors. Prolonged suppression of emotional needs may exacerbate psychological issues such as anxiety and depression. Zhu et al.further identified a marked negative correlation between self-disclosure and psychological resilience in a cross-sectional study[ 29 ].Therefore, healthcare professionals should prioritize interventions to encourage male patients and their spouses to openly articulate their needs and perspectives. Regulating negative emotions, addressing passive coping, and strengthening multidimensional support systems to enhance active coping Strategies in PTBD biliary stone patients and their spouses In the context of disease management, repeated surgical interventions and prolonged tube-dependent conditions not only exacerbate the physiological burden on patients and their spouses but also trigger significant cumulative negative emotional effects. Our findings reveal that about 70% patients exhibited reduced treatment adherence and avoidance tendencies due to recurrent invasive procedures, such as repeated tube placements and surgical complications. Notably, negative emotions between couples demonstrated marked interactive characteristics—anxiety or depressive states in one partner amplified the perceived stress in the other through emotional contagion, while positive emotional expression enhanced dyadic coping efficacy via the resource gain effect, consistent with the findings of Xing et al[ 30 ].Further analysis indicated that stage-specific disparities in disease management capabilities critically modulate couples’ coping patterns. For 30% of newly diagnosed patients and spouses lacking caregiving experience, particularly during the transition from acute hospitalization to home care, challenges in maintaining PTBD tubes and managing emergencies (e.g., tube dislodgement) often led to a "capability-demand imbalance," subsequently triggering adaptive anxiety.These findings underscore the necessity for healthcare providers to monitor the emotional states of PTBD biliary stone patients and their spouses across multiple timepoints—from hospitalization to post-discharge follow-up. Implementing phased skill training (e.g., tube maintenance, emergency response) and psychological support can strengthen collaborative dyadic coping strategies and bolster confidence in jointly managing stressors. We further found that couples with harmonious relationships demonstrated faster adaptation to role transitions during disease management and adopted more proactive coping strategies. These findings align with Wang et al.'s cross-disease validation study on dyadic coping experiences in stroke patients and their caregivers[ 15 ].The underlying mechanisms may involve two key factors:couples with strong emotional bonds can reframe stress perceptions through empathic communication, and accumulated relational capital provides a buffer for optimizing coordinated coping strategies.Milbury et al.developed a Couple-Based Meditation (CBM) program rooted in mindfulness and compassion principles[ 17 ].Participants underwent weekly 60-minute mindfulness sessions over four weeks, which significantly reduced depressive symptoms and cancer-related stress levels in both patients and spouses while enhancing intimacy. Beyond CBM, other evidence-based dyadic interventions include:Couples Coping Enhancement Training (CCET),Coping-Oriented Couples Therapy (COCT), Couple-Based Mind-Body Interventions (CBMB)[ 31 , 32 ].These programs offer tailored support to strengthen dyadic coping mechanisms and improve relationship quality across diverse partnerships, with widespread application in international settings. Therefore, healthcare professionals should adapt these frameworks by integrating cultural elements specific to China to develop localized dyadic interventions. In the context of external support systems, family and societal support play pivotal roles in dyadic coping PTBD biliary stone patients and their spouses. Family support manifests differently across age groups: for elderly patients, it primarily involves financial assistance and daily care from adult children, while younger couples rely more on emotional support from parents and siblings. This heterogeneity in family support models necessitates that healthcare providers expand the scope of health education by integrating key caregivers into intervention frameworks through tools such as family conferences and collaborative care plans, thereby optimizing the efficiency of support resource allocation.Societal support predominantly stems from healthcare teams. Our interviews revealed that over 70% of patients and spouses experienced varying degrees of care transition gaps during the "hospital-to-home" phase, characterized by:Insufficient knowledge of tube maintenance,Limited ability to recognize complications,Psychological adaptation barriers.Although current mobile health platforms offer preliminary remote guidance[ 33 ],their applications remain underdeveloped in areas such as virtual reality-assisted procedural training and AI-driven complication warning systems. Future efforts should focus on establishing interdisciplinary collaboration mechanisms that integrate resources from clinical medicine, nursing, and information engineering to develop intelligent, context-adaptive continuing care systems. Challenges to DC for patients with PTBD of bile duct stones and their spouses The results of this study indicate that patients with biliary stones undergoing percutaneous transhepatic biliary drainage (PTBD) and their spouses face multifaceted challenges, including physiological and psychological stress, dyadic communication barriers, and significant financial burdens. Among the 15 patients included in this study, 5 experienced pain episodes, 10 reported sleep disturbances, and all interviewees exhibited varying degrees of anxiety and depressive symptoms. These findings underscore the need for multidisciplinary teams comprising physicians, nurses, and psychotherapists to be established across healthcare institutions. Such teams should deliver specialized psychological interventions, including narrative nursing[ 34 ],cognitive-behavioral therapy[ 35 ],and music therapy[ 36 ]. Moreover, dyadic communication barriers were significantly associated with the adoption of passive coping strategies. Existing interventions—such as communication skills training,emotion-focused therapy, and integrated behavioral interventions have demonstrated efficacy in improving partner communication efficacy and mitigating negative emotions[ 37 – 39 ].Building on this evidence, future research should prioritize the development of tailored communication-based interventions for PTBD biliary stone patients and their spouses to enhance DC capacity. Furthermore, over half of the families in this study reported a monthly income below 5,000 RMB, and some patients faced employment disruptions during return-to-work phases due to health limitations. This aligns with the findings of Dai et al. regarding the economic strain in chronic disease households[ 23 ]. Economic stress may weaken marital intimacy through the "financial-relational strain pathway", thereby compromising the rationality of treatment decision-making.In clinical practice, healthcare providers should integrate household economic assessments into treatment planning workflows and facilitate joint spousal participation in medical decision-making to avoid inefficient treatment options[ 40 ].Concurrently, medical institutions should collaborate with social organizations to expand public assistance initiatives (e.g.,crowdfunding platforms) and establish multidimensional financial support systems to alleviate economic burdens. LIMITATIONS This study has several limitations.First, although the authors conducted separate interviews with percutaneous transhepatic biliary drainage (PTBD) biliary stone patients and their spouses whenever possible, nearly half of the dyads (n = 10) participated in joint interviews, which may have limited their willingness to disclose sensitive issues and introduced risks of social desirability bias. Second, while the study included patients at different disease stages, it did not explore the temporal impact on DC experiences in PTBD patients and their spouses. Future longitudinal studies are warranted to elucidate the evolution of dyadic coping dynamics over time, enabling more comprehensive and scientifically robust conclusions.In addition, the sample was drawn from three cities in China, resulting in limited demographic diversity (e.g., homogeneous ethnic backgrounds) and potential selection bias. Further research is needed to evaluate the cross-cultural transferability of these findings in China. IMPLICATIONS FOR PRACTICE To facilitate healthcare professionals' understanding of the DC experiences in patients with PTBD biliary stones and their spouses, it is imperative to closely monitor the shared physical and mental health of both partners. This approach will establish a robust evidence base for developing comprehensive disease management programs tailored to address the unique needs of PTBD patients and their spouses. CONCLUSION This study represents the first attempt to explore the care experiences and specific needs of patients with PTBD biliary stones and their spouses during disease management. Throughout the tube-dependent phase, couples jointly endure physical and psychological stressors, while recognizing that the patient’s rapid recovery necessitates collaborative spousal engagement. Establishing couple-centered interventions to alleviate negative emotions, strengthen multidimensional support systems, and promote active coping strategies constitutes a critical priority for future research and clinical practice. Declarations ACKNOWLEDGEMENTS The authors express their gratitude to all Patients with PTBD biliary stones and their spouses for generously sharing their disease experiences. Additionally, the authors would like to acknowledge the financial support provided by the hospital. DISCLOSURE STATEMENT The authors have no conflicts of interest to disclose. DATA AVAILABILITY STATEMENT The data that support the fndings of this study are available upon reasonable request from the corresponding author. The data cannot be made publicly available due to their containing information that could compromise the privacy of research participants. FUNDING STATEMENT This study was supported by the General Program of Chongqing Natural Science Foundation (grant numbers CSTB2023NSCQ-MSX0466).The fund is used for the publication of articles. CLINICAL TRIAL NUMBER Not Applicable Author Contribution XM T: Conceptualization; Data curation; Formal analysis; Investigation; Methodology; Project administration; Writing—original draft. XM W: Conceptualization; Investigation; Funding acquisition; Methodology; Project administration; Resources; Supervision; Writing—review & editing. HY: Data curation；Methodology; Software; Validation;Writing—review & editing.LY G: Data curation; Formal analysis. References Lu P, Lang C, Liu XY et al. Modified Glisson pedicle transection The Method of Tunnel transumbilical single-port laparoscopic left hemihepatectomy. Chin J Operative Procedures Gen Surg 2023,17(2):134. 10.3877/cma.j.issn.1674-3946.2023.02.006 Lu H, Yang H, Wu L, Liao W, He X, Li E, Wu R, Shi S. Yang Z.A novel prognostic model for diagnosing atypical bile duct hyperplasia in patients with intrahepatic lithiasis. Med (Baltim). 2019;98(17):e15364. 10.1097/md.0000000000015364 . Lorio E, Patel P, Rosenkranz L, Patel S, Sayana H. Management of Hepatolithiasis: Review of the Literature. Curr Gastroenterol Rep. 2020;22(6):30. 10.1007/s11894-020-00765-3 . Liu XW, Cheng Y, Gong JP. Value of percutaneous transhepatic choledochoscopic lithotripsy in treatment of hepatolithiasis. J Clin Hepatol 2019, 35(07):1640–3. Nursing Branch of Committee of Minimally Invasive Therapy in Oncology of Chinese Anti-Cancer Association;Interventional Perioperative Professional Committee of Chinese College of Interventionalist. the 15th Radiology Nursing Working Group of Chinese Society of Radiology:Expert consensus on drainage tube nursing of percutaneous transhepatic biliary drainage. Chin J Mod Nurs 2020(36):4997–5003 https://rs.yiigle.com/cmaid/1301030 Interventional Ultrasound Group of Ultrasonic Committee of Chinese Medical Association. Chinese expert consensus of ultrasound-guided percutaneous transhepatic biliary draine(2023 edition). Chin J Ultrasonography. 2023;32(5):369–76. 10.3760/cma.j.cn131148-20230123-00046 . Mo W, Xu Y, Yang C X,Qing Y. L.The quality of life of post-discharge patients carrying drainage tube after PTBD:a qualitative study. J Interventional Radiol 2018, 27(2):178–80. 10.3969/j.issn.1008-794X.2018.02.019 Li Q, Mo W,Li YL, Yang XC, Zhou. B F.Qualitative study of family caregivers' care experience after PTBD in patients with malignant obstructive jaundice. Chin J Interventional Radiol 2022,10(4):451–5. 10.3877/cma.j.issn.2095-5782.2022.04 . 019. Chen M, Gong J, Cao Q, Luo X, Li J, Li Q. A literature review of the relationship between dyadic coping and dyadic outcomes in cancer couples. Eur J Oncol Nurs. 2021;54:102035. 10.1016/j.ejon.2021.102035 . Bodenmann G. A systemic-transactional conceptualization of stress and coping in couples. Swiss J Psychol. 1995;54(1):34–49. Banker J, Sudano L, Banker J, Goren N, Zessin CE. Couple Therapy. In: Lebow J, Chambers A, Breunlin D, editors. Encyclopedia of Couple and Family Therapy. New York: Springer: Encyclopedia of Couple and Family Therapy;; 2017. Bodenmann G, Falconier MK, Randall AK. Systemic-Transactional Model of Dyadic Coping. Systemic-Transactional Model of Dyadic Coping; 2019. Weitkamp K, Bodenmann G. Couples Coping Together: A Scoping Review of the Quantitative and Qualitative Evidence and Conceptual Work Across Three Decades. Front Psychol. 2022;13:876455. 10.3389/fpsyg.2022.876455 . Wang Y, Zhang J, Wang S, Wu Y, Hang L, Hua Y, Shi W. Feasibility and preliminary efficacy of a systematic transaction model-guided dyadic coping nursing intervention for patients with breast cancer and their spousal caregivers: A pilot study. Asia Pac J Oncol Nurs. 2025;12:100621. 10.1016/j.apjon.2024.100621 . Wang W, Pucciarelli G, Mei Y, Zhang Z, Vellone E. The dyadic self-care experience of stroke survivors and their caregivers: A qualitative descriptive study. Health Expect. 2023;26(6):2325–39. 10.1111/hex.13838 . Karademas EC, Dimitraki G, Thomadakis C, Giannousi Z. The relation of spouse illness representations to patient representations and coping behavior: A study in couples dealing with a newly diagnosed cancer. J Psychosoc Oncol. 2019;37(2):145–59. 10.1080/07347332.2018.1508534 . Milbury K, Li Y, Durrani S, Liao Z, Tsao AS, Carmack C, Cohen L, Bruera EA, Mindfulness-Based. Intervention as a Supportive Care Strategy for Patients with Metastatic Non-Small Cell Lung Cancer and Their Spouses: Results of a Three-Arm Pilot Randomized Controlled Trial. Oncologist. 2020;25(11):e1794–802. 10.1634/theoncologist.2020-0125 . Vranceanu AM, Bannon S, Mace R, Lester E, Meyers E, Gates M, Popok P, Lin A, Salgueiro D, Tehan T, et al. Feasibility and Efficacy of a Resiliency Intervention for the Prevention of Chronic Emotional Distress Among Survivor-Caregiver Dyads Admitted to the Neuroscience Intensive Care Unit: A Randomized Clinical Trial. JAMA Netw Open. 2020;3(10):e2020807. 10.1001/jamanetworkopen.2020.20807 . McCaughan E, Curran C, Northouse L, Parahoo K. Evaluating a psychosocial intervention for men with prostate cancer and their partners: Outcomes and lessons learned from a randomized controlled trial. Appl Nurs Res. 2018;40:143–51. 10.1016/j.apnr.2018.01.008 . Yan S, Jiayi G, He W, Jiaqin P, Jingyu M. The dyadic coping experience of ICU transfer patients and their spouses: A qualitative study. Nurs Crit Care. 2023;29(4):672–81. Colorafi KJ, Evans BQ. Descriptive Methods in Health Science Research. Herd. 2016;9(4):16–25. 10.1177/1937586715614171 . Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–57. 10.1093/intqhc/mzm042 . Dai Q, Li LL, Liao CX, Gao X, Huang H, Yuan. H W.A qualitative research on the dual coping experience of patients with spinal cord injury and their spouses. Chin J Nurs. 2021;56(08):1180–6. 10.3761/j.issn.0254-1769.2021.08.010 . Pan BB, Wang W. D.A qualitative study on the couple's dual coping experience in patients with decompensated cirrhosis.Chinese Journal of Rural Medicine and Pharmacy,2024, 31(08):8–10. 10.19542/j.cnki.1006-5180.2305-132 Francis JJ, Johnston M, Robertson C, Glidewell L, Entwistle V, Eccles MP, Grimshaw JM. What is an adequate sample size? Operationalising data saturation for theory-based interview studies. Psychol Health. 2010;25(10):1229–45. 10.1080/08870440903194015 . Vaismoradi M, Turunen H, Bondas T. Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nurs Health Sci. 2013;15(3):398–405. 10.1111/nhs.12048 . Tao FY, Liu HX, Jia RZ, Wu L, Fu D Y,Zhou W, Q,Tian. Y Y.A qualitative study on the dyad coping experience of stress in pregnant women with undifferentiated connective tissue disease and their spouses. Chin J Nurs 2024, 59(22):2760–5. 10.3761/j.issn.0254-1769.2024.22.011 Curran MA, McDaniel BT, Pollitt AM, Totenhagen CJ. Gender, Emotion Work, and Relationship Quality: A Daily Diary Study. Sex Roles. 2015;73(3–4):157–73. 10.1007/s11199-015-0495-8 . Zhu H, Tao L, Hu X, Jiang X. Effects of self-disclosure and resilience on reproductive concern in patients of childbearing age with breast cancer: a cross-sectional survey study. BMJ Open. 2023;13(2):e068126. 10.1136/bmjopen-2022-068126 . Xing YF, Li JX, Zhang QL, Chen LC, Zhang L. Zheng Y J.Dual coping experience of middle?aged stroke patients and their spouses:a qualitative research. Chin Nurs Res. 2022;36(18):3355–8. 10.12102/j.issn.1009-6493.2022.18.030 . Bodenmann G, Plancherel B, Beach SR, Widmer K, Gabriel B, Meuwly N, Charvoz L, Hautzinger M, Schramm E. Effects of coping-oriented couples therapy on depression: a randomized clinical trial. J Consult Clin Psychol. 2008;76(6):944–54. 10.1037/a0013467 . Zeng X, Chiu CP, Wang R, Oei TP, Leung FY. The effect of loving-kindness meditation on positive emotions: a meta-analytic review. Front Psychol. 2015;6:1693. 10.3389/fpsyg.2015.01693 . Zhang RL, Wang YY, Guo JL, Fan YP, Feng ZL, Wu HZ. Construction and application of remote continuous nursing mode for HIV patients based on mobile medical APP. Chin Nurs Res 2022, 36(03):517–21. 10.12102/j.issn.1009-6493.2022.03.027 Slocum RB, Hart AL, Guglin ME. Narrative medicine applications for patient identity and quality of life in ventricular assist device (VAD) patients. Heart Lung. 2019;48(1):18–21. 10.1016/j.hrtlng.2018.09.013 . Carpenter JK, Andrews LA, Witcraft SM, Powers MB, Smits JAJ, Hofmann SG. Cognitive behavioral therapy for anxiety and related disorders: A meta-analysis of randomized placebo-controlled trials. Depress Anxiety. 2018;35(6):502–14. 10.1002/da.22728 . Umbrello M, Sorrenti T, Mistraletti G, Formenti P, Chiumello D, Terzoni S. Music therapy reduces stress and anxiety in critically ill patients: a systematic review of randomized clinical trials. Minerva Anestesiol. 2019;85(8):886–98. 10.23736/s0375-9393.19.13526-2 . Wiebe SA, Johnson SM. Creating relationships that foster resilience in Emotionally Focused Therapy. Curr Opin Psychol. 2017;13:65–9. 10.1016/j.copsyc.2016.05.001 . Yasmin N, Riley GA. Psychological intervention for partners post-stroke: A case report. NeuroRehabilitation. 2020;47(2):237–45. 10.3233/nre-203173 . Zhou J, Wang Z, Chen X, Lin C, Zhao J, Loke AY, Li Q. Mutual communication intervention for colorectal cancer patient-spousal caregiver dyads: A randomized controlled trial. Br J Health Psychol. 2024;29(4):855–76. 10.1111/bjhp.12734 . Sypes EE, de Grood C, Clement FM, Parsons Leigh J, Whalen-Browne L, Stelfox HT, Niven DJ. Understanding the public's role in reducing low-value care: a scoping review. Implement Sci. 2020;15(1):20. 10.1186/s13012-020-00986-0 . Tables Tables 1 to 3 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files TABLE1Inclusionandexclusioncriteria.xlsx TABLE2Interviewoutline.xlsx TABLE3Sociodemographiccharacteristicsofrespondentsatbaseline.xlsx File1.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7922196","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":552926119,"identity":"3649cc03-be4a-4878-8baa-2451cb246437","order_by":0,"name":"Xiaoman Tao","email":"","orcid":"","institution":"Second Affiliated Hospital of Chongqing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xiaoman","middleName":"","lastName":"Tao","suffix":""},{"id":552926120,"identity":"00ca1be3-be5c-41cd-a833-4e36788f5f44","order_by":1,"name":"Xiaomei Wang","email":"data:image/png;base64,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","orcid":"","institution":"Second Affiliated Hospital of Chongqing Medical University","correspondingAuthor":true,"prefix":"","firstName":"Xiaomei","middleName":"","lastName":"Wang","suffix":""},{"id":552926121,"identity":"a8dad7e0-7c3a-4b4f-8686-e5919dcb66cb","order_by":2,"name":"Huan Yu","email":"","orcid":"","institution":"Second Affiliated Hospital of Chongqing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Huan","middleName":"","lastName":"Yu","suffix":""},{"id":552926122,"identity":"5a3de11d-688c-4d53-9e2e-3caad722511e","order_by":3,"name":"Liyun Gong","email":"","orcid":"","institution":"Second Affiliated Hospital of Chongqing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Liyun","middleName":"","lastName":"Gong","suffix":""}],"badges":[],"createdAt":"2025-10-22 09:53:35","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7922196/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7922196/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":97257391,"identity":"1250d8de-9ca5-4096-8160-83512f6894ff","added_by":"auto","created_at":"2025-12-02 13:39:59","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":50882,"visible":true,"origin":"","legend":"","description":"","filename":"ThedyadiccopingexperienceofpatientswithPerc9.0.docx","url":"https://assets-eu.researchsquare.com/files/rs-7922196/v1/8f7e49be47ef8d92f3b03844.docx"},{"id":97257393,"identity":"ef84cfde-68cb-412f-8978-b0df569d211f","added_by":"auto","created_at":"2025-12-02 13:39:59","extension":"xlsx","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":10211,"visible":true,"origin":"","legend":"","description":"","filename":"TABLE1Inclusionandexclusioncriteria.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-7922196/v1/ed0f0276aecbb40b0d504276.xlsx"},{"id":97367242,"identity":"a343283d-5fc9-4b7e-bb9c-425f42707634","added_by":"auto","created_at":"2025-12-03 16:17:42","extension":"xlsx","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":10608,"visible":true,"origin":"","legend":"","description":"","filename":"TABLE2Interviewoutline.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-7922196/v1/44b29d9aa8d6c2d86ba2e1d4.xlsx"},{"id":97257395,"identity":"4bc47beb-31c4-442a-aeed-8752d909efb9","added_by":"auto","created_at":"2025-12-02 13:39:59","extension":"xlsx","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":14460,"visible":true,"origin":"","legend":"","description":"","filename":"TABLE3Sociodemographiccharacteristicsofrespondentsatbaseline.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-7922196/v1/6d73c098a084c4c75f6540c4.xlsx"},{"id":97257399,"identity":"5264acf6-a22f-4bc0-b22f-c7e57002b0a5","added_by":"auto","created_at":"2025-12-02 13:39:59","extension":"json","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":6424,"visible":true,"origin":"","legend":"","description":"","filename":"5b15f740c42a46068ba39a38bfa6339d.json","url":"https://assets-eu.researchsquare.com/files/rs-7922196/v1/a85d0521c50e3d9df78d71ef.json"},{"id":97367055,"identity":"6feaf42c-683d-4fe8-bef4-96c304faacbc","added_by":"auto","created_at":"2025-12-03 16:15:54","extension":"docx","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":21848,"visible":true,"origin":"","legend":"","description":"","filename":"File1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7922196/v1/824ffaffc3092f2a1717a46e.docx"},{"id":97257402,"identity":"1cd09d57-04d4-4099-81e7-8cafa74421f0","added_by":"auto","created_at":"2025-12-02 13:39:59","extension":"xml","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":107765,"visible":true,"origin":"","legend":"","description":"","filename":"5b15f740c42a46068ba39a38bfa6339d1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7922196/v1/4d296c2c23dda2d826d9e8ee.xml"},{"id":97367622,"identity":"65fba735-2f1b-4677-bc57-bcb76583004b","added_by":"auto","created_at":"2025-12-03 16:19:50","extension":"pdf","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":172100,"visible":true,"origin":"","legend":"","description":"","filename":"Figure1.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7922196/v1/06a3a2e1ad763636063a52fa.pdf"},{"id":97257404,"identity":"2a390ebc-be7f-4399-96e5-9f67037963f7","added_by":"auto","created_at":"2025-12-02 13:39:59","extension":"xml","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":104161,"visible":true,"origin":"","legend":"","description":"","filename":"5b15f740c42a46068ba39a38bfa6339d1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7922196/v1/73cfa730a0d1510d9226459e.xml"},{"id":97257400,"identity":"4c6c1921-fdfa-4ce6-9448-1cfe677d34c4","added_by":"auto","created_at":"2025-12-02 13:39:59","extension":"html","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":115118,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7922196/v1/ba21c0ee7eb36eede6a30409.html"},{"id":97366984,"identity":"1e7cb1c0-a121-4642-ac3b-d382120d1c0f","added_by":"auto","created_at":"2025-12-03 16:14:52","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":296846,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7922196/v1/8858071eded54d3714b7f9b8.jpg"},{"id":104490532,"identity":"dae334af-e5f7-4b75-93b6-b5e968ea5202","added_by":"auto","created_at":"2026-03-12 11:27:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":824776,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7922196/v1/4395e238-e048-4091-9fb7-7768d3c9f19e.pdf"},{"id":97257389,"identity":"40b45929-9300-4e9f-be2a-c9ed6d40e80d","added_by":"auto","created_at":"2025-12-02 13:39:59","extension":"xlsx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":10211,"visible":true,"origin":"","legend":"","description":"","filename":"TABLE1Inclusionandexclusioncriteria.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-7922196/v1/1ac03eaa25a3933cd2427f69.xlsx"},{"id":97366849,"identity":"23487ade-ad17-456d-a272-6b073357248c","added_by":"auto","created_at":"2025-12-03 16:09:42","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":10608,"visible":true,"origin":"","legend":"","description":"","filename":"TABLE2Interviewoutline.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-7922196/v1/69593e40f5c16556e91d2a4e.xlsx"},{"id":97257394,"identity":"c6184184-3e05-4a5b-87f2-c3612aafa593","added_by":"auto","created_at":"2025-12-02 13:39:59","extension":"xlsx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":14460,"visible":true,"origin":"","legend":"","description":"","filename":"TABLE3Sociodemographiccharacteristicsofrespondentsatbaseline.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-7922196/v1/be7ec38e19bf63918a7cb0c0.xlsx"},{"id":97366683,"identity":"d119ddb7-8dca-4afb-b94b-6303a9a7cffd","added_by":"auto","created_at":"2025-12-03 15:57:43","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":21848,"visible":true,"origin":"","legend":"","description":"","filename":"File1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7922196/v1/9aeee7dceae30e756d9fb494.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"The dyadic coping experience of patients with Percutaneous Transhepatic Biliary Drainage of bile duct stones and their spouses:A qualitative descriptive study","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eBile duct stones which develop in the intrahepatic or extrahepatic bile ducts due to bile stasis and biliary tract infections[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], are traditionally rare in Western countries but predominantly observed in the Asia-Pacific region, particularly Hepatolithiasis. Epidemiological studies indicate a high prevalence of 3.1%-21.2% in China, South Korea, and Japan, with 4%-12% of cases complicated by concurrent cholangiocarcinoma[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Notably, recent increases in immigration and shifts in diet have contributed to a rising incidence of bile duct stones in Western populations[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Although classified as a benign condition, bile duct stones demonstrate clinical features typically associated with malignancies, including recurrent biliary obstruction and refractory infections[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].Traditional open surgery is limited by high residual stone rates and recurrence rates, primarily due to anatomical complexity and incomplete clearance. These therapeutic challenges frequently progress to life-threatening complications such as cholangitis, liver abscesses, and sepsis, making bile duct stones a significant contributor to mortality in benign biliary disorders.\u003c/p\u003e\u003cp\u003ePTBD is a minimally invasive procedure performed when biliary obstruction prevents bile from entering the intestines properly, involving percutaneous transhepatic puncture of intrahepatic bile ducts to place a drainage catheter, thereby relieving intrabiliary hypertension above the obstruction level, reducing serum bilirubin, or alleviating biliary inflammation[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].For patients with bile duct stones, PTBD catheter retention for 2\u0026ndash;4 weeks post-puncture is required, Each stone extraction at monthly intervals, a total of 2\u0026ndash;3 times, enabling effective removal of distal biliary stones and correction of biliary strictures, with advantages of minimal invasiveness and rapid recovery[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].However, the shift in treatment modalities has paradoxically introduced new challenges: patients require PTBD catheter retention for 1\u0026ndash;3 months postoperatively, which not only imposes significant lifestyle restrictions and increases the risk of post-discharge catheter-related complications, but may also induce social withdrawal and disease-related stigma due to body image disturbances[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].For most patients with bile duct stones, treatment and care primarily occur in home settings.The spouse,as the primary caregiver, not only confronts uncertainties regarding disease progression and acquires catheter management skills, but also shoulders main responsibility to take care of family, collectively contributing to a marked decline in their quality of life[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].Presently, the concept of coping with illness has evolved from an individual perspective to a dual perspective involving the couple.Dyadic coping (DC) refers to the shared decision-making by both partners when faced with stressful events, aiming to enhance the psychosocial adjustment and relationship functioning of both the patient and the spouse, while maining optimal them well-being[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].The Systemic-transactional Model (STM), initially proposed by Bodenmann in 1995 on the basis of an individual-oriented theory of stress and coping[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].Among the various DC approaches, the STM has gained the most international recognition and serves as the predominant theoretical model guiding research[\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].The STM emphasizes the dynamic interplay between partners, positing that stress experienced by one partner invariably affects the other through bidirectional influence pathways. Simultaneously, the coping strategies employed by the other partner serve as relational resources, generating novel synergistic effects that enhance the dyadic coping process. Currently, the STM has been extensively adapted to adress couples coping with severe stressors, particularly in contexts involving critical life events (e.g. the deadth of a child[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]) or the severe health conditions of a partner (e.g.cancer[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e];strok[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]). Research indicates that positive dyadic coping enhances patients' self-management abilities and caregivers' caregiving skills[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e],reduces negative emotions in both patients and caregivers[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], and improves intimacy between partners[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePrevious researches have predominantly focused on patients' experiences living with indwelling catheter or the prevention and management of complications, lacking a holistic perspective that integrates patients and spouses as a dyadic unit in evaluating their psychophysiological adaptations and quality of life adjustments during stressor events. We hypothesize that couples face shared challenges and unmet needs during catheter retention periods, and these experiences may substantially influence health outcomes for both partners. Guided by the STM, this study aims to explore the lived experiences of disease coping in patients with PTBD bile duct stones and their spouses. The findings of this studying will provide an evidence base for implementing couple-centered DC interventions.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e\u003cb\u003eStudy Design\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis qualitative study was based on a qualitative descriptive design to explore the DC experience of patients with PTBD of bile duct stones and their spouses and provide a basis for developing DC intervention measures[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].From a philosophical point of view, this research method is closely linked to constructivism and critical theory, utilizing interpretive and naturalistic approaches. The use of this method produces a concise summary in everyday language that helps the researcher to understand a particular phenomenon.In this study,the qualitative descriptive approach facilitated a straightforward process to understand the feelings and perspectives of patients with PTBD of bile duct stones and their spouses in coping with the disease.The qualitative descriptive approach facilitated a straightforward process to understand the feelings and perspectives of patients with PTBD choledocholithiasis and their spouses in coping with the disease.The Consolidated Criteria for Reporting Qualitative Research was used for study reporting[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cb\u003eObject of study\u003c/b\u003e\u003c/p\u003e\u003cp\u003e Purposive sampling was used to recruit participants for this study.Period from December 2024 to February 2025, patients with PTBD bile duct stones and their spouses, enroled after discharge from four cities in China, were asked to participate in the study. Hospital professionals referred participants to the research team, and eligibility screening was conducted by the research team.A total of 15 couples were interviewed.The inclusion and exclusion criteria can be found in Table\u0026nbsp;1.\u003c/p\u003e\u003cp\u003eInsert table 1.\u003c/p\u003e\n\u003ch3\u003eResearch methodology\u003c/h3\u003e\n\u003cp\u003eDefining the outline of the interview\u003c/p\u003e\u003cp\u003eThrough literature review[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e],a preliminary interview outline was developed based on the STM ,research group discussion and expert consultation.Prior to the formal interviews, two pairs of patients PTBD bile duct stones and spouses underwent pre-interviews,which helped in refining the final interview outline.The final interview outline is shown in Table\u0026nbsp;2.\u003c/p\u003e\u003cp\u003eInsert table 2.\u003c/p\u003e\u003cp\u003eData collection methods\u003c/p\u003e\u003cp\u003e Before the interviews, the first author explained the purpose of the interviews to the participants through phone calls or face-to‐face meetings, obtained their informed consent and scheduled interview times.Then,Separate semi-structured interviews were conducted in a face-to-face or online format.Face-to-face interviews took place in a quiet, private conference room. All interviews were conducted by the first author.During the interviews the first author flexibly utilized the interview outline, used techniques such as listening, responding, clarifying, and following up, and recorded nonverbal information such as the interviewee's facial expressions and body movements.Each interview lasted approximately 30 min.The sample size was determined by data saturation, which means that interviews were stopped after analysing at least 10 interviews, and only when no new data emerged from three consecutive interviews[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].The interview transcripts were anonymized, and all data, including audio recordings, transcripts, handwritten notes, and consent forms, were securely stored in a locked drawer and password-protected computer files.\u003c/p\u003e\u003cp\u003eMethods of information analysis\u003c/p\u003e\u003cp\u003e The first author transcribed the audio recordings verbatim within 24 hours post-interview through iterative review processes that annotated nonverbal cues, generating preliminary transcripts which were subsequently cross-verified by an independent researcher, with discrepancies resolved through third-party adjudication to ensure transcription fidelity. Using the thematic analysis[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e],combined with the STM, the interview scripts were read repeatedly by 2 researchers to extract the statements that were relevant and meaningful to the purpose of the study, coded, and codes with common concepts and characteristics were summarized to form themes and subthemes with complete descriptions.The first author who conducted the interviews is a graduate student in Nursing who had undergone comprehensive training and acquired proficiency in qualitative research methods and interviewing techniques.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eHuman Ethics and Consent to Participate declarations\u003c/h2\u003e\u003cp\u003e The study adhered to the ethical standards outlined in the 1964 Helsinki Declaration and its subsequent amendments. Prior to the interviews, participants provided written informed consent, which was reiterated verbally. Signed informed consent was obtained from all participants. The informed consent form explicitly stated that participant responses would be anonymized following data collection and that participants had the right to withdraw from the study at any point prior to the publication of the data. Ethical approval for this study (EC-SAH-CQMU-2024-66) was granted by the Ethics Committee of the Second Affiliated Hospital of Chongqing Medical University.\u003c/p\u003e\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe sample consisted of 30 participants. Through effective coordination and communication between the nurse manager, patients, and their spouses, 15 couples successfully completed the interviews without any dropouts. Table\u0026nbsp;3 presents the characteristics of each participant. The analysis yielded three main themes and ten sub-themes, as illustrated in Fig.\u0026nbsp;1.Additional quotes illustrating our findings can be found in the Additional file 1.\u003c/p\u003e\u003cp\u003eInsert table 3.\u003c/p\u003e\u003cp\u003eInsert Fgure 1.\u003c/p\u003e\u003cp\u003eTheme 1: Active coping\u003c/p\u003e\u003cp\u003eMaintenance of a positive and optimistic mindset\u003c/p\u003e\u003cp\u003eCertain couples stay positive, encourage each other, and promote positive coping styles.For instance,P1 stated,\u0026lsquo;I maintained a positive mindset throughout my journey from diagnosis to treatment, with my husband consistently by my side, which helped me sustain emotional stability.\u0026rsquo;This health challenge has reinforced the importance of prioritizing regular follow-up exams, engaging in physical activity, and adhering to a balanced diet.\u0026rsquo;S1 mentioned,\u0026lsquo;I often reassure her, 'It\u0026rsquo;s okay. We\u0026rsquo;re only human\u0026mdash;falling ill is part of life.\u0026rsquo;Similiarly,P2 experessed,\u0026lsquo;I have maintained a stable emotional state, supported by my spouse's attentive care. I continue to engage in daily outings and feel no hesitation about others noticing my drainage bag.\u0026rsquo;As cheerfully recounted by S2,\u0026lsquo; I\u0026rsquo;ve always believed in her swift recovery and consistently encouraged her to maintain an optimistic mindset. Once the drainage tube is removed, I plan to take her out to enjoy life and celebrate this clinical milestone together.\u0026rsquo;\u003c/p\u003e\u003cp\u003eActively seeking solutions\u003c/p\u003e\u003cp\u003eDuring the indwelling tube management phase, particularly in the critical transition from hospital to home care without immediate medical supervision, acute complications may inevitably arise. Proactive problem-solving emerges as a prioritized strategy for many patients.P1 expressed,\u0026lsquo;During my time at home, I experienced a sudden episode of pain. I promptly consulted Dr. Wang in our WeChat group, who advised me to take ibuprofen capsules. After two doses, the pain subsided completely!\u0026rsquo;. Similarly, P2 exclaimed emotionally,\u0026lsquo;When I experience significant physical discomfort, I vent my emotions to my spouse, who responds by comforting me and coordinating with doctors to seek medical guidance. This collaborative approach consistently alleviates my distress\u0026rsquo;. On the other hand,Some spouses actively engage in acquiring disease management knowledge while providing tangible support and advices.As S2 mentioned,\u0026lsquo;Upon learning that she would require home care with an indwelling PTBD tube,I proactively acquired comprehensive knowledge on catheter management under the guidance of healthcare professionals prior to discharge. This included recognizing potential complications and developing targeted resolution strategies.\u0026rsquo; Simultaneously, some spouses rely on support from other family members to alleviate the burden of caregiving.S5 stated,\u0026lsquo;During the post-discharge period, we resided at our daughter\u0026rsquo;s home. She actively participated in caregiving by assisting with meal preparation, collaboratively studying catheter management protocols, and sharing responsibilities in caring for my husband. This collective engagement resulted in a significantly reduced caregiving burden compared to previous experiences.\u0026rsquo;\u003c/p\u003e\u003cp\u003eFacing challenges together\u003c/p\u003e\u003cp\u003eMany patients reported that mutual empathy, reciprocal support, and effective communication between spouses significantly strengthened intimacy, thereby enhancing their joint capacity to manage illness-related challenges.P1 cheerfully shared,\u0026lsquo;Since this illness, I feel our marital relationship has grown stronger. During moments of difficulty, he provided unwavering support, and through navigating these challenges together, we\u0026rsquo;ve deepened our mutual understanding\u0026mdash;this reciprocal dynamic has fostered a positive feedback loop in our relationship.\u0026rsquo; Similarly, P3 recunted,\u0026lsquo;Since the beginning of my hospitalization, my husband has been caring for me. Every time the doctors and nurses conducted ward rounds, he diligently documented the specific characteristics of my condition and proactively sought guidance from healthcare professionals on catheter care techniques. As a result, I never had to worry about a thing. After returning home, his expertise in caregiving became evident\u0026mdash;he attended to me exceptionally well, and my physical recovery progressed rapidly(smiling contentedly) .\u0026rsquo; S1 affirmed,\u0026lsquo;I\u0026rsquo;ve come to profoundly understand the saying, \u0026lsquo;In youth, lovers; in age, companions.\u0026rsquo; When illness strikes, it is ultimately the spouse who steps into the caregiver role. Our children have work commitments and cannot assist consistently\u0026mdash;this is why I took leave to personally care for her.\u0026rsquo;\u003c/p\u003e\u003cp\u003eTheme 2: Negative coping\u003c/p\u003e\u003cp\u003eLosing confidence\u003c/p\u003e\u003cp\u003eDuring home-based tube management, some patients experienced complications such as tube dislodgement and infection, severely impairing their quality of life and leading to considerations of treatment discontinuation. P6 lamented,\u0026lsquo;I have had the tube for nearly two months. Previously, the tube dislodged once, requiring a repeat PTBD procedure. However, my current laboratory markers do not meet the criteria for stone removal, necessitating prolonged tube retention. After returning home, I developed bile leakage and persistent pruritus, particularly at night, which severely disrupted my sleep. The physical and emotional toll made me consider abandoning treatment altogether.\u0026rsquo;Similarly, P14 reported, \u0026lsquo;Following tube placement, purulent discharge developed around the wound site, accompanied by intense itching and pain. Despite adhering to daily wound cleansing as advised by my physician, the condition worsened, resulting in fistula formation. This outcome has left me deeply distressed(sobbing).\u0026rsquo;\u003c/p\u003e\u003cp\u003eAvoidance of the problem\u003c/p\u003e\u003cp\u003eThe prolonged retention of catheters forces patients to change their original lifestyles, resulting in a chronic state of stress in the body and mind, such as disorganized self-image and a sense of social detachment, which is accompanied by mood fluctuations, leading to symptoms such as anxiety and depression.Concurrently, spouses experience multifaceted psychological strain\u0026mdash;stemming from fears of disease recurrence, self-doubt regarding caregiving competence, and socioeconomic pressures due to income loss. Some couples choose to solve problems through avoidance and refusal to communicate.P15 lamented,\u0026lsquo;This disease has been with me for over 10 years, with many surgeries, and I feel numb ,\u0026rsquo;followed by ensuing silence.likewise, P3 described,\u0026lsquo;Since coming home to live with a tube, I've pretty much eliminated all socializing, only going out for walks in the evenings, and I'm worried about people seeing my bag of bile and not wanting to say too much about it.\u0026rsquo;S4 tearfully disclosed,\u0026lsquo;He always says I don't care about him, but then he ignores you every time I try to share knowledge with him about something related to his health condition.(choking).\u0026rsquo;\u003c/p\u003e\u003cp\u003eDisplaying overprotective behaviour\u003c/p\u003e\u003cp\u003eFollowing the transition from hospital to home, patients are in the early stages of physical recovery. For those without prior experience in managing medical tubes at home, some spouses may exhibit overprotective behaviors, such as restricting daily activities. S4 admitted,\u0026lsquo; Sometimes I become overly concerned about him, fearing the tube might dislodge, so I try to prevent him from engaging in any activities.\u0026rsquo;S7 shared, \u0026lsquo;After returning home, my focus has been entirely on my husband. I rarely let him engage in any activities because he is the primary breadwinner of our family. I desperately want him to recover quickly; otherwise, I truly don\u0026rsquo;t know how we would cope.(visible tension).\u0026rsquo;\u003c/p\u003e\u003cp\u003eBearing the burden alone\u003c/p\u003e\u003cp\u003eIn addition,some couples attempted to conceal their struggles to alleviate each other\u0026rsquo;s burdens, bearing pressures and challenges alone. P15 acknowledged,\u0026lsquo;Since being discharged with the tube, I have never shared my physical discomfort with my wife. She has already sacrificed tremendously\u0026mdash;years ago, I underwent a major surgery that incurred substantial costs, and she has cared for me ever since. I can\u0026rsquo;t burden her further with my worries.\u0026rsquo;S11 ststed,\u0026lsquo;The medical expenses for this treatment were significant, but I'm afraid to tell her. As her husband, these responsibilities are mine to bear.\u0026rsquo;\u003c/p\u003e\u003cp\u003eTheme 3: Difficulties and challenges\u003c/p\u003e\u003cp\u003eSignificant physical and mental stress\u003c/p\u003e\u003cp\u003eThroughout the period of living with tubes, both patients and their spouses experienced significant physical and psychological distress. P7 stated,\u0026lsquo;The thought of being unable to work as I used to because of the tube makes me feel like a burden.\u0026rsquo; P9 shared,\u0026lsquo;After returning home, I barely slept for days, terrified of accidentally dislodging the tube. It was utterly exhausting.\u0026rsquo;S10 expressed,\u0026lsquo;Since her illness began, I\u0026rsquo;ve stayed by her side constantly. Seeing her in pain and being unable to help has left me heartbroken.\u0026rsquo;Similarly,S12 remarked, \u0026lsquo;Alongside caring for my wife, I also look after our grandchildren. Our children are busy with work and financial obligations\u0026mdash;I understand\u0026mdash;but the fatigue is overwhelming, and I have no one to talk to.\u0026rsquo;\u003c/p\u003e\u003cp\u003eCommunication disorders\u003c/p\u003e\u003cp\u003eSome couples exhibited significant communication barriers during disease management, influenced by personality differences, conflicting perspectives, and emotional strain. P6 complained,\u0026lsquo; Although my husband now handles all household chores and cooking, his efforts are poorly executed. When I try to offer feedback, he either ignores me or outright dismisses my concerns. His indifference fuels my frustration, worsening my emotional state and often leaving me resorting to silent resentment.\u0026rsquo; Similarly, P8 exasperatedly stated, \u0026lsquo;Whenever I mention my discomfort, my spouse dismisses it as \u0026lsquo;normal\u0026rsquo; and accuses me of overreacting. This inevitably escalates into arguments, followed by days of cold silence.\u0026rsquo;S6 shared, \u0026lsquo;Since retiring, I\u0026rsquo;ve dedicated myself to caring for her. Yet, she constantly criticizes my efforts, claiming I\u0026rsquo;m incompetent. At times, she even snaps, \u0026lsquo;You must be thrilled to see me sick.\u0026rsquo; I understand her pain, but such remarks hurt deeply. The exhaustion and emotional toll make me withdraw from conversations altogether.\u0026rsquo;S13 expressed,\u0026lsquo;I\u0026rsquo;ve repeatedly urged him to reduce alcohol intake and exercise more, especially given his history of pancreatitis. Yet, he neglects follow-up examinations and dismisses my advice. I\u0026rsquo;ve disengaged from reiterating these concerns\u0026mdash;he never listens, and the consequences are his to bear.\u0026rsquo;\u003c/p\u003e\u003cp\u003eHigh financial burden\u003c/p\u003e\u003cp\u003eRepeated surgeries, prolonged tube management, and potential complications impose substantial financial burdens on patients undergoing PTBD for biliary stones. P3 explained, \u0026lsquo;Each procedure costs tens of thousands of yuan. My husband and I are rural farmers with no stable income, and our children have their own families to support\u0026mdash;their financial assistance is limited.\u0026rsquo;(He shook his head helplessly.) S2 detailed,\u0026lsquo;In 2014, hepatic resection surgery depleted our savings. In 2021, we traveled to Southwest Hospital for another stone removal, which alone cost over 10,000 yuan for non-reimbursable albumin infusions. Combined with accommodation and meals, total expenses exceeded 100,000 yuan. This time, transferring from Kai County\u0026mdash;where local hospitals lack adequate resources\u0026mdash;added another 40,000 yuan.\"\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eDC approach for patients with PTBD of bile duct stones and their spouses\u003c/p\u003e\u003cp\u003eThe findings of this study indicate that both active and passive coping strategies coexist in the DC styles of PTBD patients with biliary stones and their spouses, consistent with the results reported by Tao et al[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].Notably, our interviews revealed significant gender disparities: female patients and spouses demonstrated higher efficacy in emotional expression during disease management, with significantly stronger desire to share and emotional regulation capabilities compared to males. This may be attributed to societal gender role expectations (e.g., women are often assigned greater responsibility for emotional labor)[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].Conversely, male patients and spouses tended to minimize their emotional experiences and adopt avoidance strategies when confronting stressors. Prolonged suppression of emotional needs may exacerbate psychological issues such as anxiety and depression. Zhu et al.further identified a marked negative correlation between self-disclosure and psychological resilience in a cross-sectional study[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].Therefore, healthcare professionals should prioritize interventions to encourage male patients and their spouses to openly articulate their needs and perspectives.\u003c/p\u003e\u003cp\u003eRegulating negative emotions, addressing passive coping, and strengthening multidimensional support systems to enhance active coping Strategies in PTBD biliary stone patients and their spouses\u003c/p\u003e\u003cp\u003eIn the context of disease management, repeated surgical interventions and prolonged tube-dependent conditions not only exacerbate the physiological burden on patients and their spouses but also trigger significant cumulative negative emotional effects. Our findings reveal that about 70% patients exhibited reduced treatment adherence and avoidance tendencies due to recurrent invasive procedures, such as repeated tube placements and surgical complications. Notably, negative emotions between couples demonstrated marked interactive characteristics\u0026mdash;anxiety or depressive states in one partner amplified the perceived stress in the other through emotional contagion, while positive emotional expression enhanced dyadic coping efficacy via the resource gain effect, consistent with the findings of Xing et al[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].Further analysis indicated that stage-specific disparities in disease management capabilities critically modulate couples\u0026rsquo; coping patterns. For 30% of newly diagnosed patients and spouses lacking caregiving experience, particularly during the transition from acute hospitalization to home care, challenges in maintaining PTBD tubes and managing emergencies (e.g., tube dislodgement) often led to a \"capability-demand imbalance,\" subsequently triggering adaptive anxiety.These findings underscore the necessity for healthcare providers to monitor the emotional states of PTBD biliary stone patients and their spouses across multiple timepoints\u0026mdash;from hospitalization to post-discharge follow-up. Implementing phased skill training (e.g., tube maintenance, emergency response) and psychological support can strengthen collaborative dyadic coping strategies and bolster confidence in jointly managing stressors.\u003c/p\u003e\u003cp\u003eWe further found that couples with harmonious relationships demonstrated faster adaptation to role transitions during disease management and adopted more proactive coping strategies. These findings align with Wang et al.'s cross-disease validation study on dyadic coping experiences in stroke patients and their caregivers[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].The underlying mechanisms may involve two key factors:couples with strong emotional bonds can reframe stress perceptions through empathic communication, and accumulated relational capital provides a buffer for optimizing coordinated coping strategies.Milbury et al.developed a Couple-Based Meditation (CBM) program rooted in mindfulness and compassion principles[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].Participants underwent weekly 60-minute mindfulness sessions over four weeks, which significantly reduced depressive symptoms and cancer-related stress levels in both patients and spouses while enhancing intimacy. Beyond CBM, other evidence-based dyadic interventions include:Couples Coping Enhancement Training (CCET),Coping-Oriented Couples Therapy (COCT), Couple-Based Mind-Body Interventions (CBMB)[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].These programs offer tailored support to strengthen dyadic coping mechanisms and improve relationship quality across diverse partnerships, with widespread application in international settings. Therefore, healthcare professionals should adapt these frameworks by integrating cultural elements specific to China to develop localized dyadic interventions.\u003c/p\u003e\u003cp\u003eIn the context of external support systems, family and societal support play pivotal roles in dyadic coping PTBD biliary stone patients and their spouses. Family support manifests differently across age groups: for elderly patients, it primarily involves financial assistance and daily care from adult children, while younger couples rely more on emotional support from parents and siblings. This heterogeneity in family support models necessitates that healthcare providers expand the scope of health education by integrating key caregivers into intervention frameworks through tools such as family conferences and collaborative care plans, thereby optimizing the efficiency of support resource allocation.Societal support predominantly stems from healthcare teams. Our interviews revealed that over 70% of patients and spouses experienced varying degrees of care transition gaps during the \"hospital-to-home\" phase, characterized by:Insufficient knowledge of tube maintenance,Limited ability to recognize complications,Psychological adaptation barriers.Although current mobile health platforms offer preliminary remote guidance[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e],their applications remain underdeveloped in areas such as virtual reality-assisted procedural training and AI-driven complication warning systems. Future efforts should focus on establishing interdisciplinary collaboration mechanisms that integrate resources from clinical medicine, nursing, and information engineering to develop intelligent, context-adaptive continuing care systems.\u003c/p\u003e\u003cp\u003eChallenges to DC for patients with PTBD of bile duct stones and their spouses\u003c/p\u003e\u003cp\u003eThe results of this study indicate that patients with biliary stones undergoing percutaneous transhepatic biliary drainage (PTBD) and their spouses face multifaceted challenges, including physiological and psychological stress, dyadic communication barriers, and significant financial burdens.\u003c/p\u003e\u003cp\u003eAmong the 15 patients included in this study, 5 experienced pain episodes, 10 reported sleep disturbances, and all interviewees exhibited varying degrees of anxiety and depressive symptoms. These findings underscore the need for multidisciplinary teams comprising physicians, nurses, and psychotherapists to be established across healthcare institutions. Such teams should deliver specialized psychological interventions, including narrative nursing[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e],cognitive-behavioral therapy[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e],and music therapy[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMoreover, dyadic communication barriers were significantly associated with the adoption of passive coping strategies. Existing interventions\u0026mdash;such as communication skills training,emotion-focused therapy, and integrated behavioral interventions have demonstrated efficacy in improving partner communication efficacy and mitigating negative emotions[\u003cspan additionalcitationids=\"CR38\" citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e].Building on this evidence, future research should prioritize the development of tailored communication-based interventions for PTBD biliary stone patients and their spouses to enhance DC capacity.\u003c/p\u003e\u003cp\u003eFurthermore, over half of the families in this study reported a monthly income below 5,000 RMB, and some patients faced employment disruptions during return-to-work phases due to health limitations. This aligns with the findings of Dai et al. regarding the economic strain in chronic disease households[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Economic stress may weaken marital intimacy through the \"financial-relational strain pathway\", thereby compromising the rationality of treatment decision-making.In clinical practice, healthcare providers should integrate household economic assessments into treatment planning workflows and facilitate joint spousal participation in medical decision-making to avoid inefficient treatment options[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].Concurrently, medical institutions should collaborate with social organizations to expand public assistance initiatives (e.g.,crowdfunding platforms) and establish multidimensional financial support systems to alleviate economic burdens.\u003c/p\u003e\n\u003ch3\u003eLIMITATIONS\u003c/h3\u003e\n\u003cp\u003eThis study has several limitations.First, although the authors conducted separate interviews with percutaneous transhepatic biliary drainage (PTBD) biliary stone patients and their spouses whenever possible, nearly half of the dyads (n\u0026thinsp;=\u0026thinsp;10) participated in joint interviews, which may have limited their willingness to disclose sensitive issues and introduced risks of social desirability bias. Second, while the study included patients at different disease stages, it did not explore the temporal impact on DC experiences in PTBD patients and their spouses. Future longitudinal studies are warranted to elucidate the evolution of dyadic coping dynamics over time, enabling more comprehensive and scientifically robust conclusions.In addition, the sample was drawn from three cities in China, resulting in limited demographic diversity (e.g., homogeneous ethnic backgrounds) and potential selection bias. Further research is needed to evaluate the cross-cultural transferability of these findings in China.\u003c/p\u003e\n\u003ch3\u003eIMPLICATIONS FOR PRACTICE\u003c/h3\u003e\n\u003cp\u003eTo facilitate healthcare professionals' understanding of the DC experiences in patients with PTBD biliary stones and their spouses, it is imperative to closely monitor the shared physical and mental health of both partners. This approach will establish a robust evidence base for developing comprehensive disease management programs tailored to address the unique needs of PTBD patients and their spouses.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis study represents the first attempt to explore the care experiences and specific needs of patients with PTBD biliary stones and their spouses during disease management. Throughout the tube-dependent phase, couples jointly endure physical and psychological stressors, while recognizing that the patient\u0026rsquo;s rapid recovery necessitates collaborative spousal engagement. Establishing couple-centered interventions to alleviate negative emotions, strengthen multidimensional support systems, and promote active coping strategies constitutes a critical priority for future research and clinical practice.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eACKNOWLEDGEMENTS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors express their gratitude to all Patients with PTBD biliary stones and their spouses for generously sharing their disease experiences. Additionally, the authors would like to acknowledge the financial support provided by the hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDISCLOSURE STATEMENT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no conflicts of interest to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDATA AVAILABILITY STATEMENT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the fndings of this study are available upon reasonable request from the corresponding author. The data cannot be made publicly available due to their containing information that could compromise the privacy of research participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFUNDING STATEMENT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the \u003cstrong\u003eGeneral Program of Chongqing Natural Science Foundation\u003c/strong\u003e(grant numbers\u0026nbsp;CSTB2023NSCQ-MSX0466).The fund is used for the publication of articles.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCLINICAL TRIAL NUMBER\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNot Applicable\u003c/strong\u003e\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eXM T: Conceptualization; Data curation; Formal analysis; Investigation; Methodology; Project administration; Writing\u0026mdash;original draft. XM W: Conceptualization; Investigation; Funding acquisition; Methodology; Project administration; Resources; Supervision; Writing\u0026mdash;review \u0026amp; editing. HY: Data curation；Methodology; Software; Validation;Writing\u0026mdash;review \u0026amp; editing.LY G: Data curation; Formal analysis.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLu P, Lang C, Liu XY et al. Modified Glisson pedicle transection The Method of Tunnel transumbilical single-port laparoscopic left hemihepatectomy. Chin J Operative Procedures Gen Surg 2023,17(2):134.\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3877/cma.j.issn.1674-3946.2023.02.006\u003c/span\u003e\u003cspan address=\"10.3877/cma.j.issn.1674-3946.2023.02.006\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLu H, Yang H, Wu L, Liao W, He X, Li E, Wu R, Shi S. Yang Z.A novel prognostic model for diagnosing atypical bile duct hyperplasia in patients with intrahepatic lithiasis. Med (Baltim). 2019;98(17):e15364. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/md.0000000000015364\u003c/span\u003e\u003cspan address=\"10.1097/md.0000000000015364\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLorio E, Patel P, Rosenkranz L, Patel S, Sayana H. Management of Hepatolithiasis: Review of the Literature. Curr Gastroenterol Rep. 2020;22(6):30. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s11894-020-00765-3\u003c/span\u003e\u003cspan address=\"10.1007/s11894-020-00765-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiu XW, Cheng Y, Gong JP. Value of percutaneous transhepatic choledochoscopic lithotripsy in treatment of hepatolithiasis. J Clin Hepatol 2019, 35(07):1640\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNursing Branch of Committee of Minimally Invasive Therapy in Oncology of Chinese Anti-Cancer Association;Interventional Perioperative Professional Committee of Chinese College of Interventionalist. the 15th Radiology Nursing Working Group of Chinese Society of Radiology:Expert consensus on drainage tube nursing of percutaneous transhepatic biliary drainage. Chin J Mod Nurs 2020(36):4997\u0026ndash;5003\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://rs.yiigle.com/cmaid/1301030\u003c/span\u003e\u003cspan address=\"https://rs.yiigle.com/cmaid/1301030\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eInterventional Ultrasound Group of Ultrasonic Committee of Chinese Medical Association. Chinese expert consensus of ultrasound-guided percutaneous transhepatic biliary draine(2023 edition). Chin J Ultrasonography. 2023;32(5):369\u0026ndash;76. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3760/cma.j.cn131148-20230123-00046\u003c/span\u003e\u003cspan address=\"10.3760/cma.j.cn131148-20230123-00046\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMo W, Xu Y, Yang C X,Qing Y. L.The quality of life of post-discharge patients carrying drainage tube after PTBD:a qualitative study. J Interventional Radiol 2018, 27(2):178\u0026ndash;80.\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3969/j.issn.1008-794X.2018.02.019\u003c/span\u003e\u003cspan address=\"10.3969/j.issn.1008-794X.2018.02.019\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLi Q, Mo W,Li YL, Yang XC, Zhou. B F.Qualitative study of family caregivers' care experience after PTBD in patients with malignant obstructive jaundice. Chin J Interventional Radiol 2022,10(4):451\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3877/cma.j.issn.2095-5782.2022.04\u003c/span\u003e\u003cspan address=\"10.3877/cma.j.issn.2095-5782.2022.04\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. 019.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChen M, Gong J, Cao Q, Luo X, Li J, Li Q. A literature review of the relationship between dyadic coping and dyadic outcomes in cancer couples. Eur J Oncol Nurs. 2021;54:102035. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ejon.2021.102035\u003c/span\u003e\u003cspan address=\"10.1016/j.ejon.2021.102035\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBodenmann G. A systemic-transactional conceptualization of stress and coping in couples. Swiss J Psychol. 1995;54(1):34\u0026ndash;49.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBanker J, Sudano L, Banker J, Goren N, Zessin CE. Couple Therapy. In: Lebow J, Chambers A, Breunlin D, editors. Encyclopedia of Couple and Family Therapy. New York: Springer: Encyclopedia of Couple and Family Therapy;; 2017.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBodenmann G, Falconier MK, Randall AK. Systemic-Transactional Model of Dyadic Coping. Systemic-Transactional Model of Dyadic Coping; 2019.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWeitkamp K, Bodenmann G. Couples Coping Together: A Scoping Review of the Quantitative and Qualitative Evidence and Conceptual Work Across Three Decades. Front Psychol. 2022;13:876455. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fpsyg.2022.876455\u003c/span\u003e\u003cspan address=\"10.3389/fpsyg.2022.876455\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang Y, Zhang J, Wang S, Wu Y, Hang L, Hua Y, Shi W. Feasibility and preliminary efficacy of a systematic transaction model-guided dyadic coping nursing intervention for patients with breast cancer and their spousal caregivers: A pilot study. Asia Pac J Oncol Nurs. 2025;12:100621. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.apjon.2024.100621\u003c/span\u003e\u003cspan address=\"10.1016/j.apjon.2024.100621\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang W, Pucciarelli G, Mei Y, Zhang Z, Vellone E. The dyadic self-care experience of stroke survivors and their caregivers: A qualitative descriptive study. Health Expect. 2023;26(6):2325\u0026ndash;39. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/hex.13838\u003c/span\u003e\u003cspan address=\"10.1111/hex.13838\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKarademas EC, Dimitraki G, Thomadakis C, Giannousi Z. The relation of spouse illness representations to patient representations and coping behavior: A study in couples dealing with a newly diagnosed cancer. J Psychosoc Oncol. 2019;37(2):145\u0026ndash;59. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/07347332.2018.1508534\u003c/span\u003e\u003cspan address=\"10.1080/07347332.2018.1508534\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMilbury K, Li Y, Durrani S, Liao Z, Tsao AS, Carmack C, Cohen L, Bruera EA, Mindfulness-Based. Intervention as a Supportive Care Strategy for Patients with Metastatic Non-Small Cell Lung Cancer and Their Spouses: Results of a Three-Arm Pilot Randomized Controlled Trial. Oncologist. 2020;25(11):e1794\u0026ndash;802. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1634/theoncologist.2020-0125\u003c/span\u003e\u003cspan address=\"10.1634/theoncologist.2020-0125\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVranceanu AM, Bannon S, Mace R, Lester E, Meyers E, Gates M, Popok P, Lin A, Salgueiro D, Tehan T, et al. Feasibility and Efficacy of a Resiliency Intervention for the Prevention of Chronic Emotional Distress Among Survivor-Caregiver Dyads Admitted to the Neuroscience Intensive Care Unit: A Randomized Clinical Trial. JAMA Netw Open. 2020;3(10):e2020807. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/jamanetworkopen.2020.20807\u003c/span\u003e\u003cspan address=\"10.1001/jamanetworkopen.2020.20807\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMcCaughan E, Curran C, Northouse L, Parahoo K. Evaluating a psychosocial intervention for men with prostate cancer and their partners: Outcomes and lessons learned from a randomized controlled trial. Appl Nurs Res. 2018;40:143\u0026ndash;51. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.apnr.2018.01.008\u003c/span\u003e\u003cspan address=\"10.1016/j.apnr.2018.01.008\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYan S, Jiayi G, He W, Jiaqin P, Jingyu M. The dyadic coping experience of ICU transfer patients and their spouses: A qualitative study. Nurs Crit Care. 2023;29(4):672\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eColorafi KJ, Evans BQ. Descriptive Methods in Health Science Research. Herd. 2016;9(4):16\u0026ndash;25. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/1937586715614171\u003c/span\u003e\u003cspan address=\"10.1177/1937586715614171\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349\u0026ndash;57. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/intqhc/mzm042\u003c/span\u003e\u003cspan address=\"10.1093/intqhc/mzm042\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDai Q, Li LL, Liao CX, Gao X, Huang H, Yuan. H W.A qualitative research on the dual coping experience of patients with spinal cord injury and their spouses. Chin J Nurs. 2021;56(08):1180\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3761/j.issn.0254-1769.2021.08.010\u003c/span\u003e\u003cspan address=\"10.3761/j.issn.0254-1769.2021.08.010\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePan BB, Wang W. D.A qualitative study on the couple's dual coping experience in patients with decompensated cirrhosis.Chinese Journal of Rural Medicine and Pharmacy,2024, 31(08):8\u0026ndash;10.\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.19542/j.cnki.1006-5180.2305-132\u003c/span\u003e\u003cspan address=\"10.19542/j.cnki.1006-5180.2305-132\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFrancis JJ, Johnston M, Robertson C, Glidewell L, Entwistle V, Eccles MP, Grimshaw JM. What is an adequate sample size? Operationalising data saturation for theory-based interview studies. Psychol Health. 2010;25(10):1229\u0026ndash;45. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/08870440903194015\u003c/span\u003e\u003cspan address=\"10.1080/08870440903194015\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVaismoradi M, Turunen H, Bondas T. Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nurs Health Sci. 2013;15(3):398\u0026ndash;405. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/nhs.12048\u003c/span\u003e\u003cspan address=\"10.1111/nhs.12048\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTao FY, Liu HX, Jia RZ, Wu L, Fu D Y,Zhou W, Q,Tian. Y Y.A qualitative study on the dyad coping experience of stress in pregnant women with undifferentiated connective tissue disease and their spouses. Chin J Nurs 2024, 59(22):2760\u0026ndash;5.\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3761/j.issn.0254-1769.2024.22.011\u003c/span\u003e\u003cspan address=\"10.3761/j.issn.0254-1769.2024.22.011\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCurran MA, McDaniel BT, Pollitt AM, Totenhagen CJ. Gender, Emotion Work, and Relationship Quality: A Daily Diary Study. Sex Roles. 2015;73(3\u0026ndash;4):157\u0026ndash;73. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s11199-015-0495-8\u003c/span\u003e\u003cspan address=\"10.1007/s11199-015-0495-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhu H, Tao L, Hu X, Jiang X. Effects of self-disclosure and resilience on reproductive concern in patients of childbearing age with breast cancer: a cross-sectional survey study. BMJ Open. 2023;13(2):e068126. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bmjopen-2022-068126\u003c/span\u003e\u003cspan address=\"10.1136/bmjopen-2022-068126\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eXing YF, Li JX, Zhang QL, Chen LC, Zhang L. Zheng Y J.Dual coping experience of middle?aged stroke patients and their spouses:a qualitative research. Chin Nurs Res. 2022;36(18):3355\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.12102/j.issn.1009-6493.2022.18.030\u003c/span\u003e\u003cspan address=\"10.12102/j.issn.1009-6493.2022.18.030\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBodenmann G, Plancherel B, Beach SR, Widmer K, Gabriel B, Meuwly N, Charvoz L, Hautzinger M, Schramm E. Effects of coping-oriented couples therapy on depression: a randomized clinical trial. J Consult Clin Psychol. 2008;76(6):944\u0026ndash;54. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1037/a0013467\u003c/span\u003e\u003cspan address=\"10.1037/a0013467\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZeng X, Chiu CP, Wang R, Oei TP, Leung FY. The effect of loving-kindness meditation on positive emotions: a meta-analytic review. Front Psychol. 2015;6:1693. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fpsyg.2015.01693\u003c/span\u003e\u003cspan address=\"10.3389/fpsyg.2015.01693\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhang RL, Wang YY, Guo JL, Fan YP, Feng ZL, Wu HZ. Construction and application of remote continuous nursing mode for HIV patients based on mobile medical APP. Chin Nurs Res 2022, 36(03):517\u0026ndash;21.\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.12102/j.issn.1009-6493.2022.03.027\u003c/span\u003e\u003cspan address=\"10.12102/j.issn.1009-6493.2022.03.027\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSlocum RB, Hart AL, Guglin ME. Narrative medicine applications for patient identity and quality of life in ventricular assist device (VAD) patients. Heart Lung. 2019;48(1):18\u0026ndash;21. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.hrtlng.2018.09.013\u003c/span\u003e\u003cspan address=\"10.1016/j.hrtlng.2018.09.013\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCarpenter JK, Andrews LA, Witcraft SM, Powers MB, Smits JAJ, Hofmann SG. Cognitive behavioral therapy for anxiety and related disorders: A meta-analysis of randomized placebo-controlled trials. Depress Anxiety. 2018;35(6):502\u0026ndash;14. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/da.22728\u003c/span\u003e\u003cspan address=\"10.1002/da.22728\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eUmbrello M, Sorrenti T, Mistraletti G, Formenti P, Chiumello D, Terzoni S. Music therapy reduces stress and anxiety in critically ill patients: a systematic review of randomized clinical trials. Minerva Anestesiol. 2019;85(8):886\u0026ndash;98. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.23736/s0375-9393.19.13526-2\u003c/span\u003e\u003cspan address=\"10.23736/s0375-9393.19.13526-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWiebe SA, Johnson SM. Creating relationships that foster resilience in Emotionally Focused Therapy. Curr Opin Psychol. 2017;13:65\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.copsyc.2016.05.001\u003c/span\u003e\u003cspan address=\"10.1016/j.copsyc.2016.05.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYasmin N, Riley GA. Psychological intervention for partners post-stroke: A case report. NeuroRehabilitation. 2020;47(2):237\u0026ndash;45. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3233/nre-203173\u003c/span\u003e\u003cspan address=\"10.3233/nre-203173\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhou J, Wang Z, Chen X, Lin C, Zhao J, Loke AY, Li Q. Mutual communication intervention for colorectal cancer patient-spousal caregiver dyads: A randomized controlled trial. Br J Health Psychol. 2024;29(4):855\u0026ndash;76. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/bjhp.12734\u003c/span\u003e\u003cspan address=\"10.1111/bjhp.12734\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSypes EE, de Grood C, Clement FM, Parsons Leigh J, Whalen-Browne L, Stelfox HT, Niven DJ. Understanding the public's role in reducing low-value care: a scoping review. Implement Sci. 2020;15(1):20. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s13012-020-00986-0\u003c/span\u003e\u003cspan address=\"10.1186/s13012-020-00986-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 3 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"percutaneous transhepatic biliary drainage, dyadic coping, qualitative research, spouses","lastPublishedDoi":"10.21203/rs.3.rs-7922196/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7922196/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eAs interventional minimally invasive technology develops rapidly, Percutaneous Transhepatic Biliary Drainage (PTBD) has become one of the surgical methods for subsequent stone extraction in patients with bile duct stones because of easy operation, low trauma, fewer complications, and high success rate.However, the need for long-term indwelling drainage tubes after the operation puts the patients and their spouses in different degrees of stress for a long period of their lives, leading to poor dyadic coping.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives: \u003c/strong\u003ethis study aimed to explore the dyadic coping experience of patients with PTBD of bile duct stones and their spouses in China and to provide a basis for developing dyadic coping intervention measures.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDesign: \u003c/strong\u003eA descriptive qualitative design was used to conduct the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eA total of three themes and ten sub-themes emerged from the analysis.The identified themes include positive coping (Maintenance of a positive and optimistic mindset, actively seeking solutions, and facing challenges together), negative coping (avoiding problems, displaying overprotective behaviour, and bearing the burden alone), difficulties and challenges (high physical and psychological stress,communication disorders and significant financial burden).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion and Conclusion: \u003c/strong\u003eHealthcare professionals should pay increased attention to the stress and challenges faced by both PTBD patients with bile duct stones and their spouses during the period of living with indwelling drainage tubes. Developing couple-centered interventions to mitigate negative emotions in patients and their spouses and facilitate the adoption of positive coping strategies may represent a critical area for future research and clinical practice, ultimately enhancing their joint quality of life.\u003c/p\u003e","manuscriptTitle":"The dyadic coping experience of patients with Percutaneous Transhepatic Biliary Drainage of bile duct stones and their spouses:A qualitative descriptive study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-02 13:39:54","doi":"10.21203/rs.3.rs-7922196/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f1a445a8-9c6d-43ff-bda1-dcfbcc2c6c00","owner":[],"postedDate":"December 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-12T11:26:39+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-02 13:39:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7922196","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7922196","identity":"rs-7922196","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}