Dyadic Coping Experience With Pancreatic Cancer: a Qualitative Study of Dyadic Interviews

Dyadic Coping Experience With Pancreatic Cancer: a Qualitative Study of Dyadic Interviews | 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 Article Dyadic Coping Experience With Pancreatic Cancer: a Qualitative Study of Dyadic Interviews Bo Zhang, Qigui Xiao, Jingtao Gu, Qingyong Ma, Liang Han This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3964081/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 11 Aug, 2024 Read the published version in Scientific Reports → Version 1 posted 10 You are reading this latest preprint version Abstract Objective: Cancer affects the patients as well as their spouses. Couples use different strategies to cope with cancer and the associated burden. This qualitative dyadic interviews aims to gain a deeper and more differentiated understanding of the support system about couples. Methods: An exploratory qualitative study set in China. The study was based on 10 pancreatic cancer couples semi-structured face-to-face interviews with patients undergoing pancreatic cancer and experiencing different symptoms. Interviews were verbatim transcribed and analysed using thematic framework analysis. This study was guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Results: Ten pancreatic cancer couples (patients: seven men and three women) with different ages (patients: range = 49-75; spouses: range = 47-73), different stage of cancer (e.g., potentially resectable, borderline resectable, locally advanced) and cancer types (initial diagnosis or relapse) participated in the study. Eleven minor themes emerged from the data, namely unbearable pain, suffer from malnutrition,unhealthy eating habits, negative emotions, disease stigma, lack of knowledge, unable to fulfill social roles, forced to stop work, worried about a costly medical bill, conceal the fact about illness, and loss of intimacy with friends and spouse. All couples described cohesion in relationship as an essential common dyadic coping strategy. Most strategies were focused on the patient’s well-being. Furthermore, couples reported different common plans for the future: while some wanted to return to normality, others were reaching out for new goals. Conclusions: Active dyadic coping is conducive to promoting disease adaptation, spouses seemed to need more psychological support to improve their own well-being particularly. Health care systems should pay attention to patients and spouses with pancreatic cancer in terms of the four areas of the RAM: physiological, self-concept, role function and interdependence. Future studies should use a combination of qualitative and quantitative methods to explain dyadic coping in greater depth. Biological sciences/Cancer Biological sciences/Psychology Health sciences/Health care Health sciences/Oncology pancreatic cancer couple (spouses) dyadic interview dyadic coping qualitative study Contributions to the literature Research has shown that individuals facing cancer alone can generate many negative emotions, and for cancer patients, couples coping is very supportive and may be more beneficial for the treatment and prognosis of the disease. Our findings illustrate the experience of dyadic coping in patients with pancreatic cancer which may offer guidance to healthcare providers caring for patients who have failed to adapt to pancreatic cancer. These findings indicate that areas of physiological, self-concept, role function, and interdependence should be taken into consideration when promoting the experience of dyadic coping in patients with pancreatic cancer. Introduction Pancreatic cancer is a malignant tumor with high morbidity and a high mortality rate 1 . Patients often have no obvious symptoms and signs in the early stage, and more than half of the patients are in the late stage at the time of diagnosis. According to the latest data of the American Cancer Society in 2022, the incidence rate of pancreatic cancer ranks 10 among men and 7 among women in the world's new cancers, but pancreatic cancer ranks 4 in the cancer mortality, and the five-year survival rate of pancreatic cancer is the lowest among all tumors, only 11% 2 . Due to the great uncertainty about treatment effectiveness and risk of cancer, it will cause great psychological burden to the spouse 3 . The couple faces new challenges (e.g., unable to effectively obtain information about disease and its treatment, a costly medical bill), role function transformation (e.g., had to stop working, manage the family affairs) and changing in self-concept (e.g., negative emotions, nervous about the future) 4 . The research on coping style of cancer has shifted from the individual level to the couple level 5 . Bodenmann pointed out that for couples, stress events are not individual reactions of one party, but have common effects on both parties 6 . Coping with cancer and its related burdens requires collaboration,which is called dyadic coping (DC), means the common reactions and strategies of partners with intimate relationships when facing dual stress events 6 . The couple relationship is one of the most important resources for patients to face stress events. Traditional model such as systemic transactional model emphasizes that both partners should jointly perceive and evaluate stress, help each other, promote physical and mental health, and strengthen intimate relationships 7 – 9 in coping with stress. Spouses play a key role in treatment decisions and in facilitating disease management 10 . According to the dyadic disease management theory 11 , coping behavior is a related factor affecting quality of life. The dyadic perspective of couples as a whole, focusing on the dyadic response of cancer patients and their spouses, is a new perspective to improve the physical and mental health of both parties and improve the quality of life 12 – 13 . Couples facing cancer usually adopt dyadic response 14 to reduce disease pressure. Theoretical models, The Roy Adaptation Model (RAM) 15 , can be used to explore and describe the experiences of disease adaptation in patients with pancreatic cancer better. The RAM regards individuals as a whole who uses conscious choices to establish the process and results of integration between people and the environment 16 . The RAM includes four modes of adaptation: physiological, self-concept, role function, and interdependence 17 – 18 . The physiological model focuses on maintaining basic physiological needs, such as pain relief, balanced nutrition, rest and sleep. The self-concept model refers to the recognition and evaluation of self. The role function model focuses on the role and function of individuals in the family and society. The interdependence model represents the intimate relationship between individuals and important others 15 . RAM is widely used in the filed of nursing, which can organise, theorise, interpret and suggest ways to provide practical guidance and exploration for the adaptation process. Quantitative research about coping with cancer is very extensive, but there have been fewer qualitative studies in this field. A recent qualitative study with pancreatic cancer patients and their caregivers reported coping strategies like changing in roles and identity, management of weight loss and gastrointestinal problems 19 . A Systematic review of caregiver burden of patients with pancreatic cancer identified coping strategies such as symptom management, better clinical communication, support seeking, and Keep a good attitude 20 . However, less is known about the use of different types of coping strategies by patients and their spouses and social support styles from outside the couples. In sum, we aim to explore couples, one of whom was diagnosed with pancreatic cancer, how to cope with the disease together, and what coping and support strategies they use. In addition, we want to identify possible differences in coping behavior between patients and spouses. Insight into specific types of coping strategies can improve the development of more tailored and detailed intervention programs for patients with cancer and their spouses. Methods Design and sampling strategy A qualitative design was used in this study. The four modes of the RAM were used as the framework for data collection and analysis. Reporting was done in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) reporting guideline 21 . This study used purposive sampling 22 to recruit inpatients from the a general hospitals in China as participants. Eligibility was based on the following criteria: being a patient with pancreatic cancer, age 18–75 years, living with spouse. Exclusion criteria for patients: severe cognitive impairment, serious heart, lung, kidney and other diseases, consciousness disorder. Inclusion criteria for spouse: able to communicate normally. Exclusion criteria for spouse: cognitive impairment. Both patients and spouses were required to provide written informed consent prior to enrolment. Data collection At baseline assessment of the qualitative study was conducted. Sociodemographic information including age, gender, stage of cancer, time since diagnosis, per capita monthly income of family followed by an individual, audio-recorded, semi-structured in-depth interview. Semi-structured interviews 23 were conducted between June 2023 and December 2023 in a general hospitals in China.The interview lasted between 20 and 74 minutes, with an average time of 30 minutes. Based on a review of the existing literature and the four modes of the RAM 15 , we developed an interview guide (Table 1) . The researcher explained the information of the study to the interviewees and asked for permission to record the whole process. After the interviewees signed the informed consent form, they started the conversation from the daily relaxed topics. During the interview, the researcher asked flexible and in-depth questions and inquiries to the interviewees with the help of the interview outline, listened carefully to the interviewees' words and made responses appropriately. Record important words, key words and temporary comments, and pay attention to the non-verbal information of the interviewees. Each interview was conducted by the researcher himself to ensure the consistency and accuracy of the recorded data. The interview can be ended when no new information appears in the patient's statement, that is, information saturation 24 . If the interview data is consistent with that before, the investigation is finished. After the interview, the researcher expressed sincere gratitude to the interviewees. Check the transcript and recording content, and get the contact information of the interviewee politely after no error, so as to facilitate the timely confirmation of information to the interviewee in the later period. Table 1.Interview guide for pancreatic cancer patients and their spouse Data analysis Sociodemographic information was reported with basic descriptive statistics using IBM SPSS Statistics 24. At the end of each interview, the authors need to independently transcribe the recordings into text within 24 hours, compare each other's recordings, and then import the text into NVivo 11 software 25 . The seven-step analysis method of the phenomenological data of Colaizzi was used to analyze the data 26 . First step of this analysis process included recording and carefully reading all interview contents. Within the second step, a code list was developed to identify interesting features in the transcript. The third step included refining recurring ideas and finding common features for coding. The fourth step focused on summarizing the encoded ideas into themes and sub-themes. Based on these collected text passages, a detailed and complete description was written in the fifth step. Analysis was stopped when it was determined that all codes in each theme were consistent. The sixth step included clearly defining the themes, and determining extracts of representative examples. Within the last step each subcategory was analyzed thematically and presented in summary, in which the four modes of the RAM were used for deductive analysis; specific themes and codes were classified into the relevant mode (physiological, self-concept, role function, or interdependence). Moreover, the personal information and text files of the research object are numbered according to the interview sequence, P1, P2, P3... ("P" stands for "Patient") and S1, S2, S3... ("S" stands for "Spouse") are named, and the above information is anonymously marked for reference in the follow-up research results. In the process of inductive coding and deductive classification, if there is any inconsistency, the first to second authors discussed the differences with the third researcher and reached a consensus. Finally, the research group discussed and reviewed all the identified themes and categories. Ethics This study complied with the Declaration of Helsinki, was approved by the Ethics Committee of the First Affiliated Hospital of Xi’an Jiaotong University (XJTU1AF2019LSK086). Written informed consent was obtained from participants included in the study. All participants were informed that any personal information obtained in this study would remain confidential. Rigor We used reliable data collection and analysis methods to ensure the reliability of the data. The researchers are all postgraduate students, who have received systematic training and mastered qualitative research methods and interview skills. Keep a neutral attitude during the interview, properly use the methods of retelling, counter-inquiring, questioning, and ask the interviewees to clarify the unclear opinions again. After the interview, two researchers independently transcribe, analyze and code the data. If there is disagreement, the research group will discuss and analyze the data to ensure accuracy. Ask the interviewees to check the sorted text to ensure its authenticity. Results Sample Characteristics A total of 10 couples were recruited. The mean age of the patients was 62.9 years, and the median age was 63 (range 49–75). More than half of the participants were men (n = 7), the majority most had a secondary school education or below (n = 9) and were all married (n = 10). Approximately 50% (n = 5) were classified as borderline resectable and initial diagnosis. The duration of pancreatic cancer ranged from 0.5 to 5 years. Among the spouses, the mean age was 62.4 years, and the median age was 62 (range 47–73). The majority most had a secondary school education or below (n = 9). Three people had nursing experience. The characteristics of the participants are shown in Table 2 . Table 2 Participants’ characteristics (n = 20) Characteristics Patients(n = 10) n(%) Spouse(n = 10) n(%) Age in years (mean, range) 62.9(49–75) 62.4(47–73) Gender Male Female 7(70%) 3(30%) 3(30%) 7(70%) Highest education level Primary school Secondary school High school 6 (60%) 3(50%) 1 (10%) 4(40%) 5 (30%) 1 (10%) Marital status Married Not married 10(100%) 0(0%) 10(100%) 0(0%) Disease type Initial diagnosis Relapse 7(70%) 3(30%) NA NA Stage of cancer PR BR LA 3(30%) 5(50%) 2(20%) NA NA NA Time since diagnosis ≤2 years 3–5 years ≥ 5 years 4(40%) 5(50%) 1(10%) NA NA NA Per capita monthly income of family (yuan) ≤ 3,000 3000–5000 ≥ 5,000 NA NA NA 6(60%) 3(30%) 1(10%) Prior caregiving experience Yes No NA NA 3(30%) 7(70%) PR: Potentially resectable; BR: Borderline resectable; LA: Locally advanced. NA: Not applicable. Eleven minor themes were identified and grouped according to the four modes of adaptation found in the RAM: the physiological, self-concept, role function, and interdependence modes. These four modes formed the major themes under which the 11 minor themes were grouped. The themes are shown in Table 3 . Table 3 Themes and sub-themes of the study (10 couples) Themes Sub-themes Codes Physiological (physical) Unbearable pain Suffer from malnutrition Unhealthy eating habits Cannot sleep due to pain Cannot digest meat and fish Lack of appetite Losing weight Nervous about their condition Like greasy food Unaware of their high sodium diet Self-concept (emotional) Negative emotions Disease stigma Lack of knowledge Becoming anxious, depressed and irritable Confused about diseases and patients Feeling shameful to get sick Feeling psychological pressure Believing illness could not be cured Feeling that life is meaningless Role function (functional) Unable to fulfill social roles Forced to stop work No longer manage the family affairs Had to stop working Interdependence (social) Worried about a costly medical bill Conceal the fact about illness Loss of intimacy with friends and spouse Deliberately avoid his illness to friends and family Treatment costs are too high to afford Less contact with friends Don't want to communicate with spouse Participants’ Experience of Physiological Factors Unbearable pain Participants mentioned that due to the disease, they were experiencing unbearable pain.Thus, these participants may be at risk of sleep disorders due to severe pain. Because couples often share the night sleep environment, the sleep related factors of one party will also seriously affect the sleep quality of the other party. I wake up every night with pain. (Patient 2, Female, 59years) I can't sleep due to the severe pain, and the painkillers can't relieve it. (Patient 8, Male, 75years) She used to be an optimistic and cheerful person. Since she fell ill, she couldn't sleep and cried all night, so I could only accompany her. (Spouse 2, Male, 61years) Suffer from malnutrition Some participants were not able to guarantee a balanced diet due to their preferences or physical condition. They suffered from nutritional imbalance. Thus, these participants may be at risk of malnutrition. I am losing weight, but I do not like to eat meat, but my doctor told me that if I do not get enough nutrition, I may suffer from malnutrition. (Patient 1, Male, 49years) Since my illness, my stomach was particularly uncomfortable. I have no appetite at all. I feel sick when I saw food. (Patient 10, Male, 62years) Unhealthy eating habits Some participants mentioned that they did not control their unhealthy diet every day every day. I like to eat salty food, but the doctor told me to have a light diet, otherwise it would only aggravate my condition. (Patient 7, Male, 69years) I like eating salty and tasty food in my daily life. otherwise, I feel it has no taste. (Patient 3, Male, 68years) I pay attention to light diet and balanced nutrition when I cook every day, but my spouse feels no taste. (Spouse 6, Female, 56years) Participants’ Experience of Self-Concept Negative emotions Some participants said that they felt psychological pressure after being diagnosed with pancreatic cancer, and became depressed, anxious and irritable. Pancreatic cancer affects her mood and makes her feel anxious and irritable. (Spouse 4, Male, 69years) I constantly thought about my illness. I felt that life is meaningless because the illness could not be cured. (Patient 4, Female, 72years) Disease stigma Some participants mentioned that they would subconsciously perceive the difference between themselves and others, and even had a sense of guilt. When we had dinner with other relatives, several of them dared not sit next to me. I know what they thought. (Patient 3, Male, 68years) After my diagnosis, my relatives came to visit me. They had learned about my illness from my wife. Although they no longer asked me about my illness, I still felt that they were chatting with me to gossip about my strange illness, and even felt that they looked at me differently than before. (Patient 9, Female, 63years) Lack of knowledge Some participants knew little about pancreatic cancer. They didn't know why they were diagnosed and how to treat pancreatic cancer. I started digging through medical journals and trying to understand more about the treatments and the side effects he might have, how to help mitigate some of those things in addition to whatever we got from the cancer center. (Patient 1, Male, 49years) Sometimes I ask the doctor what stage my husband's disease is now and how many years are left. They don't answer directly. Now I still have no idea. This is the first illness in the family, such big illness and we were certainly scared. (Spouse 3, Female, 67years) Participants’ Experience of Role Function Unable to fulfill social roles Some participants could not manage family affairs as before after being diagnosed. I used to be the backbone of my family, but now I suddenly fell down, and my family had no financial resources. (Patient 1, Male, 49years) My wife was diagnosed suddenly, and I also had high blood pressure. At that time, I felt so tired. I used to worry very little about things at home. My meals were ready and my clothes were washed. I couldn't find anything without asking her. (Spouse 2, Male, 61years) Forced to stop work Some participants had to stop working after being diagnosed with pancreatic cancer in order to avoid fatigue. I have not worked for two years since I was diagnosed with pancreatic cancer. (Patient 5, Male, 58years) My main task now is to take care of him. Every time he comes to the hospital, I will accompany him. I spend every day in the hospital, and I can't do what I want to do. Moreover, because of the COVID-19 epidemic, it is not convenient for families to get in and out. (Spouse 5, Female, 55years) Participants’ Experience of Interdependence Worried about a costly medical bill Some participants mentioned that the treatment was expensive and ineffective, and families could not bear the heavy financial burden. Despite the medical insurance support, there are still serious problems such as insufficient economic capacity, delayed reimbursement and low reimbursement ratio. Our child has just bought a house and needs to pay back the loan every month. Now I spend a lot of money on hospitalization. My spouse borrows money everywhere, but she never tells me about the cost. I feel very guilty. (Patient 6, Male, 54years) Our family's economic condition is not good. I know that the cost of chemotherapy is very expensive. I want to ask him about the specific cost and where he borrowed the money, but he never mentioned this matter to me. I'm afraid people and money will be wasted. Alas, it's not worth it. (Patient 9, Female, 63years) Conceal the fact about illness Some participants mentioned that they did not want to discuss the disease with their family and friends. They are worried that their situation will further increase the pressure and burden of their spouse, and they choose to face it alone and hide it from themselves. To tell the truth, I'm worried every day, but I can't show it. He was already very vulnerable when he was ill. I can't give him any more pressure and let him see that I'm not strong. (Spouse 10, Female, 61years) Pancreatic cancer is really uncomfortable, which makes me feel weak and painful, affecting my sleep. But I don't want to tell my spouse, just want to bear it silently. (Patient 8, Male, 75years) Loss of intimacy with friends and spouse Some participants mentioned that they were alienated from their friends after being diagnosed with pancreatic cancer because they could not get together with them as before Just a few days after the diagnosis, I couldn't accept that I had cancer, so I often cried. My husband advised me that it was bad for me to cry when I was ill. I will bear not to cry, or I will appear too sentimental. I feel sad, but I have no chance to talk to him. (Patient 4, Female, 72years) I vomited heavily every time I received chemotherapy, and my whole body was tired. I told my spouse that I was very uncomfortable and might not persist until the chemotherapy was over. She immediately changed the topic and didn't let me continue to complain. In fact, I hoped she would cheer me up instead of avoiding me like this. (Patient 6, Male, 54years) I used to interrupt her when she said anything, but now I know what she did was wrong. Men and women release in different ways. In fact, I should let her say it. So now I listen carefully to what she said and constantly comfort her. (Spouse 2, Male, 61years) Discussion Coping and support strategies are key factors in improving well-being and adjustment in couples facing cancer. This qualitative study was to go beyond quantitative data from prior questionnaire studies to explored deeper insight into the specific strategies that are summarized in the theoretical categories in terms of the four modes of adaptation found in the RAM. Eleven minor themes emerged from the data, namely unbearable pain, suffer from malnutrition,unhealthy eating habits, negative emotions, disease stigma, lack of knowledge, unable to fulfill social roles, forced to stop work, worried about a costly medical bill, conceal the fact about illness, and loss of intimacy with friends and spouse. Compared to previous quantitative studies 3 – 4 , we were able to confirm the main dyadic coping categories, as well as show similarities in the distribution of coping and support proportions between patient and spouse. To our knowledge, this is the first study considering the four modes of adaptation found in the Roy adaptation model using a dyadic interview and set different coping and support strategies in pancreatic cancer patients and their spouses. Some participants had adaptation difficulties regarding pain, nutrition, and eating habits. In terms of pain, participants reported severe pain that is difficult to be suppressed by drugs. The spouse can take some measures to regulate the patient's mood to reduce pain. Guide patients to carry out correct deep breathing training to achieve the purpose of relaxation and divert the patient's attention to relieve pain, such as listening to music, watching video 27 . Patients with pancreatic cancer often experience malnutrition, which is related to a lack of intake or uptake of nutrients 28 . Malnutrition can lead to an alteration in body composition, resulting in physical and mental deterioration. Moreover, we found that some participants got unhealthy eating habits due to they were unaware of their high sodium and greasy diet. Thus, the spouse should follow the requirements of the doctor and dietitian, understand the contents of the patient's individual diet and the relevant rehabilitation training plan, supervise the patient to complete the relevant contents step by step, and assist the patient to complete the relevant rehabilitation training content with a positive attitude. Dyadic coping is beneficial to the adaptation and recovery of patients' physiological functions. Self-concept plays an important role in mental health 29 , which involves the perceptions, values, and self-confidence that affect a person’s behavior. People with positive self-concept are better at developing and maintaining interpersonal relationships and resisting mental and physical diseases 30 . On the contrary, negative or poor self-concept is a risk factor. In our study, all the participants mentioned that they became anxious, irritable, and depressed after being diagnosed, possibly due to realize that pancreatic cancer could not be cured. Therefore, most participants showed a poor self-concept. The spouses should learn more about the disease and share it with patients to reduce their anxiety. In addition, spouses should encourage patients to communicate more with fellow wards to reduce the stigma of disease. Role function is manifested primarily in major areas of individual life, including interpersonal interactions and relationships in the community, society, and citizen live 31 . Due to the change of role function, spouses take on more supportive dyadic coping roles 4 . Companion and support of spouses during disease diagnosis and hospitalization were very essential, while patients wanted to rebuild the role function after returning home 32 . Positive reframing was also expressed through the gratitude and enjoyment for trivial matters, a lifestyle that is also important for patients with advanced cancer 33 . For couples, being around the patient helped both parties not feel lonely. In addition to supportive behavior, when the patient was unable to complete the task, the spouse would also take over the task completely. Therefore, the spouse may also worry about being considered just as a caregiver, which may cause the relationship to be out of balance. Cohesion is crucial to all couples and is expressed in various ways. In addition to common activities, it seems important for both sides to stay away from negative and stressful things. Through all these experiences, the couple had achieved common growth and became more intimate in their relationship 3 – 4 . Effective communication is one of the key elements in dyadic coping with cancer, considering the individual differences in the couple, research should avoid using too abstract concepts, and turn to more concise and different descriptions. Moreover, communication within the couple can change over cancer trajectory 34 . In terms of communication strategies, patients focused on various activities to improve emotional well-being, while spouses reported more unfavorable strategies. This is consistent with previous studies showing that spouses usually ignore their need for well-being and always think with patients 35 . Effective communication about cancer-related topics will reduce anxiety, depression, and improve the quality of life of the couple 36 . A previous study developed communication skills training program for cancer patients and their spouses 37 , which could improve the avoidance of cancer-related topics and the intimate relationship with spouses. It is an effective intervention way to promote the communication and expression in the couple. Our study reported the relaxing effect of stress communication, while some spouses could not bear patients’ stress communication. To improve the difference, couple-based supportive interventions should move the general communication to more individual approaches 38 . Due to couples with good relationships may be more willing to accept interviews, there are generally fewer reports of negative dyadic response. In fact, the interview is conducted jointly by both couples, which may reduce the opportunity to observe negative dyadic response. Spouses typically receive less social support from friends and families when dyadic coping with cancer patients 39 . Spouses' distress could be indirectly alleviated by instrumental social support for patients. The support from others was necessary and helpful, apart from some suggestions that made patients feel stressed. Therefore, the social support provided was most important to meet the needs and expectations of the patients 40 . All in all, interventions should be developed to strengthen couples’ social support system. Study strength and limitations The strength of this study is the combination of deductive and inductive categorization strategies. This approach offers more flexibility. In addition, the setting of dyadic interviews has the advantage that couples are together because they also care about each other. This study also has limitations. Given that we recruited participants from only one hospital of China, there may be limitations to generalizability. Furthermore, there may be a selection bias due to both partners had to agree to participate, thus some couples with discordant relationships did not want to participate in the interviews. Clinical implication Couples coping with cancer is very supportive for patients. In this study, patients and spouses differ in the strategies used and the support received. First, clinicians should track the strategies used and suggest targeted improvement strategies based on actual circumstances. In addition, health care systems should provide support for couples' cancer coping, especially focusing on spouses' psychological conditions because their distress is easily overlooked. When spouses have stress and bad emotions, health care systems should actively provide suitable strategies to help relax and improve their well-being. These new insights can serve as a new direction for couples' interventions for the future. Tailored couples support based on online interventions may be an appropriate implementation to achieve this goal 41 . Furthermore, our study indicates that areas of physiological, self-concept, role function, and interdependence should be taken into consideration when promoting dyadic coping in patients with pancreatic cancer. Conclusion Active dyadic coping is conducive to promoting disease adaptation. This study explored the experiences of dyadic coping in patients with pancreatic cancer based on the four modes of the RAM. Both patients and spouses had different coping strategies that helped patients cope with distress during treatment and enabled them to support each other better. In addition, there were some communication difficulties between patients and spouses, but some support could help them with problems. It appears that couples coping with pancreatic cancer is crucial for disease adaptation, spouses seemed to need more psychological support to improve their own well-being particularly. Health care systems should pay attention to patients and spouses with pancreatic cancer in terms of the four areas of the RAM: physiological, self-concept, role function and interdependence. Future studies should use a combination of qualitative and quantitative methods to explain dyadic coping in greater depth. Declarations Author Contribution All authors had a substantial contribution to the manuscript. Bo Zhang: Conceptualisation, Study design, Data collection, Data analysis, Data interpretation, Writing—original draf, Review and editing, Final approval; Qigui Xiao and Jingtao Gu: Conceptualisation, Study design; Qingyong Ma: Study design, Review and editing; Liang Han: Study design, Review and editing. References Li, MY, Tang, DD, Yang, T, Qian, D and Xu, RC, (2022) Apoptosis Triggering, an Important Way for Natural Products From Herbal Medicines to Treat Pancreatic Cancers. Frontiers in pharmacology 12. Siegel, RL, Miller, KD, Fuchs, HE and Jemal, A, (2022) Cancer statistics, 2022. CA Cancer J Clin 72: 7–33. Yanai, Y, Makihara, RA, Matsunaga, N, Shimizu, R, Tominaga, S and Hoshino, S et al. , (2022) A feasibility study of a peer discussion group intervention for patients with pancreatobiliary cancer and their caregivers. Palliat Support Care 20: 527–534. 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Benzing, V, Siegwart, V, Spitzhuttl, J, Schmid, J, Grotzer, M and Roebers, CM et al. , (2021) Motor ability, physical self-concept and health-related quality of life in pediatric cancer survivors. Cancer Med 10: 1860–1871. Geuskens, GA, Burdorf, A and Hazes, JM, (2007) Consequences of rheumatoid arthritis for performance of social roles–a literature review. J Rheumatol 34: 1248–60. van Roij, J, Raijmakers, N, Kloover, J, Kuip, E, Smilde, T and van der Velden, LA et al. , (2022) Dyadic coping and its association with emotional functioning in couples confronted with advanced cancer: Results of the multicenter observational eQuiPe study. Psychooncology 31: 1545–1554. Cottingham, AH, Cripe, LD, Rand, KL and Frankel, RM, (2018) "My Future is Now": A Qualitative Study of Persons Living With Advanced Cancer. Am J Hosp Palliat Care 35: 640–646. Siminoff, LA, Wilson-Genderson, M, Barta, S and Thomson, MD, (2020) Hematological cancer patient-caregiver dyadic communication: A longitudinal examination of cancer communication concordance. Psychooncology 29: 1571–1578. Heynsbergh, N, Botti, M, Heckel, L and Livingston, PM, (2019) Caring for the person with cancer and the role of digital technology in supporting carers. Support Care Cancer 27: 2203–2209. Shin, DW, Shin, J, Kim, SY, Yang, HK, Cho, J and Youm, JH et al. , (2016) Family Avoidance of Communication about Cancer: A Dyadic Examination. Cancer Res Treat 48: 384–92. Porter, LS, Keefe, FJ, Baucom, DH, Hurwitz, H, Moser, B and Patterson, E et al. , (2012) Partner-assisted emotional disclosure for patients with GI cancer: 8-week follow-up and processes associated with change. Support Care Cancer 20: 1755–62. Gremore, TM, Brockstein, B, Porter, LS, Brenner, S, Benfield, T and Baucom, DH et al. , (2021) Couple-based communication intervention for head and neck cancer: a randomized pilot trial. Support Care Cancer 29: 3267–3275. Bodschwinna, D, Ernst, J, Mehnert-Theuerkauf, A, Gundel, H, Weissflog, G and Honig, K, (2021) Dyadic coping and social support: Various types of support in hematooncological patients and their spouses-Associations with psychological distress. Psychooncology 30: 1041–1050. Vodermaier, A and Linden, W, (2019) Social support buffers against anxiety and depressive symptoms in patients with cancer only if support is wanted: a large sample replication. Support Care Cancer 27: 2345–2347. Luo, X, Gao, L, Li, J, Lin, Y, Zhao, J and Li, Q, (2020) A critical literature review of dyadic web-based interventions to support cancer patients and their caregivers, and directions for future research. Psychooncology 29: 38–48. Additional Declarations No competing interests reported. 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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-3964081","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":276369648,"identity":"26d1eaaa-386e-4986-9705-c8940d7f9d69","order_by":0,"name":"Bo Zhang","email":"","orcid":"","institution":"First Affiliated Hospital of Xi’an Jiaotong University","correspondingAuthor":false,"prefix":"","firstName":"Bo","middleName":"","lastName":"Zhang","suffix":""},{"id":276369649,"identity":"7d105802-aadb-4595-a226-83cead8ed21a","order_by":1,"name":"Qigui Xiao","email":"","orcid":"","institution":"First Affiliated Hospital of Xi’an Jiaotong University","correspondingAuthor":false,"prefix":"","firstName":"Qigui","middleName":"","lastName":"Xiao","suffix":""},{"id":276369650,"identity":"8ed2bd9c-d6f4-41fe-8eb3-573d929c9f38","order_by":2,"name":"Jingtao Gu","email":"","orcid":"","institution":"First Affiliated Hospital of Xi’an Jiaotong University","correspondingAuthor":false,"prefix":"","firstName":"Jingtao","middleName":"","lastName":"Gu","suffix":""},{"id":276369651,"identity":"08b2cf95-a0c6-48fb-a781-378743897508","order_by":3,"name":"Qingyong Ma","email":"","orcid":"","institution":"First Affiliated Hospital of Xi’an Jiaotong University","correspondingAuthor":false,"prefix":"","firstName":"Qingyong","middleName":"","lastName":"Ma","suffix":""},{"id":276369652,"identity":"2a9accaf-452f-4f5a-8361-1628c0af3550","order_by":4,"name":"Liang Han","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5ElEQVRIie3PvQrCMBDA8SuFdCl2VXyJiOAHlPoqKYFORXwAh0xOxVnfwkc4PewmXTs46OLk4CQOItaqa5tRMP/phvtxCYDJ9INxAAtFOSLAhfuBDoEPIbAWk0jqkfdog+1eNpaqI31nh3iY7oPVOkvbPkcbHNquqsgwGQsU6UkuFbF2zPcNcKMor3wYxhwFI+lBSU42NN1eNcnOBXmQZC8y4GSpWpIXV8IZBeUV0CPFlXBOoqWoO0x4JFntX7K4c7xdacTz9TG/3f3AcyitJN9C1cT3xHTWX43AU7q7JpPJ9G89ASjcUzP2owFNAAAAAElFTkSuQmCC","orcid":"","institution":"First Affiliated Hospital of Xi’an Jiaotong University","correspondingAuthor":true,"prefix":"","firstName":"Liang","middleName":"","lastName":"Han","suffix":""}],"badges":[],"createdAt":"2024-02-17 12:45:52","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3964081/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3964081/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-024-69599-7","type":"published","date":"2024-08-11T15:57:28+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":62298330,"identity":"858ee35d-736a-4237-97d9-9ea1505c9c45","added_by":"auto","created_at":"2024-08-12 16:12:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":665811,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3964081/v1/4b900f48-af11-4ea7-8aba-4b9dc9f67d5a.pdf"},{"id":52007949,"identity":"cb5827b0-e89d-4445-8d24-9ec256f821aa","added_by":"auto","created_at":"2024-03-05 09:49:23","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":26149,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaryfile.docx","url":"https://assets-eu.researchsquare.com/files/rs-3964081/v1/24e0c6cb8c18c49dd84bb88b.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Dyadic Coping Experience With Pancreatic Cancer: a Qualitative Study of Dyadic Interviews","fulltext":[{"header":"Contributions to the literature","content":"\u003cp\u003eResearch has shown that individuals facing cancer alone can generate many negative emotions, and for cancer patients, couples coping is very supportive and may be more beneficial for the treatment and prognosis of the disease.\u003c/p\u003e\n\u003cp\u003eOur findings illustrate the experience of dyadic coping in patients with pancreatic cancer which may offer guidance to healthcare providers caring for patients who have failed to adapt to pancreatic cancer.\u003c/p\u003e\n\u003cp\u003eThese findings indicate that areas of physiological, self-concept, role function, and interdependence should be taken into consideration when promoting the experience of dyadic coping in patients with pancreatic cancer.\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003ePancreatic cancer is a malignant tumor with high morbidity and a high mortality rate\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. Patients often have no obvious symptoms and signs in the early stage, and more than half of the patients are in the late stage at the time of diagnosis. According to the latest data of the American Cancer Society in 2022, the incidence rate of pancreatic cancer ranks 10 among men and 7 among women in the world's new cancers, but pancreatic cancer ranks 4 in the cancer mortality, and the five-year survival rate of pancreatic cancer is the lowest among all tumors, only 11%\u003csup\u003e2\u003c/sup\u003e. Due to the great uncertainty about treatment effectiveness and risk of cancer, it will cause great psychological burden to the spouse\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. The couple faces new challenges (e.g., unable to effectively obtain information about disease and its treatment, a costly medical bill), role function transformation (e.g., had to stop working, manage the family affairs) and changing in self-concept (e.g., negative emotions, nervous about the future)\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe research on coping style of cancer has shifted from the individual level to the couple level\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. Bodenmann pointed out that for couples, stress events are not individual reactions of one party, but have common effects on both parties\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Coping with cancer and its related burdens requires collaboration,which is called dyadic coping (DC), means the common reactions and strategies of partners with intimate relationships when facing dual stress events\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. The couple relationship is one of the most important resources for patients to face stress events. Traditional model such as systemic transactional model emphasizes that both partners should jointly perceive and evaluate stress, help each other, promote physical and mental health, and strengthen intimate relationships\u003csup\u003e\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e in coping with stress. Spouses play a key role in treatment decisions and in facilitating disease management\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. According to the dyadic disease management theory\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e, coping behavior is a related factor affecting quality of life. The dyadic perspective of couples as a whole, focusing on the dyadic response of cancer patients and their spouses, is a new perspective to improve the physical and mental health of both parties and improve the quality of life\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. Couples facing cancer usually adopt dyadic response\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e to reduce disease pressure.\u003c/p\u003e \u003cp\u003eTheoretical models, The Roy Adaptation Model (RAM)\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e, can be used to explore and describe the experiences of disease adaptation in patients with pancreatic cancer better. The RAM regards individuals as a whole who uses conscious choices to establish the process and results of integration between people and the environment\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. The RAM includes four modes of adaptation: physiological, self-concept, role function, and interdependence\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. The physiological model focuses on maintaining basic physiological needs, such as pain relief, balanced nutrition, rest and sleep. The self-concept model refers to the recognition and evaluation of self. The role function model focuses on the role and function of individuals in the family and society. The interdependence model represents the intimate relationship between individuals and important others\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. RAM is widely used in the filed of nursing, which can organise, theorise, interpret and suggest ways to provide practical guidance and exploration for the adaptation process.\u003c/p\u003e \u003cp\u003eQuantitative research about coping with cancer is very extensive, but there have been fewer qualitative studies in this field. A recent qualitative study with pancreatic cancer patients and their caregivers reported coping strategies like changing in roles and identity, management of weight loss and gastrointestinal problems\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. A Systematic review of caregiver burden of patients with pancreatic cancer identified coping strategies such as symptom management, better clinical communication, support seeking, and Keep a good attitude\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. However, less is known about the use of different types of coping strategies by patients and their spouses and social support styles from outside the couples.\u003c/p\u003e \u003cp\u003eIn sum, we aim to explore couples, one of whom was diagnosed with pancreatic cancer, how to cope with the disease together, and what coping and support strategies they use. In addition, we want to identify possible differences in coping behavior between patients and spouses. Insight into specific types of coping strategies can improve the development of more tailored and detailed intervention programs for patients with cancer and their spouses.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003ch2\u003eDesign and sampling strategy\u003c/h2\u003e\n\u003cp\u003eA qualitative design was used in this study. The four modes of the RAM were used as the framework for data collection and analysis. Reporting was done in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) reporting guideline\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThis study used purposive sampling\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e to recruit inpatients from the a general hospitals in China as participants. Eligibility was based on the following criteria: being a patient with pancreatic cancer, age 18\u0026ndash;75 years, living with spouse. Exclusion criteria for patients: severe cognitive impairment, serious heart, lung, kidney and other diseases, consciousness disorder. Inclusion criteria for spouse: able to communicate normally. Exclusion criteria for spouse: cognitive impairment. Both patients and spouses were required to provide written informed consent prior to enrolment.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n\u003ch2\u003eData collection\u003c/h2\u003e\n\u003cp\u003eAt baseline assessment of the qualitative study was conducted. Sociodemographic information including age, gender, stage of cancer, time since diagnosis, per capita monthly income of family followed by an individual, audio-recorded, semi-structured in-depth interview. Semi-structured interviews\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e were conducted between June 2023 and December 2023 in a general hospitals in China.The interview lasted between 20 and 74 minutes, with an average time of 30 minutes. Based on a review of the existing literature and the four modes of the RAM\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e, we developed an interview guide \u003cstrong\u003e(Table\u0026nbsp;1)\u003c/strong\u003e. The researcher explained the information of the study to the interviewees and asked for permission to record the whole process. After the interviewees signed the informed consent form, they started the conversation from the daily relaxed topics. During the interview, the researcher asked flexible and in-depth questions and inquiries to the interviewees with the help of the interview outline, listened carefully to the interviewees' words and made responses appropriately. Record important words, key words and temporary comments, and pay attention to the non-verbal information of the interviewees. Each interview was conducted by the researcher himself to ensure the consistency and accuracy of the recorded data. The interview can be ended when no new information appears in the patient's statement, that is, information saturation\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. If the interview data is consistent with that before, the investigation is finished. After the interview, the researcher expressed sincere gratitude to the interviewees. Check the transcript and recording content, and get the contact information of the interviewee politely after no error, so as to facilitate the timely confirmation of information to the interviewee in the later period.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.Interview guide for \u003c/strong\u003e\u003cstrong\u003epancreatic\u003c/strong\u003e\u003cstrong\u003e cancer patients and \u003c/strong\u003e\u003cstrong\u003etheir spouse\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cimg 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\" alt=\"\" /\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n\u003ch2\u003eData analysis\u003c/h2\u003e\n\u003cp\u003eSociodemographic information was reported with basic descriptive statistics using IBM SPSS Statistics 24. At the end of each interview, the authors need to independently transcribe the recordings into text within 24 hours, compare each other's recordings, and then import the text into NVivo 11 software\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. The seven-step analysis method of the phenomenological data of Colaizzi was used to analyze the data\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. First step of this analysis process included recording and carefully reading all interview contents. Within the second step, a code list was developed to identify interesting features in the transcript. The third step included refining recurring ideas and finding common features for coding. The fourth step focused on summarizing the encoded ideas into themes and sub-themes. Based on these collected text passages, a detailed and complete description was written in the fifth step. Analysis was stopped when it was determined that all codes in each theme were consistent. The sixth step included clearly defining the themes, and determining extracts of representative examples. Within the last step each subcategory was analyzed thematically and presented in summary, in which the four modes of the RAM were used for deductive analysis; specific themes and codes were classified into the relevant mode (physiological, self-concept, role function, or interdependence). Moreover, the personal information and text files of the research object are numbered according to the interview sequence, P1, P2, P3... (\"P\" stands for \"Patient\") and S1, S2, S3... (\"S\" stands for \"Spouse\") are named, and the above information is anonymously marked for reference in the follow-up research results. In the process of inductive coding and deductive classification, if there is any inconsistency, the first to second authors discussed the differences with the third researcher and reached a consensus. Finally, the research group discussed and reviewed all the identified themes and categories.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n\u003ch2\u003eEthics\u003c/h2\u003e\n\u003cp\u003eThis study complied with the Declaration of Helsinki, was approved by the Ethics Committee of the First Affiliated Hospital of Xi\u0026rsquo;an Jiaotong University (XJTU1AF2019LSK086). Written informed consent was obtained from participants included in the study. All participants were informed that any personal information obtained in this study would remain confidential.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n\u003ch2\u003eRigor\u003c/h2\u003e\n\u003cp\u003eWe used reliable data collection and analysis methods to ensure the reliability of the data. The researchers are all postgraduate students, who have received systematic training and mastered qualitative research methods and interview skills. Keep a neutral attitude during the interview, properly use the methods of retelling, counter-inquiring, questioning, and ask the interviewees to clarify the unclear opinions again. After the interview, two researchers independently transcribe, analyze and code the data. If there is disagreement, the research group will discuss and analyze the data to ensure accuracy. Ask the interviewees to check the sorted text to ensure its authenticity.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eSample Characteristics\u003c/h2\u003e \u003cp\u003eA total of 10 couples were recruited. The mean age of the patients was 62.9 years, and the median age was 63 (range 49\u0026ndash;75). More than half of the participants were men (n\u0026thinsp;=\u0026thinsp;7), the majority most had a secondary school education or below (n\u0026thinsp;=\u0026thinsp;9) and were all married (n\u0026thinsp;=\u0026thinsp;10). Approximately 50% (n\u0026thinsp;=\u0026thinsp;5) were classified as borderline resectable and initial diagnosis. The duration of pancreatic cancer ranged from 0.5 to 5 years. Among the spouses, the mean age was 62.4 years, and the median age was 62 (range 47\u0026ndash;73). The majority most had a secondary school education or below (n\u0026thinsp;=\u0026thinsp;9). Three people had nursing experience. The characteristics of the participants are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParticipants\u0026rsquo; characteristics (n\u0026thinsp;=\u0026thinsp;20)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatients(n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003cp\u003en(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSpouse(n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003cp\u003en(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge in years (mean, range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e62.9(49\u0026ndash;75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e62.4(47\u0026ndash;73)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7(70%)\u003c/p\u003e \u003cp\u003e3(30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(30%)\u003c/p\u003e \u003cp\u003e7(70%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHighest education level\u003c/p\u003e \u003cp\u003ePrimary school Secondary school\u003c/p\u003e \u003cp\u003eHigh school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (60%) 3(50%)\u003c/p\u003e \u003cp\u003e1 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(40%) 5 (30%)\u003c/p\u003e \u003cp\u003e1 (10%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003cp\u003eMarried\u003c/p\u003e \u003cp\u003eNot married\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10(100%)\u003c/p\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(100%)\u003c/p\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisease type\u003c/p\u003e \u003cp\u003eInitial diagnosis\u003c/p\u003e \u003cp\u003eRelapse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7(70%)\u003c/p\u003e \u003cp\u003e3(30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStage of cancer\u003c/p\u003e \u003cp\u003ePR\u003c/p\u003e \u003cp\u003eBR\u003c/p\u003e \u003cp\u003eLA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(30%)\u003c/p\u003e \u003cp\u003e5(50%)\u003c/p\u003e \u003cp\u003e2(20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003cp\u003eNA\u003c/p\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime since diagnosis\u003c/p\u003e \u003cp\u003e\u0026le;2 years\u003c/p\u003e \u003cp\u003e3\u0026ndash;5 years\u003c/p\u003e \u003cp\u003e\u0026ge;\u0026thinsp;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(40%)\u003c/p\u003e \u003cp\u003e5(50%)\u003c/p\u003e \u003cp\u003e1(10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003cp\u003eNA\u003c/p\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePer capita monthly income of family (yuan)\u003c/p\u003e \u003cp\u003e\u0026le;\u0026thinsp;3,000\u003c/p\u003e \u003cp\u003e3000\u0026ndash;5000\u003c/p\u003e\u003cp\u003e\u0026ge;\u0026thinsp;5,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003cp\u003eNA\u003c/p\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(60%)\u003c/p\u003e \u003cp\u003e3(30%)\u003c/p\u003e \u003cp\u003e1(10%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrior caregiving experience\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(30%)\u003c/p\u003e \u003cp\u003e7(70%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003ePR: Potentially resectable; BR: Borderline resectable; LA: Locally advanced. NA: Not applicable.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eEleven minor themes were identified and grouped according to the four modes of adaptation found in the RAM: the physiological, self-concept, role function, and interdependence modes. These four modes formed the major themes under which the 11 minor themes were grouped. The themes are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThemes and sub-themes of the study (10 couples)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThemes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSub-themes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCodes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysiological (physical)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnbearable pain\u003c/p\u003e \u003cp\u003eSuffer from malnutrition\u003c/p\u003e \u003cp\u003eUnhealthy eating habits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCannot sleep due to pain\u003c/p\u003e \u003cp\u003eCannot digest meat and fish\u003c/p\u003e \u003cp\u003eLack of appetite\u003c/p\u003e \u003cp\u003eLosing weight\u003c/p\u003e \u003cp\u003eNervous about their condition\u003c/p\u003e \u003cp\u003eLike greasy food\u003c/p\u003e \u003cp\u003eUnaware of their high sodium diet\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-concept (emotional)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNegative emotions\u003c/p\u003e \u003cp\u003eDisease stigma\u003c/p\u003e \u003cp\u003eLack of knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBecoming anxious, depressed and irritable\u003c/p\u003e \u003cp\u003eConfused about diseases and patients\u003c/p\u003e \u003cp\u003eFeeling shameful to get sick\u003c/p\u003e \u003cp\u003eFeeling psychological pressure\u003c/p\u003e \u003cp\u003eBelieving illness could not be cured\u003c/p\u003e \u003cp\u003eFeeling that life is meaningless\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRole function (functional)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnable to fulfill social roles\u003c/p\u003e \u003cp\u003eForced to stop work\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo longer manage the family affairs\u003c/p\u003e \u003cp\u003eHad to stop working\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInterdependence (social)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWorried about a costly medical bill\u003c/p\u003e \u003cp\u003eConceal the fact about illness\u003c/p\u003e \u003cp\u003eLoss of intimacy with friends and spouse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDeliberately avoid his illness to friends and family\u003c/p\u003e \u003cp\u003eTreatment costs are too high to afford\u003c/p\u003e \u003cp\u003eLess contact with friends\u003c/p\u003e \u003cp\u003eDon't want to communicate with spouse\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u0026rsquo; Experience of Physiological Factors\u003c/h2\u003e \u003cdiv id=\"Sec11\" class=\"Section3\"\u003e \u003ch2\u003eUnbearable pain\u003c/h2\u003e \u003cp\u003eParticipants mentioned that due to the disease, they were experiencing unbearable pain.Thus, these participants may be at risk of sleep disorders due to severe pain. Because couples often share the night sleep environment, the sleep related factors of one party will also seriously affect the sleep quality of the other party.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e\u003cem\u003eI wake up every night with pain.\u003c/em\u003e (Patient 2, Female, 59years)\u003c/h2\u003e \u003cp\u003e \u003cem\u003eI can't sleep due to the severe pain, and the painkillers can't relieve it.\u003c/em\u003e (Patient 8, Male, 75years)\u003c/p\u003e \u003cp\u003e \u003cem\u003eShe used to be an optimistic and cheerful person. Since she fell ill, she couldn't sleep and cried all night, so I could only accompany her.\u003c/em\u003e (Spouse 2, Male, 61years)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eSuffer from malnutrition\u003c/h2\u003e \u003cp\u003eSome participants were not able to guarantee a balanced diet due to their preferences or physical condition. They suffered from nutritional imbalance. Thus, these participants may be at risk of malnutrition.\u003c/p\u003e \u003cp\u003e \u003cem\u003eI am losing weight, but I do not like to eat meat, but my doctor told me that if I do not get enough nutrition, I may suffer from malnutrition.\u003c/em\u003e (Patient 1, Male, 49years)\u003c/p\u003e \u003cp\u003e \u003cem\u003eSince my illness, my stomach was particularly uncomfortable. I have no appetite at all. I feel sick when I saw food.\u003c/em\u003e (Patient 10, Male, 62years)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eUnhealthy eating habits\u003c/h2\u003e \u003cp\u003eSome participants mentioned that they did not control their unhealthy diet every day every day.\u003c/p\u003e \u003cp\u003e \u003cem\u003eI like to eat salty food, but the doctor told me to have a light diet, otherwise it would only aggravate my condition.\u003c/em\u003e (Patient 7, Male, 69years)\u003c/p\u003e \u003cp\u003e \u003cem\u003eI like eating salty and tasty food in my daily life. otherwise, I feel it has no taste.\u003c/em\u003e (Patient 3, Male, 68years)\u003c/p\u003e \u003cp\u003e \u003cem\u003eI pay attention to light diet and balanced nutrition when I cook every day, but my spouse feels no taste.\u003c/em\u003e (Spouse 6, Female, 56years)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u0026rsquo; Experience of Self-Concept\u003c/h2\u003e \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e \u003ch2\u003eNegative emotions\u003c/h2\u003e \u003cp\u003eSome participants said that they felt psychological pressure after being diagnosed with pancreatic cancer, and became depressed, anxious and irritable.\u003c/p\u003e \u003cp\u003e \u003cem\u003ePancreatic cancer affects her mood and makes her feel anxious and irritable.\u003c/em\u003e (Spouse 4, Male, 69years)\u003c/p\u003e \u003cp\u003e \u003cem\u003eI constantly thought about my illness. I felt that life is meaningless because the illness could not be cured.\u003c/em\u003e (Patient 4, Female, 72years)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eDisease stigma\u003c/h2\u003e \u003cp\u003e Some participants mentioned that they would subconsciously perceive the difference between themselves and others, and even had a sense of guilt.\u003c/p\u003e \u003cp\u003e \u003cem\u003eWhen we had dinner with other relatives, several of them dared not sit next to me. I know what they thought.\u003c/em\u003e (Patient 3, Male, 68years)\u003c/p\u003e \u003cp\u003e \u003cem\u003eAfter my diagnosis, my relatives came to visit me. They had learned about my illness from my wife. Although they no longer asked me about my illness, I still felt that they were chatting with me to gossip about my strange illness, and even felt that they looked at me differently than before.\u003c/em\u003e (Patient 9, Female, 63years)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eLack of knowledge\u003c/h2\u003e \u003cp\u003eSome participants knew little about pancreatic cancer. They didn't know why they were diagnosed and how to treat pancreatic cancer.\u003c/p\u003e \u003cp\u003e \u003cem\u003eI started digging through medical journals and trying to understand more about the treatments and the side effects he might have, how to help mitigate some of those things in addition to whatever we got from the cancer center.\u003c/em\u003e (Patient 1, Male, 49years)\u003c/p\u003e \u003cp\u003e \u003cem\u003eSometimes I ask the doctor what stage my husband's disease is now and how many years are left. They don't answer directly. Now I still have no idea. This is the first illness in the family, such big illness and we were certainly scared.\u003c/em\u003e (Spouse 3, Female, 67years)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u0026rsquo; Experience of Role Function\u003c/h2\u003e \u003cdiv id=\"Sec20\" class=\"Section3\"\u003e \u003ch2\u003eUnable to fulfill social roles\u003c/h2\u003e \u003cp\u003eSome participants could not manage family affairs as before after being diagnosed.\u003c/p\u003e \u003cp\u003e \u003cem\u003eI used to be the backbone of my family, but now I suddenly fell down, and my family had no financial resources.\u003c/em\u003e (Patient 1, Male, 49years)\u003c/p\u003e \u003cp\u003e \u003cem\u003eMy wife was diagnosed suddenly, and I also had high blood pressure. At that time, I felt so tired. I used to worry very little about things at home. My meals were ready and my clothes were washed. I couldn't find anything without asking her.\u003c/em\u003e (Spouse 2, Male, 61years)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eForced to stop work\u003c/h2\u003e \u003cp\u003eSome participants had to stop working after being diagnosed with pancreatic cancer in order to avoid fatigue.\u003c/p\u003e \u003cp\u003e \u003cem\u003eI have not worked for two years since I was diagnosed with pancreatic cancer.\u003c/em\u003e (Patient 5, Male, 58years)\u003c/p\u003e \u003cp\u003e \u003cem\u003eMy main task now is to take care of him. Every time he comes to the hospital, I will accompany him. I spend every day in the hospital, and I can't do what I want to do. Moreover, because of the COVID-19 epidemic, it is not convenient for families to get in and out.\u003c/em\u003e (Spouse 5, Female, 55years)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u0026rsquo; Experience of Interdependence\u003c/h2\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eWorried about a costly medical bill\u003c/h2\u003e \u003cp\u003eSome participants mentioned that the treatment was expensive and ineffective, and families could not bear the heavy financial burden. Despite the medical insurance support, there are still serious problems such as insufficient economic capacity, delayed reimbursement and low reimbursement ratio.\u003c/p\u003e \u003cp\u003e \u003cem\u003eOur child has just bought a house and needs to pay back the loan every month. Now I spend a lot of money on hospitalization. My spouse borrows money everywhere, but she never tells me about the cost. I feel very guilty.\u003c/em\u003e (Patient 6, Male, 54years)\u003c/p\u003e \u003cp\u003e \u003cem\u003eOur family's economic condition is not good. I know that the cost of chemotherapy is very expensive. I want to ask him about the specific cost and where he borrowed the money, but he never mentioned this matter to me. I'm afraid people and money will be wasted. Alas, it's not worth it.\u003c/em\u003e (Patient 9, Female, 63years)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eConceal the fact about illness\u003c/h2\u003e \u003cp\u003eSome participants mentioned that they did not want to discuss the disease with their family and friends. They are worried that their situation will further increase the pressure and burden of their spouse, and they choose to face it alone and hide it from themselves.\u003c/p\u003e \u003cp\u003e \u003cem\u003eTo tell the truth, I'm worried every day, but I can't show it. He was already very vulnerable when he was ill. I can't give him any more pressure and let him see that I'm not strong.\u003c/em\u003e (Spouse 10, Female, 61years)\u003c/p\u003e \u003cp\u003e \u003cem\u003ePancreatic cancer is really uncomfortable, which makes me feel weak and painful, affecting my sleep. But I don't want to tell my spouse, just want to bear it silently.\u003c/em\u003e (Patient 8, Male, 75years)\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eLoss of intimacy with friends and spouse\u003c/h2\u003e \u003cp\u003eSome participants mentioned that they were alienated from their friends after being diagnosed with pancreatic cancer because they could not get together with them as before\u003c/p\u003e \u003cp\u003e \u003cem\u003eJust a few days after the diagnosis, I couldn't accept that I had cancer, so I often cried. My husband advised me that it was bad for me to cry when I was ill. I will bear not to cry, or I will appear too sentimental. I feel sad, but I have no chance to talk to him.\u003c/em\u003e (Patient 4, Female, 72years)\u003c/p\u003e \u003cp\u003e \u003cem\u003eI vomited heavily every time I received chemotherapy, and my whole body was tired. I told my spouse that I was very uncomfortable and might not persist until the chemotherapy was over. She immediately changed the topic and didn't let me continue to complain. In fact, I hoped she would cheer me up instead of avoiding me like this.\u003c/em\u003e (Patient 6, Male, 54years)\u003c/p\u003e \u003cp\u003e \u003cem\u003eI used to interrupt her when she said anything, but now I know what she did was wrong. Men and women release in different ways. In fact, I should let her say it. So now I listen carefully to what she said and constantly comfort her.\u003c/em\u003e (Spouse 2, Male, 61years)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eCoping and support strategies are key factors in improving well-being and adjustment in couples facing cancer. This qualitative study was to go beyond quantitative data from prior questionnaire studies to explored deeper insight into the specific strategies that are summarized in the theoretical categories in terms of the four modes of adaptation found in the RAM. Eleven minor themes emerged from the data, namely unbearable pain, suffer from malnutrition,unhealthy eating habits, negative emotions, disease stigma, lack of knowledge, unable to fulfill social roles, forced to stop work, worried about a costly medical bill, conceal the fact about illness, and loss of intimacy with friends and spouse. Compared to previous quantitative studies\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e, we were able to confirm the main dyadic coping categories, as well as show similarities in the distribution of coping and support proportions between patient and spouse. To our knowledge, this is the first study considering the four modes of adaptation found in the Roy adaptation model using a dyadic interview and set different coping and support strategies in pancreatic cancer patients and their spouses.\u003c/p\u003e \u003cp\u003eSome participants had adaptation difficulties regarding pain, nutrition, and eating habits. In terms of pain, participants reported severe pain that is difficult to be suppressed by drugs. The spouse can take some measures to regulate the patient's mood to reduce pain. Guide patients to carry out correct deep breathing training to achieve the purpose of relaxation and divert the patient's attention to relieve pain, such as listening to music, watching video\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. Patients with pancreatic cancer often experience malnutrition, which is related to a lack of intake or uptake of nutrients\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. Malnutrition can lead to an alteration in body composition, resulting in physical and mental deterioration. Moreover, we found that some participants got unhealthy eating habits due to they were unaware of their high sodium and greasy diet. Thus, the spouse should follow the requirements of the doctor and dietitian, understand the contents of the patient's individual diet and the relevant rehabilitation training plan, supervise the patient to complete the relevant contents step by step, and assist the patient to complete the relevant rehabilitation training content with a positive attitude. Dyadic coping is beneficial to the adaptation and recovery of patients' physiological functions.\u003c/p\u003e \u003cp\u003eSelf-concept plays an important role in mental health\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e, which involves the perceptions, values, and self-confidence that affect a person\u0026rsquo;s behavior. People with positive self-concept are better at developing and maintaining interpersonal relationships and resisting mental and physical diseases\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. On the contrary, negative or poor self-concept is a risk factor. In our study, all the participants mentioned that they became anxious, irritable, and depressed after being diagnosed, possibly due to realize that pancreatic cancer could not be cured. Therefore, most participants showed a poor self-concept. The spouses should learn more about the disease and share it with patients to reduce their anxiety. In addition, spouses should encourage patients to communicate more with fellow wards to reduce the stigma of disease.\u003c/p\u003e \u003cp\u003eRole function is manifested primarily in major areas of individual life, including interpersonal interactions and relationships in the community, society, and citizen live\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e. Due to the change of role function, spouses take on more supportive dyadic coping roles\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Companion and support of spouses during disease diagnosis and hospitalization were very essential, while patients wanted to rebuild the role function after returning home\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e. Positive reframing was also expressed through the gratitude and enjoyment for trivial matters, a lifestyle that is also important for patients with advanced cancer\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e. For couples, being around the patient helped both parties not feel lonely. In addition to supportive behavior, when the patient was unable to complete the task, the spouse would also take over the task completely. Therefore, the spouse may also worry about being considered just as a caregiver, which may cause the relationship to be out of balance. Cohesion is crucial to all couples and is expressed in various ways. In addition to common activities, it seems important for both sides to stay away from negative and stressful things. Through all these experiences, the couple had achieved common growth and became more intimate in their relationship\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eEffective communication is one of the key elements in dyadic coping with cancer, considering the individual differences in the couple, research should avoid using too abstract concepts, and turn to more concise and different descriptions. Moreover, communication within the couple can change over cancer trajectory\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e. In terms of communication strategies, patients focused on various activities to improve emotional well-being, while spouses reported more unfavorable strategies. This is consistent with previous studies showing that spouses usually ignore their need for well-being and always think with patients\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e. Effective communication about cancer-related topics will reduce anxiety, depression, and improve the quality of life of the couple\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e. A previous study developed communication skills training program for cancer patients and their spouses\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e, which could improve the avoidance of cancer-related topics and the intimate relationship with spouses. It is an effective intervention way to promote the communication and expression in the couple. Our study reported the relaxing effect of stress communication, while some spouses could not bear patients\u0026rsquo; stress communication. To improve the difference, couple-based supportive interventions should move the general communication to more individual approaches\u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e. Due to couples with good relationships may be more willing to accept interviews, there are generally fewer reports of negative dyadic response. In fact, the interview is conducted jointly by both couples, which may reduce the opportunity to observe negative dyadic response.\u003c/p\u003e \u003cp\u003eSpouses typically receive less social support from friends and families when dyadic coping with cancer patients\u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e. Spouses' distress could be indirectly alleviated by instrumental social support for patients. The support from others was necessary and helpful, apart from some suggestions that made patients feel stressed. Therefore, the social support provided was most important to meet the needs and expectations of the patients\u003csup\u003e\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e. All in all, interventions should be developed to strengthen couples\u0026rsquo; social support system.\u003c/p\u003e \u003cdiv id=\"Sec27\" class=\"Section2\"\u003e \u003ch2\u003eStudy strength and limitations\u003c/h2\u003e \u003cp\u003eThe strength of this study is the combination of deductive and inductive categorization strategies. This approach offers more flexibility. In addition, the setting of dyadic interviews has the advantage that couples are together because they also care about each other. This study also has limitations. Given that we recruited participants from only one hospital of China, there may be limitations to generalizability. Furthermore, there may be a selection bias due to both partners had to agree to participate, thus some couples with discordant relationships did not want to participate in the interviews.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003eClinical implication\u003c/h2\u003e \u003cp\u003eCouples coping with cancer is very supportive for patients. In this study, patients and spouses differ in the strategies used and the support received. First, clinicians should track the strategies used and suggest targeted improvement strategies based on actual circumstances. In addition, health care systems should provide support for couples' cancer coping, especially focusing on spouses' psychological conditions because their distress is easily overlooked. When spouses have stress and bad emotions, health care systems should actively provide suitable strategies to help relax and improve their well-being. These new insights can serve as a new direction for couples' interventions for the future. Tailored couples support based on online interventions may be an appropriate implementation to achieve this goal\u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e. Furthermore, our study indicates that areas of physiological, self-concept, role function, and interdependence should be taken into consideration when promoting dyadic coping in patients with pancreatic cancer.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eActive dyadic coping is conducive to promoting disease adaptation. This study explored the experiences of dyadic coping in patients with pancreatic cancer based on the four modes of the RAM. Both patients and spouses had different coping strategies that helped patients cope with distress during treatment and enabled them to support each other better. In addition, there were some communication difficulties between patients and spouses, but some support could help them with problems. It appears that couples coping with pancreatic cancer is crucial for disease adaptation, spouses seemed to need more psychological support to improve their own well-being particularly. Health care systems should pay attention to patients and spouses with pancreatic cancer in terms of the four areas of the RAM: physiological, self-concept, role function and interdependence. Future studies should use a combination of qualitative and quantitative methods to explain dyadic coping in greater depth.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors had a substantial contribution to the manuscript. Bo Zhang: Conceptualisation, Study design, Data collection, Data analysis, Data interpretation, Writing\u0026mdash;original draf, Review and editing, Final approval; Qigui Xiao and Jingtao Gu: Conceptualisation, Study design; Qingyong Ma: Study design, Review and editing; Liang Han: Study design, Review and editing.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLi, MY, Tang, DD, Yang, T, Qian, D and Xu, RC, (2022) Apoptosis Triggering, an Important Way for Natural Products From Herbal Medicines to Treat Pancreatic Cancers. Frontiers in pharmacology 12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSiegel, RL, Miller, KD, Fuchs, HE and Jemal, A, (2022) Cancer statistics, 2022. 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J Rheumatol 34: 1248\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan Roij, J, Raijmakers, N, Kloover, J, Kuip, E, Smilde, T and van der Velden, LA \u003cem\u003eet al.\u003c/em\u003e, (2022) Dyadic coping and its association with emotional functioning in couples confronted with advanced cancer: Results of the multicenter observational eQuiPe study. Psychooncology 31: 1545\u0026ndash;1554.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCottingham, AH, Cripe, LD, Rand, KL and Frankel, RM, (2018) \"My Future is Now\": A Qualitative Study of Persons Living With Advanced Cancer. Am J Hosp Palliat Care 35: 640\u0026ndash;646.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSiminoff, LA, Wilson-Genderson, M, Barta, S and Thomson, MD, (2020) Hematological cancer patient-caregiver dyadic communication: A longitudinal examination of cancer communication concordance. Psychooncology 29: 1571\u0026ndash;1578.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHeynsbergh, N, Botti, M, Heckel, L and Livingston, PM, (2019) Caring for the person with cancer and the role of digital technology in supporting carers. Support Care Cancer 27: 2203\u0026ndash;2209.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShin, DW, Shin, J, Kim, SY, Yang, HK, Cho, J and Youm, JH \u003cem\u003eet al.\u003c/em\u003e, (2016) Family Avoidance of Communication about Cancer: A Dyadic Examination. Cancer Res Treat 48: 384\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePorter, LS, Keefe, FJ, Baucom, DH, Hurwitz, H, Moser, B and Patterson, E \u003cem\u003eet al.\u003c/em\u003e, (2012) Partner-assisted emotional disclosure for patients with GI cancer: 8-week follow-up and processes associated with change. Support Care Cancer 20: 1755\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGremore, TM, Brockstein, B, Porter, LS, Brenner, S, Benfield, T and Baucom, DH \u003cem\u003eet al.\u003c/em\u003e, (2021) Couple-based communication intervention for head and neck cancer: a randomized pilot trial. Support Care Cancer 29: 3267\u0026ndash;3275.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBodschwinna, D, Ernst, J, Mehnert-Theuerkauf, A, Gundel, H, Weissflog, G and Honig, K, (2021) Dyadic coping and social support: Various types of support in hematooncological patients and their spouses-Associations with psychological distress. Psychooncology 30: 1041\u0026ndash;1050.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVodermaier, A and Linden, W, (2019) Social support buffers against anxiety and depressive symptoms in patients with cancer only if support is wanted: a large sample replication. Support Care Cancer 27: 2345\u0026ndash;2347.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLuo, X, Gao, L, Li, J, Lin, Y, Zhao, J and Li, Q, (2020) A critical literature review of dyadic web-based interventions to support cancer patients and their caregivers, and directions for future research. Psychooncology 29: 38\u0026ndash;48.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"pancreatic cancer, couple (spouses), dyadic interview, dyadic coping, qualitative study","lastPublishedDoi":"10.21203/rs.3.rs-3964081/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3964081/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eCancer affects the patients as well as their spouses. Couples use different strategies to cope with cancer and the associated burden. This qualitative dyadic interviews aims to gain a deeper and more differentiated understanding of the support system about couples.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eAn exploratory qualitative study set in China. The study was based on 10 pancreatic cancer couples semi-structured face-to-face interviews with patients undergoing pancreatic cancer and experiencing different symptoms. Interviews were verbatim transcribed and analysed using thematic framework analysis. This study was guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Ten pancreatic cancer couples (patients: seven men and three women) with different ages (patients: range = 49-75; spouses: range = 47-73), different stage of cancer (e.g., potentially resectable, borderline resectable, locally advanced) and cancer types (initial diagnosis or relapse) participated in the study. Eleven minor themes emerged from the data, namely unbearable pain, suffer from malnutrition,unhealthy eating habits, negative emotions, disease stigma, lack of knowledge, unable to fulfill social roles, forced to stop work, worried about a costly medical bill, conceal the fact about illness, and loss of intimacy with friends and spouse. All couples described cohesion in relationship as an essential common dyadic coping strategy. Most strategies were focused on the patient’s well-being. Furthermore, couples reported different common plans for the future: while some wanted to return to normality, others were reaching out for new goals.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eActive dyadic coping is conducive to promoting disease adaptation, spouses seemed to need more psychological support to improve their own well-being particularly. Health care systems should pay attention to patients and spouses with pancreatic cancer in terms of the four areas of the RAM: physiological, self-concept, role function and interdependence. Future studies should use a combination of qualitative and quantitative methods to explain dyadic coping in greater depth.\u003c/p\u003e","manuscriptTitle":"Dyadic Coping Experience With Pancreatic Cancer: a Qualitative Study of Dyadic Interviews","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-05 09:49:18","doi":"10.21203/rs.3.rs-3964081/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-04-26T05:16:39+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-04-24T09:56:33+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-04-22T17:54:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"e66a9dc3-eca2-40d6-baa9-30d5d92e49db","date":"2024-04-19T07:57:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"99c815ef-6918-483d-80db-3c9c5be6c832","date":"2024-04-18T12:25:23+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-04-12T14:27:57+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-04-09T10:06:07+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-03-01T18:20:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-03-01T18:14:19+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-02-17T12:30:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bf52ae07-c151-4067-9d3c-18ac455ff4fa","owner":[],"postedDate":"March 5th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":29130105,"name":"Biological sciences/Cancer"},{"id":29130106,"name":"Biological sciences/Psychology"},{"id":29130107,"name":"Health sciences/Health care"},{"id":29130108,"name":"Health sciences/Oncology"}],"tags":[],"updatedAt":"2024-08-12T16:02:17+00:00","versionOfRecord":{"articleIdentity":"rs-3964081","link":"https://doi.org/10.1038/s41598-024-69599-7","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2024-08-11 15:57:28","publishedOnDateReadable":"August 11th, 2024"},"versionCreatedAt":"2024-03-05 09:49:18","video":"","vorDoi":"10.1038/s41598-024-69599-7","vorDoiUrl":"https://doi.org/10.1038/s41598-024-69599-7","workflowStages":[]},"version":"v1","identity":"rs-3964081","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3964081","identity":"rs-3964081","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}