Analysis of the actor-partner interdependence effect of social support on benefit finding in advanced lung cancer patients and caregivers

Analysis of the actor-partner interdependence effect of social support on benefit finding in advanced lung cancer patients and caregivers | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Analysis of the actor-partner interdependence effect of social support on benefit finding in advanced lung cancer patients and caregivers Mengjiao Zhao, Na Na, Naijiao Xing, Hua Zhu, Guixia Wu, Guangyi Xu, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3620241/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Purpose: The mental health of patients with advanced lung cancer and their primary caregivers may influence each other. This study used dyadic analyses to explore the dyadic effects of social support on benefit finding and whether hope level mediates the patient-caregiver dichotomy in advanced lung cancer. Methods: 295 pairs of patients with advanced lung cancer and primary caregivers completed the Social Support Rating Scale (SSRS), the Herth Hope Index (HHI), and the Benefit Finding Scale (BFS). Dyadic analyses were conducted using structural equation modelling based on the actor-partner interdependence mediation model. Results: The results indicated that for both patients and their primary caregivers, hope level mediated the actor effect of social support on benefit finding; social support was positively associated with hope level and further enhanced benefit finding. Regarding partner effects, primary caregivers' social support had a significant indirect effect on patients' benefit finding through patients' hope level. Conclusion: There is an interaction between social support, hope level, and benefit finding in patients with advanced lung cancer and their primary caregivers. Healthcare professionals should be mindful of identifying vulnerable patients and caregivers with poorer social support and hope levels and develop effective targeted interventions to improve benefit finding for patients with advanced lung cancer and caregivers. Advanced lung cancer Caregiver Actor-partner interdependence mediation model Figures Figure 1 1. Introduction Lung cancer accounts for a major proportion of all cancer-related deaths and poses a significant threat to human health [ 1 ]. Despite some progress in the clinical management of the disease, increasing survival rates remains difficult. Nearly 72–76% of lung cancer patients diagnosed with stage III or IV have lower survival rates, with 1-year survival rates of only 48.7% and 19.3%, respectively [ 2 ]. A considerable amount of evidence found that traumatic events affect patients' stress levels, increase symptomatic burdens such as pain and fatigue, and reduce psychosocial adjustment, which in turn causes anxiety and depression but also motivates patients to experience positive cognitive changes such as more positive attitudes towards life, and more empathy towards others, and closer family relationships [ 3 ], which is known as benefit finding. Taylor defines benefit finding as a positive cognitive and behavioral adaptive process that an individual gains from an adverse event, such as trauma or illness, due to an excellent psychological stress response. The development of positive psychology has led researchers to focus more on the survival benefits of cancer patients in their disease state rather than just focusing on the stimulus caused by traumatic events to the patient's physical health [ 4 ]. Previous research has found that benefit findings can play an essential role through multifarious powerful mechanisms, such as alleviating negative feelings and facilitating creative thinking [ 5 ]. Considering the constrained expert support available in the healthcare system, primary caregivers are vital in meeting cancer patients' primary care needs and emotional and financial support [ 6 ]. Even though caregiving is crucial for cancer patients, caregivers assume the responsibility of caring for their patients unprepared, which can be burdensome. Researchers have focused on the negative emotional experiences of caregivers, failing to effectively reduce the burden on caregivers and enable caregivers to achieve physical and emotional well-being [ 7 ]. Several researchers point out that a caregiver's psychological status affects the patient's feelings of coping with the disease, which in turn affects their quality of life [ 8 ]. A recent study suggests that benefit findings for caregivers of lung cancer patients remain low compared to the general population [ 9 ]. Currently, more studies on caregiver benefit findings are needed; therefore, healthcare professionals should attach importance to caregivers' psychological well-being and follow a holistic care model of thinking while improving benefit findings in patients with advanced lung cancer and their primary caregivers. According to family systems theory, when patients face stressful events such as cancer, caregivers also need to work with patients to cope with these challenges [ 10 ]. Previous research has shown that the cancer experience and accompanying caregiving needs can cause patients and caregivers to stay at home longer while spending less time in social interactions, faltering social networks, and reduced social support [ 11 ]. Social support means the material and spiritual help from others that an individual receives during social interactions and is an external resource available to the individual. Social support can alleviate the adverse effects of stress, provide an emotional buffer, and tap the positive aspects of the disease [ 12 ]. Family caregivers' economic and social burdens, the most valuable source of support for patients, suggest that caregivers also need more social support. Concurrent attention to the social support status of patients and caregivers improves their psychosocial adaptation and promotes physical health. Relevant studies have demonstrated a positive correlation between social support and benefit findings among cancer patients [ 13 ]. Nevertheless, most prior studies have concentrated more on the patients and neglected the caregivers with the primary caregiving responsibility. Even though they come from the same family, caregivers and patients do not receive the same sources and levels of social support, and individuals have different perceptions of the disease, so there are significant differences in their perceived social support [ 14 ]. Studies have yet to adequately focus on the correlation between dyadic social support and benefit findings for patients and caregivers. According to Kelly's interdependence theory [ 15 ], there are strong interactions between dyadic individuals in an intimate relationship, and the cognition, behavior, and emotion of an individual are easily transferred between the two to influence the health outcomes of the other. The social support of patients and caregivers not only affects their benefit finding but also plays a role in the benefit finding of the other part of the dyadic relationship. Given the interdependence between the two, we will examine the correlation between patient and caregiver social support and benefit finding at the dyadic level. Herth's hope theory suggests that hope is a strong belief based on inner fulfillment, an overall perception that a goal is achievable. It can help individuals identify obstacles and find strategies to overcome them while achieving a goal [ 16 ]. According to the stress process theory proposed by Shelly, when a stressful event occurs, individuals mobilize internal and external coping resources (social support) to facilitate adaptive cognitive appraisal (hope level), which in turn buffers the detrimental impacts of the stressful event on physical and mental health [ 17 ]. Studies have been conducted to extend the stress process model to explore the dyadic level [ 10 ]. As patients and caregivers need to spend more time and energy on treatment and caregiving, family functioning is seriously threatened. In this situation, positive social support networks serve as an external protective resource for increased hope, thus enhancing the individual's health status, improving resilience and benefit finding. Benefit finding is essential for assessing patients' mental status and predicting an individual's psychosocial resilience. It can be hypothesized that hope level mediates the relationship between social support and benefit finding. To date, no studies explore the correlations between social support, hope level and benefit finding in patients and caregivers at the dyadic level. The actor-partner interdependence model (APIM) [ 18 ] is a dyadic approach to data analysis proposed by Kenny and Cook in 1999, which allows the researcher to analyze how the dependent variable of the subject of the study is affected by the predictor variables of the other party (partner effect), in addition to their predictor variables (actor effect). The actor-partner interdependence mediation model (APIMeM) [ 19 ] is a model by Ledermann based on the APIM with the inclusion of mediating variables, which allows for the estimation of the mediating effect of the hope level in the patient-caregiver dyadic relationship. In general, this study aimed to discuss the dyadic effects of social support and hope level on benefit finding in advanced lung cancer patient-caregiver dyads. Based on the literature review and theoretical support [ 13 , 17 ], we postulated that, in advanced lung cancer patient-caregiver dyads, social support and hope level were connected with benefit findings, and the association between social support and benefit finding was mediated by hope level. 2. Methods 2.1. Study design and participants This research employed a cross-sectional design. We followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline for reporting this study. We used convenience sampling to select patients and caregivers with advanced lung cancer in the respiratory medicine and oncology wards of a tertiary hospital in Qingdao, Shandong Province, China, between September 2022 and March 2023. The following were the inclusion criteria for patients: ① having stage IIIb to IV advanced lung cancer as diagnosed by histopathology; ② being 18 years of age or older; ③ being able to complete the questionnaire in writing or verbally. The inclusion criteria for caregivers were: ① patients designating them as primary caregivers; ② 18 years of age or older; ③ knowing the patient's condition and capable of normal communication; ④ offering unpaid informal care. The following were the exclusion criteria for patients and caregivers: ① combined with severe health issues including heart, liver and kidney; ② patients with mental illness and cognitive impairment. 2.2. Procedures The researcher's university's ethical committee gave its approval to all the processes of this investigation (HEC-2022207). We use G*Power 3.1.9. to calculate the minimum sample size. Based on the literature review, we set the α value of 0.05, the power (1 - β) of 0.90, and the effect size of 0.25; the final calculations showed that a minimum of 260 pairs of participants were required, with 295 valid pairs of data collected for this study. Data collectors were uniformly trained prior to data collection to ensure that participants received consistent instructions. Data collectors illustrated the research objective and significance to the participants. They instructed participants to finish the surveys in two distinct spaces and were not allowed to discuss with each other. Meanwhile, participants gave their informed consent in the interim. The data collectors were ready to assist participants with difficulty reading, writing or understanding. Questionnaires were collected by the data collectors immediately after completion to check for missing items and to eliminate invalid questionnaires. Any information used to identify participants was anonymized. 2.3. Measurements 2.3.1. Social Support Rating Scale (SSRS) The Social Support Rating Scale (SSRS) [ 20 ] was used to measure social support. Its 10-item Chinese version was grouped into the following three subscales: objective support dimension, subjective support dimension and support utilization dimension. The three-dimensional scores were summed to give a total score ranging from 12 to 66 points, with higher scores meaning greater social support. The Cronbach’s α of the SSRS scale for patients was 0.762 and for caregivers was 0.772. 2.3.2. Herth Hope Index (HHI) The Chinese 12-item Herth Hope Index (HHI) was used to measure hope level [ 21 ]. The HHI measured three subscales of hope level: temporality and future (3 items), positive readiness (3 items) and expectancy and interconnectedness (3 items). The participants' responses are recorded using a four-point Likert scale (1 = strongly disagree, 4 = strongly agree), where entries 3 and 6 are reverse scored and the rest are positive scored. The standardized total of the scale was calculated by summing the individual items and ranging from 12 to 48 points, with higher scores indicating higher hope. The Cronbach's α of the HHI for patients was 0.877 and for caregivers was 0.919. 2.3.3. Benefit Finding Scale (BFS) The Benefit Finding Scale (BFS), which has 22 items in Chinese [ 22 ], was used to measure benefit finding. Its six subscales are as follows: acceptance (3 items), family relationships (2 items), worldview (4 items), personal growth (7 items), social relationships (3 items) and health behaviors (3 items). The BFS rated each item on a five-point Likert scale (1 = not at all, 4 = very much). Total scores ranged from 22 to 110, with higher scores meaning more benefit to patients and caregivers. The Cronbach's α of the BFS for patients was 0.944 and for caregivers was 0.959, with patients' Cronbach's α for the six subscales ranging from 0.782 to 0.929 and caregivers' Cronbach's α for the six subscales ranging from 0.781 to 0.934. 2.3.4. Socio-demographic and clinical characteristics Patients and primary caregivers' demographic information was gathered using a self-completed questionnaire. The medical chart review provided information about the patient's clinical characteristics. 2.4. Statistical analysis Descriptive statistics (means, standard deviations, frequencies, and percentages) were used to describe the sociodemographic characteristics, disease-related characteristics, social support, hope level, and benefit finding of patients and primary caregivers. Considering that the missing data rate for each scale was less than 20%, we used mean imputation to deal with missing values for the main variables. We used paired-sample t-tests to describe differences between patients and caregivers on the main study variables. Pearson correlation analyses described correlations between patient-caregiver dyads on crucial variables. The patient-caregiver dyads in this study were identified as distinguishable data. The APIMeM was used to examine the impact of social support on patient-caregiver benefit finding, mediated by hope level. Indirect effects were performed using bias-corrected bootstrapping 95% confidence intervals with 5000 samples. The chi-squared/degrees of freedom ratios (χ 2 /df), root mean square error of approximation (RMSEA), comparative fit index (CFI), Tucker–Lewis index (TLI), Normed Fit Index (NFI) to evaluate the goodness of fit of the model. χ2/df < 3, RMSEA ≤ 0.08, CFI ≥ 0.90, TLI ≥ 0.90 and NFI ≥ 0.90 indicated a good model fit. After utilizing SPSS 23.0 and AMOS 24.0 for data analysis, a difference of p ≤ 0.05 was deemed statistically significant. 3. Results 3.1. Sociodemographic and clinical characteristics A total of 295 pairs of patients and caregivers were included in this study. The mean ages of patients and caregivers were 61.9 (SD = 9.21) and 44.98 (SD = 11.66) years, respectively. Patients were predominantly male (70.5%), more than half of the caregivers were female (62.0%), and the majority of patients and caregivers were married (95.6% of patients and 94.9% of caregivers). 61% of the patients were diagnosed as stage IV, with adenocarcinoma as the predominant pathologic type, and most patients could care for themselves completely. Among caregivers, 54.6% were the patients' spouses, and 41.0% were children. Table 1 displays the patients' and caregivers' sociodemographic characteristics and disease-related data. Table 1 Sociodemographic and Clinical Characteristics of Participants(N = 295 dyads) Variables Patients Caregivers Age 18–44 10(3.4) 101(34.2) 45–60 119(40.3) 135(45.8) >60 166(56.3) 59(20.0) Gender Male 208(70.5) 112(38.0) Female 87(29.5) 183(62.0) Educational level Primary school and below 56(19.0) 29(9.8) Junior high school 124(42.0) 92(31.2) High school/vocational high school 74(25.1) 75(25.4) College degree or above 41(13.9) 99(33.6) Marital Status Single/divorced/widowed 13(4.4) 15(5.1) Married 282(95.6) 280(94.9) Employment status Employed 78(26.4) 176(59.7) Unemployed 61(20.7) 45(15.3) Retired 156(52.9) 74(25.1) Per capita monthly household income (US dollars) Below 420 108(36.6) 420–840 119(40.3) Above 840 68(23.1) Medical insurance type Employee medical insurance 125(42.4) Resident medical insurance 138(46.8) Remote medical insurance 32(10.8) Residence City 102(34.6) Suburban 59(20.0) Countryside 134(45.4) Patient self-care level Fully self-care 194(65.8) Basic self-care 74(25.1) Partial self-care 18(6.1) Unable to take care of oneself 9(3.1) Clinical Tumour-Node-Metastasis stage III 115(39.0) IV 180(61.0) Lung cancer type Squamous cell carcinoma 71(24.1) Adenocarcinoma 184(62.4) Small cell carcinoma 38(12.9) Large cell carcinoma 2(0.7) Time since diagnosis <6 month 165(55.9) 6–12 month 50(16.9) ≥1 year 80(27.1) Relationship to patient Spouse 161(54.6) Child 121(41.0) Sibling 3(1.0) Friends 2(0.7) Others 8(2.8) Caregiving hours per day ≤ 8h 138(46.8) 9-16h 58(19.7) 17-24h 99(33.6) Accumulated care time <6 month 149(50.5) 6–12 month 52(17.6) ≥1 year 94(31.9) Living with patients Yes 225(76.3) No 70(23.7) 3.2. Correlation of social support, hope level, and benefit finding Table 2 illustrates the study variables' means, standard deviations, correlations, and whether each variable differed in the patient-caregiver dyads. Correlation analyses found significant correlations between patient and caregiver social support ( r = 0.60, p < 0.001), hope level ( r = 0.71, p < 0.001), and benefit finding ( r = 0.76, p < 0.001), suggesting that there was a nonindependence of the patient-caregiver dyads. Paired-sample t-tests indicated significant differences between patient and caregiver social support, hope level, and benefit finding. Patients' social support (46.38 ± 6.23), hope level (41.03 ± 4.80), and benefit finding (80.89 ± 14.32) were significantly lower than caregivers' social support (48.76 ± 6.52), hope level (41.93 ± 5.16), and benefit finding (84.68 ± 16.23). Table 2 Inter-correlations, Means, and SDs of the Study Variables for patient-caregiver dyads(N = 295 dyads). Social Support Hope Level Benefit Finding PT CG PT CG PT CG PT Social Support 1 CG Social Support 0.60 ** 1 PT Hope Level 0.41 ** 0.41 ** 1 CG Hope Level 0.34 ** 0.51 ** 0.71 ** 1 PT Benefit Finding 0.46 ** 0.45 ** 0.65 ** 0.56 ** 1 CG Benefit Finding 0.35 ** 0.54 ** 0.54 ** 0.69 ** 0.76 ** 1 Mean 46.38 48.76 41.03 41.93 80.89 84.68 SD 6.23 6.52 4.80 5.16 14.32 16.23 P a <0.001 <0.001 <0.001 Note. PT: patient; CG: caregiver; a paired-sample t-test. ** P < 0.01. 3.3. Analysis of the APIMeM With an appropriate model-data fit (χ2/df = 1.583, RMSEA = 0.045, CFI = 0.996, TLI = 0.991, NFI = 0.996), the APIMeM results of social support, hope level, and benefit finding in patients and caregivers are presented in Table 3 . The results of the analysis of social support on benefit finding pathways are shown in Table 3 and Fig. 1 . Table 3 Unstandardized total effects, indirect effects, and direct effects of patients’ and caregivers’ social support on benefit finding via hope level in the APIMeM. Effect B 95%CI P Actor effect(Individual’s social support→Individual’s benefit finding) Patient Total effect 0.687 (0.455, 0.919) 0.000 Total IE 0.276 (0.126, 0.447) 0.001 Actor-actor simple IE Patient social support→patient hope level→patient benefit finding 0.259 (0.135, 0.423) 0.000 Partner-partner simple IE Patient social support→caregiver hope level→patient benefit finding 0.017 (-0.012, 0.091) 0.240 Direct effect Patient social support→patient benefit finding 0.411 (0.188, 0.626) 0.000 Caregiver Total effect 1.287 (0.980, 1.589) 0.000 Total IE 0.650 (0.457, 0.887) 0.000 Actor-actor simple IE Caregiver social support→caregiver hope level→caregiver benefit finding 0.596 (0.403, 0.838) 0.000 Partner-partner simple IE Caregiver social support→patient hope level→caregiver benefit finding 0.054 (-0,010, 0.161) 0.092 Direct effect Caregiver social support→caregiver benefit finding 0.637 (0.349, 0.924) 0.000 Partner effect (Individual’s social support →Partner’s benefit finding) Patient Total effect 0.606 (0.329, 0.869) 0.001 Total IE 0.383 (0.209, 0.583) 0.000 Actor-partner simple IE Caregiver social support→caregiver hope level→patient benefit finding 0.141 (0.006, 0.298) 0.040 Partner-actor simple IE Caregiver social support→patient hope level→patient benefit finding 0.242 (0.119, 0.404) 0.000 Direct effect Caregiver social support→patient benefit finding 0.221 (-0.036, 0.483) 0.093 Caregiver Total effect 0.096 (-0.228, 0.413) 0.553 Total IE 0.129 (-0.049, 0.314) 0.164 Actor-partner simple IE Patient social support→patient hope level→caregiver benefit finding 0.058 (-0.010, 0.156) 0.086 Partner-actor simple IE Patient social support→caregiver hope level→caregiver benefit finding 0.071 (-0.076, 0.250) 0.353 Direct effect Patient social support→caregiver benefit finding -0.033 (-0.319, 0.242) 0.821 Note. APIMeM: Actor Partner Interdependence Mediation model; IE: indirect effect; B = unstandardized estimate; CI: confidence interval. P < 0.001. The significant actor effect of social support on benefit findings indicated that social support positively predicted benefit findings for patients and caregivers. However, the partner effect was not significant for both patients and caregivers. The results are shown in Table 3 . The actor effects of both patient and caregiver social support on hope level were significantly positive, indicating that social support positively predicted hope level. A significant partner effect was observed among patients; the more social support received by the caregivers, the higher the patient's hope level. However, the partner effect of patients' social support on caregivers' hope levels was insignificant. In addition, patients' and caregivers' hope levels directly and positively predicted their benefit findings. The partner effects of hope levels on benefit findings were insignificant in patients or caregivers. The mediation analyses found significant actor-actor effects for both patients and caregivers, suggesting that high levels of social support can enhance one's level of hope, which improves benefit finding for both patients and caregivers. Furthermore, a significant partner-actor effect was validated in patients, suggesting that caregiver social support positively impacts patients' benefit finding, which is mediated by patients' hope level. 4. Discussion The researchers examined the actor effect between social support and benefit findings in past studies [ 23 ]. The present study explored the actor-partner effect of social support on benefit finding in a dyadic perspective and examined whether hope level mediated the effect. As far as we know, it is the first dyadic study to examine how social support and hope level affect benefit finding. Consistent with Qiuping Li and others [ 24 ], the study found that caregivers had substantially higher benefit findings than patients. Benefit finding was positively and directly correlated with the social support of patients and caregivers. The buffering effect model suggests that supportive social support can mitigate the detrimental effects of financial or emotional stress on mental health [ 25 ]. Social support can encourage individuals to handle stressful events positively by guiding them to understand events from a favorable perspective and motivating positive coping strategies [ 26 ]. For patients, financial, emotional, and informational support from others can alleviate adverse disease evaluations. It can enable patients to feel cared for and valued, change negative perceptions, and tap into the positive aspects of the illness [ 27 ]. As for caregivers, social support is considered to be an external resource available to caregivers and an essential factor in reducing caregivers' stress, buffering the negative impact of the caregiving burden on caregivers, enabling them to feel help from the outside, to realize the benefits of interpersonal relationships, to overcome the adversity of the disease, and to experience more positive feelings [ 28 , 29 ]. Individuals with more social support are more likely to find benefits from stressful events. Consistent with prior studies, the latest research discovered that social support affirmatively affected patients' and caregivers' hope levels [ 30 , 31 ]. Symbolic interactionist theory [ 32 ] states that individuals use social support as a coping mechanism to help one another out when they encounter problems; they believe that they will be helped when they encounter difficulties, generating positive self-feedback and that this support creates motivation to overcome obstacles and achieve desired goals, in other words, social support enhances their hope [ 33 ]. In addition, caregiver social support positively predicts patients' hope levels. One possible explanation is that caregivers' perceived level of social support, as an essential support resource for patients, is highly correlated with the level of support perceived by patients. Second, enhanced hope in patients results from the interaction between their internal resources and external environmental factors. The caregiver's perceived increased social support during caregiving also puts the patient in a supportive environment, which reduces the negative stimuli associated with the illness, generates positive cognitive appraisals, and contributes to the patient's increased hope. This result suggests that interventions targeting patient and caregiver social support effectively produce a positive psychological experience for the patient and that caregiver psychological health is a prerequisite for patients to receive comfortable care. Our findings suggest that patients' and caregivers' hope levels positively predict their benefit findings. Previous studies have demonstrated that people with high levels of hope exhibit positive attitudes, positive actions, and close relationships. Hope also motivates individuals to restore cognitive homeostasis, which enhances their capacity to deal with traumatic events and increases the degree of benefit finding [ 34 ]. It was found that a positive hope level could only enhance their benefit finding, while the effect of patient or caregiver perceived hope on the partner's benefit findings was weak. Since caregiver-patient hope levels were highly correlated, positive hope levels were still beneficial in increasing benefit findings for both patients and caregivers. The mediation analysis results indicated that social support of patients and caregivers indirectly influenced benefit findings through hope levels, which is consistent with previous findings [ 35 ]. As patients need to devote more time and energy to receiving treatment and interact with others less, a social support network with protective functions can contribute to coping with challenges from the environment and serve as an external resource to increase hope levels [ 36 ], thus improving the health status of the individual and enhancing benefit finding. Of interest, caregivers' social support was positively associated with patients' level of hope, improving patients' benefit findings. This indicates that we should conduct further investigations and implement intervention experiments to identify caregivers with poor social support and provide them with psychological health education to avoid poor emotional experiences for patients due to vulnerable caregivers, which in turn helps patients find meaning in their lives. It is essential to recognize the limitations of this study. First, as a cross-sectional study, it could not take long-term trends in social support, hope level, and benefit finding for patients and primary caregivers. Therefore, no causal relationship could be drawn. Second, the data were self-reporting, which is highly subjective and may be biased. We could use more objective outcome indicators to minimize bias in the future. Third, the researcher collected data from only one hospital, limiting the study's generalizability. In future studies, we should use large-scale, multicenter studies to prove the scientific validity of the study. 5. Conclusion Healthcare practitioners can enhance patient-caregiver benefit findings at the dyadic level by developing a theoretical foundation through a deeper comprehension of the impacts of social support and hope level on patients' benefit findings. This study found an interdependent relationship between patients with advanced lung cancer and their primary caregivers (dyadic effect), in which more social support from the primary caregiver was associated with better levels of hope for the patient and further influenced patient benefit finding. This assessment can help us identify which patients and caregivers would benefit most from psychological therapies to assist both in working together to overcome cancer-related difficulties and challenges. Healthcare professionals should be aware of the current status of social support for patients and caregivers, encourage caregivers to participate in the patient's cancer treatment process actively, rationalize the use of resources for active coping, develop dyadic-based interventions that consider the patient-caregiver as a whole, and maintain an equal level of caregiver attention to maximize benefit finding for both patients and the caregivers. Declarations Competing interests: The authors have no relevant financial or non-financial interests to disclose. Authorship statement All authors contributed to the study conception and design. Data collection and resources were performed by Mengjiao Zhao, Na Na, Naijiao Xing, Hua Zhu, Guixia Wu and Guangyi Xu. Methodology and formal analysis were performed by Mengjiao Zhao. Writing - Review & Editing and supervision were performed by Yunxia Jiang. The first draft of the manuscript was written by Mengjiao Zhao and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Ethics approval: This study was performed in line with the principles of the Declaration of Helsinki. The questionnaire and methodology for this study was approved by the Human Research Ethics committee of the Qingdao University (Ethics approval number: QDU-HEC-2022207). Consent to participate: Informed consent was obtained from all individual participants included in the study. Acknowledgments Thank you to the healthcare providers and care managers who helped with this study and many thanks to the patients who gave their time to this study. Funding: The authors did not receive support from any organization for the submitted work. Author Contribution All authors contributed to the study conception and design. Data collection and resources were performed by M.Z., N.N., N.X., H.Z., G.W. and G.X.. Methodology and formal analysis were performed by M.Z.. Writing - Review & Editing and supervision were performed by Y.J.. The first draft of the manuscript was written by M.Z. and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Data availability: All data, models, and code generated or used during the study appear in the submitted article. References Marasović Šušnjara I (2020) Lung cancer incidence and mortality in Split-Dalmatia County, 2003–2012. Central European journal of public health 28:59–64 https://doi.org/10.21101/cejph.a4993 Cancer Research UK. Survival. 2020. Accessed January 4, 2021. https://www.cancerresearchuk.org/about-cancer/lung-cancer/survival Mosher CE, Adams RN, Helft PR, O'Neil BH, Shahda S, Rattray NA, Champion VL (2017) Positive changes among patients with advanced colorectal cancer and their family caregivers: a qualitative analysis. 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Medicine and Society 35:101–105 https://doi.org/10.13723/j.yxysh.2022.11.019 Rong H, Yin M, Ren P, Li Y, Qu H, Chen X (2023) Spirituality as a Mediator Between Social Support and Benefit Finding Among Advanced Cancer Patients. Cancer nursing 46:E230-e237 https://doi.org/10.1097/ncc.0000000000001134 Chen JJ, Wang QL, Li HP, Zhang T, Zhang SS, Zhou MK (2021) Family resilience, perceived social support, and individual resilience in cancer couples: Analysis using the actor-partner interdependence mediation model. European journal of oncology nursing: the official journal of European Oncology Nursing Society 52:101932 https://doi.org/10.1016/j.ejon.2021.101932 Kelley HH, Thibaut JW (1978) Interpersonal Relations: A Theory of Interdependence. Wiley, New York. Herth K (1990) Fostering hope in terminally-ill people. Journal of advanced nursing 15:1250–1259 https://doi.org/10.1111/j.1365-2648.1990.tb01740.x Taylor SE, Stanton AL (2007) Coping resources, coping processes, and mental health. Annual review of clinical psychology 3:377–401 https://doi.org/10.1146/annurev.clinpsy.3.022806.091520 Kenny DA, Cook W (1999) Partner effects in relationship research: Conceptual issues, analytic difficulties and illustrations. Personal Relat 6:433–448. Kenny DA, Ledermann T (2010) Detecting, measuring, and testing dyadic patterns in the actor-partner interdependence model. Journal of family psychology: JFP : journal of the Division of Family Psychology of the American Psychological Association (Division 43) 24:359–366 https://doi.org/10.1037/a0019651 Xiao S (1994) The Theoretical Basis and Research Application of the 《Social Support Rating Scale》. Journal of Clinical Psychiatry 98–100 Zhao H, Wang J (2000) Social support and Hope of Patients with Hemodialysis. Chinese Journal of Nursing 49–51 Liu Z, Zhang L, Gudenkauf L (2015) Cross-cultural adaptation of the Benefit Finding Scale (BFS) in Chinese Cancer Patients. Chinese Journal of Nursing 50:561–566 https://doi.org/10.3761/j.issn.0254-1769.2015.05.010 Zhao M, Jiang Y, Xu G, Lin X (2023) The Mediating Effect of Hope Level Between Social Support and Benefit Finding in Patients With Advanced Lung Cancer. Cancer nursing https://doi.org/10.1097/NCC.0000000000001295 Li Q, Lin Y, Zhou H, Xu Y, Yang L, Xu Y (2018) Factors moderating the mutual impact of benefit finding between Chinese patients with cancer and their family caregivers: A cross-sectional study. Psycho-oncology 27:2363–2373 https://doi.org/10.1002/pon.4833 Aneshensel CS, Stone JD (1982) Stress and depression: a test of the buffering model of social support. Archives of general psychiatry 39:1392–1396 https://doi.org/10.1001/archpsyc.1982.04290120028005 Pascoe L, Edvardsson D (2013) Benefit finding in cancer: a review of influencing factors and health outcomes. European journal of oncology nursing: the official journal of European Oncology Nursing Society 17:760–766 https://doi.org/10.1016/j.ejon.2013.03.005 Chen C, Chen Y, Liu X, Gu W, Fan G, Zhu P (2022) Construction of Structural Equation Modelf or Influencing Factors of Benefit Finding in Patients with Lung Cancer. Military Nursing 39:39–43 https://doi.org/10.3969/j.issn.1008-9993.2022.06.010 Ding X, Ding Y, Xu Q, Li H (2019) Relation among positive feelings, adult attachment, social support of the primary caregivers of cancer patients. Chinese Journal of General Practice 17:2111–2114 https://doi.org/10.16766/j.cnki.issn.1674-4152.001140 Gardner MH, Mrug S, Schwebel DC, Phipps S, Whelan K, Madan-Swain A (2017) Demographic, medical, and psychosocial predictors of benefit finding among caregivers of childhood cancer survivors. Psycho-oncology 26:125–132 https://doi.org/10.1002/pon.4014 Liu M, Liu L, Zhang S, Li T, Ma F, Liu Y (2022) Fear of cancer recurrence and hope level in patients receiving surgery for non-small cell lung cancer: a study on the mediating role of social support. Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer 30:9453–9460 https://doi.org/10.1007/s00520-022-07318-6 Nouzari R, Najafi SS, Momennasab M (2019) Post-Traumatic Growth among Family Caregivers of Cancer Patients and Its Association with Social Support and Hope. International journal of community based nursing and midwifery 7:319–328 https://doi.org/10.30476/ijcbnm.2019.73959.0 Thoits PA (1982) Conceptual, methodological, and theoretical problems in studying social support as a buffer against life stress. Journal of health and social behavior 23:145–159 https://doi.org/10.2307/2136511 Pasyar N, Rambod M, Behrouzi Z (2020) The Predictor Role of Perceived Social Support and Spiritual Intelligence in Hope Among Thalassemia Patients. The Malaysian journal of medical sciences: MJMS 27:75–83 https://doi.org/10.21315/mjms2020.27.3.8 Zhou X, Wu X, Wang W, Tian Y, Zeng M (2017) The Relationship Between Rumination and Posttraumatic Growth Among Adolescents Following Ya'an Earthquake: The Mediated Role of Deliberated Rumination and Moderated Role of Hope. Studies of Psychology and Behavior 15:544–550 + 561 https://doi.org/10.3969/j.issn.1672-0628.2017.04.016 Li H (2022) Multifactorial analysis of posttraumatic growth levels after emergency thrombolysis in patients with acute cerebral infarction. Journal of Aerospace Medicine 33:1019–1021 https://doi.org/10.3969/j.issn.2095-1434.2022.08.043 Zhang D, Zhang N, Chang H, Shi Y, Tao Z, Zhang X, Miao Q, Li X (2023) Mediating Role of Hope Between Social Support and Self-Management Among Chinese Liver Transplant Recipients: A Multi-Center Cross-Sectional Study. Clinical nursing research 32:776–784 https://doi.org/10.1177/10547738221078897 Additional Declarations No competing interests reported. Supplementary Files Checklist.docx SupplementaryMaterial1.doc Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 07 Feb, 2024 Reviews received at journal 28 Dec, 2023 Reviewers agreed at journal 28 Dec, 2023 Reviewers invited by journal 28 Dec, 2023 Editor assigned by journal 28 Dec, 2023 Submission checks completed at journal 19 Nov, 2023 First submitted to journal 16 Nov, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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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-3620241","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":251146612,"identity":"17ff4d1f-c62d-4f09-9316-6432e7224923","order_by":0,"name":"Mengjiao Zhao","email":"","orcid":"","institution":"Qingdao University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Mengjiao","middleName":"","lastName":"Zhao","suffix":""},{"id":251146613,"identity":"d218137a-1280-458e-874f-31359551d6a6","order_by":1,"name":"Na Na","email":"","orcid":"","institution":"Affiliated Hospital of Qingdao University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Na","middleName":"","lastName":"Na","suffix":""},{"id":251146614,"identity":"3d5b7f75-6a96-4af4-9490-e96fbe90139a","order_by":2,"name":"Naijiao Xing","email":"","orcid":"","institution":"Qingdao shi zhongxin yiyuan","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Naijiao","middleName":"","lastName":"Xing","suffix":""},{"id":251146615,"identity":"3d5ae5d9-8a2c-4089-9ff2-6fe0f228ba40","order_by":3,"name":"Hua Zhu","email":"","orcid":"","institution":"Affiliated Hospital of Qingdao University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Hua","middleName":"","lastName":"Zhu","suffix":""},{"id":251146616,"identity":"358b286d-687a-40de-a78e-7e18ac0ebdd7","order_by":4,"name":"Guixia Wu","email":"","orcid":"","institution":"Affiliated Hospital of Qingdao University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Guixia","middleName":"","lastName":"Wu","suffix":""},{"id":251146617,"identity":"8a5f01ae-a9fa-4c90-9098-4c80a109398c","order_by":5,"name":"Guangyi Xu","email":"","orcid":"","institution":"Qingdao University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Guangyi","middleName":"","lastName":"Xu","suffix":""},{"id":251146618,"identity":"df88ced1-45a8-4703-98c6-6e16100426f6","order_by":6,"name":"Yunxia Jiang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAuklEQVRIiWNgGAWjYLCCBAYGZn5m5sMPSNMi2c6WZkCaTQbneRQkiFN5I/eYxIMaBnbjwzwMBgw1NtFEaMlLNkg4xsBsdpj3wAOGY2m5DYS15Bg+SGADaeFLMGBsOEyUFoMDCf8YmI2beQwkiNVi+CCxjYHZgJlYLZJn3hgbJPZJMEscBgZyAjF+4TueYyb545tNMn//4cMPPtTYENaicABMSSSDqQRCykFAHmqoHTGKR8EoGAWjYIQCAIi8OkN+oyCTAAAAAElFTkSuQmCC","orcid":"","institution":"Qingdao University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Yunxia","middleName":"","lastName":"Jiang","suffix":""}],"badges":[],"createdAt":"2023-11-16 12:14:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3620241/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3620241/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":46882215,"identity":"8835530e-9888-4f48-8db8-61c5b8a2fba4","added_by":"auto","created_at":"2023-11-21 21:41:58","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":90442,"visible":true,"origin":"","legend":"\u003cp\u003eAPIMeM results of social support, hope level on benefit finding.\u003c/p\u003e\n\u003cp\u003eNote. APIMeM: Actor Partner Interdependence Mediation model.\u003c/p\u003e\n\u003cp\u003eValues are unstandardized coefficients.\u003c/p\u003e\n\u003cp\u003eSolid lines represent significant paths, and dotted lines represent nonsignificant paths.\u003c/p\u003e\n\u003cp\u003e**\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.01.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-3620241/v1/78eb18663b4f1420ed78e000.png"},{"id":46882634,"identity":"e1c9ef47-6829-4645-b45f-b688e5adffd0","added_by":"auto","created_at":"2023-11-21 21:49:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":623951,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3620241/v1/742dd574-28f5-4ec4-ad3e-17557a67735e.pdf"},{"id":46882214,"identity":"23dda627-d657-4e62-b8a6-32b5c9322fa4","added_by":"auto","created_at":"2023-11-21 21:41:58","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":31082,"visible":true,"origin":"","legend":"","description":"","filename":"Checklist.docx","url":"https://assets-eu.researchsquare.com/files/rs-3620241/v1/27d451a106ca0c34566cd741.docx"},{"id":46882213,"identity":"e527be81-687d-4ea0-a18b-b8cd2e8e687d","added_by":"auto","created_at":"2023-11-21 21:41:58","extension":"doc","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":31578,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterial1.doc","url":"https://assets-eu.researchsquare.com/files/rs-3620241/v1/9ccb20c09cfed9191305ca26.doc"}],"financialInterests":"No competing interests reported.","formattedTitle":"Analysis of the actor-partner interdependence effect of social support on benefit finding in advanced lung cancer patients and caregivers","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eLung cancer accounts for a major proportion of all cancer-related deaths and poses a significant threat to human health [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Despite some progress in the clinical management of the disease, increasing survival rates remains difficult. Nearly 72\u0026ndash;76% of lung cancer patients diagnosed with stage III or IV have lower survival rates, with 1-year survival rates of only 48.7% and 19.3%, respectively [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. A considerable amount of evidence found that traumatic events affect patients' stress levels, increase symptomatic burdens such as pain and fatigue, and reduce psychosocial adjustment, which in turn causes anxiety and depression but also motivates patients to experience positive cognitive changes such as more positive attitudes towards life, and more empathy towards others, and closer family relationships [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], which is known as benefit finding. Taylor defines benefit finding as a positive cognitive and behavioral adaptive process that an individual gains from an adverse event, such as trauma or illness, due to an excellent psychological stress response. The development of positive psychology has led researchers to focus more on the survival benefits of cancer patients in their disease state rather than just focusing on the stimulus caused by traumatic events to the patient's physical health [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Previous research has found that benefit findings can play an essential role through multifarious powerful mechanisms, such as alleviating negative feelings and facilitating creative thinking [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eConsidering the constrained expert support available in the healthcare system, primary caregivers are vital in meeting cancer patients' primary care needs and emotional and financial support [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Even though caregiving is crucial for cancer patients, caregivers assume the responsibility of caring for their patients unprepared, which can be burdensome. Researchers have focused on the negative emotional experiences of caregivers, failing to effectively reduce the burden on caregivers and enable caregivers to achieve physical and emotional well-being [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Several researchers point out that a caregiver's psychological status affects the patient's feelings of coping with the disease, which in turn affects their quality of life [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. A recent study suggests that benefit findings for caregivers of lung cancer patients remain low compared to the general population [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Currently, more studies on caregiver benefit findings are needed; therefore, healthcare professionals should attach importance to caregivers' psychological well-being and follow a holistic care model of thinking while improving benefit findings in patients with advanced lung cancer and their primary caregivers.\u003c/p\u003e \u003cp\u003eAccording to family systems theory, when patients face stressful events such as cancer, caregivers also need to work with patients to cope with these challenges [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Previous research has shown that the cancer experience and accompanying caregiving needs can cause patients and caregivers to stay at home longer while spending less time in social interactions, faltering social networks, and reduced social support [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Social support means the material and spiritual help from others that an individual receives during social interactions and is an external resource available to the individual. Social support can alleviate the adverse effects of stress, provide an emotional buffer, and tap the positive aspects of the disease [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Family caregivers' economic and social burdens, the most valuable source of support for patients, suggest that caregivers also need more social support. Concurrent attention to the social support status of patients and caregivers improves their psychosocial adaptation and promotes physical health.\u003c/p\u003e \u003cp\u003eRelevant studies have demonstrated a positive correlation between social support and benefit findings among cancer patients [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Nevertheless, most prior studies have concentrated more on the patients and neglected the caregivers with the primary caregiving responsibility. Even though they come from the same family, caregivers and patients do not receive the same sources and levels of social support, and individuals have different perceptions of the disease, so there are significant differences in their perceived social support [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Studies have yet to adequately focus on the correlation between dyadic social support and benefit findings for patients and caregivers. According to Kelly's interdependence theory [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], there are strong interactions between dyadic individuals in an intimate relationship, and the cognition, behavior, and emotion of an individual are easily transferred between the two to influence the health outcomes of the other. The social support of patients and caregivers not only affects their benefit finding but also plays a role in the benefit finding of the other part of the dyadic relationship. Given the interdependence between the two, we will examine the correlation between patient and caregiver social support and benefit finding at the dyadic level.\u003c/p\u003e \u003cp\u003eHerth's hope theory suggests that hope is a strong belief based on inner fulfillment, an overall perception that a goal is achievable. It can help individuals identify obstacles and find strategies to overcome them while achieving a goal [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. According to the stress process theory proposed by Shelly, when a stressful event occurs, individuals mobilize internal and external coping resources (social support) to facilitate adaptive cognitive appraisal (hope level), which in turn buffers the detrimental impacts of the stressful event on physical and mental health [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Studies have been conducted to extend the stress process model to explore the dyadic level [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. As patients and caregivers need to spend more time and energy on treatment and caregiving, family functioning is seriously threatened. In this situation, positive social support networks serve as an external protective resource for increased hope, thus enhancing the individual's health status, improving resilience and benefit finding. Benefit finding is essential for assessing patients' mental status and predicting an individual's psychosocial resilience. It can be hypothesized that hope level mediates the relationship between social support and benefit finding. To date, no studies explore the correlations between social support, hope level and benefit finding in patients and caregivers at the dyadic level.\u003c/p\u003e \u003cp\u003eThe actor-partner interdependence model (APIM) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] is a dyadic approach to data analysis proposed by Kenny and Cook in 1999, which allows the researcher to analyze how the dependent variable of the subject of the study is affected by the predictor variables of the other party (partner effect), in addition to their predictor variables (actor effect). The actor-partner interdependence mediation model (APIMeM) [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] is a model by Ledermann based on the APIM with the inclusion of mediating variables, which allows for the estimation of the mediating effect of the hope level in the patient-caregiver dyadic relationship.\u003c/p\u003e \u003cp\u003eIn general, this study aimed to discuss the dyadic effects of social support and hope level on benefit finding in advanced lung cancer patient-caregiver dyads. Based on the literature review and theoretical support [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], we postulated that, in advanced lung cancer patient-caregiver dyads, social support and hope level were connected with benefit findings, and the association between social support and benefit finding was mediated by hope level.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Study design and participants\u003c/h2\u003e \u003cp\u003eThis research employed a cross-sectional design. We followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline for reporting this study. We used convenience sampling to select patients and caregivers with advanced lung cancer in the respiratory medicine and oncology wards of a tertiary hospital in Qingdao, Shandong Province, China, between September 2022 and March 2023.\u003c/p\u003e \u003cp\u003eThe following were the inclusion criteria for patients: ① having stage IIIb to IV advanced lung cancer as diagnosed by histopathology; ② being 18 years of age or older; ③ being able to complete the questionnaire in writing or verbally. The inclusion criteria for caregivers were: ① patients designating them as primary caregivers; ② 18 years of age or older; ③ knowing the patient's condition and capable of normal communication; ④ offering unpaid informal care. The following were the exclusion criteria for patients and caregivers: ① combined with severe health issues including heart, liver and kidney; ② patients with mental illness and cognitive impairment.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Procedures\u003c/h2\u003e \u003cp\u003eThe researcher's university's ethical committee gave its approval to all the processes of this investigation (HEC-2022207). We use G*Power 3.1.9. to calculate the minimum sample size. Based on the literature review, we set the α value of 0.05, the power (1 - β) of 0.90, and the effect size of 0.25; the final calculations showed that a minimum of 260 pairs of participants were required, with 295 valid pairs of data collected for this study. Data collectors were uniformly trained prior to data collection to ensure that participants received consistent instructions. Data collectors illustrated the research objective and significance to the participants. They instructed participants to finish the surveys in two distinct spaces and were not allowed to discuss with each other. Meanwhile, participants gave their informed consent in the interim. The data collectors were ready to assist participants with difficulty reading, writing or understanding. Questionnaires were collected by the data collectors immediately after completion to check for missing items and to eliminate invalid questionnaires. Any information used to identify participants was anonymized.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Measurements\u003c/h2\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.3.1. Social Support Rating Scale (SSRS)\u003c/h2\u003e \u003cp\u003eThe Social Support Rating Scale (SSRS) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] was used to measure social support. Its 10-item Chinese version was grouped into the following three subscales: objective support dimension, subjective support dimension and support utilization dimension. The three-dimensional scores were summed to give a total score ranging from 12 to 66 points, with higher scores meaning greater social support. The Cronbach\u0026rsquo;s α of the SSRS scale for patients was 0.762 and for caregivers was 0.772.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.3.2. Herth Hope Index (HHI)\u003c/h2\u003e \u003cp\u003eThe Chinese 12-item Herth Hope Index (HHI) was used to measure hope level [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The HHI measured three subscales of hope level: temporality and future (3 items), positive readiness (3 items) and expectancy and interconnectedness (3 items). The participants' responses are recorded using a four-point Likert scale (1\u0026thinsp;=\u0026thinsp;strongly disagree, 4\u0026thinsp;=\u0026thinsp;strongly agree), where entries 3 and 6 are reverse scored and the rest are positive scored. The standardized total of the scale was calculated by summing the individual items and ranging from 12 to 48 points, with higher scores indicating higher hope. The Cronbach's α of the HHI for patients was 0.877 and for caregivers was 0.919.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003e2.3.3. Benefit Finding Scale (BFS)\u003c/h2\u003e \u003cp\u003eThe Benefit Finding Scale (BFS), which has 22 items in Chinese [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], was used to measure benefit finding. Its six subscales are as follows: acceptance (3 items), family relationships (2 items), worldview (4 items), personal growth (7 items), social relationships (3 items) and health behaviors (3 items). The BFS rated each item on a five-point Likert scale (1\u0026thinsp;=\u0026thinsp;not at all, 4\u0026thinsp;=\u0026thinsp;very much). Total scores ranged from 22 to 110, with higher scores meaning more benefit to patients and caregivers. The Cronbach's α of the BFS for patients was 0.944 and for caregivers was 0.959, with patients' Cronbach's α for the six subscales ranging from 0.782 to 0.929 and caregivers' Cronbach's α for the six subscales ranging from 0.781 to 0.934.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003e2.3.4. Socio-demographic and clinical characteristics\u003c/h2\u003e \u003cp\u003ePatients and primary caregivers' demographic information was gathered using a self-completed questionnaire. The medical chart review provided information about the patient's clinical characteristics.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e2.4. Statistical analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics (means, standard deviations, frequencies, and percentages) were used to describe the sociodemographic characteristics, disease-related characteristics, social support, hope level, and benefit finding of patients and primary caregivers. Considering that the missing data rate for each scale was less than 20%, we used mean imputation to deal with missing values for the main variables. We used paired-sample t-tests to describe differences between patients and caregivers on the main study variables. Pearson correlation analyses described correlations between patient-caregiver dyads on crucial variables.\u003c/p\u003e \u003cp\u003eThe patient-caregiver dyads in this study were identified as distinguishable data. The APIMeM was used to examine the impact of social support on patient-caregiver benefit finding, mediated by hope level. Indirect effects were performed using bias-corrected bootstrapping 95% confidence intervals with 5000 samples. The chi-squared/degrees of freedom ratios (χ\u003csup\u003e2\u003c/sup\u003e/df), root mean square error of approximation (RMSEA), comparative fit index (CFI), Tucker\u0026ndash;Lewis index (TLI), Normed Fit Index (NFI) to evaluate the goodness of fit of the model. χ2/df\u0026thinsp;\u0026lt;\u0026thinsp;3, RMSEA\u0026thinsp;\u0026le;\u0026thinsp;0.08, CFI\u0026thinsp;\u0026ge;\u0026thinsp;0.90, TLI\u0026thinsp;\u0026ge;\u0026thinsp;0.90 and NFI\u0026thinsp;\u0026ge;\u0026thinsp;0.90 indicated a good model fit. After utilizing SPSS 23.0 and AMOS 24.0 for data analysis, a difference of \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026le;\u0026thinsp;0.05 was deemed statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n\u003ch2\u003e3.1. Sociodemographic and clinical characteristics\u003c/h2\u003e\n\u003cp\u003eA total of 295 pairs of patients and caregivers were included in this study. The mean ages of patients and caregivers were 61.9 (SD\u0026thinsp;=\u0026thinsp;9.21) and 44.98 (SD\u0026thinsp;=\u0026thinsp;11.66) years, respectively. Patients were predominantly male (70.5%), more than half of the caregivers were female (62.0%), and the majority of patients and caregivers were married (95.6% of patients and 94.9% of caregivers). 61% of the patients were diagnosed as stage IV, with adenocarcinoma as the predominant pathologic type, and most patients could care for themselves completely. Among caregivers, 54.6% were the patients' spouses, and 41.0% were children. Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e displays the patients' and caregivers' sociodemographic characteristics and disease-related data.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eSociodemographic and Clinical Characteristics of Participants(N\u0026thinsp;=\u0026thinsp;295 dyads)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariables\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePatients\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCaregivers\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18\u0026ndash;44\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e10(3.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e101(34.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e45\u0026ndash;60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e119(40.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e135(45.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e166(56.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e59(20.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGender\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e208(70.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e112(38.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e87(29.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e183(62.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEducational level\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePrimary school and below\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e56(19.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e29(9.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eJunior high school\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e124(42.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e92(31.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHigh school/vocational high school\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e74(25.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e75(25.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCollege degree or above\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e41(13.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e99(33.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMarital Status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSingle/divorced/widowed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e13(4.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e15(5.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMarried\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e282(95.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e280(94.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEmployment status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEmployed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e78(26.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e176(59.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUnemployed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e61(20.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e45(15.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRetired\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e156(52.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e74(25.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePer capita monthly household income (US dollars)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBelow 420\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e108(36.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e420\u0026ndash;840\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e119(40.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAbove 840\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e68(23.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMedical insurance type\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEmployee medical insurance\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e125(42.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eResident medical insurance\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e138(46.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRemote medical insurance\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e32(10.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eResidence\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCity\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e102(34.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSuburban\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e59(20.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCountryside\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e134(45.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePatient self-care level\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFully self-care\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e194(65.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBasic self-care\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e74(25.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePartial self-care\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e18(6.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUnable to take care of oneself\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e9(3.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eClinical Tumour-Node-Metastasis stage\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIII\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e115(39.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIV\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e180(61.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLung cancer type\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSquamous cell carcinoma\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e71(24.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAdenocarcinoma\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e184(62.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSmall cell carcinoma\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e38(12.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLarge cell carcinoma\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2(0.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTime since diagnosis\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;6 month\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e165(55.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6\u0026ndash;12 month\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e50(16.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ge;1 year\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e80(27.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRelationship to patient\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSpouse\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e161(54.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eChild\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e121(41.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSibling\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3(1.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFriends\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2(0.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOthers\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e8(2.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCaregiving hours per day\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026le;\u0026thinsp;8h\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e138(46.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9-16h\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e58(19.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17-24h\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e99(33.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAccumulated care time\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;6 month\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e149(50.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6\u0026ndash;12 month\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e52(17.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ge;1 year\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e94(31.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLiving with patients\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e225(76.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e70(23.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n\u003ch2\u003e3.2. Correlation of social support, hope level, and benefit finding\u003c/h2\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e illustrates the study variables' means, standard deviations, correlations, and whether each variable differed in the patient-caregiver dyads. Correlation analyses found significant correlations between patient and caregiver social support (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.60, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), hope level (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.71, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and benefit finding (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.76, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), suggesting that there was a nonindependence of the patient-caregiver dyads. Paired-sample t-tests indicated significant differences between patient and caregiver social support, hope level, and benefit finding. Patients' social support (46.38\u0026thinsp;\u0026plusmn;\u0026thinsp;6.23), hope level (41.03\u0026thinsp;\u0026plusmn;\u0026thinsp;4.80), and benefit finding (80.89\u0026thinsp;\u0026plusmn;\u0026thinsp;14.32) were significantly lower than caregivers' social support (48.76\u0026thinsp;\u0026plusmn;\u0026thinsp;6.52), hope level (41.93\u0026thinsp;\u0026plusmn;\u0026thinsp;5.16), and benefit finding (84.68\u0026thinsp;\u0026plusmn;\u0026thinsp;16.23).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eInter-correlations, Means, and SDs of the Study Variables for patient-caregiver dyads(N\u0026thinsp;=\u0026thinsp;295 dyads).\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eSocial Support\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eHope Level\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eBenefit Finding\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePT\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCG\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePT\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCG\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePT\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCG\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePT Social Support\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCG Social Support\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.60\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePT Hope Level\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.41\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.41\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCG Hope Level\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.34\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.51\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.71\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePT Benefit Finding\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.46\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.45\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.65\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.56\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCG Benefit Finding\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.35\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.54\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.54\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.69\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.76\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMean\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e46.38\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e48.76\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e41.03\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e41.93\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e80.89\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e84.68\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.52\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4.80\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14.32\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16.23\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"7\" align=\"left\"\u003e\n\u003cp\u003eNote. PT: patient; CG: caregiver; \u003csup\u003ea\u003c/sup\u003e paired-sample t-test.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003csup\u003e**\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n\u003ch2\u003e3.3. Analysis of the APIMeM\u003c/h2\u003e\n\u003cp\u003eWith an appropriate model-data fit (\u0026chi;2/df\u0026thinsp;=\u0026thinsp;1.583, RMSEA\u0026thinsp;=\u0026thinsp;0.045, CFI\u0026thinsp;=\u0026thinsp;0.996, TLI\u0026thinsp;=\u0026thinsp;0.991, NFI\u0026thinsp;=\u0026thinsp;0.996), the APIMeM results of social support, hope level, and benefit finding in patients and caregivers are presented in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e. The results of the analysis of social support on benefit finding pathways are shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eUnstandardized total effects, indirect effects, and direct effects of patients\u0026rsquo; and caregivers\u0026rsquo; social support on benefit finding via hope level in the APIMeM.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eEffect\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eB\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e95%CI\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eActor effect(Individual\u0026rsquo;s social support\u0026rarr;Individual\u0026rsquo;s benefit finding)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePatient\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTotal effect\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.687\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e(0.455, 0.919)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTotal IE\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.276\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e(0.126, 0.447)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eActor-actor simple IE\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ePatient social support\u0026rarr;patient hope level\u0026rarr;patient benefit finding\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.259\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e(0.135, 0.423)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePartner-partner simple IE\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePatient social support\u0026rarr;caregiver hope level\u0026rarr;patient benefit finding\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.017\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(-0.012, 0.091)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.240\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eDirect effect\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ePatient social support\u0026rarr;patient benefit finding\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.411\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e(0.188, 0.626)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCaregiver\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTotal effect\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e1.287\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e(0.980, 1.589)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTotal IE\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.650\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e(0.457, 0.887)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eActor-actor simple IE\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eCaregiver social support\u0026rarr;caregiver hope level\u0026rarr;caregiver benefit finding\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.596\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e(0.403, 0.838)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePartner-partner simple IE\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCaregiver social support\u0026rarr;patient hope level\u0026rarr;caregiver benefit finding\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.054\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(-0,010, 0.161)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.092\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eDirect effect\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eCaregiver social support\u0026rarr;caregiver benefit finding\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.637\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e(0.349, 0.924)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003ePartner effect (Individual\u0026rsquo;s social support \u0026rarr;Partner\u0026rsquo;s benefit finding)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePatient\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTotal effect\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.606\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e(0.329, 0.869)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTotal IE\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.383\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e(0.209, 0.583)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eActor-partner simple IE\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCaregiver social support\u0026rarr;caregiver hope level\u0026rarr;patient benefit finding\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.141\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(0.006, 0.298)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.040\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ePartner-actor simple IE\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eCaregiver social support\u0026rarr;patient hope level\u0026rarr;patient benefit finding\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.242\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e(0.119, 0.404)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDirect effect\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCaregiver social support\u0026rarr;patient benefit finding\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.221\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(-0.036, 0.483)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.093\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCaregiver\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTotal effect\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.096\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(-0.228, 0.413)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.553\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTotal IE\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.129\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(-0.049, 0.314)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.164\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eActor-partner simple IE\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePatient social support\u0026rarr;patient hope level\u0026rarr;caregiver benefit finding\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.058\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(-0.010, 0.156)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.086\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePartner-actor simple IE\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePatient social support\u0026rarr;caregiver hope level\u0026rarr;caregiver benefit finding\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.071\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(-0.076, 0.250)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.353\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDirect effect\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePatient social support\u0026rarr;caregiver benefit finding\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.033\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(-0.319, 0.242)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.821\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\"\u003eNote. APIMeM: Actor Partner Interdependence Mediation model; IE: indirect effect; B\u0026thinsp;=\u0026thinsp;unstandardized estimate; CI: confidence interval.\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe significant actor effect of social support on benefit findings indicated that social support positively predicted benefit findings for patients and caregivers. However, the partner effect was not significant for both patients and caregivers. The results are shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\n\u003cp\u003eThe actor effects of both patient and caregiver social support on hope level were significantly positive, indicating that social support positively predicted hope level. A significant partner effect was observed among patients; the more social support received by the caregivers, the higher the patient's hope level. However, the partner effect of patients' social support on caregivers' hope levels was insignificant. In addition, patients' and caregivers' hope levels directly and positively predicted their benefit findings. The partner effects of hope levels on benefit findings were insignificant in patients or caregivers.\u003c/p\u003e\n\u003cp\u003eThe mediation analyses found significant actor-actor effects for both patients and caregivers, suggesting that high levels of social support can enhance one's level of hope, which improves benefit finding for both patients and caregivers. Furthermore, a significant partner-actor effect was validated in patients, suggesting that caregiver social support positively impacts patients' benefit finding, which is mediated by patients' hope level.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe researchers examined the actor effect between social support and benefit findings in past studies [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The present study explored the actor-partner effect of social support on benefit finding in a dyadic perspective and examined whether hope level mediated the effect. As far as we know, it is the first dyadic study to examine how social support and hope level affect benefit finding. Consistent with Qiuping Li and others [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], the study found that caregivers had substantially higher benefit findings than patients.\u003c/p\u003e \u003cp\u003eBenefit finding was positively and directly correlated with the social support of patients and caregivers. The buffering effect model suggests that supportive social support can mitigate the detrimental effects of financial or emotional stress on mental health [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Social support can encourage individuals to handle stressful events positively by guiding them to understand events from a favorable perspective and motivating positive coping strategies [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. For patients, financial, emotional, and informational support from others can alleviate adverse disease evaluations. It can enable patients to feel cared for and valued, change negative perceptions, and tap into the positive aspects of the illness [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. As for caregivers, social support is considered to be an external resource available to caregivers and an essential factor in reducing caregivers' stress, buffering the negative impact of the caregiving burden on caregivers, enabling them to feel help from the outside, to realize the benefits of interpersonal relationships, to overcome the adversity of the disease, and to experience more positive feelings [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Individuals with more social support are more likely to find benefits from stressful events.\u003c/p\u003e \u003cp\u003eConsistent with prior studies, the latest research discovered that social support affirmatively affected patients' and caregivers' hope levels [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Symbolic interactionist theory [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] states that individuals use social support as a coping mechanism to help one another out when they encounter problems; they believe that they will be helped when they encounter difficulties, generating positive self-feedback and that this support creates motivation to overcome obstacles and achieve desired goals, in other words, social support enhances their hope [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. In addition, caregiver social support positively predicts patients' hope levels. One possible explanation is that caregivers' perceived level of social support, as an essential support resource for patients, is highly correlated with the level of support perceived by patients. Second, enhanced hope in patients results from the interaction between their internal resources and external environmental factors. The caregiver's perceived increased social support during caregiving also puts the patient in a supportive environment, which reduces the negative stimuli associated with the illness, generates positive cognitive appraisals, and contributes to the patient's increased hope. This result suggests that interventions targeting patient and caregiver social support effectively produce a positive psychological experience for the patient and that caregiver psychological health is a prerequisite for patients to receive comfortable care.\u003c/p\u003e \u003cp\u003eOur findings suggest that patients' and caregivers' hope levels positively predict their benefit findings. Previous studies have demonstrated that people with high levels of hope exhibit positive attitudes, positive actions, and close relationships. Hope also motivates individuals to restore cognitive homeostasis, which enhances their capacity to deal with traumatic events and increases the degree of benefit finding [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. It was found that a positive hope level could only enhance their benefit finding, while the effect of patient or caregiver perceived hope on the partner's benefit findings was weak. Since caregiver-patient hope levels were highly correlated, positive hope levels were still beneficial in increasing benefit findings for both patients and caregivers.\u003c/p\u003e \u003cp\u003eThe mediation analysis results indicated that social support of patients and caregivers indirectly influenced benefit findings through hope levels, which is consistent with previous findings [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. As patients need to devote more time and energy to receiving treatment and interact with others less, a social support network with protective functions can contribute to coping with challenges from the environment and serve as an external resource to increase hope levels [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], thus improving the health status of the individual and enhancing benefit finding. Of interest, caregivers' social support was positively associated with patients' level of hope, improving patients' benefit findings. This indicates that we should conduct further investigations and implement intervention experiments to identify caregivers with poor social support and provide them with psychological health education to avoid poor emotional experiences for patients due to vulnerable caregivers, which in turn helps patients find meaning in their lives.\u003c/p\u003e \u003cp\u003eIt is essential to recognize the limitations of this study. First, as a cross-sectional study, it could not take long-term trends in social support, hope level, and benefit finding for patients and primary caregivers. Therefore, no causal relationship could be drawn. Second, the data were self-reporting, which is highly subjective and may be biased. We could use more objective outcome indicators to minimize bias in the future. Third, the researcher collected data from only one hospital, limiting the study's generalizability. In future studies, we should use large-scale, multicenter studies to prove the scientific validity of the study.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eHealthcare practitioners can enhance patient-caregiver benefit findings at the dyadic level by developing a theoretical foundation through a deeper comprehension of the impacts of social support and hope level on patients' benefit findings. This study found an interdependent relationship between patients with advanced lung cancer and their primary caregivers (dyadic effect), in which more social support from the primary caregiver was associated with better levels of hope for the patient and further influenced patient benefit finding. This assessment can help us identify which patients and caregivers would benefit most from psychological therapies to assist both in working together to overcome cancer-related difficulties and challenges. Healthcare professionals should be aware of the current status of social support for patients and caregivers, encourage caregivers to participate in the patient's cancer treatment process actively, rationalize the use of resources for active coping, develop dyadic-based interventions that consider the patient-caregiver as a whole, and maintain an equal level of caregiver attention to maximize benefit finding for both patients and the caregivers.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eCompeting interests:\u003c/h2\u003e\n\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eAuthorship statement\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Data collection and resources were performed by Mengjiao Zhao, Na Na, Naijiao Xing, Hua Zhu, Guixia Wu and Guangyi Xu. Methodology and formal analysis were performed by Mengjiao Zhao. Writing - Review \u0026amp; Editing and supervision were performed by Yunxia Jiang. The first draft of the manuscript was written by Mengjiao Zhao and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003ch2\u003eEthics approval:\u003c/h2\u003e\n\u003cp\u003eThis study was performed in line with the principles of the Declaration of Helsinki. The questionnaire and methodology for this study was approved by the Human Research Ethics committee of the Qingdao University (Ethics approval number: QDU-HEC-2022207).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThank you to the healthcare providers and care managers who helped with this study and many thanks to the patients who gave their time to this study.\u003c/p\u003e\n\u003ch2\u003eFunding:\u003c/h2\u003e\n\u003cp\u003eThe authors did not receive support from any organization for the submitted work.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Data collection and resources were performed by M.Z., N.N., N.X., H.Z., G.W. and G.X.. Methodology and formal analysis were performed by M.Z.. Writing - Review \u0026amp; Editing and supervision were performed by Y.J.. The first draft of the manuscript was written by M.Z. and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003ch2\u003eData availability:\u003c/h2\u003e\n\u003cp\u003eAll data, models, and code generated or used during the study appear in the submitted article.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMarasović Šušnjara I (2020) Lung cancer incidence and mortality in Split-Dalmatia County, 2003\u0026ndash;2012. 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Journal of Aerospace Medicine 33:1019\u0026ndash;1021 \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3969/j.issn.2095-1434.2022.08.043\u003c/span\u003e\u003cspan address=\"10.3969/j.issn.2095-1434.2022.08.043\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang D, Zhang N, Chang H, Shi Y, Tao Z, Zhang X, Miao Q, Li X (2023) Mediating Role of Hope Between Social Support and Self-Management Among Chinese Liver Transplant Recipients: A Multi-Center Cross-Sectional Study. Clinical nursing research 32:776\u0026ndash;784 \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/10547738221078897\u003c/span\u003e\u003cspan address=\"10.1177/10547738221078897\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\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":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Advanced lung cancer, Caregiver, Actor-partner interdependence mediation model","lastPublishedDoi":"10.21203/rs.3.rs-3620241/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3620241/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose:\u003c/strong\u003eThe mental health of patients with advanced lung cancer and their primary caregivers may influence each other. This study used dyadic analyses to explore the dyadic effects of social support on benefit finding and whether hope level mediates the patient-caregiver dichotomy in advanced lung cancer.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e 295 pairs of patients with advanced lung cancer and primary caregivers completed the Social Support Rating Scale (SSRS), the Herth Hope Index (HHI), and the Benefit Finding Scale (BFS). Dyadic analyses were conducted using structural equation modelling based on the actor-partner interdependence mediation model.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The results indicated that for both patients and their primary caregivers, hope level mediated the actor effect of social support on benefit finding; social support was positively associated with hope level and further enhanced benefit finding. Regarding partner effects, primary caregivers' social support had a significant indirect effect on patients' benefit finding through patients' hope level.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e There is an interaction between social support, hope level, and benefit finding in patients with advanced lung cancer and their primary caregivers. Healthcare professionals should be mindful of identifying vulnerable patients and caregivers with poorer social support and hope levels and develop effective targeted interventions to improve benefit finding for patients with advanced lung cancer and caregivers.\u003c/p\u003e","manuscriptTitle":"Analysis of the actor-partner interdependence effect of social support on benefit finding in advanced lung cancer patients and caregivers","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-11-21 21:41:53","doi":"10.21203/rs.3.rs-3620241/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-02-08T04:20:47+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-12-28T13:18:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"9939525a-51da-410f-998b-8ac15a767580","date":"2023-12-28T12:54:00+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-12-28T12:26:43+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-12-28T12:23:50+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-11-20T03:00:44+00:00","index":"","fulltext":""},{"type":"submitted","content":"Supportive Care in Cancer","date":"2023-11-16T12:05:30+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"1e873761-e287-40e4-a8ba-c91ab86fb643","owner":[],"postedDate":"November 21st, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2024-03-12T01:39:17+00:00","versionOfRecord":[],"versionCreatedAt":"2023-11-21 21:41:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3620241","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3620241","identity":"rs-3620241","version":["v1"]},"buildId":"cBFmMYwuxLRRLfASyISRj","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}