The relationship between latent classes of illness uncertainty and anticipatory grief in family caregivers of patients with advanced digestive cancer

The relationship between latent classes of illness uncertainty and anticipatory grief in family caregivers of patients with advanced digestive cancer | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The relationship between latent classes of illness uncertainty and anticipatory grief in family caregivers of patients with advanced digestive cancer Fuwen Hou, Yangyang Li, Chongdie Hu, Qianqian Chen, Yuanyuan Zhao, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6484672/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 10 You are reading this latest preprint version Abstract Purpose To explore the latent classes of illness uncertainty in family caregivers of patients with advanced digestive cancer, and to analyze the influence of different latent classes on their levels of anticipatory grief. Methods A questionnaire survey was conducted among family caregivers of patients with advanced digestive cancer by convenient sampling method. The self-compiled general information questionnaire, Mishel illness uncertainty Scale for Family Member (MULS-FM), Anticipatory Grief Scale (AGS), Perceptive Social Support Scale (PSSS), and Simplified Coping Style Questionnaire (SCSQ) were used to investigate them. Latent profile analysis was used to identify the latent classes of illness uncertainty. Multiple linear regression analysis was used to explore the influence of different latent classes of illness uncertainty on anticipatory grief. Results Three latent classes were identified: intermediate-level-unpredictability group (24.4%), middle-upper-level- stability group (48.4%), and high-level-complexity group (27.2%), and only the high-level-complexity group can positively predict anticipatory grief, In addition, education level, age, individual average monthly income, coping style, perceptive social support, and current residence were also important influencing factors for family caregivers of patients with advanced digestive cancer. Conclusion There were obvious classification characteristics of illness uncertainty in family caregivers of patients with advanced digestive system cancer. Our findings may lay a theoretical and practical foundation for the subsequent precise intervention of illness uncertainty to improve anticipatory grief in family caregivers. Advanced digestive cancer Family caregivers Illness uncertainty Anticipatory grief Latent profile analysis Figures Figure 1 Introduction According to the latest national cancer statistics released by the National Cancer Center, there were 4,824,700 new cancer cases and 2,574,200 cancer deaths in China, of which the annual number of new cases and new deaths from digestive system cancer showed a rapid upward trend, Although the survival cycle of patients with digestive system cancers has been effectively prolonged thanks to standardized cancer diagnosis and treatment guidelines and the emergence of new treatment technologies, digestive system cancers such as colorectal cancer, gastric cancer, liver cancer, and esophageal cancer are still the second highest mortality rate after lung cancer. 1,2 The lack of specific clinical symptoms in the early stage of digestive system cancer, coupled with the lack of awareness of gastrointestinal endoscopy and other examinations among Chinese residents, the participation rate in early screening of digestive system cancer is low, so it often enters the medium and advanced stages once it is detected. 3,4 Advanced cancer not only threatens the lives of patients, but also imposes a heavy burden on family caregivers (FCs) in terms of time, energy, and finance, giving rise to serious challenges on their physical and mental health, work life, and self-image, as well as a series of physical and psychological stress responses, resulting in varying degrees of anticipatory grief before the death of their loved ones. 5 Anticipatory grief is a multidimensional concept defined as the process of mourning, coping, planning, interaction, and psychosocial reorganization that is triggered and initiated by past, present, and future-related losses. 6 FCs often show varying degrees of anticipatory grief when they perceive the possibility of losing a loved one who is meaningful and valuable to them. A meta-analysis of FCs in patients with life-threatening serious illnesses showed that the prevalence of anticipatory grief symptoms in FCs was 24.78% during patient care, Other studies have also confirmed that nearly one-third of FCs have anticipatory grief, and about 15% of them show extremely severe symptoms. 7,8 Anticipatory grief can lead to physical and psychological discomfort such as depression, hopelessness, pain, sleep disturbance, and loss of appetite in FCs of patients with advanced cancer, it can also negatively affect their behavior and social function, even lead to excessive behaviors such as self-harm and suicide. 9 If effective intervention is not implemented, approximately 9.8% of individuals will not be relieved of their grief for more than 6 months, manifesting as prolonged grief disorder, in other words, pathological grief or complicated grief, which is one of the risk factors for bereavement maladaptation. 10 Relevant studies have shown that middle-upper-level anticipatory grief is prevalent in FCs of patients with advanced digestive cancer in China. 11–14 The level of anticipatory grief experienced by FCs is influenced by a multitude of factors, including age, 15 gender, 16,17 educational level, 17–19 relationship with patient, 11,20 religious beliefs, 20 family economic status, 13,21 current residence and total time spent caring for patient. 13,17,21 Furthermore, A high level of perceived social support and positive coping can effectively prevent FCs from being immersed in prolonged grief over the impending death of their loved ones. 18,22,23 Illness uncertainty, which refers to an individual's lack of ability to identify things related to an illness, A state in which an individual is unable to accurately generalize and summarize the disease-related stimulus. 24 FCs often experience illness uncertainty due to factors such as the lack of knowledge related to increasingly complex treatment and care of advanced cancer, the lack of information about the severity of the disease, and the confusion about the development and outcome of the patients' disease. In recent studies, the high level of anticipatory grief in FCs of advanced cancer patients has been shown to be closely related to their illness uncertainty. 25–27 According to the theory of illness uncertainty, 24 this concept is inherently a neutral aspect of the illness experience. Its impact on individuals depends on their evaluation, thereby exhibiting dual attributes: it can be perceived as either an opportunity or a threat, potentially leading to positive outcomes. The heterogeneity of illness uncertainty among FCs may be influenced by varying socio-demographic characteristics and complex psycho-social factors such as perceived social support and positive coping styles. Therefore, it is imperative to further investigate how illness uncertainty with different characteristics affects the level of anticipatory grief in FCs. Currently, few studies in China have explored the relationship between illness uncertainty and anticipation-related grief in patients with advanced digestive system cancer. Moreover, previous studies often assessed the level of illness uncertainty in FCs using standardized scales, the level of illness uncertainty of FCs was mostly judged based on relevant scales in previous studies, and it was regarded as a homogeneous whole, ignoring the differences between individuals. which may lead to poorly targeted illness uncertainty intervention programs constructed at a later stage to improve anticipatory grief in FCs. Latent profile analysis (LPA) is an individual-centered analysis technique that classifies individuals with similar latent characteristics into the same class based on the best-fit model, which has a unique advantage in judging the class to which individuals belong and their difference. 28 Therefore, this study intends to explore whether there is heterogeneity in the sense of illness uncertainty in FCs of patients with advanced digestive system cancer based on LPA, and on this basis, analyze the effect of different latent classes of illness uncertainty on the anticipatory grief in FCs. Given the high incidence and potential adverse outcomes of anticipatory grief in FCs of patients with advanced digestive system cancer, it is necessary to further validate and enrich the research on its related factors. Therefore, the purpose of this study is to (1) clarify the occurrence of anticipatory grief and illness uncertainty in FCs of patients with advanced digestive system cancer; (2) Using multivariate techniques to determine the impact of latent classes of illness uncertainty and other influence factors on the anticipatory grief of FCs in patients with advanced digestive system cancer. Methods Participants and procedures The paper was a cross-sectional study, FCs of patients with advanced digestive system cancer in the gastroenterology department of Cancer Hospital of Shangdong First Medical University were selected from December 2023 to June 2024 by convenient sampling method. Inclusion criteria: ①FCs of patients with a pathological, histological, or cytological diagnosis of digestive system cancer (TNM stage Ⅲ or IV), ②aged > 18 years, ③good Chinese reading and communication skills, ④assumption of primary care of the patient and be identified by the patient as his or her FCs. Exclusion criteria: ①the caregiver was the salaried person, not the relative who provided care without compensation. ②FCs had severe grief and they were unable to cooperate with the questionnaire, ③the length of care was less than 1 week. A preliminary experiment was conducted with FCs of 30 patients with advanced digestive system cancer who met the inclusion and exclusion criteria, and according to the calculation formula of sample size of cross-sectional study: N = 4U \(\:{}_{\alpha\:}{}^{2}\:\) S 2 /δ 2 . In this study, α = 0.05, U \(\:{}_{\alpha\:}{}^{2}\:\) =1.96, and the preliminary experiment results in anticipatory grief score of (87.17 ± 9.10), the S (standard deviation) is 9.10, The δ (allowable error) was determined as 0.25 times the S , with the δ calculated to be 2.28, substituting U \(\:{}_{\alpha\:}{}^{2}\:\) , S , δ into the formula yield 125 cases, considering the possible presence of 20% invalid questionnaires, estimated sample size of 150 cases is required. In the follow-up survey, an effort was made to include as many FCs as possible in this study, while ensuring that the sample size met the minimum required criteria. A total of 300 questionnaires were distributed in this survey, and 283 valid questionnaires were recovered, with an effective recovery rate of 94.3%. The study procedures were approved by the Ethics Committee of the Cancer Hospital of Shangdong First Medical University (ethics number: SDTHEC2024001031). Participants were informed of the purpose and procedures of the study before the start of the study per the Declaration of Helsinki. They had the right to leave the study at any time and were not required to answer any questions. A written informed consent was obtained prior to data collection, and all data were anonymized to ensure participant privacy. Measurements Self-compiled general information questionnaire The questionnaire mainly includes the age, gender, education level, individual average monthly income, current residence, relationship with patients, total patient care time, and other basic information of FCs of patients with advanced digestive system cancer. Mishel Illness Uncertainty Scale for Family Member (MULS-FM) The scale was developed by scholar Mishel to measure illness uncertainty of FCs. 28 The Chinese version of MUIS-FM had good cross-cultural adaptation, facial validity, content validity, and internal consistency. 29 The scale has a total of 30 items, divided into four dimensions: ①unpredictability(4 items), ②complexity(8 items), ③lack of information(5 items), and ④ambiguity(13 items), and each item adopts the Likert 5-level scoring method, in which the 6th, 9th, 11th, 19th, 23rd, 25th, 27th, 28th, 29th, and 30th items need to be scored backward. All 30 items are summed to calculate a total score that ranges from 30 to 150, with higher scores indicating higher levels of illness uncertainty. The Cronbach′s alpha of the scale in this study is 0.822. Anticipatory Grief Scale (AGS) Anticipatory grief was assessed using the Chinese version of the AGS. The AGS was initially developed by Theut et al 30 and was translated into Chinese by Xin et al, 31 which has a total of 27 items, including 7 dimensions of anger (3 items), guilt (4 items), anxiety (4 items), irritability (4 items), sadness (4 items), feelings of loss (5 items), and decreased ability to function at usual tasks (4 items). These items use Likert 5-level scoring method, all 27 items are summed to calculate a total score that ranges from 27 to 135, with higher scores indicating higher levels of anticipatory grief. The Chinese version of the AGS scale has become a more mature scale used by Chinese scholars to evaluate the sadness of caregivers of cancer patients and has shown good reliability and validity. The Cronbach′s alpha of the scale in this study was 0.854. Perceptive Social Support Scale (PSSS) The scale was developed by Zimet et al 32 to measure the degree of social support felt by individuals. The Chinese version of this scale was revised by Huang et al, 33 which consists of 12 items, including 3 dimensions of family support, friend support, and other support, each dimension has 4 items, These items use the Likert 7-level scoring method, all 12 items are summed to calculate a total score that ranges from 12 to 84, with higher scores indicating higher levels of perceptive social support. The Cronbach′s alpha of this scale in this study was 0.912. Simplified Coping Style Questionnaire (SCSQ) The scale was developed by Xie 34 based on referring to the foreign coping style scale and Chinese cultural background and was used to evaluate the cognitive and behavioral styles adopted by individuals in the face of difficulties, with a total of 20 items, including positive coping dimension(1 ~ 12 items) and negative coping dimension(13 ~ 20 items), each item adopts the Likert 4-level scoring method, the higher the score in a certain dimension, the more inclined the individual is to adopt this coping style. The Cronbach's alpha of these two dimensions in this study were 0.887, 0.842. Statistical Analysis In this study, SPSS25.0 and Mplus8.3 software were used for data processing. The scores of each dimension of the illness uncertainty scale were standardized by z-scores, then the LPA was carried out, starting from the initial model (assuming that there is one class), and the classes in the model were increased sequentially until the model reached the best fit. The model fit indices were as follows: Akaike information criterion (AIC), Bayesian information criterion (BIC), Sample-Size Adjusted Bayesian Information Criterion (aBIC), lower values of AIC, BIC, and SS-BIC indicate a better fit. The closer Entropy (classification quality) value is to one, which indicating the classification is more accurate. Significant LMR-LRT (Vuong-Lo-Mendell-Rubin likelihood ratio test) and BLRT (Bootstrap Likelihood Ratio Test) indicate a marked improvement of the k-class model compared to the k-1-class model. Measurement dates of the normal distribution are described by M ± SD. Non-normally distributed measurement data were described by Median(IQR), and the Wilcoxon Mann-Whitney U test was used for comparison between the two groups, and the Kruskal-Wallis H test was used for comparison between multiple groups. "Frequency and percentage" were used to describe categorical data or ranked data, and the chi-square test was used for comparisons between multiple groups. Spearman correlation analysis was used for correlation analysis. Multiple linear regression analysis was used to investigate the effect of different latent classes of illness uncertainty on the level of anticipated grief in FCs of patients with advanced digestive system cancer. Results latent classes of illness uncertainty A total of 1~5 latent class models were exploratorily verified, and the model fitting results are shown in Table 1. With the increase in the number of classes in the model, the AIC, BIC, and SS-BIC values all decreased successively. When the three latent classes were retained in the model, the Entropy value was closest to one, and the LMR-LRT and BLRT were statistically significant. The Entropy value was higher for the three-class model compared to the four-class model. When the number of included classes on the model increased to five, although the AIC, BIC, and SS-BIC values were the smallest, the LMR-LRT P-value was not statistically significant. Finally, the three-class model was selected as the optimal result of LPA for illness uncertainty, the average latent class probabilities for the three-class model ranged from 0.905 to 0.945, further confirming the high accuracy of the classification. Table 1 ： Goodness-of-fit statistics for 1–5 class solutions. Model AIC BIC aBIC Entropy LMR-LRT( P ) BLRT( P ) 1 3224.470 3253.633 3228.265 - - - 2 2988.520 3035.911 2994.688 0.777 <0.001 <0.001 3 2891.991 2957.609 2900.530 0.823 0.010 <0.001 4 2872.577 2956.422 2883.489 0.803 0.135 <0.001 5 2858.095 2960.168 2871.379 0.820 0.445 <0.001 Abbreviations: AIC, Akaike information criterion; BIC, Bayesian information criterion; aBIC, Sample-Size Adjusted Bayesian Information Criterion; LMR-LRT, Vuong-Lo-Mendell-Rubin likelihood ratio test; BLRT, Bootstrap Likelihood Ratio Test; -, no such value Features and names of each latent class of illness uncertainty Fig.1 shows the standardized scores of four dimensions of illness uncertainty in FCs belonging to different latent classes. The three latent classes were named according to their respective characteristics. The illness uncertainty of FCs in class 1 showed the medium level, with a score of [79.00 (74.00, 83.00)], but the standardized score of the unpredictability dimension was the highest, so it was named as "intermediate- level - unpredictability group", which accounting for 24.4% (n=69) of the sample. The illness uncertainty of FCs in class 2 showed the middle-upper level, with a score of [93.00 (88.00, 99.00)], and the standardized scores of each dimension were relatively similar, and the number of people accounted for the largest, so it was named as "middle-upper-level-stability group", which accounting for 48.4% (n=137) of the sample. The illness uncertainty of FCs in class 3 showed a high level, with a score of [118.00 (110.00, 122.00)], especially the complexity dimension showed the highest standardized score, so it was named "high- level-complexity", which accounts for 27.2% (n=77) of the sample. Comparison of demographic and perceptive social support and coping style between latent classes There are significant differences in general information such as age, individual average monthly income, education level, relationship with patients, religious beliefs, and total time spent caring for patients between multiple classes. Meanwhile, FCs who belonged to different latent classes also had statistically significant differences in scores of all dimensions of perceived social support, and all three latent classes of illness uncertainty had the highest scores of family support. Among the two dimensions of coping style, only the positive coping dimension showed a significant difference, those who belonged to the intermediate-level - unpredictability group were more inclined to adopt positive coping styles than those who belonged to the high-level-complexity group. However, in the subsequent disordered multi-class logistic regression analysis, it was found that the pairwise comparison of the three latent classes did not show significant differences in the variables, so it is not reported in this paper. See Table 2. Table 2: Comparison of demographic and perceptive social support and coping style between latent classes. Variables CLASS 1 （ n=69 ） CLASS 2 （ n=137 ） CLASS 3 （ n=77 ） Significant test P Age N(%) 48.315 a ① <0.001 50 15（21.8） 19（13.9） 44（57.1） Gender N(%) 0.066 a 0.968 male 32（46.4） 61（44.5） 35（45.5） female 37（54.6） 76（55.5） 42（54.5） Current residence N(%) 1.935 a 0.748 village 17（24.6） 44（32.1） 26（33.8） town 23（33.3） 42（30.7） 25（32.4） city 29（42.1） 51（37.2） 26（33.8） Individual average monthly income N(%) 49.066 a ① <0.001 ¥10000 30（43.5） 22（16.1） 13（16.9） Education level N(%) 17.293 a ① 0.002 Junior high school and below 15（21.7） 36（26.3） 35（45.5） Senior high school 26（37.7） 66（48.2） 28（36.4） College and above 28（40.6） 35（25.5） 14（18.1） relationship with patient N(%) 3.401 a 0.493 Couple/partner 27（39.1） 54（39.4） 26（33.8） Parents 36（52.2） 67（48.9） 37（48.0） Brothers and sisters 6（8.7） 16（11.7） 14（18.2） religious belief N(%) 9.659 a 0.008 Have 25（36.2） 23（16.8） 19（24.7） Not 44（63.8） 114（83.2） 58（75.3） Total time spent caring for patient N(%) 14.106 a 0.028 ≤ 3 months 11（15.9） 24（17.5） 24（31.2） 3~6 months 15（21.8） 33（24.1） 20（26.0） 6~12 months 16（23.2） 42（30.7） 21（27.3） ≥ 1 year 27（39.1） 38（27.7） 12（15.5） Perceived social support M±SD/Median(IQR) Family support 24.00（22.00,26.00） 19.35±3.94 16.00（14.00,19.00） 57.616 b <0.001 Friend support 24.00（21.50,27.00） 19.00（16.50,22.00） 17.00（14.00,20.00） 21.938 b <0.001 Other support 20.00（18.00,22.00） 17.00（15.00,19.00） 15.00（14.00,17.00） 11.350 b 0.003 Coping style Median(IQR) Positive coping 42.00（37.00,46.00） 42.00（38.00,46.00） 38.00（36.00,40.00） 26.275 b <0.001 Negative coping 13.00（9.00,16.00） 13.00（11.00,15.50） 14.00（12.50,16.00） 3.839 b 0.147 Note:CLASS1, intermediate-level-unpredictability; CLASS2, middle-upper-level-stability group; CLASS3, high-level-complexity group a: Chi-square; b: Kruskal-Wallis H Test Relationship between the latent classes of illness uncertainty and anticipatory grief Univariate analysis of anticipatory grief in FCs Univariate analysis showed that there were significant differences in anticipatory grief among FCs of different ages, gender, current residence, individual average monthly income, education level, relationship with patients, religious beliefs, total time spent caring for patients and latent classes of illness uncertainty. See Table 3. Table 3 : Univariate analysis of anticipatory grief in FCs. [ Median(IQR) ] Variables N Anticipatory grief score Significant test P Age < 30 36 106.00(101.00,107.75) 120.526 a 50 78 80.00(72.00,85.00) Gender male 128 97.00(88.25,105.00) -7.503 b <0.001 female 155 85.00(79.00,93.00) Current residence village 87 103.00(96.00,107.00) 115.062 a <0.001 town 90 90.00(80.00,94.00) city 106 82.00(76.50,90.00) Individual average monthly income ¥<5000 89 103.00(95.50,107.00) 136.137 a 10000 65 79.50(71.25,84.75) Education level Junior high school and below 86 103.00(96.75,107.00) 143.747 a <0.001 Senior high school 120 91.00(82.25,95.00) College and above 77 80.00(72.00,84.50) Relationship with patient Couple/partner 107 101.00(90.00,106.00) 89.788 a <0.001 Parents 140 88.50(80.00,94.00) Brothers and sisters 36 80.00(72.25,84.50) Religious beliefs Have 216 94.00(86.25,101.75) -9.212 b <0.001 Not 67 80.00(71.00,84.00) Total time spent caring for patients ≤ 3months 59 105.00(101.00,107.00) 148.621 a <0.001 3~6months 68 88.96±10.48 6~12months 79 93.00(88.00,96.00) ≥ 1year 77 80.00(72.00,84.50) latent classes of illness uncertainty Intermediate-level-unpredictability group 69 80.00(71.50,83.50) 164.204 a <0.001 Middle-upper-level-stability group 1377 90.00(82.00,94.00) High-level-complexity group 77 104.00(99.00,107.00) Note: a: Kruskal-Wallis H Test；b: Wilcoxon Mann-Whitney U Test Correlation analysis of FCs' perceived social support, coping style, and anticipatory grief Spearman correlation analysis showed that anticipatory grief in FCs of patients with advanced digestive cancer was negatively correlated with the family support dimension, friend support dimension, other support dimension of perceptive social support, and negative coping, and positively correlated with positive coping. See Table 4. Table 4: Correlation analysis of FCs ' perceived social support, coping styles, and anticipatory grief. Variables Family support Friend support Other support Positive coping Negative coping Anticipatory grief Family support 1 - - - - - Friend support 0.626** 1 - - - - Other support 0.528** 0.598** 1 - - - Positive coping 0.380** 0.266** 0.222** 1 - - Negative coping -0.364** -0.337** -0.373** -0.355** 1 - Anticipatory grief -0.475** -0.311** -0.255** -0.432** 0.308** 1 Note：**, P <0.001 Multiple linear regression analysis for anticipatory grief in FCs Taking anticipatory grief as the dependent variable, the statistically significant variables in Table 3 and Table 4 were included as independent variables in the regression equation for analysis. The model was statistically significant.Regression analysis showed that among the three latent classes, only the "high-level-complexity group" could positively predict a high level of anticipatory grief. In addition, education level, age, individual average monthly income, negative coping, positive coping, family support, and village were also important influencing factors of anticipatory grief in FCs of advanced digestive system cancer patients. See Table 5. Table 5 : Multiple linear regression analysis for anticipatory grief in FCs. Independent variable B SE β t P Constant 124.084 6.141 20.207 <0.001 Education level -4.7770 2.344 -0.291 -2.035 0.043 Negative coping 0.798 0.131 0.234 6.080 <0.001 Positive coping -0.309 0.093 -0.130 -3.329 0.001 Age -3.414 1.590 -0.170 -2.148 0.033 Individual average monthly income -4.408 1.823 -0.263 -2.418 0.016 Family support -0.327 0.137 -0.100 -2.380 0.018 Current residence village -9.853 3.110 -0.366 -3.169 0.002 latent classes of illness uncertainty High-level-complexity group 9.873 2.646 0.354 3.731 <0.001 Note：R 2 =0.673；adjusted R 2 =0.664；F=70.596； P <0.001 Discussion Three talent classes of illness uncertainty The present study employed LPA to determine that FCs of patients with advanced digestive cancer had individual differences, three latent classes were identified, including intermediate-level-unpredictability group (24.4%), middle-upper-level-stability group (48.4%) and high-level-complexity group (27.2%). Intermediate-level-unpredictability group of FCs have the lowest total score of illness uncertainty, this group of FCs can fully perceive the support and understanding from relatives, friends, medical staff, and other aspects, possess a high level of perceptive social support, and tend to adopt a problem- solving-oriented positive coping strategy to confront the illness uncertainty caused by advanced digestive system cancer, FCs of this latent class tends to view illness uncertainty is an opportunity, they endeavor to obtain information about advanced digestive system cancer from various sources to deepen their understanding of the cause, development, severity, treatment and other aspects of the disease, thereby effectively alleviate their illness uncertainty. However, clinical symptoms of advanced digestive system cancer such as severe pain, hematemesis, digestive obstruction, cachexia resulting from severe nutrient consumption, multiple organ failure, and others occur successively, the patients’ condition may change dramatically in a short period, which is difficult to predict, the treatment and nursing plan becomes increasingly intricate, and it is difficult to determine whether there is a therapeutic effect or other factors, which result in the illness uncertainty of this group of FCs is mainly manifested in the dimension of unpredictability and ambiguity. High-level-complexity group of FCs have the highest total score of illness uncertainty, with the highest score in the complexity dimension among the four dimensions. They are characterized by relatively older age, lower education level and individual average monthly income, so usually encounter difficulties in comprehending knowledge related to the treatment of advanced digestive system cancer and limited access to disease-related information, 35 in addition, negative perception toward cancer significantly decreased their willingness of self-disclosure, 36 it is difficult for the outside world to provide targeted medical information support based on their current confusion, FCs of this latent class tends to view illness uncertainty is a threat, which can easily form a vicious cycle and ultimately lead to the emergence of high levels of illness uncertainty. 27 Among the three latent classes, the middle-upper-level-stability group of FCs occupies the largest proportion, nearly half of the FCs of patients with advanced digestive system cancer fall into this class, this group of FCs care for patients for a relatively short duration, and they usually have to endure a series of adverse factors such as limited comprehension of the patients’ current overall condition, treatment measures and daily nursing procedures, and the medical staff might not have fully explained the condition, resulting in a relatively high level of illness uncertainty. This group can be regarded as a transition between intermediate-level-unpredictability group and high-level-complexity group, for this group of FCs, medical staff should consider implementing cognitive-behavioral interventions for this latent class of FCs to change their fear of illness uncertainty caused by advanced cancer, and guide them to consider improving their own illness uncertainty as an positive factor in further enhancing their nursing abilities and improving the quality of life of their loved ones in the end-of-life stage, in order to prevent them further sliding into the high-level-complexity group. Effect of latent classes of illness uncertainty on anticipatory grief The results of this study show that FCs who belong to different latent classes of illness uncertainty have statistically significant differences in anticipatory grief. The high-level-complexity group of FCs have the highest level of anticipatory grief, followed by the middle-upper-level-stability group of FCs and the intermediate-level-unpredictability group of FCs have the lowest level of anticipatory grief. Multiple linear regression analysis shows that only the high-level-complexity group can positively predict anticipatory grief, which is one of the important influencing factors of anticipatory grief. The high level of illness uncertainty can increase the caregiver burden of FCs, 37 resulting in the deterioration of their physical fitness and quality of life, 38 and diminish their psychological resilience, 39 thereby resulting in FCs being in negative emotions such as anxiety, fear, pessimism, and disappointment, which is manifested as an escalation in the level of anticipatory grief. In contrast, the intermediate-level-unpredictability group of FCs focus on patient care, actively seek help from medical professionals, learn knowledge about disease treatment and care, and strive to improve their ability to complete nursing tasks, effectively maintain the quality of life of their loved ones in the final stages of life, the reduction of pain before the death of a loved one can effectively relieve the grief of FCs. 40 Therefore, clinical nurses should pay special attention to FCs demonstrating a high degree of illness uncertainty, and fully take into account the characteristics of the high-level-complexity group of FCs, such as poor learning adaptability, lack of information-receiving channels, and low willingness for self-disclosure, offer multiple and individualized interventions to guarantee that FCs of patients with advanced digestive system cancer can form accurate cognition and judgment of the disease status of their loved ones, reduce their level of illness uncertainty, to help FCs reduce their level of anticipatory grief, get rid of the emotional distress caused by sadness earlier, and accept the imminent occurrence of bereavement events. Influencing factors of anticipatory grief Age, education level, individual average monthly income, current residence, coping style, and perceived social support were also verified to be important influencing factors of anticipatory grief in FCs of patients with advanced digestive system cancer. Compared with the elderly, middle-aged and young people, especially <30 years old FCs, tend to have a higher level of anticipatory grief, most middle-aged people have to strike a balance between work and care tasks, therefore their physical and mental burden substantially exacerbate, resulting in a relatively high level of anticipatory grief, 31 Chinese young people often lack death education, and lack the experience of caring for relatives or facing their death, 41 making youth more difficult to accept the imminent occurrence of bereavement events, and easily fall into intense grief. FCs with higher education levels usually have higher cognition and acceptance of advanced digestive system cancer, thus the level of illness uncertainty is relatively low, and understand that bereavement events should be viewed more holistically, and positive factors from traumatic events can be found to obtain corresponding growth. Therefore, there is an inverse relationship between education level and anticipatory grief. 42 The buffer theory of social support suggests that perceived social support can provide individuals with important psychological resources, effectively replenish their lost psychological energy, buffer the impact of negative life events on individuals, 43 and control their grief within a reasonable range, in this study, the family support dimension scored the highest among the three dimensions of perceived social support, indicating that FCs are more inclined to use family affection rather than friendship or other social relationships to deal with their grief, because family members can express and share emotions more openly, and fully listen to and meet each other's needs, which can make FCs more likely to experience support and understanding from the outside world, which may also be the reason for the relatively high level of anticipatory grief in FCs living in village, they usually have to seek medical treatment outside of FCs’ current residence and are separated from family support system in unfamiliar environment, FCs has received extremely limited support, which makes their difficult to express their negative emotions effectively, resulting in high level of anticipatory grief. Coping style is an important regulating factor between stress response and stress outcome, the level of anticipatory grief is lower in FCs with positive coping. However, when negative attitudes such as avoidance and denial are used to deal with various problems during the care period, the level of anticipatory grief is higher. Positive coping styles can achieve positive adjustment of emotions and effective solutions of problems to maintain the good mental health of FCs and form a virtuous cycl. 44 FCs with negative coping attitudes tend to underestimate their ability to solve problems and escape from them, avoidance and self-abandonment can amplify the negative effects of bereavement events and cause FCs to experience more intense feelings of grief. Study limitations Several limitations in this study should not be ignored. The research objects included in this study were only from one hospital, and a convenient sampling method was adopted to collect data, which limited the representativeness and popularization of samples. Future studies should plan to adopt multi-center and large sample designs to verify the results of this study. In addition, this study is a cross-sectional study, future studies may adopt a longitudinal study design to explore the dynamic change trajectory of anticipatory grief in FCs of patients with advanced digestive system cancer, and further analyze the influence of illness uncertainty on different trajectory classes of FCs in anticipatory grief. Clinical implications The present study employed LPA to identify three different latent classes of illness uncertainty in FCs of patients with advanced digestive system cancer. Only the high-level-complexity group could positively predict the high level of anticipatory grief in FCs of patients with advanced digestive system cancer, this study laid a theoretical and practical foundation for the subsequent precise intervention of illness uncertainty based on improving anticipatory grief in FCs. Conclusion In the current study, we demonstrated the heterogeneity of illness uncertainty by a person-centered approach and analyzed the effect of different latent classes of illness uncertainty on anticipatory grief in FCs, in addition to exploring associated influencing factors of anticipatory grief in family caregivers of patients with advanced digestive cancer. Clinical nurses should pay special attention to FCs demonstrating a high degree of illness uncertainty and develop an appropriate intervention program to help FCs reduce their anticipatory grief earlier. Abbreviations FCs family caregivers Declarations Acknowlegements We appreciate each participant’s contributions and the study participants' cooperation. Authors' contributions Conceptualization, Methodology, Data curation, Formal analysis, writing: F.W.H, Y.Y.L, H.X.Z; Methodology, Writing-Original draft preparation: F.W.H, H.X.Z; Formal ananlysis, Writing-Revised draft preparation, Data curation: Y.Y.L, Q.Q.C; Conce-ptualization, Methodology, Data collection, Writing-Original and Revised draft preparation: F.W.H, Y.Y.Z, C.D.H. All authors had full access to all the data in the study, and the corresponding author had final responsibility for the decision to submit for publication. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. Funding None Data availability The data that support the findings of this study are available from the corresponding author upon reasonable request. Ethics approval and consent to participate This study was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. Approval was granted by the Ethics Committee of the Cancer Hospital of Shangdong First Medical University (ethics number: SDTHEC2024001031). Consent for publication Not applicable. Competing interests The authors declare no competing interests. References Han RS, Zheng RS, Zeng HM, et al. Cancer incidence and mortality in China,2022. Natl Cancer Cent . 2024;46(3):221-231. https://doi.org/10.1016/j.jncc.2024.01.006 Jia SQ, Zhou QY, Liu HM, et al. The mortality trend of digestive tract malignant tumor in China from 2004 to 2018. Chin J Dis Control Prev . 2021;25(09):1020-1025. Li J, Li H, Zeng H, et al. Trends in high-risk rates and screening rates for the population-based cancer screening program on esophageal, stomach and liver cancer in China,2010—2016. 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Int J Aging Hum Dev. 1991;33(2):113-118. https://doi.org/10.2190/4KYG-J2E1-5KEM-LEBA Xin DJ. Study on Grief of Advanced Cancer Patients and Their Family (Master's Thesis). 2016. Southwest Medical University , Luzhou. Zimet GD, Powell SS, Farley GK, et al. Psychometric characteristics of the Multidimensional Scale of Perceived Social Support. J Pers Assess. 1990;55(3-4):610-617. https://doi.org/10.1080/00223891.1990.9674095 Huang L, Jiang QJ, Ren WH. Correlation between coping style, social support and psychosomatic symptoms of cancer patients. Chinese Mental Health Journal. 1996;10(4):160–166. Xie YN, A preliminary study on the reliability and validity of the Simplified Coping style scale. Chinese Journal of Clinical Psychology . 1999;(2):53-54. Guan T, Chapman MV, de Saxe Zerden L, et al. Correlates of illness uncertainty in cancer survivors and family caregivers: a systematic review and meta-analysis. 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Psychol Med . 1987;17(1):91-108. https://doi.org/10.1017/s0033291700013015 Yu W, Lu Q, Lu Y, et al. Anticipatory Grief among Chinese Family Caregivers of Patients with Advanced Cancer: A Cross-Sectional Study. Asia Pac J Oncol Nurs . 2021;8(4):369-376. https://doi.org/10.4103/apjon.apjon-214 Additional Declarations No competing interests reported. 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12:23:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6484672/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6484672/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88501588,"identity":"e4deae2e-6f21-4053-a9b2-9c9eb0845f16","added_by":"auto","created_at":"2025-08-07 06:54:35","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":21491,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThree-class model of illness uncertainty in family caregivers of patients with advanced digestive cancer\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6484672/v1/1a9ffc6fa4ac518b0e573781.png"},{"id":88504670,"identity":"4fef0b67-2c02-4c61-a229-ee5d64b6aa22","added_by":"auto","created_at":"2025-08-07 07:10:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1576295,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6484672/v1/4f0665bf-f04c-4db4-8f02-29d9f1129646.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The relationship between latent classes of illness uncertainty and anticipatory grief in family caregivers of patients with advanced digestive cancer","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAccording to the latest national cancer statistics released by the National Cancer Center, there were 4,824,700 new cancer cases and 2,574,200 cancer deaths in China, of which the annual number of new cases and new deaths from digestive system cancer showed a rapid upward trend, Although the survival cycle of patients with digestive system cancers has been effectively prolonged thanks to standardized cancer diagnosis and treatment guidelines and the emergence of new treatment technologies, digestive system cancers such as colorectal cancer, gastric cancer, liver cancer, and esophageal cancer are still the second highest mortality rate after lung cancer.\u003csup\u003e1,2\u003c/sup\u003e The lack of specific clinical symptoms in the early stage of digestive system cancer, coupled with the lack of awareness of gastrointestinal endoscopy and other examinations among Chinese residents, the participation rate in early screening of digestive system cancer is low, so it often enters the medium and advanced stages once it is detected.\u003csup\u003e3,4\u003c/sup\u003e Advanced cancer not only threatens the lives of patients, but also imposes a heavy burden on family caregivers (FCs) in terms of time, energy, and finance, giving rise to serious challenges on their physical and mental health, work life, and self-image, as well as a series of physical and psychological stress responses, resulting in varying degrees of anticipatory grief before the death of their loved ones.\u003csup\u003e5\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eAnticipatory grief is a multidimensional concept defined as the process of mourning, coping, planning, interaction, and psychosocial reorganization that is triggered and initiated by past, present, and future-related losses.\u003csup\u003e6\u003c/sup\u003e FCs often show varying degrees of anticipatory grief when they perceive the possibility of losing a loved one who is meaningful and valuable to them. A meta-analysis of FCs in patients with life-threatening serious illnesses showed that the prevalence of anticipatory grief symptoms in FCs was 24.78% during patient care, Other studies have also confirmed that nearly one-third of FCs have anticipatory grief, and about 15% of them show extremely severe symptoms.\u003csup\u003e7,8\u003c/sup\u003e Anticipatory grief can lead to physical and psychological discomfort such as depression, hopelessness, pain, sleep disturbance, and loss of appetite in FCs of patients with advanced cancer, it can also negatively affect their behavior and social function, even lead to excessive behaviors such as self-harm and suicide.\u003csup\u003e9\u003c/sup\u003e If effective intervention is not implemented, approximately 9.8% of individuals will not be relieved of their grief for more than 6 months, manifesting as prolonged grief disorder, in other words, pathological grief or complicated grief, which is one of the risk factors for bereavement maladaptation.\u003csup\u003e10\u003c/sup\u003e Relevant studies have shown that middle-upper-level anticipatory grief is prevalent in FCs of patients with advanced digestive cancer in China.\u003csup\u003e11\u0026ndash;14\u003c/sup\u003e The level of anticipatory grief experienced by FCs is influenced by a multitude of factors, including age,\u003csup\u003e15\u003c/sup\u003e gender,\u003csup\u003e16,17\u003c/sup\u003e educational level,\u003csup\u003e17\u0026ndash;19\u003c/sup\u003e relationship with patient,\u003csup\u003e11,20\u003c/sup\u003e religious beliefs,\u003csup\u003e20\u003c/sup\u003e family economic status,\u003csup\u003e13,21\u003c/sup\u003e current residence and total time spent caring for patient.\u003csup\u003e13,17,21\u003c/sup\u003e Furthermore, A high level of perceived social support and positive coping can effectively prevent FCs from being immersed in prolonged grief over the impending death of their loved ones.\u003csup\u003e18,22,23\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eIllness uncertainty, which refers to an individual's lack of ability to identify things related to an illness, A state in which an individual is unable to accurately generalize and summarize the disease-related stimulus. \u003csup\u003e24\u003c/sup\u003e FCs often experience illness uncertainty due to factors such as the lack of knowledge related to increasingly complex treatment and care of advanced cancer, the lack of information about the severity of the disease, and the confusion about the development and outcome of the patients' disease. In recent studies, the high level of anticipatory grief in FCs of advanced cancer patients has been shown to be closely related to their illness uncertainty.\u003csup\u003e25\u0026ndash;27\u003c/sup\u003e According to the theory of illness uncertainty,\u003csup\u003e24\u003c/sup\u003e this concept is inherently a neutral aspect of the illness experience. Its impact on individuals depends on their evaluation, thereby exhibiting dual attributes: it can be perceived as either an opportunity or a threat, potentially leading to positive outcomes. The heterogeneity of illness uncertainty among FCs may be influenced by varying socio-demographic characteristics and complex psycho-social factors such as perceived social support and positive coping styles. Therefore, it is imperative to further investigate how illness uncertainty with different characteristics affects the level of anticipatory grief in FCs. Currently, few studies in China have explored the relationship between illness uncertainty and anticipation-related grief in patients with advanced digestive system cancer. Moreover, previous studies often assessed the level of illness uncertainty in FCs using standardized scales, the level of illness uncertainty of FCs was mostly judged based on relevant scales in previous studies, and it was regarded as a homogeneous whole, ignoring the differences between individuals. which may lead to poorly targeted illness uncertainty intervention programs constructed at a later stage to improve anticipatory grief in FCs.\u003c/p\u003e\u003cp\u003eLatent profile analysis (LPA) is an individual-centered analysis technique that classifies individuals with similar latent characteristics into the same class based on the best-fit model, which has a unique advantage in judging the class to which individuals belong and their difference.\u003csup\u003e28\u003c/sup\u003e Therefore, this study intends to explore whether there is heterogeneity in the sense of illness uncertainty in FCs of patients with advanced digestive system cancer based on LPA, and on this basis, analyze the effect of different latent classes of illness uncertainty on the anticipatory grief in FCs.\u003c/p\u003e\u003cp\u003eGiven the high incidence and potential adverse outcomes of anticipatory grief in FCs of patients with advanced digestive system cancer, it is necessary to further validate and enrich the research on its related factors. Therefore, the purpose of this study is to (1) clarify the occurrence of anticipatory grief and illness uncertainty in FCs of patients with advanced digestive system cancer; (2) Using multivariate techniques to determine the impact of latent classes of illness uncertainty and other influence factors on the anticipatory grief of FCs in patients with advanced digestive system cancer.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eParticipants and procedures\u003c/h2\u003e\u003cp\u003eThe paper was a cross-sectional study, FCs of patients with advanced digestive system cancer in the gastroenterology department of Cancer Hospital of Shangdong First Medical University were selected from December 2023 to June 2024 by convenient sampling method. Inclusion criteria: ①FCs of patients with a pathological, histological, or cytological diagnosis of digestive system cancer (TNM stage Ⅲ or IV), ②aged\u0026thinsp;\u0026gt;\u0026thinsp;18 years, ③good Chinese reading and communication skills, ④assumption of primary care of the patient and be identified by the patient as his or her FCs. Exclusion criteria: ①the caregiver was the salaried person, not the relative who provided care without compensation. ②FCs had severe grief and they were unable to cooperate with the questionnaire, ③the length of care was less than 1 week.\u003c/p\u003e\u003cp\u003eA preliminary experiment was conducted with FCs of 30 patients with advanced digestive system cancer who met the inclusion and exclusion criteria, and according to the calculation formula of sample size of cross-sectional study: N\u0026thinsp;=\u0026thinsp;\u003cem\u003e4U\u003c/em\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{}_{\\alpha\\:}{}^{2}\\:\\)\u003c/span\u003e\u003c/span\u003e\u003cem\u003eS\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003cem\u003e/δ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e. In this study, α\u0026thinsp;=\u0026thinsp;0.05, \u003cem\u003eU\u003c/em\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{}_{\\alpha\\:}{}^{2}\\:\\)\u003c/span\u003e\u003c/span\u003e=1.96, and the preliminary experiment results in anticipatory grief score of (87.17\u0026thinsp;\u0026plusmn;\u0026thinsp;9.10), the \u003cem\u003eS\u003c/em\u003e (standard deviation) is 9.10, The \u003cem\u003eδ\u003c/em\u003e (allowable error) was determined as 0.25 times the \u003cem\u003eS\u003c/em\u003e, with the \u003cem\u003eδ\u003c/em\u003e calculated to be 2.28, substituting \u003cem\u003eU\u003c/em\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{}_{\\alpha\\:}{}^{2}\\:\\)\u003c/span\u003e\u003c/span\u003e, \u003cem\u003eS\u003c/em\u003e, \u003cem\u003eδ\u003c/em\u003e into the formula yield 125 cases, considering the possible presence of 20% invalid questionnaires, estimated sample size of 150 cases is required. In the follow-up survey, an effort was made to include as many FCs as possible in this study, while ensuring that the sample size met the minimum required criteria. A total of 300 questionnaires were distributed in this survey, and 283 valid questionnaires were recovered, with an effective recovery rate of 94.3%.\u003c/p\u003e\u003cp\u003e The study procedures were approved by the Ethics Committee of the Cancer Hospital of Shangdong First Medical University (ethics number: SDTHEC2024001031). Participants were informed of the purpose and procedures of the study before the start of the study per the Declaration of Helsinki. They had the right to leave the study at any time and were not required to answer any questions. A written informed consent was obtained prior to data collection, and all data were anonymized to ensure participant privacy.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eMeasurements\u003c/h3\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eSelf-compiled general information questionnaire\u003c/h2\u003e\u003cp\u003eThe questionnaire mainly includes the age, gender, education level, individual average monthly income, current residence, relationship with patients, total patient care time, and other basic information of FCs of patients with advanced digestive system cancer.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eMishel Illness Uncertainty Scale for Family Member (MULS-FM)\u003c/h3\u003e\n\u003cp\u003eThe scale was developed by scholar Mishel to measure illness uncertainty of FCs.\u003csup\u003e28\u003c/sup\u003e The Chinese version of MUIS-FM had good cross-cultural adaptation, facial validity, content validity, and internal consistency.\u003csup\u003e29\u003c/sup\u003e The scale has a total of 30 items, divided into four dimensions: ①unpredictability(4 items), ②complexity(8 items), ③lack of information(5 items), and ④ambiguity(13 items), and each item adopts the Likert 5-level scoring method, in which the 6th, 9th, 11th, 19th, 23rd, 25th, 27th, 28th, 29th, and 30th items need to be scored backward. All 30 items are summed to calculate a total score that ranges from 30 to 150, with higher scores indicating higher levels of illness uncertainty. The Cronbach\u0026prime;s alpha of the scale in this study is 0.822.\u003c/p\u003e\n\u003ch3\u003eAnticipatory Grief Scale (AGS)\u003c/h3\u003e\n\u003cp\u003eAnticipatory grief was assessed using the Chinese version of the AGS. The AGS was initially developed by Theut et al\u003csup\u003e30\u003c/sup\u003e and was translated into Chinese by Xin et al,\u003csup\u003e31\u003c/sup\u003e which has a total of 27 items, including 7 dimensions of anger (3 items), guilt (4 items), anxiety (4 items), irritability (4 items), sadness (4 items), feelings of loss (5 items), and decreased ability to function at usual tasks (4 items). These items use Likert 5-level scoring method, all 27 items are summed to calculate a total score that ranges from 27 to 135, with higher scores indicating higher levels of anticipatory grief. The Chinese version of the AGS scale has become a more mature scale used by Chinese scholars to evaluate the sadness of caregivers of cancer patients and has shown good reliability and validity. The Cronbach\u0026prime;s alpha of the scale in this study was 0.854.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003ePerceptive Social Support Scale (PSSS)\u003c/h2\u003e\u003cp\u003eThe scale was developed by Zimet et al\u003csup\u003e32\u003c/sup\u003e to measure the degree of social support felt by individuals. The Chinese version of this scale was revised by Huang et al,\u003csup\u003e33\u003c/sup\u003e which consists of 12 items, including 3 dimensions of family support, friend support, and other support, each dimension has 4 items, These items use the Likert 7-level scoring method, all 12 items are summed to calculate a total score that ranges from 12 to 84, with higher scores indicating higher levels of perceptive social support. The Cronbach\u0026prime;s alpha of this scale in this study was 0.912.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSimplified Coping Style Questionnaire (SCSQ)\u003c/h3\u003e\n\u003cp\u003eThe scale was developed by Xie\u003csup\u003e34\u003c/sup\u003e based on referring to the foreign coping style scale and Chinese cultural background and was used to evaluate the cognitive and behavioral styles adopted by individuals in the face of difficulties, with a total of 20 items, including positive coping dimension(1\u0026thinsp;~\u0026thinsp;12 items) and negative coping dimension(13\u0026thinsp;~\u0026thinsp;20 items), each item adopts the Likert 4-level scoring method, the higher the score in a certain dimension, the more inclined the individual is to adopt this coping style. The Cronbach's alpha of these two dimensions in this study were 0.887, 0.842.\u003c/p\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eIn this study, SPSS25.0 and Mplus8.3 software were used for data processing. The scores of each dimension of the illness uncertainty scale were standardized by z-scores, then the LPA was carried out, starting from the initial model (assuming that there is one class), and the classes in the model were increased sequentially until the model reached the best fit. The model fit indices were as follows: Akaike information criterion (AIC), Bayesian information criterion (BIC), Sample-Size Adjusted Bayesian Information Criterion (aBIC), lower values of AIC, BIC, and SS-BIC indicate a better fit. The closer Entropy (classification quality) value is to one, which indicating the classification is more accurate. Significant LMR-LRT (Vuong-Lo-Mendell-Rubin likelihood ratio test) and BLRT (Bootstrap Likelihood Ratio Test) indicate a marked improvement of the k-class model compared to the k-1-class model. Measurement dates of the normal distribution are described by M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD. Non-normally distributed measurement data were described by Median(IQR), and the Wilcoxon Mann-Whitney U test was used for comparison between the two groups, and the Kruskal-Wallis H test was used for comparison between multiple groups. \"Frequency and percentage\" were used to describe categorical data or ranked data, and the chi-square test was used for comparisons between multiple groups. Spearman correlation analysis was used for correlation analysis. Multiple linear regression analysis was used to investigate the effect of different latent classes of illness uncertainty on the level of anticipated grief in FCs of patients with advanced digestive system cancer.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003elatent classes of illness uncertainty\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 1~5 latent class models were exploratorily verified, and the model fitting results are shown in Table 1. With the increase in the number of classes in the model, the AIC, BIC, and SS-BIC values all decreased successively. When the three latent classes were retained in the model, the Entropy value was closest to one, and the LMR-LRT and BLRT were statistically significant. The Entropy value was higher for the three-class model compared to the four-class model. When the number of included classes on the model increased to five, although the AIC, BIC, and SS-BIC values were the smallest, the LMR-LRT P-value was not statistically significant. Finally, the three-class model was selected as the optimal result of LPA for illness uncertainty, the average latent class probabilities for the three-class model ranged from 0.905 to 0.945, further confirming the high accuracy of the classification.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003e\u003cstrong\u003eGoodness-of-fit statistics for 1\u0026ndash;5 class solutions.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eModel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003eAIC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003eBIC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003eaBIC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eEntropy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eLMR-LRT(\u003cem\u003eP\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eBLRT(\u003cem\u003eP\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e3224.470\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e3253.633\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e3228.265\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e2988.520\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e3035.911\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e2994.688\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0.777\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e2891.991\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e2957.609\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e2900.530\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0.823\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e2872.577\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e2956.422\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e2883.489\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0.803\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e0.135\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e2858.095\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e2960.168\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e2871.379\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0.820\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e0.445\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: AIC, Akaike information criterion; BIC, Bayesian information criterion; aBIC, Sample-Size Adjusted Bayesian Information\u0026nbsp;Criterion; LMR-LRT, Vuong-Lo-Mendell-Rubin likelihood ratio test; BLRT, Bootstrap Likelihood Ratio Test; -, no such value\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFeatures and names of each latent class of illness uncertainty\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFig.1 shows the standardized scores of four dimensions of illness uncertainty in FCs belonging to different latent classes. The three latent classes were named according to their respective characteristics. The illness uncertainty of FCs in class 1 showed the medium level, with a score of [79.00 (74.00, 83.00)], but the standardized score of the unpredictability dimension was the highest, so it was named as \u0026quot;intermediate- level\u003cstrong\u003e-\u003c/strong\u003eunpredictability group\u0026quot;, which accounting for 24.4% (n=69) of the sample. The illness uncertainty of FCs in class 2 showed the middle-upper level, with a score of [93.00 (88.00, 99.00)], and the standardized scores of each dimension were relatively similar, and the number of people accounted for the largest, so it was named as \u0026quot;middle-upper-level-stability group\u0026quot;, which accounting for 48.4% (n=137) of the sample. The illness uncertainty of FCs in class 3 showed a high level, with a score of [118.00 (110.00, 122.00)], especially the complexity dimension showed the highest standardized score, so it was named \u0026quot;high- level-complexity\u0026quot;, which accounts for 27.2% (n=77) of the sample.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComparison of demographic and perceptive social support and coping style between latent classes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere are significant differences in general information such as age, individual average monthly income, education level, relationship with patients, religious beliefs, and total time spent caring for patients between multiple classes. Meanwhile, FCs who belonged to different latent classes also had statistically significant differences in scores of all dimensions of perceived social support, and all three latent classes of illness uncertainty had the highest scores of family support. Among the two dimensions of coping style, only the positive coping dimension showed a significant difference, those who belonged to the intermediate-level\u003cstrong\u003e-\u003c/strong\u003eunpredictability group were more inclined to adopt positive coping styles than those who belonged to the high-level-complexity group. However, in the subsequent disordered multi-class logistic regression analysis, it was found that the pairwise comparison of the three latent classes did not show significant differences in the variables, so it is not reported in this paper. See Table 2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Comparison of demographic and perceptive social support and coping style between latent classes.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCLASS 1\u003c/strong\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003en=69\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCLASS 2\u003c/strong\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003en=137\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCLASS 3\u003c/strong\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003en=77\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSignificant test\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003eAge N(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e48.315\u003csup\u003ea\u003c/sup\u003e\u003csup\u003e①\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003e\u0026lt; 30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e11（15.9）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e19（13.9）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e6（7.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003e30~50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e43（62.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e99（72.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e27（35.1）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003e\u0026gt; 50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e15（21.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e19（13.9）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e44（57.1）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003eGender N(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.066\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.968\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003emale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e32（46.4）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e61（44.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e35（45.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e37（54.6）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e76（55.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e42（54.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003eCurrent residence \u0026nbsp;N(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e1.935\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.748\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003evillage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e17（24.6）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e44（32.1）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e26（33.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003etown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e23（33.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e42（30.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e25（32.4）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003ecity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e29（42.1）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e51（37.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e26（33.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003eIndividual average monthly income N(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e49.066\u003csup\u003ea\u003c/sup\u003e\u003csup\u003e①\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003e\u0026yen;\u0026lt;5000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e11（15.9）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e35（25.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e43（55.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003e\u0026yen;5000~10000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e28（40.6）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e80（58.4）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e21（27.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003e\u0026yen;\u0026gt;10000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e30（43.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e22（16.1）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e13（16.9）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003eEducation level N(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e17.293\u003csup\u003ea\u003c/sup\u003e\u003csup\u003e①\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003eJunior high school and below\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e15（21.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e36（26.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e35（45.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003eSenior high school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e26（37.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e66（48.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e28（36.4）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003eCollege and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e28（40.6）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e35（25.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e14（18.1）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003erelationship with patient N(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e3.401\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.493\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003eCouple/partner\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e27（39.1）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e54（39.4）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e26（33.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003eParents\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e36（52.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e67（48.9）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e37（48.0）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003eBrothers and sisters\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e6（8.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e16（11.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e14（18.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003ereligious belief N(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e9.659\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003eHave\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e25（36.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e23（16.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e19（24.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003eNot\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e44（63.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e114（83.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e58（75.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003eTotal time spent caring for patient N(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e14.106\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003e\u0026le; 3 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e11（15.9）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e24（17.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e24（31.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003e3~6 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e15（21.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e33（24.1）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e20（26.0）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003e6~12 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e16（23.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e42（30.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e21（27.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003e\u0026ge; 1 year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e27（39.1）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e38（27.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e12（15.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 347px;\"\u003e\n \u003cp\u003ePerceived social support M\u0026plusmn;SD/Median(IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003eFamily support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e24.00（22.00,26.00）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e19.35\u0026plusmn;3.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e16.00（14.00,19.00）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e57.616\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003eFriend support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e24.00（21.50,27.00）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e19.00（16.50,22.00）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e17.00（14.00,20.00）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e21.938\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003eOther support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e20.00（18.00,22.00）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e17.00（15.00,19.00）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e15.00（14.00,17.00）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e11.350\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003eCoping style Median(IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003ePositive coping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e42.00（37.00,46.00）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e42.00（38.00,46.00）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e38.00（36.00,40.00）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e26.275\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003eNegative coping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e13.00（9.00,16.00）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e13.00（11.00,15.50）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e14.00（12.50,16.00）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e3.839\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.147\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote:CLASS1, intermediate-level-unpredictability; CLASS2, middle-upper-level-stability group; CLASS3, high-level-complexity group\u003c/p\u003e\n\u003cp\u003ea: Chi-square; b: Kruskal-Wallis H Test\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRelationship between the latent classes of illness uncertainty and anticipatory grief\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUnivariate analysis of anticipatory grief in FCs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUnivariate analysis showed that there were significant differences in anticipatory grief among FCs of different ages, gender, current residence, individual average monthly income, education level, relationship with patients, religious beliefs, total time spent caring for patients and latent classes of illness uncertainty. See Table 3.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e\u003cstrong\u003e: Univariate analysis of anticipatory grief in FCs. [\u003c/strong\u003e\u003cstrong\u003eMedian(IQR)\u003c/strong\u003e\u003cstrong\u003e]\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnticipatory grief score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSignificant test\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u0026lt; 30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e106.00(101.00,107.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e120.526\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e30~50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e169\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e92.00(84.50,98.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u0026gt; 50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e80.00(72.00,85.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003emale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e97.00(88.25,105.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e-7.503\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e85.00(79.00,93.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eCurrent residence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003evillage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e103.00(96.00,107.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e115.062\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003etown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e90.00(80.00,94.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003ecity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e82.00(76.50,90.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eIndividual average monthly income\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u0026yen;\u0026lt;5000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e103.00(95.50,107.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e136.137\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u0026yen;5000~10000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e91.00(82.00,94.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u0026yen;\u0026gt;10000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e79.50(71.25,84.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eEducation level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eJunior high school and below\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e103.00(96.75,107.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e143.747\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eSenior high school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e91.00(82.25,95.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eCollege and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e80.00(72.00,84.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eRelationship with patient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eCouple/partner\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e101.00(90.00,106.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e89.788\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eParents\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e88.50(80.00,94.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eBrothers and sisters\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e80.00(72.25,84.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eReligious beliefs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eHave\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e216\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e94.00(86.25,101.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e-9.212\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eNot\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e80.00(71.00,84.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eTotal time spent caring for patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u0026le; 3months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e105.00(101.00,107.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e148.621\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e3~6months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e88.96\u0026plusmn;10.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e6~12months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e93.00(88.00,96.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u0026ge; 1year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e80.00(72.00,84.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003elatent classes of illness uncertainty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eIntermediate-level-unpredictability group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e80.00(71.50,83.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e164.204\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eMiddle-upper-level-stability group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e1377\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e90.00(82.00,94.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eHigh-level-complexity group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e104.00(99.00,107.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: a: Kruskal-Wallis H Test；b: Wilcoxon Mann-Whitney U Test\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorrelation analysis of FCs\u0026apos; perceived social support, coping style, and anticipatory grief\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSpearman correlation analysis showed that anticipatory grief in FCs\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eof patients with advanced digestive cancer was negatively correlated with the family support dimension, friend support dimension, other support dimension of perceptive social support, and negative coping, and positively correlated with positive coping. See Table 4.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4: Correlation analysis of FCs\u003c/strong\u003e\u003cstrong\u003e\u0026apos;\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eperceived social support, coping styles, and anticipatory grief.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily support\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFriend support\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOther support\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePositive coping\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNegative coping\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnticipatory grief\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eFamily support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eFriend support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0.626**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eOther support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0.528**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0.598**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003ePositive coping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0.380**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0.266**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.222**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eNegative coping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e-0.364**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e-0.337**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e-0.373**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e-0.355**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eAnticipatory grief\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e-0.475**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e-0.311**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e-0.255**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e-0.432**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e0.308**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote：**, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.001\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMultiple linear regression analysis for anticipatory grief in FCs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTaking anticipatory grief as the dependent variable, the statistically significant variables in Table 3 and Table 4 were included as independent variables in the regression equation for analysis. The model was statistically significant.Regression analysis showed that among the three latent classes, only the \u0026quot;high-level-complexity group\u0026quot; could positively predict a high level of anticipatory grief. In addition, education level, age, individual average monthly income, negative coping, positive coping, family support, and village were also important influencing factors of anticipatory grief in FCs of advanced digestive system cancer patients. See Table 5.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5\u003c/strong\u003e\u003cstrong\u003e: Multiple linear regression analysis for anticipatory grief in FCs.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndependent variable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026beta;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003et\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003eConstant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e124.084\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e6.141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e20.207\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003eEducation level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e-4.7770\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e2.344\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e-0.291\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e-2.035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.043\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003eNegative coping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.798\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e0.234\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e6.080\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003ePositive coping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e-0.309\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.093\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e-0.130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e-3.329\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e-3.414\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1.590\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e-0.170\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e-2.148\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003eIndividual average monthly income\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e-4.408\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1.823\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e-0.263\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e-2.418\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003eFamily support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e-0.327\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e-0.100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e-2.380\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003eCurrent residence\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003evillage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e-9.853\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e3.110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e-0.366\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e-3.169\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003elatent classes of illness uncertainty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003eHigh-level-complexity group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e9.873\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e2.646\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e0.354\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e3.731\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote：R\u003csup\u003e2\u003c/sup\u003e=0.673；adjusted R\u003csup\u003e2\u003c/sup\u003e=0.664；F=70.596；\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cstrong\u003eThree talent classes of illness uncertainty\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe present study employed LPA to determine that FCs of patients with advanced digestive cancer had individual differences, three latent classes were identified, including intermediate-level-unpredictability group (24.4%), middle-upper-level-stability group (48.4%) and high-level-complexity group (27.2%).\u0026nbsp;Intermediate-level-unpredictability group of FCs have the lowest total score of\u0026nbsp;illness uncertainty, this group\u0026nbsp;of FCs can\u0026nbsp;fully perceive the support and understanding from relatives, friends, medical staff, and other aspects, possess a high level of\u0026nbsp;perceptive\u0026nbsp;social support, and tend to adopt a problem- solving-oriented\u0026nbsp;positive coping strategy\u0026nbsp;to confront the\u0026nbsp;illness\u0026nbsp;uncertainty caused by advanced digestive system cancer, FCs of this latent class tends to view illness uncertainty is an opportunity, they endeavor to obtain information about advanced digestive system cancer from various sources to deepen their understanding of the cause, development, severity, treatment and other aspects of the disease, thereby\u0026nbsp;effectively alleviate\u0026nbsp;their\u0026nbsp;illness\u0026nbsp;uncertainty. However, clinical symptoms of advanced\u0026nbsp;digestive system cancer such as severe pain, hematemesis,\u0026nbsp;digestive\u0026nbsp;obstruction, cachexia resulting from severe nutrient consumption, multiple organ failure, and others occur successively, the patients\u0026rsquo; condition may change dramatically in a short period, which\u0026nbsp;is\u0026nbsp;difficult to predict, the treatment and nursing plan becomes increasingly\u0026nbsp;intricate, and it is\u0026nbsp;difficult to determine whether there is a therapeutic effect or\u0026nbsp;other factors, which result in the\u0026nbsp;illness\u0026nbsp;uncertainty of this\u0026nbsp;group\u0026nbsp;of FCs\u0026nbsp;is\u0026nbsp;mainly\u0026nbsp;manifested in\u0026nbsp;the\u0026nbsp;dimension of\u0026nbsp;unpredictability\u0026nbsp;and\u0026nbsp;ambiguity. High-level-complexity\u0026nbsp;group of FCs have\u0026nbsp;the\u0026nbsp;highest total score of\u0026nbsp;illness uncertainty, with the highest score in the complexity dimension among the four dimensions. They are characterized by relatively older age, lower education level and individual average monthly income, so usually encounter difficulties in comprehending knowledge related to the treatment of advanced digestive system cancer and limited access to disease-related information,\u003csup\u003e35\u003c/sup\u003e in addition,\u0026nbsp;negative perception toward cancer significantly decreased\u0026nbsp;their willingness of\u0026nbsp;self-disclosure,\u003csup\u003e36\u003c/sup\u003e it is difficult for the outside world to provide targeted medical information support based on their current confusion, FCs of this latent class tends to view illness uncertainty is a threat, which can easily form a vicious cycle and ultimately lead to the emergence of high levels of illness uncertainty.\u003csup\u003e27\u0026nbsp;\u003c/sup\u003eAmong the three latent classes, the middle-upper-level-stability group of FCs occupies the largest proportion, nearly half of the FCs of patients with advanced digestive system cancer fall into this class, this group of FCs care for patients for a relatively short duration, and they usually have to endure a series of adverse factors such as limited comprehension of the patients\u0026rsquo; current overall condition, treatment measures and daily nursing procedures, and the medical staff might not have fully explained the condition, resulting in a relatively high level of illness uncertainty. This group can be regarded as a transition between intermediate-level-unpredictability group and high-level-complexity group, for this group of FCs, medical staff should consider implementing cognitive-behavioral interventions for this latent class of FCs to change their fear of illness uncertainty caused by advanced cancer, and guide them to consider improving their own illness uncertainty as an positive factor in further enhancing their nursing abilities and improving the quality of life of their loved ones in the end-of-life stage, in order to prevent them further sliding into the high-level-complexity group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEffect of latent classes of illness uncertainty on anticipatory grief\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results of this study show that FCs who belong to different latent classes of illness uncertainty have statistically significant differences in anticipatory grief. The high-level-complexity group of FCs have the highest level of anticipatory grief, followed by the middle-upper-level-stability group of FCs and the intermediate-level-unpredictability group of FCs have the lowest level of anticipatory grief. Multiple linear regression analysis shows that only the high-level-complexity group can positively predict anticipatory grief, which is one of the important influencing factors of anticipatory grief. The high level of illness uncertainty can increase the caregiver burden of FCs,\u003csup\u003e37\u003c/sup\u003e resulting in the deterioration of their physical fitness and quality of life,\u003csup\u003e38\u003c/sup\u003e and diminish their psychological resilience,\u003csup\u003e39\u003c/sup\u003e thereby resulting in FCs being in negative emotions such as anxiety, fear, pessimism, and disappointment, which is manifested as an escalation in the level of anticipatory grief. In contrast, the intermediate-level-unpredictability group of FCs focus on patient care, actively seek help from medical professionals, learn knowledge about disease treatment and care, and strive to improve their ability to complete nursing tasks, effectively maintain the quality of life of their loved ones in the final stages of life, the reduction of pain before the death of a loved one can effectively relieve the grief of FCs.\u003csup\u003e40\u003c/sup\u003e Therefore, clinical nurses should pay special attention to FCs demonstrating a high degree of illness uncertainty, and fully take into account the characteristics of the high-level-complexity group of FCs, such as poor learning adaptability, lack of information-receiving channels, and low willingness for self-disclosure,\u0026nbsp;offer multiple and individualized interventions to guarantee that FCs of patients with advanced digestive system cancer can form accurate cognition and judgment of the disease status of their loved ones, reduce their level of illness uncertainty, to help FCs reduce their level of anticipatory grief, get rid of the emotional distress caused by sadness earlier, and accept the imminent occurrence of bereavement events.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInfluencing factors of anticipatory grief\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAge, education level, individual average monthly income, current residence, coping style, and perceived social support were also verified to be important influencing factors of anticipatory grief in FCs of patients with advanced digestive system cancer. Compared with the elderly, middle-aged and young people, especially \u0026lt;30 years old FCs, tend to have a higher level of anticipatory grief, most middle-aged people have to strike a balance between work and care tasks, therefore their physical and mental burden substantially exacerbate, resulting in a relatively high level of anticipatory grief,\u003csup\u003e31\u003c/sup\u003e Chinese young people often lack death education, and lack the experience of caring for relatives or facing their death,\u003csup\u003e41\u003c/sup\u003e making youth more difficult to accept the imminent occurrence of bereavement events, and easily fall into intense grief. FCs with higher education levels usually have higher cognition and acceptance of advanced digestive system cancer, thus the level of illness uncertainty is relatively low, and understand that bereavement events should be viewed more holistically, and positive factors from traumatic events can be found to obtain corresponding growth. Therefore, there is an inverse relationship between education level and anticipatory grief.\u003csup\u003e42\u003c/sup\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ebuffer theory of social support suggests that perceived social support can provide individuals with important psychological resources, effectively replenish their lost psychological energy, buffer the impact of negative life events on individuals,\u003csup\u003e43\u003c/sup\u003e and control their grief within a reasonable range, in this study, the family support dimension scored the highest among the three dimensions of perceived social support, indicating that FCs are more inclined to use family affection rather than friendship or other social relationships to deal with their grief, because family members can express and share emotions more openly, and fully listen to and meet each other\u0026apos;s needs, which can make FCs more likely to experience support and understanding from the outside world, which may also be the reason for the relatively high level of anticipatory grief in FCs living in village, they usually have to seek medical treatment outside of FCs\u0026rsquo; current residence and are separated from family support system in unfamiliar environment, FCs has received extremely limited support, which makes their difficult to express their negative emotions effectively, resulting in high level of anticipatory grief. Coping style is an important regulating factor between stress response and stress outcome, the level of anticipatory grief is lower in FCs with positive coping. However, when negative attitudes such as avoidance and denial are used to deal with various problems during the care period, the level of anticipatory grief is higher. Positive coping styles can achieve positive adjustment of emotions and effective solutions of problems to maintain the good mental health of FCs and form a virtuous cycl.\u003csup\u003e44\u003c/sup\u003e FCs with negative coping attitudes tend to underestimate their ability to solve problems and escape from them, avoidance and self-abandonment can amplify the negative effects of bereavement events and cause FCs to experience more intense feelings of grief.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy limitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSeveral limitations in this study should not be ignored. The research objects included in this study were only from one hospital, and a convenient sampling method was adopted to collect data, which limited the representativeness and popularization of samples. Future studies should plan to adopt multi-center and large sample designs to verify the results of this study. In addition, this study is a cross-sectional study, future studies may adopt a longitudinal study design to explore the dynamic change trajectory of anticipatory grief in FCs of patients with advanced digestive system cancer, and further analyze the influence of illness uncertainty on different trajectory classes of FCs in anticipatory grief.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical implications\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe present study employed LPA to identify three different latent classes of illness uncertainty in FCs of patients with advanced digestive system cancer. Only the high-level-complexity group could positively predict the high level of anticipatory grief in FCs of patients with advanced digestive system cancer, this study laid a theoretical and practical foundation for the subsequent precise intervention of illness uncertainty based on improving anticipatory grief in FCs.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn the current study, we demonstrated the heterogeneity of illness uncertainty by a person-centered approach and analyzed the effect of different latent classes of illness uncertainty on anticipatory grief in FCs, in addition to exploring associated influencing factors of anticipatory grief in family caregivers of patients with advanced digestive cancer. Clinical nurses should pay special attention to FCs demonstrating a high degree of illness uncertainty and develop an appropriate intervention program to help FCs reduce their anticipatory grief earlier.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eFCs \u0026nbsp; family caregivers\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowlegements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe appreciate each participant\u0026rsquo;s contributions and the study participants\u0026apos; cooperation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization, Methodology, Data curation, Formal analysis, writing: F.W.H, Y.Y.L, H.X.Z; Methodology, Writing-Original draft preparation: F.W.H, H.X.Z; Formal ananlysis, Writing-Revised draft preparation, Data curation: Y.Y.L, Q.Q.C; Conce-ptualization, Methodology, Data collection, Writing-Original and Revised draft preparation: F.W.H, Y.Y.Z, C.D.H. All authors had full access to all the data in the study, and the corresponding author had final responsibility for the decision to submit for publication. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. Approval was granted by the Ethics Committee of the Cancer Hospital of Shangdong First Medical University (ethics number: SDTHEC2024001031).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHan RS, Zheng RS, Zeng HM, et al. Cancer incidence and mortality in China,2022. \u003cem\u003eNatl Cancer Cent\u003c/em\u003e. 2024;46(3):221-231. https://doi.org/10.1016/j.jncc.2024.01.006\u003c/li\u003e\n\u003cli\u003eJia SQ, Zhou QY, Liu HM, et al. The mortality trend of digestive tract malignant tumor in China from 2004 to 2018. \u003cem\u003eChin J Dis Control Prev\u003c/em\u003e. 2021;25(09):1020-1025.\u003c/li\u003e\n\u003cli\u003eLi J, Li H, Zeng H, et al. 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Applicability of the pre-death grief concept to dementia family caregivers in Asia. \u003cem\u003eInt J Geriatr Psychiatry\u003c/em\u003e. 2016;31(7):749-754. https://doi.org/10.1002/gps.4387\u003c/li\u003e\n\u003cli\u003eAlloway R, Bebbington P. The buffer theory of social support--a review of the literature.\u003cem\u003e Psychol Med\u003c/em\u003e. 1987;17(1):91-108. https://doi.org/10.1017/s0033291700013015\u003c/li\u003e\n\u003cli\u003eYu W, Lu Q, Lu Y, et al. Anticipatory Grief among Chinese Family Caregivers of Patients with Advanced Cancer: A Cross-Sectional Study. \u003cem\u003eAsia Pac J Oncol Nurs\u003c/em\u003e. 2021;8(4):369-376. https://doi.org/10.4103/apjon.apjon-214\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Advanced digestive cancer, Family caregivers, Illness uncertainty, Anticipatory grief, Latent profile analysis","lastPublishedDoi":"10.21203/rs.3.rs-6484672/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6484672/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e\u003cp\u003eTo explore the latent classes of illness uncertainty in family caregivers of patients with advanced digestive cancer, and to analyze the influence of different latent classes on their levels of anticipatory grief.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA questionnaire survey was conducted among family caregivers of patients with advanced digestive cancer by convenient sampling method. The self-compiled general information questionnaire, Mishel illness uncertainty Scale for Family Member (MULS-FM), Anticipatory Grief Scale (AGS), Perceptive Social Support Scale (PSSS), and Simplified Coping Style Questionnaire (SCSQ) were used to investigate them. Latent profile analysis was used to identify the latent classes of illness uncertainty. Multiple linear regression analysis was used to explore the influence of different latent classes of illness uncertainty on anticipatory grief.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThree latent classes were identified: intermediate-level-unpredictability group (24.4%), middle-upper-level- stability group (48.4%), and high-level-complexity group (27.2%), and only the high-level-complexity group can positively predict anticipatory grief, In addition, education level, age, individual average monthly income, coping style, perceptive social support, and current residence were also important influencing factors for family caregivers of patients with advanced digestive cancer.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThere were obvious classification characteristics of illness uncertainty in family caregivers of patients with advanced digestive system cancer. Our findings may lay a theoretical and practical foundation for the subsequent precise intervention of illness uncertainty to improve anticipatory grief in family caregivers.\u003c/p\u003e","manuscriptTitle":"The relationship between latent classes of illness uncertainty and anticipatory grief in family caregivers of patients with advanced digestive cancer","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-07 06:54:30","doi":"10.21203/rs.3.rs-6484672/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-18T06:33:23+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-03T23:12:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"153810110285690000488189612477395868594","date":"2026-04-24T18:36:21+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-31T20:30:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"315452196579502223397829374544032695313","date":"2025-08-17T19:55:27+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-04T13:27:47+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-25T13:42:31+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-23T23:10:19+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-23T23:08:21+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychology","date":"2025-04-19T12:17:47+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b13972eb-954d-40e1-a291-bb22c3b52e3c","owner":[],"postedDate":"August 7th, 2025","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-18T06:33:23+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-03T23:12:52+00:00","index":97,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-18T06:39:15+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-07 06:54:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6484672","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6484672","identity":"rs-6484672","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}