Family Mutuality Enhances the Family Resilience of CRC Patients through Positive Family Functioning

Family Mutuality Enhances the Family Resilience of CRC Patients through Positive Family Functioning | 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 Family Mutuality Enhances the Family Resilience of CRC Patients through Positive Family Functioning Mengwei Shao, Yanyan Xue, Menghan Zhang, Huiyue Zhou, Bin Ma, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4793857/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 13 Sep, 2025 Read the published version in Supportive Care in Cancer → Version 1 posted 7 You are reading this latest preprint version Abstract Aims: To elucidate the influencing factors of family resilience of postoperative colorectal cancer (CRC) patients, and how family resilience is affected by family function and mutuality. Methods: In this cross-sectional study, we investigated 216 postoperative CRC patients from two public hospitals. We started by studying the sociodemographic and disease-related factors impacting family resilience of CRC patient families through t-tests, one-way ANOVA, and Post Hoc Multiple Comparisons. To understand how family resilience could be affected from the family level, given the critical role of the copying capacity of family in the outcomes of postoperative CRC patients, we further investigated three key aspects of a family, i.e., family resilience, family function, and family mutuality using the Family Resilience Questionnaire (FaREQ), the Family Adaptation, Partnership, Growth, Affection, Resolve (APGAR) Scale, and the Mutuality Scale (MS). Then, based on all these results, we examined the interaction between family resilience, family function, and mutuality through Pearson correlations and the SPSS PROCESS macro. Results: Six factors were identified to be associated with family resilience among families of postoperative CRC patients, including postoperative duration( F =3.684, p =0.013), education level ( F =7.609, p < 0.001), marital status ( F =2.822, p =0.040), working status ( F =3.807, p =0.024), family income ( F =9.487, p <0.001), and stoma status ( t =-2.991, p =0.003). We found that family resilience was positively correlated with both family mutuality ( r =0.170~0.473, p <0.05) and family function ( r =0.135~0.451, p <0.05). Furthermore, we found that a healthy family mutuality could enhance family resilience, and the effectiveness of this enhancement was affected by the status of family function. Conclusions: In addition to sociodemographic and disease-related factors, this work studied the influence factors of family resilience of CRC patient families from a unique perspective, by systematically investigating the interaction between family resilience, family function, and family mutuality. Our results suggested that (1) family mutuality and family function were protective factors for family resilience; (2) Family function played a crucial role in mediating the positive effects of mutuality on family resilience. Based on our results, we suggest that healthcare professionals should assess family resilience actively from not only the sociodemographic and disease levels, but also from a more comprehensive family level, to develop effective intervention strategies to enhance the coping and adaptive capacities of families of CRC patients during the postoperative cancer management. colorectal cancer family function mutuality family resilience cancer management. Figures Figure 1 Figure 2 Figure 3 1. Introduction Colorectal cancer (CRC), a type of cancer that affects the colon or rectum, is a significant health concern worldwide (Dekker et al., 2019 ). The nature of CRC makes it a particular challenge for caring. As known, CRC is featured by an insidious onset, often without apparent symptoms in the early stages, which causes a large number of patients to be diagnosed in the middle or late stages, and leads to a poorer prognosis (Lu et al., 2020 ). Importantly, surgery is still the primary treatment of CRC, which not only significantly alters the body perception of patients (e.g., stomas status), but also is accompanied by high recurrence rates, prolonged treatment schemes, and high treatment costs. As a result, despite advances in CRC diagnosis and treatment over the past decades, with around a 50% increase in the five-year survival rate, the challenges of coping with the physical and psychological burden of CRC treatment remain a significant concern for both patients and healthcare providers and often results in compromised treatment motivation and poor quality of life for both CRC patients and their families (Cotrim and Pereira, 2008 ). It is essential to provide comprehensive support to CRC patients and their caregivers (normally their family members) as a whole to improve the outcome of CRC treatment. Indeed, strong family support is critically important to help CRC patients and their families cope with the crises brought about by the disease (Shao et al., 2023b ). In this aspect, three key aspects that determine the copying capacity of a family, i.e., family resilience, function, and mutuality, have been particularly emphasized. Family resilience refers to the inherent quality and capacity of a family to adapt, thrive, and maintain stability in the face of adversity or crises (Walsh, 1996 ). A good family resilience is especially important in the context of postoperative CRC management. This is because the prolonged physiological, psychological, and social pressures potentially induce conflicts among CRC family members and patients, and lead to a decline in family intimacy and even family crises (Samuelsson et al., 2022 ; Tseng et al., 2019 ). Family function refers to the capacity of a family to meet its members' physical and emotional requirements through mutual support, emotional communication, and sharing burdens (Shek, 2002 ; Zhang, 2018 ). Olson claimed that effective family function was a fundamental cornerstone for a well-operating family, which could help cultivate the capacity of a family to cope with adversarial situations (Olson et al., 1983 ). At the same time, multiple research studies have indicated a positive correlation between family function and family resilience. Families with better family function commonly exhibited greater resilience to changes in family production and life caused by diseases (Kim and Ahn, 2022 ). Mutuality denotes the quality of communication, cooperation, and intimacy between the patients and family caregivers (Archbold et al., 1990 ). Li et al.indicated that strengthening the mutuality between patients and family caregivers could foster their empathy and trust, leading to a more intimate bond and creating a positive family environment to cope with lung cancer (C. Li et al., 2022 ). Indeed, positive mutuality between patients and family caregivers could not only create a healthy, more interactive environment among family members but also directly enhance family resilience to help families effectively deal with crises raised by cancer treatment (Ahmad et al., 2017 ). Although all these three factors collectively contribute to effective CRC management, family resilience plays a central role in the crisis management of the family. However, the detailed interactive mechanisms between these factors, especially about how family function and mutuality affect family resilience, remain unknown. Answering these questions is of obvious importance for improved CRC care. Recently, we identified several sociodemographic (e.g., age, educational level, family income) and disease-related factors (e.g., disease duration, stoma status) that potentially impact family resilience in postoperative CRC patients (Shao et al., 2023b ). In this work, we will further investigate the interactions of these factors for optimal CRC care. And importantly, these results will serve as a starting point to allow us to explore the interaction between family resilience, function, and mutuality. This will provide deep insights into this critical area of CRC care. 1.1 Conceptual Framework The conceptual framework of this study was based on existing theories of the Resiliency Model of Family Stress Adjustment and Adaptation (RMFAA) and Family Systems. According to RMFAA, the family function and mutuality among family members play significant roles in shaping family resilience (Mccubbin et al., 1993 ). Meanwhile, the Family Systems theory proposes that the family is a system characterized by constraints and interconnections, and the mutuality among family members (marital, parent-child, and sibling relationships) is essential for the orderly operation of the family function (Fisher et al., 2021 ; Watson, 2012 ). Additionally, the research by Gibbons and Macía demonstrated that fostering healthy mutuality could strengthen emotional connections within a family, improve family function, and empower family members to cope with crises and challenges collaboratively (Gibbons et al., 2019 ; Macía et al., 2021 ). Thus, based on the above theories and studies, we hypothesized that both family function and mutuality were protective factors for family resilience, and family function may mediate between mutuality and family resilience. Based on this, we further suggested that such a relationship exists among postoperative CRC families and that family function mediates the effects of mutuality on family resilience. The conceptual framework of this study is illustrated in Fig. 1 . 1.2 Aim and Hypotheses To date, there has been a lack of investigation into the interaction between family resilience, function, and mutuality among postoperative CRC families and the underlying mechanisms involved. To fill the knowledge gap in this area, this study aimed to (1) investigate the interaction between family resilience, function, and mutuality and (2) elucidate whether and how \family function mediates the effect of mutuality on family resilience. The study's hypotheses are formulated as follows: H1: Family function is positively correlated with mutuality and family resilience. H2: Mutuality is positively correlated with family resilience. H3: Family function mediates the correlation between mutuality and family resilience. 2. Methods 2.1 Experimental Design and Participants In this cross-sectional study performed from February 2023 to July 2023, a convenience sampling approach was employed. Postoperative colorectal cancer (CRC) patients who met inclusion criteria were recruited from two major public hospitals in Henan Province, China. These criteria included: (1) being pathologically diagnosed with CRC, (2) having undergone surgery, (3) being 18 years or older, and (4) providing informed consent. Exclusion criteria comprised having a history of mental illness, severe mental or cognitive dysfunction, primary malignant tumors in other sites, and severe lung, brain, heart, liver, or kidney diseases. 2.2 Ethical Considerations This study was carried out in adherence to the principles of the Declaration of Helsinki. The Zhengzhou University Life Sciences Ethics Review Board approved this study with the assigned approval number ZZUIRB 2023-097. Before conducting the survey, the participants were provided with a comprehensive explanation of the objective and importance of the study. Then, all the participants signed informed consent forms and completed paper questionnaires anonymously. The data we collected were kept strictly confidential. Participants could withdraw anytime during the study, and we would respect their willingness. 2.3 Sample Size The sample size was estimated using the Monte Carlo Power Analysis for Indirect Effects Software (Schoemann et al., 2017 ). The target power (1- β ) was set at 0.8, and the confidence interval width was 95% (corresponding to α = 0.05). Based on the pre-experimental results, the sample size for this study was calculated to be 123 (refer to Supplementary Table 1). After accounting for a wastage rate of 20%, a minimum sample size of 154 was required. 2.4 Data Collection This investigation was conducted by three postgraduate nursing students who had received specialized training. Postoperative CRC patients were recruited through convenience sampling from February 2023 to July 2023 from two public hospitals in Henan Province, China. Before the commencement of the investigation, the purpose, content, procedures, and the principle of anonymity of the study were explained to the participants. Following this, the participants provided informed consent and proceeded to complete a paper questionnaire. In cases where participants were unable to independently complete the questionnaire, the investigator read out the questions and recorded the responses provided by the participants. Out of the 231 questionnaires collected, 15 were deemed invalid and were excluded from the analysis due to missing data or incorrect completion. The final number of valid questionnaires included in the analysis was 216, resulting in a valid response rate of 93.5% (Fig. 2 ). 2.5 Measurements 2.5.1 General Information Questionnaire for Participants A self-designed general information questionnaire was utilized to collect demographic and disease-related data from postoperative CRC patients. Demographic details encompassed age, gender, residence, education level, marital status, and income, while disease-related information included stoma status, postoperative duration, and cancer stages. Participants provided their demographic characteristics, whereas the investigators recorded the disease-related information based on the participant's medical records. 2.5.2 Family Resilience Questionnaire (FaREQ) Family resilience was assessed using the 24-item Chinese version of the Family Resilience Questionnaire (FaREQ), a self-reported scale developed by Italian scholar FACCIO (Faccio et al., 2019 ) and translated by Li (Li et al., 2022 ). The scale consisted of four subscales: Communication and Cohesion, Perceived Family Coping, Perceived Social Support, and Religiousness and Spirituality. Each item was scored using a 7-point Likert scale, with 1 ~ 7 representing “strongly disagree” to “strongly agree”. The scale scores ranged from 24 to 168, with higher scores indicating better family resilience. In this study, the Cronbach's α coefficient of this scale was 0.88. 2.5.3 The Family Adaptation, Partnership, Growth, Affection, Resolve Index Scale (APGAR) The family function was assessed using the Chinese version of the APGAR scale, a convenient self-report scale developed by Smilkstein (Smilkstein, 1978 ). The scale consisted of four subscales: adaptation, partnership, growth, affection, and resolution. Each item was scored using a 3-point Likert scale, with 0 ~ 2 representing “never” to “often”. A total score of 7 ~ 10 indicated good family function, 4 ~ 6 indicated a moderate disorder of family function, and 3 or less indicated a severe disorder of family function. In this study, the Cronbach’s α coefficient of this scale was 0.72. 2.5.4 Mutuality Scale (MS) This study assessed the mutuality between patients and family caregivers using the 15-item Chinese version of the Mutuality Scale (MS) (Archbold et al., 1990 ; Shyu et al., 2010 ). The scale consisted of four subscales: Love and Affection, Pleasurable Activities, Reciprocity, and Shared Value. Each item was scored using a 4-point Likert scale, with 0 ~ 4 representing “not at all” to “very much”. The scale was scored on average, with higher scores indicating better intimacy and mutuality, while a score below 2.5 indicated poor mutuality. In this study, the Cronbach's α coefficient of this scale was 0.95. 2.6 Data Analysis IBM SPSS Statistics for Windows (version 25.0, IBM, USA) was used for data analysis. Firstly, the sociodemographic and disease characteristics of the participants and the main study variables (family resilience, family function, and mutuality) were described using descriptive statistics. Continuous data were expressed as M ± SD and categorical data were expressed as percentages and frequencies. Secondly, we compared the associations of sociodemographic and disease characteristics with family resilience scores using t-test and ANOVA. Two independent samples t-test was used to compare two groups of measured values; one-way ANOVA was used to compare multiple groups of measured values. The variables that exhibited statistically significant variations between groups in the one-way analysis of variance (ANOVA) were subjected to Post Hoc Multiple Comparisons (Least Significant Difference, LSD) to elucidate the precise differences between the groups. Pearson correlations were applied to identify correlations between mutuality, family function, and family resilience. Thirdly, we used the SPSS PROCESS (version 3.3) macro to test the mediating effects of family function on the relationship between mutuality and family resilience. A bootstrapping procedure with 5,000 samples was used for the analysis, which provided a more reliable estimate for the small sample size (Igartua and Hayes, 2021 ). The significant indirect effect was indicated by a 95% CI (Confidence Interval) of indirect effect without including 0. Sociodemographic and disease variables showing significant associations with family resilience were set as control variables in the mediation model. All significant tests were two-tailed with a significance level of P < 0.05. 3. Results 3.1 Descriptive Statistics The participants of this study had an average age of 57.38 years (SD = 11.61), with more male patients (62.5%) compared to female patients (37.5%). The majority of the patients were unemployed (61.1%), married (93.5%), and had stage III cancer (40.3%). The data also showed that 57.4% of the patients were within 3 months post-surgery, 58.8% resided in rural areas, 69.4% had a secondary school education or lower, and 42.6% had a chronic illness. Most patients were covered by Medical Insurance for Urban and Rural Residents (73.6%). More detailed sociodemographic and disease characteristics of postoperative patients with CRC are shown in Table 1 . 3.2 Family Resilience Scores for Different Sociodemographic and Disease Characteristics Patients with different sociodemographic and disease characteristics showed different family resilience. The postoperative CRC patients with different postoperative duration ( F = 3.684, p = 0.013), education level ( F = 7.609, p < 0.001), marital status ( F = 2.822, p = 0.040), working status ( F = 3.807, p = 0.024), family income ( F = 9.487, p < 0.001) and stoma status ( t =-2.991, p = 0.003) had significantly different family resilience scores (Table 1 ). The Post Hoc Multiple Comparisons (Least Significant Difference, LSD) indicated that family resilience scores of patients within 3 months after surgery were comparatively lower than those in the 3 ~ 6 months and 6 ~ 12 months groups. Additionally, patients with primary school education and below had lower scores than those with middle, senior, and college education, and unemployed patients had significantly lower scores than employed patients. Meanwhile, our study found that married patients had higher family resilience scores than widowed patients, and families with per capita monthly family income ≥ 5,000 and 3,000 ~ 5,000 Yuan had significantly higher family resilience scores than those with monthly family income < 1,000 and 1,000 ~ 3,000 Yuan. Table 1 Sociodemographic and Disease Characteristics associated with Family Resilience ( n = 216) Variables n (%)/ Mean (SD, Range) Family Resilience Score [M ± SD] t/F P Post Hoc † Gender -1.492 0.137 Male 135(62.5) 96.49 ± 11.73 Female 81(37.5) 99.11 ± 13.71 Age range (Years Old) 57.38 (11.61, 26 ~ 80) 0.894 0.411 18~ 29(13.4) 95.21 ± 18.99 45~ 88(40.7) 97.01 ± 11.90 ≥ 60 99(45.8) 98.55 ± 10.66 Religious 2.012 0.450 Yes 16(7.4) 103.50 ± 9.87 No 200(92.6) 96.99 ± 12.63 Postoperative duration (Months) 3.684 0.013 < 3 (1) 124(57.4) 95.19 ± 10.70 (1) < (2)* 3~ (2) 31(14.4) 101.16 ± 14.12 (1) < (3)* 6~ (3) 25(11.6) 102.04 ± 13.97 ≥ 12 (4) 36(16.7) 99.00 ± 14.55 Cancer stage 1.489 0.219 Stage I 19(8.8) 101.58 ± 10.20 Stage Ⅱ 63(29.2) 98.25 ± 10.96 Stage Ⅲ 87(40.3) 97.46 ± 13.21 Stage Ⅳ 47(21.7) 94.79 ± 13.83 Residence -1.147 0.253 Rural 127(58.8) 96.65 ± 12.55 City 89(41.2) 98.64 ± 12.51 Educational level 7.609 <0.001 Primary school or less (1) 84(38.9) 93.19 ± 11.24 (1) < (2)* Middle school (2) 66(30.5) 97.95 ± 12.82 (1) <(3)** Senior school (3) 52(24.1) 101.79 ± 11.36 (1) (4)** Unmarried (2) 3(1.4) 91.33 ± 10.60 Divorced (3) 4(1.9) 94.75 ± 12.87 Widowed (4) 7(3.2) 85.00 ± 15.16 Work status 3.807 0.024 Unemployed (1) 132(61.1) 95.65 ± 12.35 (1) < (2)* Employed (2) 41(18.5) 101.08 ± 10.61 Retired (3) 43(20.4) 99.66 ± 13.88 Family income (Yuan (¥)) /M/P) 9.487 <0.001 < 1000 (1) 42(19.4) 92.88 ± 10.93 (1) <(3)** 1000~ (2) 99(45.8) 96.99 ± 12.63 (1) <(4)** 3000~ (3) 53(24.5) 102.49 ± 12.40 (2) <(3)** ≥ 5000 (4) 22(10.2) 104.91 ± 14.17 (2) <(4)** Insurance 2.568 0.079 Medical Insurance for Urban and Rural Residents 159(73.6) 96.36 ± 12.43 Employee Medical Insurance 52(24.1) 100.25 ± 12.28 Commercial Insurance 5(2.3) 103.80 ± 15.09 Number of children 1.941 0.124 0 6(2.8) 97.83 ± 11.44 1 38(17.6) 98.89 ± 13.22 2 97(44.9) 99.05 ± 11.66 3 or above 75(34.7) 94.68 ± 13.12 Stoma -2.991 0.003 Yes 82(38.0) 94.27 ± 13.48 No 134(62.0) 99.43 ± 11.55 Chronic illness -0.489 0.627 Yes 92(42.6) 96.99 ± 12.23 No 124(57.4) 97.83 ± 12.81 1. Note: M month, P person; 1.00 Chinese Yuan was equivalent to 0.14 US dollars in 2023. 2. † Post Hoc analyses were adjusted by the Bonferroni test; only significant correlations are listed. 3. * p < 0.05, ** p < 0.01. 3.3 Mutuality, Family Function, and Family Resilience Scores In this study, a total of 216 patients who underwent CRC surgery were included. The mean total score of mutuality was (41.04 ± 9.93). Notably, the mean item score (2.74 ± 0.66) was higher than 2.5, indicating a positive level of mutuality between the patients and family caregivers. The mean total and item score of family function were (7.46 ± 1.90) and (1.49 ± 0.38), respectively, which indicates good family function (total score greater than 7). Furthermore, the total score and item score for family resilience were (97.47 ± 12.54) and (4.06 ± 0.52), respectively. The recorded score was within the range of 50.6–65.4% of the scale score. The specific scores for each item are presented in Table 2 . Table 2 Mutuality, Family Function, and Family Resilience Scores ( n = 216) Items Range Total Score (Mean ± SD) Item Score (Mean ± SD) Love and affection 0 ~ 12 8.94 ± 2.21 2.98 ± 0.74 Pleasurable activities 0 ~ 16 10.28 ± 3.19 2.57 ± 0.80 Shared value 0 ~ 8 4.83 ± 1.43 2.41 ± 0.71 Reciprocity 0 ~ 24 16.99 ± 4.16 2.83 ± 0.69 Mutuality 0 ~ 60 41.04 ± 9.93 2.74 ± 0.66 Adaptation 0 ~ 2 1.57 ± 0.52 1.57 ± 0.52 Growth 0 ~ 2 1.37 ± 0.61 1.37 ± 0.61 Partnership 0 ~ 2 1.49 ± 0.59 1.49 ± 0.59 Affection 0 ~ 2 1.50 ± 0.58 1.50 ± 0.58 Resolve 0 ~ 2 1.53 ± 0.54 1.53 ± 0.54 Family Function 0 ~ 10 7.46 ± 1.90 1.49 ± 0.38 Communication and cohesion 8 ~ 56 39.95 ± 5.31 4.99 ± 0.66 Perceived social support 8 ~ 56 31.24 ± 5.13 3.90 ± 0.64 Perceived family coping 4 ~ 32 17.53 ± 3.06 4.38 ± 0.77 Religiousness and spirituality 4 ~ 32 8.84 ± 4.40 2.21 ± 1.10 Family Resilience 24 ~ 168 97.47 ± 12.54 4.06 ± 0.52 3.4 Correlation between Mutuality, Family Function, and Family Resilience There were significant correlations between mutuality, family function, and family resilience. The results of Pearson correlation analysis indicated that total and item scores of mutuality were positively correlated with family function ( r = 0.170 ~ 0.472, p < 0.05) and family resilience ( r = 0.170 ~ 0.473, p < 0.05) in postoperative CRC patients. Meanwhile, the total and item scores of family resilience were positively correlated with family function ( r = 0.135 ~ 0.451, p < 0.05). More specific results are shown in Table 3 . Table 3 Correlation between Mutuality, Family Function and Family Resilience ( n = 216) Items 1 2 3 4 5 6 7 8 1.Love and affection 1 2.Pleasurable activities 0.807** 1 3.Shared value 0.651** 0.714** 1 4.Reciprocity 0.732** 0.751** 0.744** 1 5.Mutuality 0.882** 0.918** 0.830** 0.930** 1 6.Adaptation 0.284** 0.200** 0.170* 0.242** 0.253** 1 7.Growth 0.344** 0.317** 0.190** 0.271** 0.319** 0.388** 1 8.Partnership 0.385** 0.323** 0.267** 0.299** 0.353** 0.275** 0.302** 1 9.Affection 0.336** 0.253** 0.222** 0.240** 0.288** 0.215** 0.296** 0.329** 10.Resolve 0.223** 0.227** 0.180** 0.219** 0.240** 0.381** 0.312** 0.289** 11.Family Function 0.472** 0.397** 0.308** 0.380** 0.436** 0.657** 0.698** 0.662** 12.Communication and cohesion 0.406** 0.336** 0.323** 0.327** 0.381** 0.155* 0.259** 0.204** 13.Perceived social support 0.185** 0.173* 0.278** 0.218** 0.228** 0.223** 0.170* 0.236** 14.Perceived family coping 0.398** 0.368** 0.318** 0.380** 0.412** 0.276** 0.314** 0.325** 15.Religiousness and spirituality 0.330** 0.313** 0.217** 0.170* 0.276** 0.193** 0.141* 0.140* 16.Family Resilience 0.473** 0.424** 0.412** 0.397** 0.467** 0.314** 0.253** 0.329** Items 9 10 11 12 13 14 15 16 1.Love and affection -- -- -- -- -- -- -- -- 2.Pleasurable activities -- -- -- -- -- -- -- -- 3.Shared value -- -- -- -- -- -- -- -- 4.Reciprocity -- -- -- -- -- -- -- -- 5.Mutuality -- -- -- -- -- -- -- -- 6.Adaptation -- -- -- -- -- -- -- -- 7.Growth -- -- -- -- -- -- -- -- 8.Partnership -- -- -- -- -- -- -- -- 9.Affection 1 -- -- -- -- -- -- -- 10.Resolve 0.352 ** 1 -- -- -- -- -- -- 11.Family Function 0.658 ** 0.682 ** 1 -- -- -- -- -- 12.Communication and cohesion 0.181** 0.259** 0.315** 1 -- -- -- -- 13.Perceived social support 0.208 ** 0.196 ** 0.307 ** 0.351 ** 1 -- -- -- 14.Perceived family coping 0.288** 0.312** 0.451** 0.491** 0.364** 1 -- -- 15.Religiousness and spirituality 0.135 * 0.097 0.210 ** 0.244 ** 0.235 ** 0.193 ** 1 -- 16.Family Resilience 0.315 ** 0.279 ** 0.443 ** 0.764 ** 0.730 ** 0.676 ** 0.585 ** 1 * p < 0.05, ** p < 0.01. 3.5 Mediating Effect of Family Function In this study, we employed family resilience as the dependent variable, mutuality as the independent variable, and family function as the mediator variable, along with control variables (postoperative duration, educational level, marital status, work status, family income, stoma) to establish the mediating effect model, as depicted in Fig. 3 . The results showed that mutuality was a positive predictor of family resilience ( β = 0.316, p < 0.01) and family function ( β = 0.225, p < 0.01). The family function was a positive predictor of family resilience ( β = 0.255, p < 0.01), as shown in Table 4 . The Bootstrap test was used to calculate the 95% CI with 5,000 random samples, and the results are shown in Table 5 . Our results indicated that family function has a mediating effect of 0.057 (95%CI: 0.021 ~ 0.098) on the relationship between mutuality and family resilience in postoperative CRC patients. Additionally, the direct effect of mutuality was 0.259 (95%CI: 0.166 ~ 0.352). These findings suggested that mutuality not only directly and positively predicted family resilience in postoperative CRC patients, but also indirectly predicted it through its influence on family function, with a mediated effect value of 0.057. Table 4 Mediating Effect Model Fitting Index Dependent Variable Independent Variable B SE t P 95%CI R R 2 P Family Function Mutuality 0.225 0.034 6.636 < 0.01 [0.158 ~ 0.291] 0.557 0.310 < 0.01 Family Resilience Mutuality 0.316 0.044 7.256 < 0.01 [0.230 ~ 0.402] 0.627 0.393 < 0.01 Family Resilience Mutuality 0.259 0.047 5.494 < 0.01 [0.166 ~ 0.352] 0.646 0.417 < 0.01 Family Function 0.255 0.088 2.907 < 0.01 [0.082 ~ 0.428] Note: Unstandardized effects reported. Control variables: Postoperative duration, Educational level, Marital status, Work status, Family income, Stoma. Abbreviation: CI, confidence interval. SE, standard error. Table 5 . Mediating Effect of Family Function on the Relationship between Mutuality and Family Resilience Effect relationship Estimate Boot (SE) Boot (BC 95% CI) Total effect of X on Y 0.316 0.044 [0.230~0.402] Direct effect of X on Y 0.259 0.047 [0.166~0.352] Indirect effect of X on Y 0.057 0.020 [0.021~0.098] Note: M, Family Function; X, Mutuality; Y, Family resilience. The indirect effect of X on Y: Mutuality→Family Function→Family resilience (X→M→Y). Control variables: Postoperative duration, Educational level, Marital status, Work status, Family income, Stoma. 4. Discussion To our knowledge, this is the first time the interaction between family resilience, function, and mutuality in postoperative CRC care was systematically investigated. Consistent with our hypotheses, there were positive correlations among mutuality, family function, and family resilience. In addition, our findings strongly suggested that healthy family mutuality could significantly enhance the family resilience of CRC patients, and this was regulated by family function. This work therefore improved our understanding of the detailed mechanisms of how family function and mutuality affect family resilience, and provided valuable information for developing effective interventions to strengthen family resilience. 4.1 CRC patients experienced reduced Family Resilience than some other cancers In this study, the mean item score for family resilience was 4.06 (SD=0.52), which was lower than that reported by Faccio for breast and prostate cancer (5.7±0.78) (Faccio et al., 2018). This could be attributed to the fact that the majority of CRC patients included in this study were within 3 months after surgery, and 38% of them had a stoma (such significant body image changes were not obvious for prostate and breast cancer). Consequently, patients not only experienced the challenges associated with postoperative symptoms but also psychological distress due to changes in body image (Tseng et al., 2019). This increase in psychological distress significantly detereated family resilience and reduced the quality of life for both patients and their families, (Mohamed et al., 2021). Additionally, we found that 61.1% of the patients included in this study were unemployed, and 58.8% lived in economically disadvantaged rural areas. These circumstances potentially exacerbated the financial burden experienced by patients and their families, thereby reducing their capacity to cope with the challenges posed by cancer and demonstrating lower family resilience (Hassan-Abbas, 2022). 4.2 Sociodemographic and Disease Characteristics Associated with Family Resilience This study revealed that several factors influenced the family resilience of postoperative CRC patients. These factors included postoperative duration, educational level, marital status, work status, family income, and stoma status. In this study, we observed that the resilience of CRC families changed over time after surgery. For example, family resilience was significantly lower in the 3-month postoperative group than in the 3~6 months and 6~12 months postoperative groups. This is similar to Li's findings in breast cancer patients, where the authors found that the <6-month group had lower levels of family resilience, and the 6~12 months group showed a tendency towards elevated levels of family resilience (Li et al., 2018). One potential explanation for this trend is that families of cancer patients may initially go through a phase of denial and uncertainty upon learning about the diagnosis (reference). During this period, families are generally not fully equipped to cope with the challenges (Shin et al., 2016). However, over time, families gradually come to terms with the reality and can actively engage in treatment, leading to enhanced family resilience (Bauer and Teply, 2023; Shin et al., 2016). Meanwhile, we found that patients' marital status significantly influenced their family resilience. Specifically, married patients normally exhibited better family resilience than widowed patients. This finding was expected, as spouses, being key members of the family, are the most important sources of emotional and physical support (Keesing et al., 2016). On the other hand, individuals who have lost their spouses may experience heightened feelings of isolation and helplessness, leading to a more pessimistic outlook towards treatment (Chen et al., 2020). Additionally, we found widowed patients tend to forego medical intervention, worrying about the financial burden it may place on their children (Davis, 2018). As a result, for better medical intervention, in the absence of spouses of patients, there is a tendency for children of cancer patients in China to conceal their parents' disease information, which has been confirmed to be able to diminish the overall familial cohesion in disease management and collective coping (Yu et al., 2022). In our study, we also observed variations in family resilience caused by differences in the educational levels of patients. Interestingly, patients who had completed only primary school exhibited lower levels of family resilience compared to those who had completed high school or university education. This disparity could be attributed to the fact that patients with higher education levels may possess more knowledge about the disease and have enhanced coping mechanisms (Toptaş Acar et al., 2022). The impact of the economic status of the family on the resilience of families with cancer patients should not be overlooked, as the high costs associated with cancer treatment often lead to significant financial anxiety for patients and their families (Perni et al., 2022). In this study, we found that patients with higher per capita monthly family incomes (>5,000 Yuan and 3,000-5,000 Yuan) had significantly higher family resilience compared to patients with lower per capita monthly family incomes (<1,000 Yuan and 1,000-3,000 Yuan), and unemployed patients perceived the lowest family resilience. Research by Ürek and Uğurluoğlu has also confirmed that families with better financial resources have higher motivation for seeking treatment and demonstrate greater confidence in managing the challenges associated with cancer (Ürek and Uğurluoğlu, 2022). Indeed, low/no-income cancer patients not only experience the physical and psychological challenges related to cancer but also encounter severe financial strain. This additional burden increases the pressure on the patient's family, potentially diminishing their motivation to seek treatment, and ultimately affecting the patient's chances of survival (Ho et al., 2018; Perni et al., 2022). 4.3 Correlation between Mutuality, Family Function, and Family Resilience In this study, we found that family resilience, as well as family function, were positively correlated with family mutuality for CRC patients, consistent with Fisher’s study in blood cancer caregivers (Fisher et al., 2021). These findings indicate that postoperative CRC patients with stronger mutuality and family function showed higher family coping and adaptation to cancer, thus demonstrating greater family resilience. The findings of our study indicated that mutuality was a crucial factor in safeguarding family resilience, consistent with our previous findings among family caregivers (Shao et al., 2023a). Additionally, we observed that enhancing the quality of relationships and interactions between patients and family caregivers (both are important aspects of family mutuality) could improve the collaborative management of cancer-related stress (Godwin et al., 2013; Li and Loke, 2015). These factors contributed to the family's capacity to quickly adapt and recover from the challenges posed by the cancer crisis, enabling them to resume a normal and productive lifestyle (Gibbons et al., 2019). The family function was another critical predictor of family resilience, as demonstrated by Kim's previous research (Kim and Ahn, 2022). Our study further reinforces the significance of family function for family resilience. As shown in our results, there was a positive correlation between family function and family resilience. A healthy family function promotes unity and cohesion among family members in the fight against the cancer crisis, facilitating the family's adaptation to the crisis (Gibbons et al., 2019). In a separate study conducted by Shao and colleagues, it was discovered that family members with better family function demonstrated higher efficacy in family communication and developed stronger emotional bonds (Shao et al., 2022). This contributed to increased confidence in patients in cancer treatment and created a more supportive family environment to effectively manage cancer-related challenges. 4.4 M utuality Indirectly Regulates Family Resilience by Affecting Function In addition to directly affecting family resilience, our research revealed that mutuality also indirectly regulates family resilience by affecting family function. Specifically, healthy family mutuality enhances the family resilience of CRC patients through positive family functioning (e.g., mutual support, emotional communication, and sharing burdens). Family Systems theory posits that the family is an intricate and interdependent system, where distinct duties and obligations are assigned to each member at different phases, and alterations in one individual might influence the entire family (Pratt and Skelton, 2018). Research has shown that family function is a determining factor in the family resilience of cancer patients (Hsiao and Tsai, 2015). The presence of a well-functioning family has been found to play a crucial role in reducing familial conflicts and promoting emotional support among its members. By improving family mutuality, the increase in family function could enhance patients' ability to adapt to their disease and minimize the negative impact of postoperative treatments for colorectal cancer on both patients and their families (Sahebihagh et al., 2016). The diagnosis and subsequent postoperative management of CRC not only elicit significant psychological distress in patients but also impose significant burdens on their families (e.g., financial strain and emotional challenges) (Pape et al., 2022). When patients and family caregivers had a higher level of mutuality (interaction and intimacy), it was observed that both of them exhibited a more positive attitude toward cancer treatment (Altschuler et al., 2018). This enabled a healthy family function as family members could effectively mobilize resources from both within the family and the society (Ahmad et al., 2017), which in turn fosters enhanced family resilience for desired cancer management. (Bandura et al., 2011). 4.5 Clinical Implications Healthcare practitioners should acknowledge the significance of family function and mutuality in enhancing the resilience of families of postoperative colorectal cancer patients. We should encourage patients and their family caregivers to engage and communicate more actively and encourage them to collaboratively navigate the challenges and pressures associated with cancer, through fostering a positive interdependent connection. At the same time, it is crucial to harness the inherent capacity of family resilience to address cancer-related challenges. This includes directly improving family mutuality based on the specific circumstances of patients' families, or through a more indirect manner, by improving family function (via family mutuality). 4.6 Limitations Our study has several inherent limitations. First, the cross-sectional design of this study may impose restrictions on constructing a causal relationship between mutuality, family function, and family resilience. Further studies are required to determine the validity of these findings by implementing longitudinal and mediating studies. Second, it is worth pointing out that the scope of this study is limited to two public hospitals in Henan Province, China. Further studies with multi-center, larger sample sizes, and universal coverage of areas are needed to validate our findings. Finally, the data in this study were obtained through a self-report questionnaire, which might introduce subjective bias. To address this potential bias, it may be beneficial to incorporate additional perspectives from family members or other sources to provide a more comprehensive and balanced understanding of the variables under investigation. 5. Conclusion In this study, we identified six factors associated with family resilience from the perspective of postoperative CRC patients. These factors include postoperative duration, education level, working status, marital status, family income, and stoma status. In addition to sociodemographic and disease-related factors affecting family resilience, our study revealed that both mutuality and family function serve as protective factors for family resilience, and family function was found to mediate the effects of mutuality on family resilience. Therefore, to enhance postoperative care for CRC patients, we suggest that healthcare professionals assess family resilience actively from not only the sociodemographic and disease levels, but also from a more comprehensive family level, to develop effective intervention strategies to enhance the coping and adaptive capacities of families of CRC patients during the postoperative cancer management. Declarations Funding This work was supported by the National Natural Science Foundation of China (No.82101505) and the China Postdoctoral Science Foundation in 2018: (2018M630839). Ethics approval and consent to participate The study was approved by the Life Sciences Ethics Review Committee of Zhengzhou University (Permit number: ZZUIRB 2023-097). Before the investigation, the purpose and significance of the study were explained to the participants, and all participants were given an informed consent form. The paper questionnaires were completed anonymously, and the data were kept strictly confidential. If a participant withdrew, we respected their wishes. Conflict of interest No conflict of interest has been declared by the authors. Data availability statement The datasets used during the current study are available from the corresponding author on reasonable request. Consent to participate Informed consent was obtained from all individual participants included in the study. 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Cite Share Download PDF Status: Published Journal Publication published 13 Sep, 2025 Read the published version in Supportive Care in Cancer → Version 1 posted Editorial decision: Revision requested 16 Apr, 2025 Reviews received at journal 25 Sep, 2024 Reviewers agreed at journal 20 Sep, 2024 Reviewers invited by journal 05 Sep, 2024 Editor assigned by journal 05 Sep, 2024 Submission checks completed at journal 26 Jul, 2024 First submitted to journal 24 Jul, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4793857","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":332019213,"identity":"ca6d611b-076a-4cff-998c-e6af38d0e850","order_by":0,"name":"Mengwei Shao","email":"","orcid":"","institution":"Shandong University","correspondingAuthor":false,"prefix":"","firstName":"Mengwei","middleName":"","lastName":"Shao","suffix":""},{"id":332019214,"identity":"8f48f8b0-2e22-4d00-a170-e694e27d8e91","order_by":1,"name":"Yanyan Xue","email":"","orcid":"","institution":"Tongji University","correspondingAuthor":false,"prefix":"","firstName":"Yanyan","middleName":"","lastName":"Xue","suffix":""},{"id":332019215,"identity":"0e01a2aa-e5c4-4147-845b-6a5f36039cf8","order_by":2,"name":"Menghan Zhang","email":"","orcid":"","institution":"The First Affiliated Hospital of Zhengzhou University","correspondingAuthor":false,"prefix":"","firstName":"Menghan","middleName":"","lastName":"Zhang","suffix":""},{"id":332019216,"identity":"e7f6a571-3c2f-443e-aa65-89a49c75c6d1","order_by":3,"name":"Huiyue Zhou","email":"","orcid":"","institution":"The Ninth People's Hospital of Zhengzhou","correspondingAuthor":false,"prefix":"","firstName":"Huiyue","middleName":"","lastName":"Zhou","suffix":""},{"id":332019217,"identity":"d53ddca3-84ac-4016-9db9-ef01864c470c","order_by":4,"name":"Bin Ma","email":"","orcid":"","institution":"Murdoch University","correspondingAuthor":false,"prefix":"","firstName":"Bin","middleName":"","lastName":"Ma","suffix":""},{"id":332019218,"identity":"a1d6d0c8-319a-43eb-a4e5-cf9b3155335e","order_by":5,"name":"Kun Wang","email":"","orcid":"","institution":"The First Affiliated Hospital of Zhengzhou University","correspondingAuthor":false,"prefix":"","firstName":"Kun","middleName":"","lastName":"Wang","suffix":""},{"id":332019219,"identity":"e51716c4-464a-417e-83d6-d4f9b36f9e7e","order_by":6,"name":"Yi Yang","email":"","orcid":"","institution":"The College of Nursing and Health of Zhengzhou University","correspondingAuthor":false,"prefix":"","firstName":"Yi","middleName":"","lastName":"Yang","suffix":""},{"id":332019220,"identity":"94d90c38-ea07-4242-89de-9f4529fa3395","order_by":7,"name":"Lulu Yu","email":"","orcid":"","institution":"The College of Nursing and Health of Zhengzhou University","correspondingAuthor":false,"prefix":"","firstName":"Lulu","middleName":"","lastName":"Yu","suffix":""},{"id":332019221,"identity":"7e2eedfa-990d-456b-9677-71fd1ea027d3","order_by":8,"name":"Changying Chen","email":"","orcid":"","institution":"The First Affiliated Hospital of Zhengzhou University","correspondingAuthor":false,"prefix":"","firstName":"Changying","middleName":"","lastName":"Chen","suffix":""},{"id":332019222,"identity":"0ee3a2fc-19e7-4054-909d-0f060c8343fc","order_by":9,"name":"Tao Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA80lEQVRIiWNgGAWjYJADxgcQOoEItQcgFLMByVrYJIjSYnD87OHXH2psovlnnzGr/PHnMAM/e44Bw88deLScyUuzOHAsLXfGuRyzGxI8hxkke94YMPaewa3F7ECOmcEBtsO5DWd4zG4YSBxmMLiRY8DM2IZHy/k3QC3/DufOB2opSDA4zGBPUMuNHOMHB9sO524AamE4kAC0RYKAFvsbb8wYzval5W48w1Ys2XAgnUfizLOCg714tEj25xh/qPhmkzvvDPPGjz/+WMvxtydvfPATjxYGRHRwgGOSB0QcwKsBGOkfIDT7AwIKR8EoGAWjYKQCAEhMVxJNpMQbAAAAAElFTkSuQmCC","orcid":"","institution":"University of Western Australia","correspondingAuthor":true,"prefix":"","firstName":"Tao","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2024-07-24 08:57:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4793857/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4793857/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00520-025-09874-z","type":"published","date":"2025-09-13T15:56:54+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":63407414,"identity":"988cb7f4-5c3a-4407-bcc0-7f3f97441d79","added_by":"auto","created_at":"2024-08-27 21:53:36","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":25338,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eConceptual Framework. \u003c/strong\u003e\u003cem\u003eBoth family function and mutuality could directly regulate family resilience. Family mutuality also indirectly regulates family resilience by affecting function.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4793857/v1/afa6edc2e4c5628c4956a40b.png"},{"id":63407415,"identity":"111b4674-dcc1-47b6-ac41-7fad22a3c8e0","added_by":"auto","created_at":"2024-08-27 21:53:36","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":82618,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlowchart of the screening process of study participants\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4793857/v1/fd925f0968f3b4d377db308c.png"},{"id":63407413,"identity":"25d338cb-955d-450c-9497-0b7f5e0581eb","added_by":"auto","created_at":"2024-08-27 21:53:36","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":25023,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eModel of the Relationship between Mutuality, Family Function, and Family Resilience. \u003c/strong\u003e*\u003cem\u003ep\u003c/em\u003e\u0026lt;0.05, **\u003cem\u003ep\u003c/em\u003e\u0026lt;0.01.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-4793857/v1/32660d763b18f1ad0337a11e.png"},{"id":91817662,"identity":"6d92f6a5-6829-4719-ad83-e76571804867","added_by":"auto","created_at":"2025-09-22 07:00:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2159195,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4793857/v1/27dd2831-1b80-469e-a0c3-098d84348f3e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Family Mutuality Enhances the Family Resilience of CRC Patients through Positive Family Functioning","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eColorectal cancer (CRC), a type of cancer that affects the colon or rectum, is a significant health concern worldwide (Dekker et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). The nature of CRC makes it a particular challenge for caring. As known, CRC is featured by an insidious onset, often without apparent symptoms in the early stages, which causes a large number of patients to be diagnosed in the middle or late stages, and leads to a poorer prognosis (Lu et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Importantly, surgery is still the primary treatment of CRC, which not only significantly alters the body perception of patients (e.g., stomas status), but also is accompanied by high recurrence rates, prolonged treatment schemes, and high treatment costs. As a result, despite advances in CRC diagnosis and treatment over the past decades, with around a 50% increase in the five-year survival rate, the challenges of coping with the physical and psychological burden of CRC treatment remain a significant concern for both patients and healthcare providers and often results in compromised treatment motivation and poor quality of life for both CRC patients and their families (Cotrim and Pereira, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2008\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIt is essential to provide comprehensive support to CRC patients and their caregivers (normally their family members) as a whole to improve the outcome of CRC treatment. Indeed, strong family support is critically important to help CRC patients and their families cope with the crises brought about by the disease (Shao et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2023b\u003c/span\u003e). In this aspect, three key aspects that determine the copying capacity of a family, i.e., family resilience, function, and mutuality, have been particularly emphasized.\u003c/p\u003e \u003cp\u003eFamily resilience refers to the inherent quality and capacity of a family to adapt, thrive, and maintain stability in the face of adversity or crises (Walsh, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e1996\u003c/span\u003e). A good family resilience is especially important in the context of postoperative CRC management. This is because the prolonged physiological, psychological, and social pressures potentially induce conflicts among CRC family members and patients, and lead to a decline in family intimacy and even family crises (Samuelsson et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Tseng et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFamily function refers to the capacity of a family to meet its members' physical and emotional requirements through mutual support, emotional communication, and sharing burdens (Shek, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2002\u003c/span\u003e; Zhang, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Olson claimed that effective family function was a fundamental cornerstone for a well-operating family, which could help cultivate the capacity of a family to cope with adversarial situations (Olson et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e1983\u003c/span\u003e). At the same time, multiple research studies have indicated a positive correlation between family function and family resilience. Families with better family function commonly exhibited greater resilience to changes in family production and life caused by diseases (Kim and Ahn, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMutuality denotes the quality of communication, cooperation, and intimacy between the patients and family caregivers (Archbold et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e1990\u003c/span\u003e). Li et al.indicated that strengthening the mutuality between patients and family caregivers could foster their empathy and trust, leading to a more intimate bond and creating a positive family environment to cope with lung cancer (C. Li et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Indeed, positive mutuality between patients and family caregivers could not only create a healthy, more interactive environment among family members but also directly enhance family resilience to help families effectively deal with crises raised by cancer treatment (Ahmad et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAlthough all these three factors collectively contribute to effective CRC management, family resilience plays a central role in the crisis management of the family. However, the detailed interactive mechanisms between these factors, especially about how family function and mutuality affect family resilience, remain unknown. Answering these questions is of obvious importance for improved CRC care.\u003c/p\u003e \u003cp\u003eRecently, we identified several sociodemographic (e.g., age, educational level, family income) and disease-related factors (e.g., disease duration, stoma status) that potentially impact family resilience in postoperative CRC patients (Shao et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2023b\u003c/span\u003e). In this work, we will further investigate the interactions of these factors for optimal CRC care. And importantly, these results will serve as a starting point to allow us to explore the interaction between family resilience, function, and mutuality. This will provide deep insights into this critical area of CRC care.\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003e1.1 Conceptual Framework\u003c/h2\u003e \u003cp\u003eThe conceptual framework of this study was based on existing theories of the Resiliency Model of Family Stress Adjustment and Adaptation (RMFAA) and Family Systems. According to RMFAA, the family function and mutuality among family members play significant roles in shaping family resilience (Mccubbin et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e1993\u003c/span\u003e). Meanwhile, the Family Systems theory proposes that the family is a system characterized by constraints and interconnections, and the mutuality among family members (marital, parent-child, and sibling relationships) is essential for the orderly operation of the family function (Fisher et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Watson, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Additionally, the research by Gibbons and Mac\u0026iacute;a demonstrated that fostering healthy mutuality could strengthen emotional connections within a family, improve family function, and empower family members to cope with crises and challenges collaboratively (Gibbons et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Mac\u0026iacute;a et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThus, based on the above theories and studies, we hypothesized that both family function and mutuality were protective factors for family resilience, and family function may mediate between mutuality and family resilience. Based on this, we further suggested that such a relationship exists among postoperative CRC families and that family function mediates the effects of mutuality on family resilience. The conceptual framework of this study is illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1.2 Aim and Hypotheses\u003c/h2\u003e \u003cp\u003eTo date, there has been a lack of investigation into the interaction between family resilience, function, and mutuality among postoperative CRC families and the underlying mechanisms involved. To fill the knowledge gap in this area, this study aimed to (1) investigate the interaction between family resilience, function, and mutuality and (2) elucidate whether and how \\family function mediates the effect of mutuality on family resilience.\u003c/p\u003e \u003cp\u003eThe study's hypotheses are formulated as follows:\u003c/p\u003e \u003cp\u003eH1: Family function is positively correlated with mutuality and family resilience.\u003c/p\u003e \u003cp\u003eH2: Mutuality is positively correlated with family resilience.\u003c/p\u003e \u003cp\u003eH3: Family function mediates the correlation between mutuality and family resilience.\u003c/p\u003e \u003c/div\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Experimental Design and Participants\u003c/h2\u003e \u003cp\u003eIn this cross-sectional study performed from February 2023 to July 2023, a convenience sampling approach was employed. Postoperative colorectal cancer (CRC) patients who met inclusion criteria were recruited from two major public hospitals in Henan Province, China. These criteria included: (1) being pathologically diagnosed with CRC, (2) having undergone surgery, (3) being 18 years or older, and (4) providing informed consent. Exclusion criteria comprised having a history of mental illness, severe mental or cognitive dysfunction, primary malignant tumors in other sites, and severe lung, brain, heart, liver, or kidney diseases.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Ethical Considerations\u003c/h2\u003e \u003cp\u003e This study was carried out in adherence to the principles of the Declaration of Helsinki. The Zhengzhou University Life Sciences Ethics Review Board approved this study with the assigned approval number ZZUIRB 2023-097. Before conducting the survey, the participants were provided with a comprehensive explanation of the objective and importance of the study. Then, all the participants signed informed consent forms and completed paper questionnaires anonymously. The data we collected were kept strictly confidential. Participants could withdraw anytime during the study, and we would respect their willingness.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Sample Size\u003c/h2\u003e \u003cp\u003eThe sample size was estimated using the Monte Carlo Power Analysis for Indirect Effects Software (Schoemann et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). The target power (1-\u003cem\u003eβ\u003c/em\u003e) was set at 0.8, and the confidence interval width was 95% (corresponding to \u003cem\u003eα\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.05). Based on the pre-experimental results, the sample size for this study was calculated to be 123 (refer to Supplementary Table\u0026nbsp;1). After accounting for a wastage rate of 20%, a minimum sample size of 154 was required.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Data Collection\u003c/h2\u003e \u003cp\u003eThis investigation was conducted by three postgraduate nursing students who had received specialized training. Postoperative CRC patients were recruited through convenience sampling from February 2023 to July 2023 from two public hospitals in Henan Province, China. Before the commencement of the investigation, the purpose, content, procedures, and the principle of anonymity of the study were explained to the participants. Following this, the participants provided informed consent and proceeded to complete a paper questionnaire. In cases where participants were unable to independently complete the questionnaire, the investigator read out the questions and recorded the responses provided by the participants. Out of the 231 questionnaires collected, 15 were deemed invalid and were excluded from the analysis due to missing data or incorrect completion. The final number of valid questionnaires included in the analysis was 216, resulting in a valid response rate of 93.5% (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Measurements\u003c/h2\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003e2.5.1 General Information Questionnaire for Participants\u003c/h2\u003e \u003cp\u003eA self-designed general information questionnaire was utilized to collect demographic and disease-related data from postoperative CRC patients. Demographic details encompassed age, gender, residence, education level, marital status, and income, while disease-related information included stoma status, postoperative duration, and cancer stages. Participants provided their demographic characteristics, whereas the investigators recorded the disease-related information based on the participant's medical records.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section3\"\u003e \u003ch2\u003e2.5.2 Family Resilience Questionnaire (FaREQ)\u003c/h2\u003e \u003cp\u003eFamily resilience was assessed using the 24-item Chinese version of the Family Resilience Questionnaire (FaREQ), a self-reported scale developed by Italian scholar FACCIO (Faccio et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) and translated by Li (Li et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). The scale consisted of four subscales: Communication and Cohesion, Perceived Family Coping, Perceived Social Support, and Religiousness and Spirituality. Each item was scored using a 7-point Likert scale, with 1\u0026thinsp;~\u0026thinsp;7 representing \u0026ldquo;strongly disagree\u0026rdquo; to \u0026ldquo;strongly agree\u0026rdquo;. The scale scores ranged from 24 to 168, with higher scores indicating better family resilience. In this study, the Cronbach's α coefficient of this scale was 0.88.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003e2.5.3 The Family Adaptation, Partnership, Growth, Affection, Resolve Index Scale (APGAR)\u003c/h2\u003e \u003cp\u003eThe family function was assessed using the Chinese version of the APGAR scale, a convenient self-report scale developed by Smilkstein (Smilkstein, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e1978\u003c/span\u003e). The scale consisted of four subscales: adaptation, partnership, growth, affection, and resolution. Each item was scored using a 3-point Likert scale, with 0\u0026thinsp;~\u0026thinsp;2 representing \u0026ldquo;never\u0026rdquo; to \u0026ldquo;often\u0026rdquo;. A total score of 7\u0026thinsp;~\u0026thinsp;10 indicated good family function, 4\u0026thinsp;~\u0026thinsp;6 indicated a moderate disorder of family function, and 3 or less indicated a severe disorder of family function. In this study, the Cronbach\u0026rsquo;s α coefficient of this scale was 0.72.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003ch2\u003e2.5.4 Mutuality Scale (MS)\u003c/h2\u003e \u003cp\u003eThis study assessed the mutuality between patients and family caregivers using the 15-item Chinese version of the Mutuality Scale (MS) (Archbold et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e1990\u003c/span\u003e; Shyu et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). The scale consisted of four subscales: Love and Affection, Pleasurable Activities, Reciprocity, and Shared Value. Each item was scored using a 4-point Likert scale, with 0\u0026thinsp;~\u0026thinsp;4 representing \u0026ldquo;not at all\u0026rdquo; to \u0026ldquo;very much\u0026rdquo;. The scale was scored on average, with higher scores indicating better intimacy and mutuality, while a score below 2.5 indicated poor mutuality. In this study, the Cronbach's α coefficient of this scale was 0.95.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e2.6 Data Analysis\u003c/h2\u003e \u003cp\u003eIBM SPSS Statistics for Windows (version 25.0, IBM, USA) was used for data analysis.\u003c/p\u003e \u003cp\u003eFirstly, the sociodemographic and disease characteristics of the participants and the main study variables (family resilience, family function, and mutuality) were described using descriptive statistics. Continuous data were expressed as M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD and categorical data were expressed as percentages and frequencies.\u003c/p\u003e \u003cp\u003eSecondly, we compared the associations of sociodemographic and disease characteristics with family resilience scores using t-test and ANOVA. Two independent samples t-test was used to compare two groups of measured values; one-way ANOVA was used to compare multiple groups of measured values. The variables that exhibited statistically significant variations between groups in the one-way analysis of variance (ANOVA) were subjected to Post Hoc Multiple Comparisons (Least Significant Difference, LSD) to elucidate the precise differences between the groups. Pearson correlations were applied to identify correlations between mutuality, family function, and family resilience.\u003c/p\u003e \u003cp\u003eThirdly, we used the SPSS PROCESS (version 3.3) macro to test the mediating effects of family function on the relationship between mutuality and family resilience. A bootstrapping procedure with 5,000 samples was used for the analysis, which provided a more reliable estimate for the small sample size (Igartua and Hayes, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). The significant indirect effect was indicated by a 95% CI (Confidence Interval) of indirect effect without including 0. Sociodemographic and disease variables showing significant associations with family resilience were set as control variables in the mediation model. All significant tests were two-tailed with a significance level of \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n \u003ch2\u003e3.1 Descriptive Statistics\u003c/h2\u003e\n \u003cp\u003eThe participants of this study had an average age of 57.38 years (SD\u0026thinsp;=\u0026thinsp;11.61), with more male patients (62.5%) compared to female patients (37.5%). The majority of the patients were unemployed (61.1%), married (93.5%), and had stage III cancer (40.3%). The data also showed that 57.4% of the patients were within 3 months post-surgery, 58.8% resided in rural areas, 69.4% had a secondary school education or lower, and 42.6% had a chronic illness. Most patients were covered by Medical Insurance for Urban and Rural Residents (73.6%). More detailed sociodemographic and disease characteristics of postoperative patients with CRC are shown in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e3.2 Family Resilience Scores for Different Sociodemographic and Disease Characteristics Patients with different sociodemographic and disease characteristics showed different family resilience.\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eThe postoperative CRC patients with different postoperative duration (\u003cem\u003eF\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.684, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.013), education level (\u003cem\u003eF\u003c/em\u003e\u0026thinsp;=\u0026thinsp;7.609, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), marital status (\u003cem\u003eF\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.822, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.040), working status (\u003cem\u003eF\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.807, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.024), family income (\u003cem\u003eF\u003c/em\u003e\u0026thinsp;=\u0026thinsp;9.487, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and stoma status (\u003cem\u003et\u003c/em\u003e=-2.991, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003) had significantly different family resilience scores (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eThe Post Hoc Multiple Comparisons (Least Significant Difference, LSD) indicated that family resilience scores of patients within 3 months after surgery were comparatively lower than those in the 3\u0026thinsp;~\u0026thinsp;6 months and 6\u0026thinsp;~\u0026thinsp;12 months groups. Additionally, patients with primary school education and below had lower scores than those with middle, senior, and college education, and unemployed patients had significantly lower scores than employed patients. Meanwhile, our study found that married patients had higher family resilience scores than widowed patients, and families with per capita monthly family income\u0026thinsp;\u0026ge;\u0026thinsp;5,000 and 3,000\u0026thinsp;~\u0026thinsp;5,000 Yuan had significantly higher family resilience scores than those with monthly family income\u0026thinsp;\u0026lt;\u0026thinsp;1,000 and 1,000\u0026thinsp;~\u0026thinsp;3,000 Yuan.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSociodemographic and Disease Characteristics associated with Family Resilience (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;216)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"6\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003en\u003c/em\u003e (%)/\u003c/p\u003e\n \u003cp\u003eMean (SD, Range)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFamily Resilience Score [M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD]\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003et/F\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePost Hoc\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"3\"\u003e\n \u003cp\u003e-1.492\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"3\"\u003e\n \u003cp\u003e0.137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e135(62.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e96.49\u0026thinsp;\u0026plusmn;\u0026thinsp;11.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e81(37.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e99.11\u0026thinsp;\u0026plusmn;\u0026thinsp;13.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge range (Years Old)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e57.38 (11.61, 26\u0026thinsp;~\u0026thinsp;80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.894\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.411\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18~\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e29(13.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e95.21\u0026thinsp;\u0026plusmn;\u0026thinsp;18.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45~\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e88(40.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e97.01\u0026thinsp;\u0026plusmn;\u0026thinsp;11.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e99(45.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e98.55\u0026thinsp;\u0026plusmn;\u0026thinsp;10.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligious\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.450\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16(7.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e103.50\u0026thinsp;\u0026plusmn;\u0026thinsp;9.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e200(92.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e96.99\u0026thinsp;\u0026plusmn;\u0026thinsp;12.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePostoperative duration (Months)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.684\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;3 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e124(57.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e95.19\u0026thinsp;\u0026plusmn;\u0026thinsp;10.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(1) \u0026lt; (2)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3~ (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31(14.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e101.16\u0026thinsp;\u0026plusmn;\u0026thinsp;14.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(1) \u0026lt; (3)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6~ (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25(11.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e102.04\u0026thinsp;\u0026plusmn;\u0026thinsp;13.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;12 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36(16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e99.00\u0026thinsp;\u0026plusmn;\u0026thinsp;14.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCancer stage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.489\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.219\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStage I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19(8.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e101.58\u0026thinsp;\u0026plusmn;\u0026thinsp;10.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStage Ⅱ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e63(29.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e98.25\u0026thinsp;\u0026plusmn;\u0026thinsp;10.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStage Ⅲ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e87(40.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e97.46\u0026thinsp;\u0026plusmn;\u0026thinsp;13.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStage Ⅳ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e47(21.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e94.79\u0026thinsp;\u0026plusmn;\u0026thinsp;13.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"3\"\u003e\n \u003cp\u003e-1.147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"3\"\u003e\n \u003cp\u003e0.253\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e127(58.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e96.65\u0026thinsp;\u0026plusmn;\u0026thinsp;12.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e89(41.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e98.64\u0026thinsp;\u0026plusmn;\u0026thinsp;12.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"5\"\u003e\n \u003cp\u003e7.609\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"5\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimary school or less (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e84(38.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e93.19\u0026thinsp;\u0026plusmn;\u0026thinsp;11.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(1) \u0026lt; (2)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMiddle school (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e66(30.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e97.95\u0026thinsp;\u0026plusmn;\u0026thinsp;12.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(1) \u0026lt;(3)**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSenior school (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e52(24.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e101.79\u0026thinsp;\u0026plusmn;\u0026thinsp;11.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(1) \u0026lt;(4)**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCollege or above (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14(6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e104.86\u0026thinsp;\u0026plusmn;\u0026thinsp;14.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.822\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.040\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e202(93.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e98.05\u0026thinsp;\u0026plusmn;\u0026thinsp;12.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(1) \u0026gt;(4)**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnmarried (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3(1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e91.33\u0026thinsp;\u0026plusmn;\u0026thinsp;10.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDivorced (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4(1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e94.75\u0026thinsp;\u0026plusmn;\u0026thinsp;12.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWidowed (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7(3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e85.00\u0026thinsp;\u0026plusmn;\u0026thinsp;15.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eWork status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.807\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnemployed (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e132(61.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e95.65\u0026thinsp;\u0026plusmn;\u0026thinsp;12.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(1) \u0026lt; (2)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmployed (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e41(18.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e101.08\u0026thinsp;\u0026plusmn;\u0026thinsp;10.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRetired (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e43(20.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e99.66\u0026thinsp;\u0026plusmn;\u0026thinsp;13.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily income\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Yuan (\u0026yen;)) /M/P)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.487\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;1000 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e42(19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e92.88\u0026thinsp;\u0026plusmn;\u0026thinsp;10.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(1) \u0026lt;(3)**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1000~ (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e99(45.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e96.99\u0026thinsp;\u0026plusmn;\u0026thinsp;12.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(1) \u0026lt;(4)**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3000~ (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e53(24.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e102.49\u0026thinsp;\u0026plusmn;\u0026thinsp;12.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(2) \u0026lt;(3)**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;5000 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22(10.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e104.91\u0026thinsp;\u0026plusmn;\u0026thinsp;14.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(2) \u0026lt;(4)**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eInsurance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.568\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.079\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedical Insurance for Urban and Rural Residents\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e159(73.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e96.36\u0026thinsp;\u0026plusmn;\u0026thinsp;12.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmployee Medical Insurance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e52(24.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e100.25\u0026thinsp;\u0026plusmn;\u0026thinsp;12.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCommercial Insurance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5(2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e103.80\u0026thinsp;\u0026plusmn;\u0026thinsp;15.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of children\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.941\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6(2.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e97.83\u0026thinsp;\u0026plusmn;\u0026thinsp;11.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38(17.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e98.89\u0026thinsp;\u0026plusmn;\u0026thinsp;13.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e97(44.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e99.05\u0026thinsp;\u0026plusmn;\u0026thinsp;11.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 or above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e75(34.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e94.68\u0026thinsp;\u0026plusmn;\u0026thinsp;13.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eStoma\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"3\"\u003e\n \u003cp\u003e-2.991\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"3\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e82(38.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e94.27\u0026thinsp;\u0026plusmn;\u0026thinsp;13.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e134(62.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e99.43\u0026thinsp;\u0026plusmn;\u0026thinsp;11.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eChronic illness\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.489\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.627\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e92(42.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e96.99\u0026thinsp;\u0026plusmn;\u0026thinsp;12.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e124(57.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e97.83\u0026thinsp;\u0026plusmn;\u0026thinsp;12.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\"\u003e1. Note: M month, P person; 1.00 Chinese Yuan was equivalent to 0.14 US dollars in 2023.\u003cbr\u003e\u003csup\u003e2. \u0026dagger;\u003c/sup\u003e Post Hoc analyses were adjusted by the Bonferroni test; only significant correlations are listed.\u003cbr\u003e3. * \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01.\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\n \u003ch2\u003e3.3 Mutuality, Family Function, and Family Resilience Scores\u003c/h2\u003e\n \u003cp\u003eIn this study, a total of 216 patients who underwent CRC surgery were included. The mean total score of mutuality was (41.04\u0026thinsp;\u0026plusmn;\u0026thinsp;9.93). Notably, the mean item score (2.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66) was higher than 2.5, indicating a positive level of mutuality between the patients and family caregivers. The mean total and item score of family function were (7.46\u0026thinsp;\u0026plusmn;\u0026thinsp;1.90) and (1.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.38), respectively, which indicates good family function (total score greater than 7).\u003c/p\u003e\n \u003cp\u003eFurthermore, the total score and item score for family resilience were (97.47\u0026thinsp;\u0026plusmn;\u0026thinsp;12.54) and (4.06\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52), respectively. The recorded score was within the range of 50.6\u0026ndash;65.4% of the scale score. The specific scores for each item are presented in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMutuality, Family Function, and Family Resilience Scores (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;216)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eItems\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal Score\u003c/p\u003e\n \u003cp\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eItem Score\u003c/p\u003e\n \u003cp\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLove and affection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u0026thinsp;~\u0026thinsp;12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.94\u0026thinsp;\u0026plusmn;\u0026thinsp;2.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.98\u0026thinsp;\u0026plusmn;\u0026thinsp;0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePleasurable activities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u0026thinsp;~\u0026thinsp;16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.28\u0026thinsp;\u0026plusmn;\u0026thinsp;3.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShared value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u0026thinsp;~\u0026thinsp;8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.83\u0026thinsp;\u0026plusmn;\u0026thinsp;1.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReciprocity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u0026thinsp;~\u0026thinsp;24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16.99\u0026thinsp;\u0026plusmn;\u0026thinsp;4.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMutuality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u0026thinsp;~\u0026thinsp;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e41.04\u0026thinsp;\u0026plusmn;\u0026thinsp;9.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAdaptation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u0026thinsp;~\u0026thinsp;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGrowth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u0026thinsp;~\u0026thinsp;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.37\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.37\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePartnership\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u0026thinsp;~\u0026thinsp;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAffection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u0026thinsp;~\u0026thinsp;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eResolve\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u0026thinsp;~\u0026thinsp;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily Function\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u0026thinsp;~\u0026thinsp;10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.46\u0026thinsp;\u0026plusmn;\u0026thinsp;1.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCommunication and cohesion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u0026thinsp;~\u0026thinsp;56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39.95\u0026thinsp;\u0026plusmn;\u0026thinsp;5.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.99\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePerceived social support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u0026thinsp;~\u0026thinsp;56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31.24\u0026thinsp;\u0026plusmn;\u0026thinsp;5.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.90\u0026thinsp;\u0026plusmn;\u0026thinsp;0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePerceived family coping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u0026thinsp;~\u0026thinsp;32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17.53\u0026thinsp;\u0026plusmn;\u0026thinsp;3.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.38\u0026thinsp;\u0026plusmn;\u0026thinsp;0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReligiousness and spirituality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u0026thinsp;~\u0026thinsp;32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.84\u0026thinsp;\u0026plusmn;\u0026thinsp;4.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.21\u0026thinsp;\u0026plusmn;\u0026thinsp;1.10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily Resilience\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u0026thinsp;~\u0026thinsp;168\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e97.47\u0026thinsp;\u0026plusmn;\u0026thinsp;12.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.06\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\n \u003ch2\u003e3.4 Correlation between Mutuality, Family Function, and Family Resilience\u003c/h2\u003e\n \u003cp\u003eThere were significant correlations between mutuality, family function, and family resilience. The results of Pearson correlation analysis indicated that total and item scores of mutuality were positively correlated with family function (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.170\u0026thinsp;~\u0026thinsp;0.472, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and family resilience (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.170\u0026thinsp;~\u0026thinsp;0.473, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) in postoperative CRC patients. Meanwhile, the total and item scores of family resilience were positively correlated with family function (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.135\u0026thinsp;~\u0026thinsp;0.451, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). More specific results are shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCorrelation between Mutuality, Family Function and Family Resilience (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;216)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"9\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eItems\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.Love and affection\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.Pleasurable activities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.807**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.Shared value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.651**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.714**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.Reciprocity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.732**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.751**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.744**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.Mutuality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.882**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.918**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.830**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.930**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e6.Adaptation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.284**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.200**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.170*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.242**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.253**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e7.Growth\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.344**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.317**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.190**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.271**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.319**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.388**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e8.Partnership\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.385**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.323**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.267**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.299**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.353**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.275**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.302**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e9.Affection\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.336**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.253**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.222**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.240**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.288**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.215**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.296**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.329**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e10.Resolve\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.223**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.227**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.180**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.219**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.240**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.381**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.312**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.289**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e11.Family Function\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.472**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.397**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.308**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.380**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.436**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.657**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.698**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.662**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e12.Communication and cohesion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.406**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.336**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.323**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.327**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.381**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.155*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.259**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.204**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e13.Perceived social support\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.185**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.173*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.278**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.218**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.228**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.223**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.170*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.236**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e14.Perceived family coping\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.398**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.368**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.318**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.380**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.412**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.276**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.314**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.325**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e15.Religiousness and spirituality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.330**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.313**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.217**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.170*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.276**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.193**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.141*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.140*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e16.Family Resilience\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.473**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.424**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.412**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.397**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.467**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.314**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.253**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.329**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eItems\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.Love and affection\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.Pleasurable activities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.Shared value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.Reciprocity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.Mutuality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e6.Adaptation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e7.Growth\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e8.Partnership\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e9.Affection\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e10.Resolve\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.352\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e11.Family Function\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.658\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.682\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e12.Communication and cohesion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.181**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.259**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.315**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e13.Perceived social support\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.208\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.196\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.307\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.351\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e14.Perceived family coping\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.288**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.312**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.451**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.491**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.364**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e15.Religiousness and spirituality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.135\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.097\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.210\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.244\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.235\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.193\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e16.Family Resilience\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.315\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.279\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.443\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.764\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.730\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.676\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.585\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e* \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\n \u003ch2\u003e3.5 Mediating Effect of Family Function\u003c/h2\u003e\n \u003cp\u003eIn this study, we employed family resilience as the dependent variable, mutuality as the independent variable, and family function as the mediator variable, along with control variables (postoperative duration, educational level, marital status, work status, family income, stoma) to establish the mediating effect model, as depicted in Fig. \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\n \u003cp\u003eThe results showed that mutuality was a positive predictor of family resilience (\u003cem\u003e\u0026beta;\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.316, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and family function (\u003cem\u003e\u0026beta;\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.225, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). The family function was a positive predictor of family resilience (\u003cem\u003e\u0026beta;\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.255, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01), as shown in Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\n \u003cp\u003eThe Bootstrap test was used to calculate the 95% CI with 5,000 random samples, and the results are shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e. Our results indicated that family function has a mediating effect of 0.057 (95%CI: 0.021\u0026thinsp;~\u0026thinsp;0.098) on the relationship between mutuality and family resilience in postoperative CRC patients. Additionally, the direct effect of mutuality was 0.259 (95%CI: 0.166\u0026thinsp;~\u0026thinsp;0.352). These findings suggested that mutuality not only directly and positively predicted family resilience in postoperative CRC patients, but also indirectly predicted it through its influence on family function, with a mediated effect value of 0.057.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMediating Effect Model Fitting Index\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"10\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDependent Variable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIndependent Variable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eB\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eSE\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eR\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eR\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFamily Function\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMutuality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.225\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.636\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e[0.158\u0026thinsp;~\u0026thinsp;0.291]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.557\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.310\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFamily Resilience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMutuality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.316\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.256\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e[0.230\u0026thinsp;~\u0026thinsp;0.402]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.627\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.393\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eFamily Resilience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMutuality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.259\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.494\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e[0.166\u0026thinsp;~\u0026thinsp;0.352]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.646\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.417\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFamily Function\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.255\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.907\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e[0.082\u0026thinsp;~\u0026thinsp;0.428]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\"\u003eNote: Unstandardized effects reported.\u003cbr\u003e\n \u003cdiv\u003e\n \u003cp\u003eControl variables: Postoperative duration, Educational level, Marital status, Work status, Family income, Stoma.\u003c/p\u003e\n \u003cp\u003eAbbreviation: CI, confidence interval. SE, standard error. \u0026nbsp;\u003c/p\u003e\n \u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cstrong\u003eTable 5\u003c/strong\u003e\u003cstrong\u003e. Mediating Effect of Family Function on the Relationship between Mutuality and Family Resilience\u003c/strong\u003e\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"558\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.87096774193548%\"\u003e\n \u003cp\u003e\u003cstrong\u003eEffect relationship\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.025089605734767%\"\u003e\n \u003cp\u003e\u003cstrong\u003eEstimate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.25089605734767%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBoot (SE)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.85304659498208%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBoot (BC 95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.87096774193548%\"\u003e\n \u003cp\u003eTotal effect of X on Y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.025089605734767%\"\u003e\n \u003cp\u003e0.316\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.25089605734767%\"\u003e\n \u003cp\u003e0.044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.85304659498208%\" valign=\"top\"\u003e\n \u003cp\u003e[0.230~0.402]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.87096774193548%\"\u003e\n \u003cp\u003eDirect effect of X on Y\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.025089605734767%\"\u003e\n \u003cp\u003e0.259\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.25089605734767%\"\u003e\n \u003cp\u003e0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.85304659498208%\" valign=\"top\"\u003e\n \u003cp\u003e[0.166~0.352]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.87096774193548%\"\u003e\n \u003cp\u003e\u0026nbsp;Indirect effect of X on Y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.025089605734767%\"\u003e\n \u003cp\u003e0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.25089605734767%\"\u003e\n \u003cp\u003e0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.85304659498208%\" valign=\"top\"\u003e\n \u003cp\u003e[0.021~0.098]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003eNote:\u0026nbsp;M, Family Function; X, Mutuality; Y, Family resilience.\u003c/p\u003e\n \u003cp\u003eThe indirect effect of X on Y: Mutuality\u0026rarr;Family Function\u0026rarr;Family resilience\u0026nbsp;(X\u0026rarr;M\u0026rarr;Y).\u003c/p\u003eControl variables: Postoperative duration, Educational level, Marital status, Work status, Family income, Stoma.\n\u003c/div\u003e"},{"header":"4. Discussion ","content":"\u003cp\u003eTo our knowledge, this is the first time the interaction between family resilience, function, and mutuality in postoperative CRC care was systematically investigated. Consistent with our hypotheses, there were positive correlations among mutuality, family function, and family resilience. In addition, our findings strongly suggested that healthy family mutuality could significantly enhance the family resilience of CRC patients, and this was regulated by family function. This work therefore improved our understanding of the detailed mechanisms of how family function and mutuality affect family resilience, and provided valuable information for developing effective interventions to strengthen family resilience.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.1 CRC patients experienced reduced Family Resilience than some other cancers\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, the mean\u0026nbsp;item score\u0026nbsp;for family resilience was 4.06 (SD=0.52), which was lower than that reported by Faccio for breast and prostate cancer (5.7±0.78)\u0026nbsp;(Faccio et al., 2018).\u0026nbsp;This could be attributed to the fact that the majority of CRC patients included in this study were within 3 months after surgery, and 38% of them had a stoma (such significant body image changes were not obvious for prostate and breast cancer). Consequently, patients not only experienced the challenges associated with postoperative symptoms but also psychological distress due to changes in body image\u0026nbsp;(Tseng et al., 2019). This increase in psychological distress significantly detereated family resilience and reduced the quality of life for both patients and their families,\u0026nbsp;(Mohamed et al., 2021). Additionally, we found that 61.1% of the patients included in this study were unemployed, and 58.8% lived in economically disadvantaged rural areas. These circumstances potentially exacerbated the financial burden experienced by patients and their families, thereby reducing their capacity to cope with the challenges posed by cancer and demonstrating lower family resilience\u0026nbsp;(Hassan-Abbas, 2022).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.2 Sociodemographic\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eand Disease Characteristics\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Associated with Family Resilience\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study revealed that several factors influenced the family resilience of postoperative CRC patients. These factors included postoperative duration, educational level, marital status, work status, family income, and stoma status.\u003c/p\u003e\n\u003cp\u003eIn this study, we\u0026nbsp;observed\u0026nbsp;that the resilience of CRC families changed over time after surgery. For example, family resilience was significantly lower in the 3-month postoperative group than in the 3~6 months and 6~12 months postoperative groups. This is similar to Li's findings in breast cancer patients, where the authors found that the \u0026lt;6-month group had lower levels of family resilience, and the 6~12 months group showed a tendency towards elevated levels of family resilience\u0026nbsp;(Li et al., 2018).\u0026nbsp;One potential explanation for this trend is that families of cancer patients may initially go through a phase of denial and uncertainty upon learning about the diagnosis (reference). During this period, families are generally not fully equipped to cope with the challenges\u0026nbsp;(Shin et al., 2016). However, over time, families gradually come to terms with the reality and can actively engage in treatment, leading to enhanced family resilience\u0026nbsp;(Bauer and Teply, 2023; Shin et al., 2016).\u003c/p\u003e\n\u003cp\u003eMeanwhile, we\u0026nbsp;found\u0026nbsp;that patients' marital status significantly influenced their family resilience. Specifically, married patients normally exhibited better family resilience than widowed patients. This finding was expected, as spouses, being key members of the family, are the most important sources of emotional and physical support\u0026nbsp;(Keesing et al., 2016). On the other hand, individuals who have lost their spouses may experience heightened feelings of isolation and helplessness, leading to a more pessimistic outlook towards treatment\u0026nbsp;(Chen et al., 2020). Additionally, we found widowed patients tend to forego medical intervention, worrying about the financial burden it may place on their children\u0026nbsp;(Davis, 2018). As a result, \u0026nbsp;for better medical intervention, in the absence of spouses of patients, there is a tendency for children of cancer patients in China to conceal their parents' disease information, which has been confirmed to be able to diminish the overall familial cohesion in disease management and collective coping\u0026nbsp;(Yu et al., 2022).\u003c/p\u003e\n\u003cp\u003eIn our study, we also observed variations in family resilience caused by differences in the educational levels of patients. Interestingly, patients who had completed only primary school exhibited lower levels of family resilience compared to those who had completed high school or university education. This disparity could be attributed to the fact that patients with higher education levels may possess more knowledge about the disease and have enhanced coping mechanisms\u0026nbsp;(Toptaş Acar et al., 2022).\u003c/p\u003e\n\u003cp\u003eThe impact of the economic status of the family on the resilience of families with cancer patients should not be overlooked, as the high costs associated with cancer treatment often lead to significant financial anxiety for patients and their families\u0026nbsp;(Perni et al., 2022). In this study, we found that patients with higher per capita monthly family incomes (\u0026gt;5,000\u0026nbsp;Yuan\u0026nbsp;and 3,000-5,000\u0026nbsp;Yuan) had significantly higher family resilience compared to patients with lower per capita monthly family incomes (\u0026lt;1,000\u0026nbsp;Yuan\u0026nbsp;and 1,000-3,000\u0026nbsp;Yuan), and\u0026nbsp;unemployed patients perceived\u0026nbsp;the lowest family resilience.\u0026nbsp;Research by\u0026nbsp;Ürek and Uğurluoğlu\u0026nbsp;has also confirmed that families with better financial resources\u0026nbsp;have\u0026nbsp;higher motivation for seeking treatment and demonstrate greater confidence in managing the challenges associated with cancer\u0026nbsp;(Ürek and Uğurluoğlu, 2022).\u0026nbsp;Indeed, low/no-income cancer patients not only experience the physical and psychological challenges related to cancer but also encounter severe financial strain. This additional burden\u0026nbsp;increases\u0026nbsp;the\u0026nbsp;pressure on the patient's family, potentially diminishing their motivation\u0026nbsp;to seek treatment, and ultimately affecting the patient's chances of survival\u0026nbsp;(Ho et al., 2018; Perni et al., 2022).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.3\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eCorrelation between Mutuality, Family Function, and Family Resilience\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, we found that family resilience, as well as family function, were positively correlated with family mutuality for CRC patients, consistent with Fisher’s study in blood cancer caregivers\u0026nbsp;(Fisher et al., 2021). These findings indicate that postoperative CRC patients with stronger mutuality and family function showed higher family coping and adaptation to cancer, thus demonstrating greater family resilience.\u003c/p\u003e\n\u003cp\u003eThe findings of our study indicated that mutuality was a crucial factor in safeguarding family resilience, consistent with our previous findings among family caregivers\u0026nbsp;(Shao et al., 2023a). Additionally, we observed that enhancing the quality of relationships and interactions between patients and family caregivers (both are important aspects of family mutuality) could improve the collaborative management of cancer-related stress\u0026nbsp;(Godwin et al., 2013; Li and Loke, 2015). These factors contributed to the family's capacity to quickly adapt and recover from the challenges posed by the cancer crisis, enabling them to resume a normal and productive lifestyle\u0026nbsp;(Gibbons et al., 2019).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe family function was another critical predictor of family resilience, as demonstrated by\u0026nbsp;Kim's previous research\u0026nbsp;(Kim and Ahn, 2022). Our study further reinforces the significance of family function for family resilience. As shown in our results, there was a positive correlation between family function and family resilience. A healthy family function promotes unity and cohesion among family members in the fight against the cancer crisis, facilitating the family's adaptation to the crisis\u0026nbsp;(Gibbons et al., 2019). In a separate study conducted by Shao and colleagues, it was discovered that family members with better family function demonstrated higher efficacy in family communication and developed stronger emotional bonds\u0026nbsp;(Shao et al., 2022). This contributed to increased confidence in patients in cancer treatment and created a more supportive family environment to effectively manage cancer-related challenges.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.4 M\u003c/strong\u003e\u003cstrong\u003eutuality Indirectly Regulates Family Resilience by Affecting Function\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn addition to directly affecting family resilience, our research revealed that mutuality also indirectly regulates family resilience by affecting family function. Specifically, healthy family mutuality enhances the family resilience of CRC patients through positive family functioning (e.g.,\u0026nbsp;mutual support, emotional communication, and sharing burdens).\u003c/p\u003e\n\u003cp\u003eFamily Systems theory posits that the family is an intricate and interdependent system, where distinct duties and obligations are assigned to each member at different phases, and alterations in one individual might influence the entire family\u0026nbsp;(Pratt and Skelton, 2018). Research has shown that family function is a determining factor in the family resilience of cancer patients\u0026nbsp;(Hsiao and Tsai, 2015). The presence of a well-functioning family has been found to play a crucial role in reducing familial conflicts and promoting emotional support among its members. By improving family mutuality, the increase in family function could enhance patients' ability to adapt to their disease and minimize the negative impact of postoperative treatments for colorectal cancer on both patients and their families\u0026nbsp;(Sahebihagh et al., 2016).\u003c/p\u003e\n\u003cp\u003eThe diagnosis and subsequent postoperative management of CRC not only elicit significant psychological distress in patients but also impose significant burdens on their families (e.g., financial strain and emotional challenges)\u0026nbsp;(Pape et al., 2022). When patients and family caregivers had a higher level of mutuality (interaction and intimacy), it was observed that both of them exhibited a more positive attitude toward cancer treatment \u0026nbsp;(Altschuler et al., 2018). This enabled a healthy family function as family members could effectively mobilize resources from both within the family and the society\u0026nbsp;(Ahmad et al., 2017), which in turn fosters enhanced family resilience for desired cancer management.\u0026nbsp;(Bandura et al., 2011).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.5 Clinical Implications\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHealthcare practitioners should acknowledge the significance of family function and mutuality in enhancing the resilience of families of postoperative colorectal cancer patients. We should encourage patients and their family caregivers to engage and communicate more actively and encourage them to collaboratively navigate the challenges and pressures associated with cancer, through fostering a positive interdependent connection. At the same time, it is crucial to harness the inherent capacity of family resilience to address cancer-related challenges. This includes directly improving family mutuality based on the specific circumstances of patients' families, or through a more indirect manner, by improving family function (via family mutuality).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.6 Limitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur study has several inherent limitations. First, the cross-sectional design of this study may impose restrictions on constructing a causal relationship between mutuality, family function, and family resilience. Further studies are required to determine the validity of these findings by implementing longitudinal and mediating studies. Second, it is worth pointing out that the scope of this study is limited to two public hospitals in Henan Province, China. Further studies with multi-center, larger sample sizes, and universal coverage of areas are needed to validate our findings. Finally, the data in this study were obtained through a self-report questionnaire, which might introduce subjective bias. To address this potential bias, it may be beneficial to incorporate additional perspectives from family members or other sources to provide a more comprehensive and balanced understanding of the variables under investigation.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eIn this study, we identified six factors associated with family resilience from the perspective of postoperative CRC patients. These factors include postoperative duration, education level, working status, marital status, family income, and stoma status. In addition to sociodemographic and disease-related factors affecting family resilience, our study revealed that both mutuality and family function serve as protective factors for family resilience, and family function was found to mediate the effects of mutuality on family resilience. Therefore, to enhance postoperative care for CRC patients, we suggest that healthcare professionals assess family resilience actively from not only the sociodemographic and disease levels, but also from a more comprehensive family level, to develop effective intervention strategies to enhance the coping and adaptive capacities of families of CRC patients during the postoperative cancer management.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the National Natural Science Foundation of China (No.82101505) and the China Postdoctoral Science Foundation in 2018: (2018M630839).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Life Sciences Ethics Review Committee of Zhengzhou University (Permit number: ZZUIRB 2023-097). Before the investigation, the purpose and significance of the study were explained to the participants, and all participants were given an informed consent form. The paper questionnaires were completed anonymously, and the data were kept strictly confidential. If a participant withdrew, we respected their wishes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo conflict of interest has been declared by the authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all individual participants included in the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAhmad, S., Fergus, K., Shatokhina, K., Gardner, S., 2017. The closer \u0026lsquo;We\u0026rsquo; are, the stronger \u0026lsquo;I\u0026rsquo; am: the impact of couple identity on cancer coping self-efficacy. J. Behav. 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Nurs. 27, 3205\u0026ndash;3224. https://doi.org/10.1111/jocn.14500\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"colorectal cancer, family function, mutuality, family resilience, cancer management.","lastPublishedDoi":"10.21203/rs.3.rs-4793857/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4793857/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eAims: \u003c/strong\u003eTo elucidate the influencing factors of family resilience of postoperative colorectal cancer (CRC) patients, and how family resilience is affected by family function and mutuality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eIn this\u003cstrong\u003e \u003c/strong\u003ecross-sectional study, we investigated 216 postoperative CRC patients from two public hospitals. We started by studying the sociodemographic and disease-related factors impacting family resilience of CRC patient families through t-tests, one-way ANOVA, and Post Hoc Multiple Comparisons. To understand how family resilience could be affected from the family level, given the critical role of the copying capacity of family in the outcomes of postoperative CRC patients, we further investigated three key aspects of a family, i.e., family resilience, family function, and family mutuality using the Family Resilience Questionnaire (FaREQ), the Family Adaptation, Partnership, Growth, Affection, Resolve (APGAR) Scale, and the Mutuality Scale (MS). Then, based on all these results, we examined the interaction between family resilience, family function, and mutuality through Pearson correlations and the SPSS PROCESS macro.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Six factors were identified to be associated with family resilience among families of postoperative CRC patients, including postoperative duration(\u003cem\u003eF\u003c/em\u003e=3.684, \u003cem\u003ep\u003c/em\u003e=0.013), education level (\u003cem\u003eF\u003c/em\u003e=7.609, \u003cem\u003ep\u003c/em\u003e\u0026lt; 0.001), marital status (\u003cem\u003eF\u003c/em\u003e=2.822, \u003cem\u003ep\u003c/em\u003e=0.040), working status (\u003cem\u003eF\u003c/em\u003e=3.807, \u003cem\u003ep\u003c/em\u003e=0.024), family income (\u003cem\u003eF\u003c/em\u003e=9.487, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001), and stoma status (\u003cem\u003et\u003c/em\u003e=-2.991, \u003cem\u003ep\u003c/em\u003e=0.003). We found that family resilience was positively correlated with both family mutuality (\u003cem\u003er\u003c/em\u003e=0.170~0.473, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.05) and family function (\u003cem\u003er\u003c/em\u003e=0.135~0.451, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.05). Furthermore, we found that a healthy family mutuality could enhance family resilience, and the effectiveness of this enhancement was affected by the status of family function.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e In addition to sociodemographic and disease-related factors, this work studied the influence factors of family resilience of CRC patient families from a unique perspective, by systematically investigating the interaction between family resilience, family function, and family mutuality. Our results suggested that (1) family mutuality and family function were protective factors for family resilience; (2) Family function played a crucial role in mediating the positive effects of mutuality on family resilience. Based on our results, we suggest that healthcare professionals should assess family resilience actively from not only the sociodemographic and disease levels, but also from a more comprehensive family level, to develop effective intervention strategies to enhance the coping and adaptive capacities of families of CRC patients during the postoperative cancer management.\u003c/p\u003e","manuscriptTitle":"Family Mutuality Enhances the Family Resilience of CRC Patients through Positive Family Functioning","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-27 21:53:31","doi":"10.21203/rs.3.rs-4793857/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-04-16T04:27:09+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-25T10:34:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"291623018805993267924705343507901168089","date":"2024-09-20T04:35:22+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-09-05T18:37:20+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-09-05T18:34:42+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-07-26T06:35:06+00:00","index":"","fulltext":""},{"type":"submitted","content":"Supportive Care in Cancer","date":"2024-07-24T08:55:51+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"32c53e6d-4b15-40c1-917d-3906d0fbc6b5","owner":[],"postedDate":"August 27th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-09-22T06:51:44+00:00","versionOfRecord":{"articleIdentity":"rs-4793857","link":"https://doi.org/10.1007/s00520-025-09874-z","journal":{"identity":"supportive-care-in-cancer","isVorOnly":false,"title":"Supportive Care in Cancer"},"publishedOn":"2025-09-13 15:56:54","publishedOnDateReadable":"September 13th, 2025"},"versionCreatedAt":"2024-08-27 21:53:31","video":"","vorDoi":"10.1007/s00520-025-09874-z","vorDoiUrl":"https://doi.org/10.1007/s00520-025-09874-z","workflowStages":[]},"version":"v1","identity":"rs-4793857","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4793857","identity":"rs-4793857","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}