Family Communication Status and Influencing Factors Among Advanced Cancer Patients: A Cross- Sectional Study

Family Communication Status and Influencing Factors Among Advanced Cancer Patients: A Cross- Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Family Communication Status and Influencing Factors Among Advanced Cancer Patients: A Cross- Sectional Study Ruirui Ma, Xiaoli Fan, Xiubin Tao, Zibao Li, Wei Zhang, Ting Chen, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7433559/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective To investigate the current status of family communication among advanced cancer patients and explore its influencing factors. Design A cross-sectional study. Methods A cross-sectional study was conducted in Anhui Province, China. Using the General Information Questionnaire, the Cancer Communication Assessment Tool for Patients（CCAT-P）、the Cancer Communication Assessment Tool for Families (CCAT-F), the Family APGAR index, (APGAR),the Fear of Progression Questionnaire-Short Form (FoP-Q-SF) and the Social Isolation Assessment Questionnaire for Cancer Patients (SIAQ-CF), SPSS 27.0 was applied to analyze the data. Results In total, 400 participants completed the survey. Their levels of family communication were moderate or lower. their mean CCAT-P total score was 59.18 ± 20.12 among the advanced cancer patients and CCAT-F total score was 58.23±18.32 among the caregivers, respectively. The family communication level was closely related to six factors regression analysis revealed that Education level, Monthly income, APGAR, FoP-Q-SF, FoP-Q-SF/C, SIAQ-CF, CBS-CP were the primary influencing factors for family communication in advanced-stage cancer patients ( P < 0.05). Conclusion Families of advanced-stage cancer patients exhibit suboptimal communication levels characterized by poor communication. Clinicians should prioritize interventions for households demonstrating family dysfunction, psychological dysregulation related to fear of disease progression, elevated social isolation among patients, low educational attainment, and limited average monthly household income. Tailored clinical interventions are recommended to enhance positive family communication dynamics and thereby improve quality of life for these late-stage cancer patient families. Advanced cancer patients Caregiver Family communication 1 | Introduction Advanced cancer represents a critical global public health burden, with escalating incidence and mortality rates worldwide 〔 1 〕 . According to 2020 data released by the International Agency for Research on Cancer (IARC), approximately 19.3 million new cancer cases and nearly 10 million cancer-related deaths occurred globally 〔 2 , 3 〕 , Of these global cases, China accounted for nearly 23.7% 〔4〕 . Moreover, IARC data indicate that China bears a disproportionately high burden of cancer, where a significant majority of patients are diagnosed at advanced stages 〔 5 〕 . Advanced cancer has evolved into a chronic condition necessitating long-term management and sustained ambulatory care. Patients with advanced disease face multifaceted challenges—including physical deterioration, treatment-related toxicities, economic hardship, and psychological distress—which collectively underscore the critical need to enhance quality of life during the terminal phase 〔 6 〕 . Therefore, constant interaction between patients and caregiver is becoming increasingly important, and the role of the caregiver is becoming crucial for optimal cancer care. Strong communication between patient and caregiver is vital for the success of this relationship 〔 7 〕 .Effective family communication has emerged as a cornerstone in addressing these challenges, as it facilitates emotional support, decision-making, and symptom management among patients and their caregivers 〔 8 〕 . However, empirical evidence indicates that family communication often remains suboptimal in advanced cancer care within China, contributing to heightened anxiety, depressive symptoms, and relational strain among patients and caregivers 〔 9 〕 . Furthermore, current research in China primarily focuses on communication dynamics between cancer patients and their spouses. Although the existing Family Avoidance of Communication About Cancer (FACC) scale evaluates communication patterns, it predominantly assesses the degree of openness versus avoidance within family discourse, Notably, the FACC scale does not evaluate communication congruence or content specificity between advanced-stage cancer patients and their family caregivers 〔 10 〕 . In contrast, the Cancer Communication Assessment Tool for Patients and Families (CCAT-PF) scale—internationally validated for its ability to characterize the unique dyadic communication patterns between cancer patients and their caregivers—has not yet been applied within the Chinese context. International studies have consistently validated the psychometric properties of the Family Communication Scale (CCAT-PF). Specifically, scholars Siminoff 〔 11 〕 et al (U.S). demonstrated its validity and specificity through a psychometric evaluation involving 190 patient-caregiver dyads. Similarly, a large-scale study by Korean researchers Dong 〔 12 〕 et al. confirmed high internal consistency reliability (Cronbach’s α > 0.90) in a cohort of 990 cancer patients, Further supporting these findings, German investigators Natasha 〔 13 〕 et al. replicated the scale’s structural validity and internal consistency in 189 dyads, reinforcing its cross-cultural applicability. Consequently, this study aimed to: (1) validate the cultural adaptability and psychometric properties of the CCAT-PF scale within China, (2) examine the current state of family communication among advanced cancer patients and their caregivers, and (3) analyze key influencing factors. The findings are expected to provide a theoretical basis for developing individualized family communication practice programs aimed at enhancing the quality of life for families facing advanced cancer. 2 | Materials and methods 2.1 | Study design and participants This cross-sectional study, conducted between September 2024 and June 2025, investigated family communication patterns among advanced cancer patient-caregiver dyads in China. Participants were recruited using a convenience sampling method from two tertiary-level general hospitals in Anhui Province, targeting individuals meeting specific inclusion criteria: (1) Patients Inclusion Criteria: ①Age ≥ 18 years; ②Diagnosed with cancer at stage III or IV (according to American Joint Committee on Cancer staging system) 〔 14 〕 ; ③Clinician-estimated life expectancy of 3–6 months, determined using validated prognostic tools; ④Ability to provide written informed consent and sufficient cognitive capacity to independently complete self-report questionnaires. independently. (2) Caregiver inclusion criteria: ①Age ≥ 18 years; ②Identified by the patient as the primary unpaid caregiver; ③ Provision of ongoing care and support at home and during hospitalizations. Exclusion Criteria (applied to both patients and caregivers): The exclusion criteria for this study are patients and their caregivers with mental illness, cognitive impairment, or other serious medical conditions. The study protocol was approved by the Institutional Review Board of Wannan Medical College Affiliated Yijishan Hospital [2024]Lun Shen Yan No.91. WAll participants provided written informed consent after receiving detailed information regarding the study's purpose and procedures. Participation was voluntary, with the right to withdraw at any time 〔 15 〕 . Sample size calculation followed statistical guidelines for logistic regression analysis, recommending a minimum of 102–204 participants considering 17 predictor variables and a 20% non-response rate 〔 12 〕 . This yielded a target range of 102–204 patient-caregiver dyads. A total of 210 dyads were initially approached. After excluding 10 dyads due to incomplete questionnaires, 200 dyads with recurrent tumors were enrolled, meeting the sample size requirement and resulting in a response rate of 95.24%. 2.2 | Measurements 2.2.1 | General information questionnaire A self-report questionnaire designed based on literature review and clinical expertise, capturing Patient and caregivers-specific variables included age, gender, religious beliefs, residence, marital status, education level, monthly income, healthcare insurance, course, modalities of treatment, employment status, CCI 〔 16 〕 , comorbid medical conditions, relationship with patient(caregiver), living with patient༈caregiver༉. 2.2.2 | The Chinese version of Cancer Communication Assessment Tool for Patients and Families (CCAT-PF) The Cancer Communication Assessment Tool for Patients and Families (CCAT-PF), originally developed by Siminoff et al. in 2008 〔 11 〕 , initially comprised 30 items and demonstrated excellent internal consistency (Cronbach’s α = 0.94). The instrument was subsequently refined into an 18-item version. The Chinese adaptation contains two parallel subscales—CCAT-P (patient version) and CCAT-F (family-caregiver version). Each subscale encompasses four dimensions and 17 items; items 2, 5, 6, 7, 11, 12, 13, 14, 15, 16, and 17 are reverse-scored. The subscales can be administered either separately or simultaneously; in the present study they were distributed individually. Total scores range from 17 to 102, with higher scores indicating greater communication barriers between patients and their family caregivers. In this investigation, the Cronbach’s α coefficient for the Chinese CCAT-P was 0.902, indicating satisfactory reliability and validity. 2.2.3 | The Adaptation Partnership Growth Affection and Resolve (APGAR) The Family APGAR Index was originally developed by Smilkstein et al. in 1978 〔 17 〕 to assess perceived family functioning among adolescents and adults. A Chinese version was subsequently introduced by Lü et al. in 1999 〔 18 〕 for use in patients with cerebrovascular disease; in a prior study involving advanced cancer patients, the scale demonstrated acceptable internal consistency (Cronbach’s α = 0.830) 〔10〕 . The instrument comprises five domains: Adaptation, Partnership, Growth, Affection, and Resolve. Total scores range from 0 to 10, with scores of 0–6 indicating family dysfunction and 7–10 indicating good family functioning. In the present study, the Cronbach’s α coefficient was 0.962, evidencing excellent reliability and validity. 2.2.4 | Fear of progression questionnaire-short form (FoP-Q-SF) and Fear of progression questionnaire for caregiver (FoP-Q-SF /C) The FoP-Q-SF scale, originally abbreviated from the Fear of Progression Questionnaire–Short Form, was streamlined by Mehnert et al. in 2006 〔 19 〕 to assess disease-related fear among breast cancer patients, demonstrating a total Cronbach’s α coefficient of 0.87. Subsequently, Qiyun Wu et al 〔 20 〕 . adapted and validated its Chinese version in 2015 for evaluating fear of disease progression in patients with primary liver cancer. This adapted version comprises two dimensions (physical health and social/family impact) across 12 items, with total scores ranging from 12 to 60. A total score ≥ 34 indicates psychological dysfunction stemming from fear of disease progression, where higher scores reflect greater psychological distress related to disease progression fears. The FoP-Q-SF/C variant modifies select items of the original spouse-focused Fear of Progression Questionnaire–Short Form to evaluate cancer caregivers’ apprehension regarding patient recurrence and disease advancement during caregiving. Both versions maintain identical item counts and scoring methodologies. In this study, both scales demonstrated robust reliability, with Cronbach’s α coefficients of 0.883 (patient version) and 0.876 (caregiver version), confirming their strong psychometric properties. 2.2.5 | Social isolation assessment questionnaire for cancer patients (SIAQ-CF) The Social Isolation Assessment Questionnaire for Cancer Patients (SIAQ-CF) was developed by Su et al. in 2023 〔 21 〕 to quantify perceived social isolation in individuals with cancer. The instrument comprises 17 items distributed across four dimensions: self-isolation, loneliness, social estrangement, and feelings of meaninglessness. Total scores range from 17 to 85, with higher scores indicating greater levels of social isolation. In the present study, the SIAQ-CF demonstrated excellent internal consistency (Cronbach’s α = 0.902), supporting its reliability and validity within this population. 2.2.6 | Caregiver Burden Scale for Cancer Patients (CBS-CP) The scale was developed by Li et al. in 2017 〔 22 〕 to measure caregiver burden among family members of cancer patients. It consists of 5 dimensions comprising 29 items, each rated on a 5-point Likert-type scale ranging from "Never" (scored as 0) to "Always" (scored as 4). Total scores range from 0 to 116. Based on the total score, caregiver burden is categorized as follows: No Burden (≤ 29 points), Mild Burden (29–58 points), Moderate Burden (58–87 points), and Severe Burden (> 87 points). In this study, the scale demonstrated a Cronbach’s α coefficient of 0.858, indicating strong internal consistency. 2.3 | Data Collection This study employed a dual-mode approach for data collection: in-person distribution of paper questionnaires and online distribution via scannable QR codes for electronic versions. Trained investigators, having undergone systematic training, distributed paper questionnaires to eligible participants and provided personal guidance to ensure accurate and complete responses. For participants with lower education levels or visual impairments, investigators verbally administered the questionnaire. All questionnaires were collected on-site and checked for completeness; any missing items were promptly supplemented. A total of 210 questionnaires were distributed, with 200 valid questionnaires recovered, yielding a valid response rate of 95.24%. 2.4 | Data Analysis Statistical analyses were performed using SPSS software version 27.0 for data entry and processing. Continuous data were described as, while categorical data were presented as \(\:\stackrel{-}{\varvec{x}}\) ± s frequencies and percentages. Univariate analyses included the Chi-square test for group comparisons, independent samples t-tests for normally distributed continuous variables, and Mann-Whitney U tests for non-normally distributed variables. Spearman’s rank correlation was employed to assess relationships between variables. Predictors demonstrating statistical significance in univariate analyses were subsequently incorporated into a logistic regression model to identify independent influencing factors. A P-value < 0.05 was considered statistically significant. 3 | Results 3.1 | Characteristics of the participants This study enrolled 200 patients with advanced cancer and 200 corresponding family caregivers. Among the patients, 107 (53.5%) were male and 93 (46.5%) were female; their mean CCAT-P score Score was 59.18 ± 20.12 among the advanced cancer patients and 58.23 ± 18.32 among the caregivers respectively, 76 (38.0%) were male and 124 (62.0%) were female, with a mean CCAT-P score of 57.34 ± 18.56.Univariate analyses showed that, within the patient group, age, marital status, educational level, monthly household income, employment status, presence of comorbid medical conditions, Charlson Comorbidity Index (CCI), and living with the caregiver were significantly associated with the family communication score ( P < 0.05). In the caregiver group, marital status, educational level, monthly household income, employment status, presence of comorbid medical conditions, and living with the patient were likewise significantly associated with the score ( P < 0.05). Further participant characteristics are detailed in Table 1 . Table 1 Differences in family communication by general characteristic (n = 200) Characteristics CCAT-P F/t p CCAT-F F/t p Total (n = 200) score ( \(\:\stackrel{-}{\varvec{x}}\) ± s ) Total (n = 200) score ( \(\:\stackrel{-}{\varvec{x}}\) ± s ) Age 60 67(33.5%) 63.04 ± 17.46 63(31.5%) 62.70 ± 10.80 Gender Male 113(56.5%) 66.35 ± 19.00 1.746 0.078 94(47.0%) 63.35 ± 14.50 1.425 0.166 Female 87(43.5%) 59.38 ± 18.86 106(53.0%) 59.86 ± 13.12 Religious beliefs Yes 15(7.5%) 62.97 ± 19.04 0.631 0.428 8(4.0%) 60.77 ± 12.13 0.721 0.324 No 185(92.5%) 59.24 ± 16.15 192(96.0%) 58.71 ± 19.04 Residence Towns 92(46.0%) 61.24 ± 19.15 2.177 0.142 123(61.5%) 59.24 ± 8.23 1.051 0.331 Rural 108(54.0%) 65.23 ± 12.44 77(38.5%) 60.23 ± 9.35 Marital status Married 137(68.5%) 58.08 ± 18.90 15.200 <0.001 145(72.5%) 51.34 ± 7.56 20.080 <0.001 Not currently married 63(31.5%) 62.15 ± 10.20 55(27.5%) 56.45 ± 14.91 Education level Primary and below 61(30.5%) 68.5 ± 12.30 4.425 0.021 56(28.0%) 52.1 ± 10.20 1.311 0.018 junior high school 83(41.5%) 62.3 ± 11.70 59(29.5%) 55.4 ± 9.80 High school/Technical secondary school 36(18.0%) 50.25 ± 17.44 45(22.5%) 40.25 ± 6.32 College degree or above 20(10%) 57.90 ± 14.80 40(20.0%) 59.7 ± 8.50 Monthly income(yuan) ≤ 3000 99(49.5%) 68.2 ± 13.10 7.046 <0.001 78(39.0%) 63.3 ± 11.40 3.046 0.040 3001–5000 61(30.5%) 63.4 ± 12.00 64(32.0%) 61.42 ± 10.16 5001–8000 34(17.0%) 60.76 ± 15.16 45(22.5%) 56.72 ± 13.59 ≥ 8000 6(3.0%) 60.9 ± 11.50 13(6.5%) 55.20 ± 12.80 Healthcare insurance Yes 167(83.5%) 62.27 ± 22.07 1.220 0.304 188(94.0%) 61.74 ± 22.97 0.836 0.476 No 33(16.5%) 66.18 ± 19.19 12(6.0%) 61.21 ± 20.06 Course 3year 48(24.0%) 63.90 ± 11.38 - - Modalities of treatment Radiotherapy 41(20.5%) 58.08 ± 18.90 1.643 0.052 - - - - Chemotherapy 57(28.5%) 61.45 ± 14.91 - - Targeted therapy 52(26.0%) 73.04 ± 7.46 - - Mixed treatments 43(21.5%) 72.15 ± 10.20 - - Others 7(3.5%) 58.08 ± 18.90 - - Employment Status Employment 26(13.0%) 41.82 ± 15.37 39.085 <0.001 59(29.5%) 42.00 ± 14.35 29.085 <0.001 Unemployment 103(51.5%) 74.95 ± 15.01 72(36.0%) 63.42 ± 10.16 Retired 71(35.5%) 61.77 ± 18.24 69(34.5%) 50.25 ± 17.44 Comorbid medical conditions Yes 138(69.0%) 76.71 ± 7.93 5.21 0.025 89(44.5%) 75.11 ± 9.21 4.800 0.012 No 62(31.5%) 68.13 ± 11.68 111(55.5%) 69.45 ± 10.34 CCI Mild 23(21.5%) 45.98 ± 17.86 8.708 <0.001 - - - - Moderate 124(62.0%) 63.16 ± 18.34 - - Severe 53(26.5%) 73.90 ± 11.38 - - Relationship with patient(Caregiver) Spouse 68(34.0%) 53.93 ± 21.88 1.942 0.065 70(35.0%) 54.13 ± 15.11 1.534 0.101 Son/daughter 53(26.5%) 59.96 ± 20.50 43(21.5%) 57.00 ± 15.56 Son-/daughter-in-law 9(4.5%) 65.78 ± 13.86 6(3.0%) 61.74 ± 22.97 Parent 56(28.5%) 56.71 ± 10.93 65(32.5%) 52.27 ± 22.07 Sibling 7(3.5%) 58.93 ± 21.88 5(2.5%) 62.89 ± 22.28 Other 7(3.5%) 77.60 ± 6.58 11(5.5%) 68.13 ± 15.11 Living with patient(Caregiver) Yes 75(37.5%) 66.71 ± 7.93 1.687 0.025 59(29.5%) 65.11 ± 9.21 1.542 0.012 No 125(62.5%) 68.40 ± 14.20 141(70.5%) 69.45 ± 10.348 Note: CCI = Charlson Comorbidity index 3.2 | Correlations APGAR, FoP-Q-SF, F oP-Q-SF/C, SIAQ-CF, CBS-CP between among Advanced Cancer Patients and Caregivers Spearman correlation analyses revealed that, among patients with advanced cancer, Family APGAR scores were inversely correlated with family communication scores ( P < 0.05), whereas both Fear of Progression Questionnaire–Short Form (FoP-Q-SF) and Self-Identity After Cancer—Couple/Family (SIAQ-CF) scores showed positive correlations with family communication scores ( P < 0.05).Among family caregivers, Family APGAR scores were likewise negatively associated with family communication scores ( P < 0.05), while FoP-Q-SF and Caregiver Burden Scale—Cancer Patient (CBS-CP) scores were positively correlated with family communication scores ( P < 0.05). Additional participant characteristics are provided in Table 2.3. Table 2 Analysis of differences between APGAR, FoP-Q-SF, FoP-Q-SF/C, SIAQ-CF, CBS-CP between advanced patients and caregivers (n = 200) Variables Patient ( \(\:\stackrel{-}{\varvec{x}}\) ± s ) t p Caregiver ( \(\:\stackrel{-}{\varvec{x}}\) ± s ) t p CCAT-P 59.18 ± 20.12 - - - - - CCAT-F - - - 58.23 ± 18.32 - - APGAR 7.97 ± 1.09 6.061 <0.001 6.24 ± 1.78 5.237 <0.001 FoP-Q-SF FoP-Q-SF/C 31.58 ± 6.38 10.408 <0.001 30.80 ± 9.16 9.167 <0.001 SIAQ-CF 49.35 ± 11.83 18.382 <0.001 - - - CBS-CP - - - 52.13 ± 7.34 13.887 <0.001 Table 3 Correlation between CCAT-P, CCAT-F, APGAR, FoP-Q-SF, FoP-Q-SF/C, SIAQ-CF, CBS-CP between advanced patients and caregivers (n = 200) Variables CCAT-P APGAR FoP-Q-SF SIAQ-CF CCAT-P 1 - - - APGAR -0.572** 1 - - FoP-Q-SF 0.712** -0.806** 1 - SIAQ-CF 0.843** -0.478** 0.651** 1 Variables CCAT-F APGAR FoP-Q-SF/C CBS-CP CCAT-F 1 - - - APGAR -0.551** 1 - - FoP-Q-SF/C 0.694** -0.806** 1 - CBS-CP 0.895** -0.480** 0.638** 1 **At the 0.01 scale (two- tailed), the correlation is significant. 3.3 | Risk factors associated with Advanced Cancer Patients and Caregivers Variables that exhibited statistical significance in the univariate analyses were entered into the logistic regression model. The results indicated that educational level, per-capita monthly household income, family function, fear of disease progression, and social alienation of patients with advanced cancer were independent determinants of family communication among patients. For family caregivers, educational level, per-capita monthly household income, family function, fear of disease progression, and caregiver burden were independently associated with family communication. Additional participant characteristics are presented in Table 4 . Table 4 The Multivariate analysis of family communication between advanced patients and caregivers (n = 200) Patient Characteristics B SE β t P 95%CI Constant term -5.148 1.912 - -2.693 0.008 - Education level -0.720 0.312 -2.308 -2.308 0.016 –1.332, − 0.108 Monthly income 0.850 0.282 3.014 3.014 0.003 0.297, 1.403 APGAR 2.713 1.919 1.314 1.314 <0.001 1.508, 6.474 FoP-Q-SF 1.115 0.813 1.372 1.371 < 0.001 –0.478, 2.708 SIAQ-CF 2.123 1.502 1.413 1.413 <0.001 –0.821, 5.067 Caregiver Characteristic B SE β t P 95%CI Constant term -6.244 1.985 - -3.146 0.002 - Education level -1.184 0.317 -3.735 3.735 < 0.001 0.563, 1.805 Monthly income 0.889 0.210 4.234 4.234 < 0.001 0.477, 1.301 APGAR 1.951 0.459 4.250 4.250 < 0.001 1.051, 2.851 FoP-Q-SF/C 1.458 0.342 4.263 4.263 < 0.001 0.788, 2.128 CBS-CP 2.432 0.510 4.772 4.772 < 0.001 1.432, 3.432 Notes: R 2 = 0.565, R od =0.554, F = 48.797, P < 0.001. Bold font represents statis tically significant P -values. 4 | Discussion 4.1 | Levels of Advanced Patient and Caregiver Family conmmunication The study findings indicate that the CCAT-P total score for advanced cancer patients was 59.18 ± 20.12, while the score for their family caregivers was 58.23 ± 18.32. These scores are higher than those reported in studies by German researcher Michael 〔 13 〕 and American researcher Siminoff 〔 23 〕 . The discrepancy may be attributed to cultural differences between Eastern and Western societies, particularly in communication styles, emotional expression, and family dynamics. Compared to the open communication patterns advocated in Western cultures, the more reserved and implicit communication style prevalent in Chinese culture may result in incomplete information exchange, exacerbating patients' feelings of isolation and familial misunderstandings, which consequently could more readily lead to communication barriers within the family 〔 24 〕 . 4.2 | Influences Related to Advanced Patient and Caregiver Family conmmunication 4.2.1 | Education level This study identified low educational attainment as a significant risk factor for impaired family communication among patients with advanced cancer ( P < 0.05), consistent with findings from Qiao et al. 〔 8 〕 The underlying mechanisms may involve cultural norms where traditional Chinese families frequently employ "protective silence" and emotional suppression strategies to mitigate psychological burden on patients. This contrasts with Western emphasis on open communication paradigms 〔 12 〕 . In Asian cultural contexts, caregivers often maintain surface harmony through avoidance of negative topics, which can compromise information completeness and potentially exacerbate patient misunderstandings or loneliness 〔 12 〕 . Lower-educated patients exhibit diminished self-efficacy due to limited expressive capabilities, adopting passive acceptance of familial decisions that establish unidirectional communication patterns. This phenomenon undermines patient autonomy and further deteriorates interfamilial interactions 〔 25 〕 . Concurrently, cognitive limitations and health literacy deficits in these families impair patients' comprehension of disease information, treatment regimens, and prognostic outcomes. Their restricted vocabulary and expression skills also hinder recognition of family emotional needs, collectively reducing communication efficacy 〔 25 〕 . To address these challenges, healthcare providers should consider implementing visual aids (e.g., illustrated manuals) to simplify medical information dissemination. Collaborative community workshops focused on "family health communication" could enhance active engagement among lower-literacy households. Additionally, patient-centered care approaches characterized by patience and meticulous explanations are recommended to ensure comprehension. These interventions aim to strengthen communication competencies in culturally disadvantaged families, ultimately improving quality of life and treatment adherence. 4.2.2 | Monthly income This study found that lower household monthly per capita income constituted a significant risk factor for impaired family communication among cancer patients ( P < 0.05), consistent with findings from Qiao et al 〔 8 〕 . The underlying mechanism may stem from the direct correlation between financial capacity and medical cost burden. Empirical evidence indicates that an increase of one unit in economic stress elevates the risk of familial conflict by 27% 〔26〕 . Financial strain forces families to prioritize treatment costs over emotional needs, leading to an "instrumental communication dominance" phenomenon. Low-income cancer families often bear substantial economic burdens, which exacerbate caregiver anxiety levels and diminish empathetic responses. This cascade of effects—increased anxiety/depression in both patients and relatives—ultimately undermines communication willingness and competence. Furthermore, socioeconomic disadvantage limits access to high-quality medical resources and social support systems, hindering timely resolution of communication issues 〔 27 〕 .To address these challenges, healthcare providers should establish dual support pathways integrating health insurance policy education with psychological counseling. By creating accessible channels for economic assistance and psychosocial interventions, professionals can alleviate the "double burden" of financial stress and mental health demands faced by low-income advanced-stage cancer families. Such targeted interventions aim to enhance communication efficacy within these populations while improving overall quality of life. 4.2.3 | FoP-Q-SF and FoP-Q-SF/C This study identified FoP-Q-SF and FoP-Q-SF/C as a significant risk factor for impaired family communication among cancer patients and caregivers( P < 0.05), consistent with findings from Li et al 〔 28 〕 . The underlying mechanism may involve maladaptive responses where families of patients experiencing heightened fear tend to excessively focus on disease deterioration (e.g., "worsening pain" or "treatment failure"), which predisposes them to catastrophizing thoughts and impedes collaborative decision-making processes. Research 〔 29 〕 demonstrated that a 5-point increase in fear of disease progression scores correlates with a 1.8-fold elevated risk of avoidant communication behaviors. Cancer patients' pathological fear cognitions and emotions can transmute into familial anxiety, intensifying tension within the household and altering communication patterns. This includes reduced positive interaction frequency and increased negative expressions, thereby exacerbating communicative barriers. To address these challenges, healthcare providers are advised to implement targeted interventions. Primarily, clinicians should proactively assess patients' fear levels and enhance patient-clinician dialogues to mitigate distress. Secondarily, cognitive behavioral therapy (CBT) could be employed to restructure maladaptive disease perceptions, while family emotion-focused therapy (EFT) might interrupt negative emotional transmission. These dual approaches aim to empower families with accurate disease understanding, reduce fear-anxiety cycles, and facilitate shared decision-making processes. 4.2.4 | APGAR This study identified family dysfunction as a significant risk factor for impaired communication among advanced cancer patients ( P < 0.05), consistent with findings from Fan et al 〔 30 〕 . The underlying mechanism may involve maladaptive coping strategies in functionally impaired families, where "blame" or "silence" often replace problem-solving approaches, thereby compromising communication quality. Research evidence indicates that patients with low family functioning exhibit only 31% of conflict resolution efficiency compared to high-functioning counterparts 〔 31 〕 . Family dysfunction also erodes mutual support and cohesion, preventing collaborative disease management. This leaves patients feeling isolated and caregivers experiencing exhaustion. Furthermore, interpersonal tension and frequent conflicts within dysfunctional families exacerbate emotional distress and psychological stress, further diminishing communication willingness 〔 30 〕 . To address these challenges, healthcare providers are recommended to implement family-focused interventions. Specifically, professional family therapy should be provided for affected households, including encouraging patient participation in cancer support groups. Additionally, structured intervention programs could assist family members in identifying and modifying maladaptive communication patterns, establishing effective mechanisms to foster mutual understanding and support. These efforts aim to restore family functionality and enhance communication quality among cancer patients and their relatives. 4.2.5 | SIAQ-CF This study identified social alienation among cancer patients as a significant risk factor for impaired family communication in advanced-stage cases ( P < 0.05), aligning with findings from Zou et al 〔 32 〕 . The underlying mechanism likely involves multidimensional psychological and physical distress—including pain, fatigue, and existential struggles—that drives emotional withdrawal from family members, thereby obstructing effective communication. Research evidence indicates that 61% of healthy individuals avoid interaction with cancer patients and their families during group activities due to fear of contagion 〔 32 〕 . Prolonged exposure to despair, hopelessness, and anxiety further exacerbates self-imposed isolation in patients, reducing familial engagement and worsening communicative barriers 〔 33 〕 . To address these challenges, clinicians are advised to implement proactive assessments at admission to identify high-risk socially isolated patient households. Tailored psychological interventions should focus on alleviating negative emotions and fostering social reintegration through early recognition of identity strategies. Complementary training programs targeting both patients and caregivers are essential to establish structured communication frameworks. These multifaceted approaches aim to meet holistic needs—physical, psychological, and sociological—while enhancing quality of life for advanced cancer patients and their families. 4.2.6 | CBS-CP This study identified caregiver burden as a significant risk factor for impaired family communication among advanced cancer patients ( P < 0.05), consistent with findings from Carli et al 〔 34 〕 .The underlying mechanisms may involve compound stressors where deteriorating patient conditions necessitate frequent chemotherapy/radiotherapy regimens, leading to escalating financial pressures. Concurrently, treatment-related physical symptoms—such as nausea, vomiting, anorexia, and hair loss—not only inflict direct suffering on patients but also impose substantial psychological strain on caregivers. The synergistic effect of economic hardship and emotional demands further exacerbates caregiver burden, thereby increasing the likelihood of communicative barriers within the household 〔 35 〕 .These findings underscore the necessity for healthcare providers to implement systemic support interventions targeting caregiver well-being. Specifically, multidimensional strategies should include psychological counseling, economic assistance programs, practical caregiving skill training, and communication facilitation workshops 〔 36 〕 . By alleviating caregivers' dual burdens through these structured supports, clinical teams can enhance their resilience and foster more effective intrafamilial interactions. This approach aims to restore equilibrium in familial communication dynamics while improving overall quality of life for both patients and caregivers. 5 | Conclusion The findings of this investigation indicate that family communication among patients with advanced cancer is characterized by significant dysfunction. Key determinants identified include educational attainment, per capita monthly household income, fear of disease progression, patient social isolation, and caregiver burden. These results suggest that nursing personnel could utilize standardized, disease-specific assessment tools to identify families at high risk for communication barriers. Furthermore, exploring the potential application of digital tools for family communication support offers promise in overcoming geographical and resource limitations, enabling timely delivery of personalized clinical interventions. Tailored strategies are recommended based on individual patient characteristics and needs, encompassing culture-sensitive communication skills training, psychosocial support, and financial assistance. Concurrently, establishing an effective end-of-life communication model led by palliative care specialist nurses, collaborating with clinical psychologists and physicians, is proposed. This model would involve regular simulated family conferences focusing on shared decision-making regarding disease information, emotional management, and advance care planning, thereby enhancing communication quality through comprehensive intervention protocols. Such multifaceted approaches aim to holistically support families of advanced cancer patients, improve communication dynamics, and elevate overall family communication competence. 6 | Limitations Notably, this study employed a cross-sectional design with samples drawn from two tertiary hospitals in Anhui Province, China, imposing certain limitations concerning temporal scope and population representativeness. Future research necessitates multicenter, large-sample longitudinal studies to track the dynamic trajectory of family communication quality over time. Additionally, as the current analysis relied solely on separate surveys administered to cancer patients and their primary family caregivers using the Cancer Family Communication Assessment Tool (CCAT-P), it may underestimate intra-family communication congruence. Subsequent studies incorporating dual-subject data collection are recommended to refine the analytical framework elucidating influencing factors. This enhanced understanding will provide a robust evidence base for developing targeted interventions to improve family communication and, ultimately, enhance the quality of life for families navigating advanced cancer. Declarations 7 | Data availability statement The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. 8 | Author contributions Ruirui Ma Contributed to this manuscript Corresponding author: R-RM was responsible for the study design, data compilation, and analysis and completed the draft manuscript. X-LF, and X-BT participated in the data collection and coordination of the study. Z-Bl, WZand TC were responsible for the quality control and manuscript review. All the authors have read and approved the final version of the manuscript. 9 | Funding This study was supported by a grant (No. 2021kcszsfkc433) from the Fund Project of Nursing Laboratory Science Provincial Curriculum Civics Demonstration Course, the Anhui Education Department. and（KY22040046）2022 Provincial Department of Education Key Projects in Natural Science. 10 | Acknowledgments The authors would like to express their sincere gratitude to all participants involved in this study. We also thank the staff at Wannan Medical University Affiliated Yi ji shan Hospital for their support and assistance throughout the research process.We would also like to acknowledge Editage (www.editage.cn) for English language editing. 11 | Conffict of interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential confflict of interest. 12 | Consent for Publication All authors have provided their consent for publication of this manuscript. Additionally, informed consent was obtained from all participants involved in the study, allowing for the publication of results and findings. We affirm that all ethical guidelines were followed, and the confidentiality of participant data has been preserved throughout the research process. 13 | Ethics declaration This was a retrospective study, and patient information was hidden prior to the study. Approval was obtained from the Ethics Review Committee of Wannan Medical College and Shan Hospital (2024) Ethics Research No. (91). The manuscript has been provided. 14 | Clinical trial number Clinical trial number: not applicable. References Bray F, Laversanne M, Sung H. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229–63. Faccio F, Renzi C, Giudice AV. Family Resilience in the Oncology Setting: Development of an Integrative Framework. Front Psychol. 2018;9:666. Sung H, Ferlay J, Siegel RL. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209–49. Xia C, Dong X, Li H. Cancer statistics in China and United States, 2022: profiles, trends, and determinants. Chin Med J (Engl). 2022;135(5):584–90. Li C, He WQ. Comparison of primary liver cancer mortality estimates from World Health Organization, global burden disease and global cancer observatory. Liver Int. 2022;42(10):2299–316. Gao XY, Chen CY, CuiPP. et.al. Research progress on end⁃of⁃life communication mode among patients with advanced cancer. Nurs Res, 2020, 34(12): 2140ཞ2144(in Chinese). Harris J, Bowen DJ, Badr H. et.al. Family communication during the cancer experience. J Health Commun, 2009, 14 Suppl 1: 76ཞ84. QiaoY DPB. WangXQ,et.al. Current Status and Influencing Factors of Family Avoidance of Communication About Cancer Among 173 Advanced Cancer Patients. J Nurs, 2023, 30(13): 18ཞ23.(in Chinese). Jeong A, Shin DW, Kim SY. Avoidance of cancer communication, perceived social support, and anxiety and depression among patients with cancer. Psychooncology. 2016;25(11):1301–7. Liu H, Liu X, Liu Z. Death anxiety and its relationship with family function and meaning in life in patients with advanced cancer-A cross-sectional survey in China. Asia Pac J Oncol Nurs. 2022;9(10):100134. Siminoff LA, Zyzanski SJ, Rose JH. The Cancer Communication Assessment Tool for Patients and Families (CCAT-PF): a new measure. Psychooncology. 2008;17(12):1216–24. Shin DW, Shin J, Kim SY. Family Avoidance of Communication about Cancer: A Dyadic Examination. Cancer Res Treat. 2016;48(1):384–92. Michael N, Gorelik A, Georgousopoulou E. Patient-caregiver communication concordance in cancer-refinement of the Cancer Communication Assessment Tool in an Australian sample. Support Care Cancer. 2022;30(9):7387–96. Zhang LN, Cao YJ, Wang A, Cuixia. et.al. Survival analysis of patients receiving community-based palliative care using the Palliative Prognostic Index. Shanxi Med J, 2023, 52(13): 988ཞ992.(in Chinese). Pei Y, Xu Z, Luo X. Study on the Current Situation and Influencing Factors of Family Resilience of Patients With Recurrent Cancer and Their Caregivers. Nurs Open. 2025;12(4):e70153. Bannay A, Chaignot C, Blotière PO. The Best Use of the Charlson Comorbidity Index With Electronic Health Care Database to Predict Mortality. Med Care. 2016;54(2):188–94. Smilkstein G. The family APGAR: a proposal for a family function test and its use by physicians. J Fam Pract. 1978;6(6):1231–9. Lv F, Zhan H, Zhiqiang. Reliability and validity of the Family APGAR questionnaire for assessing family function in patients with cerebrovascular disease. Chin J Public Health, 1999(11): 27ཞ28.(in Chinese). Mehnert A, Herschbach P, Berg P. [Fear of progression in breast cancer patients–validation of the short form of the Fear of Progression Questionnaire (FoP-Q-SF)]. Z Psychosom Med Psychother. 2006;52(3):274–88. Wu QY, Ye ZX, Li l. et.al. Cross-cultural adaptation and psychometric evaluation of the Chinese version of the Fear of Progression Questionnaire-Short Form (FoP-Q-SF) in cancer patients. Chin J Nurs, 2015, 50(12): 1515ཞ1519.(in Chinese). Su SS, Dong YM, Zhang W. et.al. Development and psychometric test of Social Isolation Assessment Questionnaire for cancer patients. J Nurs, 2023, 30(17): 51ཞ56.(in Chinese). Li QP, Xn XF, Lin Y. et.al. Development and psychometric evaluation of the Family Caregiver Burden Scale for cancer patients. Chin Nurs Manage, 2017, 17(11): 1490ཞ1494.(in Chinese). Siminoff LA, Wilson-Genderson M, Barta S. Hematological cancer patient-caregiver dyadic communication: A longitudinal examination of cancer communication concordance. Psychooncology. 2020;29(10):1571–8. Thomson MD, Genderson MW, Siminoff LA. Understanding cancer caregiver burden over time: Dyadic assessments of family cohesion, conflict and communication. Patient Educ Couns. 2022;105(6):1545–51. Yang L, Liu J, Liu Q. The relationships among symptom experience, family support, health literacy, and fear of progression in advanced lung cancer patients. J Adv Nurs. 2023;79(9):3549–58. Thomson MD, Genderson MW, Siminoff LA. Understanding cancer caregiver burden over time: Dyadic assessments of family cohesion, conflict and communication. Patient Educ Couns. 2022;105(6):1545–51. Wittenberg E, Buller H, Ferrell B. Understanding Family Caregiver Communication to Provide Family-Centered Cancer Care. Semin Oncol Nurs. 2017;33(5):507–16. Li YS, Zhang HH, Zhang N. Investigation on the current status of family avoidance of cancer communication and its influencing factors in patients with lung cancer [J]. Chin Clin Nurs, 2023, 15(03): 170ཞ173.(in Chinese). Fisher CL, Nussbaum JF. Maximizing Wellness in Successful Aging and Cancer Coping: The Importance of Family Communication from a Socioemotional Selectivity Theoretical Perspective. J Fam Commun. 2015;15(1):3–19. Fan T, Zhong M, Luo C. et.al. Effects of psychological resilience and positive coping style on self-image in postoperative breast cancer patients. J Nurses Train, 2019, 34(02): 122ཞ125.(in Chinese). Wang JHY, Brown RL, Huang E. Mediational roles of stress-coping factors in the relationship between patient-perceived communication quality and physical functioning: racial difference between Chinese and Non-Hispanic White American breast cancer survivors. Qual Life Res. 2024;33(1):253–65. Zou J, Jia H, Wang J. Social isolation as a significant risk factor for depression in colorectal cancer patients post-colostomy: a cross-sectional study. Front Psychiatry. 2025;16:1588314. Gu Z, Li M, Liu L. The moderating effect of self-efficacy between social constraints, social isolation, family environment, and depressive symptoms among breast cancer patients in China: a cross-sectional study. Support Care Cancer. 2023;31(10):594. de Carli CL, Oliveira, G P N, M, Rafaela. and A, et.al. Caring ability, burden, stress and coping of family caregivers of people in cancer treatment. Revista brasileira de enfermagem, 2019(6). Jiang W, Yang Y, Shi X. Efficacy of family centered empowerment model of support on care burden in family caregivers of patients with prostate cancer. Pak J Med Sci. 2025;41(7):2080–6. Park S, Mazanec SR, Burant CJ. Caregiver Burden in Distance Caregivers of Patients with Cancer. Curr Oncol. 2022;29(11):8967–74. Additional Declarations No competing interests reported. Supplementary Files STROBEchecklistcrosssectional823docx.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Introduction","content":"\u003cp\u003eAdvanced cancer represents a critical global public health burden, with escalating incidence and mortality rates worldwide\u003csup\u003e〔\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e〕\u003c/sup\u003e. According to 2020 data released by the International Agency for Research on Cancer (IARC), approximately 19.3\u0026nbsp;million new cancer cases and nearly 10\u0026nbsp;million cancer-related deaths occurred globally\u003csup\u003e〔\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e〕\u003c/sup\u003e, Of these global cases, China accounted for nearly 23.7%\u003csup\u003e〔4〕\u003c/sup\u003e. Moreover, IARC data indicate that China bears a disproportionately high burden of cancer, where a significant majority of patients are diagnosed at advanced stages\u003csup\u003e〔\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e〕\u003c/sup\u003e. Advanced cancer has evolved into a chronic condition necessitating long-term management and sustained ambulatory care. Patients with advanced disease face multifaceted challenges\u0026mdash;including physical deterioration, treatment-related toxicities, economic hardship, and psychological distress\u0026mdash;which collectively underscore the critical need to enhance quality of life during the terminal phase\u003csup\u003e〔\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e〕\u003c/sup\u003e. Therefore, constant interaction between patients and caregiver is becoming increasingly important, and the role of the caregiver is becoming crucial for optimal cancer care. Strong communication between patient and caregiver is vital for the success of this relationship\u003csup\u003e〔\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e〕\u003c/sup\u003e.Effective family communication has emerged as a cornerstone in addressing these challenges, as it facilitates emotional support, decision-making, and symptom management among patients and their caregivers\u003csup\u003e〔\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e〕\u003c/sup\u003e. However, empirical evidence indicates that family communication often remains suboptimal in advanced cancer care within China, contributing to heightened anxiety, depressive symptoms, and relational strain among patients and caregivers\u003csup\u003e〔\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e〕\u003c/sup\u003e. Furthermore, current research in China primarily focuses on communication dynamics between cancer patients and their spouses. Although the existing Family Avoidance of Communication About Cancer (FACC) scale evaluates communication patterns, it predominantly assesses the degree of openness versus avoidance within family discourse, Notably, the FACC scale does not evaluate communication congruence or content specificity between advanced-stage cancer patients and their family caregivers\u003csup\u003e〔\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e〕\u003c/sup\u003e. In contrast, the Cancer Communication Assessment Tool for Patients and Families (CCAT-PF) scale\u0026mdash;internationally validated for its ability to characterize the unique dyadic communication patterns between cancer patients and their caregivers\u0026mdash;has not yet been applied within the Chinese context. International studies have consistently validated the psychometric properties of the Family Communication Scale (CCAT-PF). Specifically, scholars Siminoff\u003csup\u003e〔\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e〕\u003c/sup\u003e et al (U.S). demonstrated its validity and specificity through a psychometric evaluation involving 190 patient-caregiver dyads. Similarly, a large-scale study by Korean researchers Dong\u003csup\u003e〔\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e〕\u003c/sup\u003e et al. confirmed high internal consistency reliability (Cronbach\u0026rsquo;s α\u0026thinsp;\u0026gt;\u0026thinsp;0.90) in a cohort of 990 cancer patients, Further supporting these findings, German investigators Natasha\u003csup\u003e〔\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e〕\u003c/sup\u003e et al. replicated the scale\u0026rsquo;s structural validity and internal consistency in 189 dyads, reinforcing its cross-cultural applicability. Consequently, this study aimed to: (1) validate the cultural adaptability and psychometric properties of the CCAT-PF scale within China, (2) examine the current state of family communication among advanced cancer patients and their caregivers, and (3) analyze key influencing factors. The findings are expected to provide a theoretical basis for developing individualized family communication practice programs aimed at enhancing the quality of life for families facing advanced cancer.\u003c/p\u003e"},{"header":"2 | Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 | Study design and participants\u003c/h2\u003e\u003cp\u003e This cross-sectional study, conducted between September 2024 and June 2025, investigated family communication patterns among advanced cancer patient-caregiver dyads in China. Participants were recruited using a convenience sampling method from two tertiary-level general hospitals in Anhui Province, targeting individuals meeting specific inclusion criteria: (1) Patients Inclusion Criteria: ①Age\u0026thinsp;\u0026ge;\u0026thinsp;18 years; ②Diagnosed with cancer at stage III or IV (according to American Joint Committee on Cancer staging system)\u003csup\u003e〔\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e〕\u003c/sup\u003e; ③Clinician-estimated life expectancy of 3\u0026ndash;6 months, determined using validated prognostic tools; ④Ability to provide written informed consent and sufficient cognitive capacity to independently complete self-report questionnaires.\u003c/p\u003e\u003cp\u003eindependently. (2) Caregiver inclusion criteria: ①Age\u0026thinsp;\u0026ge;\u0026thinsp;18 years; ②Identified by the patient as the primary unpaid caregiver; ③ Provision of ongoing care and support at home and during hospitalizations. Exclusion Criteria (applied to both patients and caregivers): The exclusion criteria for this study are patients and their caregivers with mental illness, cognitive impairment, or other serious medical conditions.\u003c/p\u003e\u003cp\u003e The study protocol was approved by the Institutional Review Board of Wannan Medical College Affiliated Yijishan Hospital [2024]Lun Shen Yan No.91. WAll participants provided written informed consent after receiving detailed information regarding the study's purpose and procedures. Participation was voluntary, with the right to withdraw at any time\u003csup\u003e〔\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e〕\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eSample size calculation followed statistical guidelines for logistic regression analysis, recommending a minimum of 102\u0026ndash;204 participants considering 17 predictor variables and a 20% non-response rate\u003csup\u003e〔\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e〕\u003c/sup\u003e. This yielded a target range of 102\u0026ndash;204 patient-caregiver dyads. A total of 210 dyads were initially approached. After excluding 10 dyads due to incomplete questionnaires, 200 dyads with recurrent tumors were enrolled, meeting the sample size requirement and resulting in a response rate of 95.24%.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 | Measurements\u003c/h2\u003e\u003cdiv id=\"Sec5\" class=\"Section3\"\u003e\u003ch2\u003e2.2.1 | General information questionnaire\u003c/h2\u003e\u003cp\u003eA self-report questionnaire designed based on literature review and clinical expertise, capturing Patient and caregivers-specific variables included age, gender, religious beliefs, residence, marital status, education level, monthly income, healthcare insurance, course, modalities of treatment, employment status, CCI\u003csup\u003e〔\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e〕\u003c/sup\u003e, comorbid medical conditions, relationship with patient(caregiver), living with patient༈caregiver༉.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section3\"\u003e\u003ch2\u003e\u003cb\u003e2.2.2 | The Chinese version of Cancer Communication Assessment Tool for Patients and Families (CCAT-PF)\u003c/b\u003e\u003c/h2\u003e\u003cp\u003eThe Cancer Communication Assessment Tool for Patients and Families (CCAT-PF), originally developed by Siminoff et al. in 2008\u003csup\u003e〔\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e〕\u003c/sup\u003e, initially comprised 30 items and demonstrated excellent internal consistency (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.94). The instrument was subsequently refined into an 18-item version. The Chinese adaptation contains two parallel subscales\u0026mdash;CCAT-P (patient version) and CCAT-F (family-caregiver version). Each subscale encompasses four dimensions and 17 items; items 2, 5, 6, 7, 11, 12, 13, 14, 15, 16, and 17 are reverse-scored. The subscales can be administered either separately or simultaneously; in the present study they were distributed individually. Total scores range from 17 to 102, with higher scores indicating greater communication barriers between patients and their family caregivers. In this investigation, the Cronbach\u0026rsquo;s α coefficient for the Chinese CCAT-P was 0.902, indicating satisfactory reliability and validity.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section3\"\u003e\u003ch2\u003e2.2.3 | The Adaptation Partnership Growth Affection and Resolve (APGAR)\u003c/h2\u003e\u003cp\u003eThe Family APGAR Index was originally developed by Smilkstein et al. in 1978\u003csup\u003e〔\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e〕\u003c/sup\u003e to assess perceived family functioning among adolescents and adults. A Chinese version was subsequently introduced by L\u0026uuml; et al. in 1999\u003csup\u003e〔\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e〕\u003c/sup\u003e for use in patients with cerebrovascular disease; in a prior study involving advanced cancer patients, the scale demonstrated acceptable internal consistency (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.830)\u003csup\u003e〔10〕\u003c/sup\u003e. The instrument comprises five domains: Adaptation, Partnership, Growth, Affection, and Resolve. Total scores range from 0 to 10, with scores of 0\u0026ndash;6 indicating family dysfunction and 7\u0026ndash;10 indicating good family functioning. In the present study, the Cronbach\u0026rsquo;s α coefficient was 0.962, evidencing excellent reliability and validity.\u003c/p\u003e\u003cp\u003e\u003cb\u003e2.2.4 | Fear of progression questionnaire-short form (FoP-Q-SF) and Fear of progression questionnaire for caregiver (FoP-Q-SF /C)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe FoP-Q-SF scale, originally abbreviated from the Fear of Progression Questionnaire\u0026ndash;Short Form, was streamlined by Mehnert et al. in 2006\u003csup\u003e〔\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e〕\u003c/sup\u003e to assess disease-related fear among breast cancer patients, demonstrating a total Cronbach\u0026rsquo;s α coefficient of 0.87. Subsequently, Qiyun Wu et al\u003csup\u003e〔\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e〕\u003c/sup\u003e. adapted and validated its Chinese version in 2015 for evaluating fear of disease progression in patients with primary liver cancer. This adapted version comprises two dimensions (physical health and social/family impact) across 12 items, with total scores ranging from 12 to 60. A total score\u0026thinsp;\u0026ge;\u0026thinsp;34 indicates psychological dysfunction stemming from fear of disease progression, where higher scores reflect greater psychological distress related to disease progression fears. The FoP-Q-SF/C variant modifies select items of the original spouse-focused Fear of Progression Questionnaire\u0026ndash;Short Form to evaluate cancer caregivers\u0026rsquo; apprehension regarding patient recurrence and disease advancement during caregiving. Both versions maintain identical item counts and scoring methodologies. In this study, both scales demonstrated robust reliability, with Cronbach\u0026rsquo;s α coefficients of 0.883 (patient version) and 0.876 (caregiver version), confirming their strong psychometric properties.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section3\"\u003e\u003ch2\u003e2.2.5 | Social isolation assessment questionnaire for cancer patients (SIAQ-CF)\u003c/h2\u003e\u003cp\u003eThe Social Isolation Assessment Questionnaire for Cancer Patients (SIAQ-CF) was developed by Su et al. in 2023\u003csup\u003e〔\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e〕\u003c/sup\u003e to quantify perceived social isolation in individuals with cancer. The instrument comprises 17 items distributed across four dimensions: self-isolation, loneliness, social estrangement, and feelings of meaninglessness. Total scores range from 17 to 85, with higher scores indicating greater levels of social isolation. In the present study, the SIAQ-CF demonstrated excellent internal consistency (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.902), supporting its reliability and validity within this population.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\u003ch2\u003e2.2.6 | Caregiver Burden Scale for Cancer Patients (CBS-CP)\u003c/h2\u003e\u003cp\u003eThe scale was developed by Li et al. in 2017\u003csup\u003e〔\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e〕\u003c/sup\u003e to measure caregiver burden among family members of cancer patients. It consists of 5 dimensions comprising 29 items, each rated on a 5-point Likert-type scale ranging from \"Never\" (scored as 0) to \"Always\" (scored as 4). Total scores range from 0 to 116. Based on the total score, caregiver burden is categorized as follows: No Burden (\u0026le;\u0026thinsp;29 points), Mild Burden (29\u0026ndash;58 points), Moderate Burden (58\u0026ndash;87 points), and Severe Burden (\u0026gt;\u0026thinsp;87 points). In this study, the scale demonstrated a Cronbach\u0026rsquo;s α coefficient of 0.858, indicating strong internal consistency.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e2.3 | Data Collection\u003c/h2\u003e\u003cp\u003eThis study employed a dual-mode approach for data collection: in-person distribution of paper questionnaires and online distribution via scannable QR codes for electronic versions. Trained investigators, having undergone systematic training, distributed paper questionnaires to eligible participants and provided personal guidance to ensure accurate and complete responses. For participants with lower education levels or visual impairments, investigators verbally administered the questionnaire. All questionnaires were collected on-site and checked for completeness; any missing items were promptly supplemented. A total of 210 questionnaires were distributed, with 200 valid questionnaires recovered, yielding a valid response rate of 95.24%.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e2.4 | Data Analysis\u003c/h2\u003e\u003cp\u003eStatistical analyses were performed using SPSS software version 27.0 for data entry and processing. Continuous data were described as, while categorical data were presented as \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\stackrel{-}{\\varvec{x}}\\)\u003c/span\u003e\u003c/span\u003e\u003cb\u003e\u0026plusmn; s\u003c/b\u003e frequencies and percentages. Univariate analyses included the Chi-square test for group comparisons, independent samples t-tests for normally distributed continuous variables, and Mann-Whitney U tests for non-normally distributed variables. Spearman\u0026rsquo;s rank correlation was employed to assess relationships between variables. Predictors demonstrating statistical significance in univariate analyses were subsequently incorporated into a logistic regression model to identify independent influencing factors. A P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"3 | Results","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e3.1 | Characteristics of the participants\u003c/h2\u003e\u003cp\u003eThis study enrolled 200 patients with advanced cancer and 200 corresponding family caregivers. Among the patients, 107 (53.5%) were male and 93 (46.5%) were female; their mean CCAT-P score Score was 59.18\u0026thinsp;\u0026plusmn;\u0026thinsp;20.12 among the advanced cancer patients and 58.23\u0026thinsp;\u0026plusmn;\u0026thinsp;18.32 among the caregivers respectively, 76 (38.0%) were male and 124 (62.0%) were female, with a mean CCAT-P score of 57.34\u0026thinsp;\u0026plusmn;\u0026thinsp;18.56.Univariate analyses showed that, within the patient group, age, marital status, educational level, monthly household income, employment status, presence of comorbid medical conditions, Charlson Comorbidity Index (CCI), and living with the caregiver were significantly associated with the family communication score (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). In the caregiver group, marital status, educational level, monthly household income, employment status, presence of comorbid medical conditions, and living with the patient were likewise significantly associated with the score (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Further participant characteristics are detailed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDifferences in family communication by general characteristic (n\u0026thinsp;=\u0026thinsp;200)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eCCAT-P\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eF/t\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003eCCAT-F\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eF/t\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;200)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003escore (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\stackrel{-}{\\varvec{x}}\\)\u003c/span\u003e\u003c/span\u003e\u003cem\u003e\u0026plusmn; s\u003c/em\u003e)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;200)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003escore (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\stackrel{-}{\\varvec{x}}\\)\u003c/span\u003e\u003c/span\u003e \u003cem\u003e\u0026plusmn; s\u003c/em\u003e)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46(23.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e58.08\u0026thinsp;\u0026plusmn;\u0026thinsp;18.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e3.214\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.040\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e54(27.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e53.25\u0026thinsp;\u0026plusmn;\u0026thinsp;17.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e1.578\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.061\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e40\u0026thinsp;~\u0026thinsp;60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e87(43.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e61.45\u0026thinsp;\u0026plusmn;\u0026thinsp;14.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e83(41.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e59.67\u0026thinsp;\u0026plusmn;\u0026thinsp;18.03\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e67(33.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e63.04\u0026thinsp;\u0026plusmn;\u0026thinsp;17.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e63(31.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e62.70\u0026thinsp;\u0026plusmn;\u0026thinsp;10.80\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e113(56.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e66.35\u0026thinsp;\u0026plusmn;\u0026thinsp;19.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e1.746\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.078\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e94(47.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e63.35\u0026thinsp;\u0026plusmn;\u0026thinsp;14.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e1.425\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.166\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e87(43.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e59.38\u0026thinsp;\u0026plusmn;\u0026thinsp;18.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e106(53.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e59.86\u0026thinsp;\u0026plusmn;\u0026thinsp;13.12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReligious beliefs\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15(7.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e62.97\u0026thinsp;\u0026plusmn;\u0026thinsp;19.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.631\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.428\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8(4.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e60.77\u0026thinsp;\u0026plusmn;\u0026thinsp;12.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.721\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.324\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e185(92.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e59.24\u0026thinsp;\u0026plusmn;\u0026thinsp;16.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e192(96.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e58.71\u0026thinsp;\u0026plusmn;\u0026thinsp;19.04\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eResidence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTowns\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e92(46.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e61.24\u0026thinsp;\u0026plusmn;\u0026thinsp;19.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e2.177\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.142\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e123(61.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e59.24\u0026thinsp;\u0026plusmn;\u0026thinsp;8.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e1.051\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.331\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e108(54.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e65.23\u0026thinsp;\u0026plusmn;\u0026thinsp;12.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e77(38.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e60.23\u0026thinsp;\u0026plusmn;\u0026thinsp;9.35\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e137(68.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e58.08\u0026thinsp;\u0026plusmn;\u0026thinsp;18.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e15.200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e145(72.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e51.34\u0026thinsp;\u0026plusmn;\u0026thinsp;7.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e20.080\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot currently married\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e63(31.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e62.15\u0026thinsp;\u0026plusmn;\u0026thinsp;10.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e55(27.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e56.45\u0026thinsp;\u0026plusmn;\u0026thinsp;14.91\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducation level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary and below\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e61(30.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e68.5\u0026thinsp;\u0026plusmn;\u0026thinsp;12.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e4.425\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e56(28.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e52.1\u0026thinsp;\u0026plusmn;\u0026thinsp;10.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e1.311\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.018\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ejunior high school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e83(41.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e62.3\u0026thinsp;\u0026plusmn;\u0026thinsp;11.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e59(29.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e55.4\u0026thinsp;\u0026plusmn;\u0026thinsp;9.80\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh school/Technical\u003c/p\u003e\u003cp\u003esecondary school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36(18.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e50.25\u0026thinsp;\u0026plusmn;\u0026thinsp;17.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e45(22.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e40.25\u0026thinsp;\u0026plusmn;\u0026thinsp;6.32\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCollege degree or above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20(10%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e57.90\u0026thinsp;\u0026plusmn;\u0026thinsp;14.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e40(20.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e59.7\u0026thinsp;\u0026plusmn;\u0026thinsp;8.50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMonthly income(yuan)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;3000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e99(49.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e68.2\u0026thinsp;\u0026plusmn;\u0026thinsp;13.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e7.046\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e78(39.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e63.3\u0026thinsp;\u0026plusmn;\u0026thinsp;11.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e3.046\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.040\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3001\u0026ndash;5000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e61(30.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e63.4\u0026thinsp;\u0026plusmn;\u0026thinsp;12.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e64(32.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e61.42\u0026thinsp;\u0026plusmn;\u0026thinsp;10.16\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5001\u0026ndash;8000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e34(17.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e60.76\u0026thinsp;\u0026plusmn;\u0026thinsp;15.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e45(22.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e56.72\u0026thinsp;\u0026plusmn;\u0026thinsp;13.59\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;8000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6(3.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e60.9\u0026thinsp;\u0026plusmn;\u0026thinsp;11.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e13(6.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e55.20\u0026thinsp;\u0026plusmn;\u0026thinsp;12.80\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHealthcare insurance\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e167(83.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e62.27\u0026thinsp;\u0026plusmn;\u0026thinsp;22.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e1.220\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.304\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e188(94.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e61.74\u0026thinsp;\u0026plusmn;\u0026thinsp;22.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.836\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.476\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33(16.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e66.18\u0026thinsp;\u0026plusmn;\u0026thinsp;19.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e12(6.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e61.21\u0026thinsp;\u0026plusmn;\u0026thinsp;20.06\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCourse\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;1year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e63(31.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e55.98\u0026thinsp;\u0026plusmn;\u0026thinsp;17.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e1.942\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.065\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u0026thinsp;~\u0026thinsp;3year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e89(44.5% )\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e63.16\u0026thinsp;\u0026plusmn;\u0026thinsp;18.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;3year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e48(24.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e63.90\u0026thinsp;\u0026plusmn;\u0026thinsp;11.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eModalities of treatment\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRadiotherapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41(20.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e58.08\u0026thinsp;\u0026plusmn;\u0026thinsp;18.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e1.643\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e0.052\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChemotherapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e57(28.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e61.45\u0026thinsp;\u0026plusmn;\u0026thinsp;14.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTargeted therapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e52(26.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e73.04\u0026thinsp;\u0026plusmn;\u0026thinsp;7.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMixed treatments\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e43(21.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e72.15\u0026thinsp;\u0026plusmn;\u0026thinsp;10.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7(3.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e58.08\u0026thinsp;\u0026plusmn;\u0026thinsp;18.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEmployment Status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmployment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26(13.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e41.82\u0026thinsp;\u0026plusmn;\u0026thinsp;15.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e39.085\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e59(29.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e42.00\u0026thinsp;\u0026plusmn;\u0026thinsp;14.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e29.085\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnemployment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e103(51.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e74.95\u0026thinsp;\u0026plusmn;\u0026thinsp;15.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e72(36.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e63.42\u0026thinsp;\u0026plusmn;\u0026thinsp;10.16\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRetired\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e71(35.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e61.77\u0026thinsp;\u0026plusmn;\u0026thinsp;18.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e69(34.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e50.25\u0026thinsp;\u0026plusmn;\u0026thinsp;17.44\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eComorbid medical conditions\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e138(69.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e76.71\u0026thinsp;\u0026plusmn;\u0026thinsp;7.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e5.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.025\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e89(44.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e75.11\u0026thinsp;\u0026plusmn;\u0026thinsp;9.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e4.800\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.012\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e62(31.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e68.13\u0026thinsp;\u0026plusmn;\u0026thinsp;11.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e111(55.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e69.45\u0026thinsp;\u0026plusmn;\u0026thinsp;10.34\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCCI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMild\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23(21.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e45.98\u0026thinsp;\u0026plusmn;\u0026thinsp;17.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e8.708\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e124(62.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e63.16\u0026thinsp;\u0026plusmn;\u0026thinsp;18.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSevere\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e53(26.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e73.90\u0026thinsp;\u0026plusmn;\u0026thinsp;11.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRelationship with patient(Caregiver)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpouse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e68(34.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e53.93\u0026thinsp;\u0026plusmn;\u0026thinsp;21.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003e1.942\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003e0.065\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e70(35.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e54.13\u0026thinsp;\u0026plusmn;\u0026thinsp;15.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003e1.534\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003e0.101\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSon/daughter\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e53(26.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e59.96\u0026thinsp;\u0026plusmn;\u0026thinsp;20.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e43(21.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e57.00\u0026thinsp;\u0026plusmn;\u0026thinsp;15.56\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSon-/daughter-in-law\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9(4.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e65.78\u0026thinsp;\u0026plusmn;\u0026thinsp;13.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6(3.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e61.74\u0026thinsp;\u0026plusmn;\u0026thinsp;22.97\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e56(28.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e56.71\u0026thinsp;\u0026plusmn;\u0026thinsp;10.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e65(32.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e52.27\u0026thinsp;\u0026plusmn;\u0026thinsp;22.07\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSibling\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7(3.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e58.93\u0026thinsp;\u0026plusmn;\u0026thinsp;21.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5(2.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e62.89\u0026thinsp;\u0026plusmn;\u0026thinsp;22.28\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7(3.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e77.60\u0026thinsp;\u0026plusmn;\u0026thinsp;6.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e11(5.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e68.13\u0026thinsp;\u0026plusmn;\u0026thinsp;15.11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLiving with patient(Caregiver)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e75(37.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e66.71\u0026thinsp;\u0026plusmn;\u0026thinsp;7.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e1.687\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.025\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e59(29.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e65.11\u0026thinsp;\u0026plusmn;\u0026thinsp;9.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e1.542\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.012\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e125(62.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e68.40\u0026thinsp;\u0026plusmn;\u0026thinsp;14.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e141(70.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e69.45\u0026thinsp;\u0026plusmn;\u0026thinsp;10.348\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003eNote: CCI\u0026thinsp;=\u0026thinsp;Charlson Comorbidity index\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003e3.2 | Correlations APGAR, FoP-Q-SF, F oP-Q-SF/C, SIAQ-CF, CBS-CP between among Advanced Cancer Patients and Caregivers\u003c/h2\u003e\u003cp\u003eSpearman correlation analyses revealed that, among patients with advanced cancer, Family APGAR scores were inversely correlated with family communication scores (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), whereas both Fear of Progression Questionnaire\u0026ndash;Short Form (FoP-Q-SF) and Self-Identity After Cancer\u0026mdash;Couple/Family (SIAQ-CF) scores showed positive correlations with family communication scores (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).Among family caregivers, Family APGAR scores were likewise negatively associated with family communication scores (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), while FoP-Q-SF and Caregiver Burden Scale\u0026mdash;Cancer Patient (CBS-CP) scores were positively correlated with family communication scores (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Additional participant characteristics are provided in Table\u0026nbsp;2.3.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAnalysis of differences between APGAR, FoP-Q-SF, FoP-Q-SF/C, SIAQ-CF, CBS-CP between advanced patients and caregivers (n\u0026thinsp;=\u0026thinsp;200)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePatient\u003c/p\u003e\u003cp\u003e(\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\stackrel{-}{\\varvec{x}}\\)\u003c/span\u003e\u003c/span\u003e\u003cem\u003e\u0026plusmn; s\u003c/em\u003e)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003et\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCaregiver\u003c/p\u003e\u003cp\u003e(\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\stackrel{-}{\\varvec{x}}\\)\u003c/span\u003e\u003c/span\u003e\u003cem\u003e\u0026plusmn; s\u003c/em\u003e)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003et\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCCAT-P\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e59.18\u0026thinsp;\u0026plusmn;\u0026thinsp;20.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCCAT-F\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e58.23\u0026thinsp;\u0026plusmn;\u0026thinsp;18.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAPGAR\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.97\u0026thinsp;\u0026plusmn;\u0026thinsp;1.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.061\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6.24\u0026thinsp;\u0026plusmn;\u0026thinsp;1.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5.237\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFoP-Q-SF\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eFoP-Q-SF/C\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31.58\u0026thinsp;\u0026plusmn;\u0026thinsp;6.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.408\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e30.80\u0026thinsp;\u0026plusmn;\u0026thinsp;9.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9.167\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSIAQ-CF\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e49.35\u0026thinsp;\u0026plusmn;\u0026thinsp;11.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.382\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCBS-CP\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e52.13\u0026thinsp;\u0026plusmn;\u0026thinsp;7.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e13.887\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCorrelation between CCAT-P, CCAT-F, APGAR, FoP-Q-SF, FoP-Q-SF/C, SIAQ-CF, CBS-CP between advanced patients and caregivers (n\u0026thinsp;=\u0026thinsp;200)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCCAT-P\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAPGAR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFoP-Q-SF\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSIAQ-CF\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCCAT-P\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAPGAR\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.572**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFoP-Q-SF\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.712**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.806**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSIAQ-CF\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.843**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.478**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.651**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eVariables\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eCCAT-F\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eAPGAR\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eFoP-Q-SF/C\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eCBS-CP\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCCAT-F\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAPGAR\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.551**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFoP-Q-SF/C\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.694**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.806**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCBS-CP\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.895**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.480**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.638**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e**At the 0.01 scale (two- tailed), the correlation is significant.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003e3.3 | Risk factors associated with Advanced Cancer Patients and Caregivers\u003c/h2\u003e\u003cp\u003eVariables that exhibited statistical significance in the univariate analyses were entered into the logistic regression model. The results indicated that educational level, per-capita monthly household income, family function, fear of disease progression, and social alienation of patients with advanced cancer were independent determinants of family communication among patients. For family caregivers, educational level, per-capita monthly household income, family function, fear of disease progression, and caregiver burden were independently associated with family communication. Additional participant characteristics are presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe Multivariate analysis of family communication between advanced patients and caregivers (n\u0026thinsp;=\u0026thinsp;200)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003ePatient\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCharacteristics\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eB\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eSE\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eβ\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003et\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003eP\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e95%CI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eConstant term\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-5.148\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.912\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-2.693\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.008\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducation level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.720\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.312\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-2.308\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-2.308\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.016\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026ndash;1.332, \u0026minus;\u0026thinsp;0.108\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMonthly income\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.850\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.282\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.014\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.014\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.297, 1.403\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAPGAR\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.713\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.919\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.314\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.314\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.508, 6.474\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFoP-Q-SF\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.115\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.813\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.372\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.371\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026ndash;0.478, 2.708\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSIAQ-CF\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.123\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.502\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.413\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.413\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026ndash;0.821, 5.067\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCaregiver\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCharacteristic\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eB\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eSE\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eβ\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003et\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003eP\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e95%CI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eConstant term\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-6.244\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.985\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-3.146\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducation level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-1.184\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.317\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-3.735\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.735\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.563, 1.805\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMonthly income\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.889\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.210\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.234\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.234\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.477, 1.301\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAPGAR\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.951\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.459\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.250\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.250\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.051, 2.851\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFoP-Q-SF/C\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.458\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.342\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.263\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.263\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.788, 2.128\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCBS-CP\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.432\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.510\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.772\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.772\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.432, 3.432\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003eNotes: \u003cem\u003eR\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.565, \u003cem\u003eR\u003c/em\u003e\u003csub\u003e\u003cem\u003eod\u003c/em\u003e\u003c/sub\u003e=0.554, \u003cem\u003eF\u003c/em\u003e\u0026thinsp;=\u0026thinsp;48.797, \u003cem\u003eP\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.001. Bold font represents statis tically significant \u003cem\u003eP\u003c/em\u003e-values.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"4 | Discussion","content":"\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003e4.1 | Levels of Advanced Patient and Caregiver Family conmmunication\u003c/h2\u003e\u003cp\u003e The study findings indicate that the CCAT-P total score for advanced cancer patients was 59.18\u0026thinsp;\u0026plusmn;\u0026thinsp;20.12, while the score for their family caregivers was 58.23\u0026thinsp;\u0026plusmn;\u0026thinsp;18.32. These scores are higher than those reported in studies by German researcher Michael\u003csup\u003e〔\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e〕\u003c/sup\u003eand American researcher Siminoff\u003csup\u003e〔\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e〕\u003c/sup\u003e. The discrepancy may be attributed to cultural differences between Eastern and Western societies, particularly in communication styles, emotional expression, and family dynamics. Compared to the open communication patterns advocated in Western cultures, the more reserved and implicit communication style prevalent in Chinese culture may result in incomplete information exchange, exacerbating patients' feelings of isolation and familial misunderstandings, which consequently could more readily lead to communication barriers within the family\u003csup\u003e〔\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e〕\u003c/sup\u003e.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003e4.2 | Influences Related to Advanced Patient and Caregiver Family conmmunication\u003c/h2\u003e\u003cdiv id=\"Sec19\" class=\"Section3\"\u003e\u003ch2\u003e4.2.1 | Education level\u003c/h2\u003e\u003cp\u003eThis study identified low educational attainment as a significant risk factor for impaired family communication among patients with advanced cancer (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), consistent with findings from Qiao et al.\u003csup\u003e〔\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e〕\u003c/sup\u003eThe underlying mechanisms may involve cultural norms where traditional Chinese families frequently employ \"protective silence\" and emotional suppression strategies to mitigate psychological burden on patients. This contrasts with Western emphasis on open communication paradigms\u003csup\u003e〔\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e〕\u003c/sup\u003e. In Asian cultural contexts, caregivers often maintain surface harmony through avoidance of negative topics, which can compromise information completeness and potentially exacerbate patient misunderstandings or loneliness\u003csup\u003e〔\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e〕\u003c/sup\u003e. Lower-educated patients exhibit diminished self-efficacy due to limited expressive capabilities, adopting passive acceptance of familial decisions that establish unidirectional communication patterns. This phenomenon undermines patient autonomy and further deteriorates interfamilial interactions\u003csup\u003e〔\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e〕\u003c/sup\u003e. Concurrently, cognitive limitations and health literacy deficits in these families impair patients' comprehension of disease information, treatment regimens, and prognostic outcomes. Their restricted vocabulary and expression skills also hinder recognition of family emotional needs, collectively reducing communication efficacy\u003csup\u003e〔\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e〕\u003c/sup\u003e. To address these challenges, healthcare providers should consider implementing visual aids (e.g., illustrated manuals) to simplify medical information dissemination. Collaborative community workshops focused on \"family health communication\" could enhance active engagement among lower-literacy households. Additionally, patient-centered care approaches characterized by patience and meticulous explanations are recommended to ensure comprehension. These interventions aim to strengthen communication competencies in culturally disadvantaged families, ultimately improving quality of life and treatment adherence.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section3\"\u003e\u003ch2\u003e4.2.2 | Monthly income\u003c/h2\u003e\u003cp\u003eThis study found that lower household monthly per capita income constituted a significant risk factor for impaired family communication among cancer patients (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), consistent with findings from Qiao et al\u003csup\u003e〔\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e〕\u003c/sup\u003e. The underlying mechanism may stem from the direct correlation between financial capacity and medical cost burden. Empirical evidence indicates that an increase of one unit in economic stress elevates the risk of familial conflict by 27%\u003csup\u003e〔26〕\u003c/sup\u003e. Financial strain forces families to prioritize treatment costs over emotional needs, leading to an \"instrumental communication dominance\" phenomenon. Low-income cancer families often bear substantial economic burdens, which exacerbate caregiver anxiety levels and diminish empathetic responses. This cascade of effects\u0026mdash;increased anxiety/depression in both patients and relatives\u0026mdash;ultimately undermines communication willingness and competence. Furthermore, socioeconomic disadvantage limits access to high-quality medical resources and social support systems, hindering timely resolution of communication issues\u003csup\u003e〔\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e〕\u003c/sup\u003e.To address these challenges, healthcare providers should establish dual support pathways integrating health insurance policy education with psychological counseling. By creating accessible channels for economic assistance and psychosocial interventions, professionals can alleviate the \"double burden\" of financial stress and mental health demands faced by low-income advanced-stage cancer families. Such targeted interventions aim to enhance communication efficacy within these populations while improving overall quality of life.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section3\"\u003e\u003ch2\u003e4.2.3 | FoP-Q-SF and FoP-Q-SF/C\u003c/h2\u003e\u003cp\u003eThis study identified FoP-Q-SF and FoP-Q-SF/C as a significant risk factor for impaired family communication among cancer patients and caregivers(\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), consistent with findings from Li et al\u003csup\u003e〔\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e〕\u003c/sup\u003e. The underlying mechanism may involve maladaptive responses where families of patients experiencing heightened fear tend to excessively focus on disease deterioration (e.g., \"worsening pain\" or \"treatment failure\"), which predisposes them to catastrophizing thoughts and impedes collaborative decision-making processes. Research\u003csup\u003e〔\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e〕\u003c/sup\u003edemonstrated that a 5-point increase in fear of disease progression scores correlates with a 1.8-fold elevated risk of avoidant communication behaviors. Cancer patients' pathological fear cognitions and emotions can transmute into familial anxiety, intensifying tension within the household and altering communication patterns. This includes reduced positive interaction frequency and increased negative expressions, thereby exacerbating communicative barriers. To address these challenges, healthcare providers are advised to implement targeted interventions. Primarily, clinicians should proactively assess patients' fear levels and enhance patient-clinician dialogues to mitigate distress. Secondarily, cognitive behavioral therapy (CBT) could be employed to restructure maladaptive disease perceptions, while family emotion-focused therapy (EFT) might interrupt negative emotional transmission. These dual approaches aim to empower families with accurate disease understanding, reduce fear-anxiety cycles, and facilitate shared decision-making processes.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section3\"\u003e\u003ch2\u003e4.2.4 | APGAR\u003c/h2\u003e\u003cp\u003eThis study identified family dysfunction as a significant risk factor for impaired communication among advanced cancer patients (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), consistent with findings from Fan et al\u003csup\u003e〔\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e〕\u003c/sup\u003e. The underlying mechanism may involve maladaptive coping strategies in functionally impaired families, where \"blame\" or \"silence\" often replace problem-solving approaches, thereby compromising communication quality. Research evidence indicates that patients with low family functioning exhibit only 31% of conflict resolution efficiency compared to high-functioning counterparts\u003csup\u003e〔\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e〕\u003c/sup\u003e. Family dysfunction also erodes mutual support and cohesion, preventing collaborative disease management. This leaves patients feeling isolated and caregivers experiencing exhaustion. Furthermore, interpersonal tension and frequent conflicts within dysfunctional families exacerbate emotional distress and psychological stress, further diminishing communication willingness\u003csup\u003e〔\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e〕\u003c/sup\u003e. To address these challenges, healthcare providers are recommended to implement family-focused interventions. Specifically, professional family therapy should be provided for affected households, including encouraging patient participation in cancer support groups. Additionally, structured intervention programs could assist family members in identifying and modifying maladaptive communication patterns, establishing effective mechanisms to foster mutual understanding and support. These efforts aim to restore family functionality and enhance communication quality among cancer patients and their relatives.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\u003ch2\u003e4.2.5 | SIAQ-CF\u003c/h2\u003e\u003cp\u003eThis study identified social alienation among cancer patients as a significant risk factor for impaired family communication in advanced-stage cases (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), aligning with findings from Zou et al\u003csup\u003e〔\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e〕\u003c/sup\u003e. The underlying mechanism likely involves multidimensional psychological and physical distress\u0026mdash;including pain, fatigue, and existential struggles\u0026mdash;that drives emotional withdrawal from family members, thereby obstructing effective communication. Research evidence indicates that 61% of healthy individuals avoid interaction with cancer patients and their families during group activities due to fear of contagion\u003csup\u003e〔\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e〕\u003c/sup\u003e. Prolonged exposure to despair, hopelessness, and anxiety further exacerbates self-imposed isolation in patients, reducing familial engagement and worsening communicative barriers\u003csup\u003e〔\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e〕\u003c/sup\u003e. To address these challenges, clinicians are advised to implement proactive assessments at admission to identify high-risk socially isolated patient households. Tailored psychological interventions should focus on alleviating negative emotions and fostering social reintegration through early recognition of identity strategies. Complementary training programs targeting both patients and caregivers are essential to establish structured communication frameworks. These multifaceted approaches aim to meet holistic needs\u0026mdash;physical, psychological, and sociological\u0026mdash;while enhancing quality of life for advanced cancer patients and their families.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec24\" class=\"Section3\"\u003e\u003ch2\u003e4.2.6 | CBS-CP\u003c/h2\u003e\u003cp\u003eThis study identified caregiver burden as a significant risk factor for impaired family communication among advanced cancer patients (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), consistent with findings from Carli et al\u003csup\u003e〔\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e〕\u003c/sup\u003e.The underlying mechanisms may involve compound stressors where deteriorating patient conditions necessitate frequent chemotherapy/radiotherapy regimens, leading to escalating financial pressures. Concurrently, treatment-related physical symptoms\u0026mdash;such as nausea, vomiting, anorexia, and hair loss\u0026mdash;not only inflict direct suffering on patients but also impose substantial psychological strain on caregivers. The synergistic effect of economic hardship and emotional demands further exacerbates caregiver burden, thereby increasing the likelihood of communicative barriers within the household\u003csup\u003e〔\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e〕\u003c/sup\u003e.These findings underscore the necessity for healthcare providers to implement systemic support interventions targeting caregiver well-being. Specifically, multidimensional strategies should include psychological counseling, economic assistance programs, practical caregiving skill training, and communication facilitation workshops\u003csup\u003e〔\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e〕\u003c/sup\u003e. By alleviating caregivers' dual burdens through these structured supports, clinical teams can enhance their resilience and foster more effective intrafamilial interactions. This approach aims to restore equilibrium in familial communication dynamics while improving overall quality of life for both patients and caregivers.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"5 | Conclusion","content":"\u003cp\u003eThe findings of this investigation indicate that family communication among patients with advanced cancer is characterized by significant dysfunction. Key determinants identified include educational attainment, per capita monthly household income, fear of disease progression, patient social isolation, and caregiver burden. These results suggest that nursing personnel could utilize standardized, disease-specific assessment tools to identify families at high risk for communication barriers. Furthermore, exploring the potential application of digital tools for family communication support offers promise in overcoming geographical and resource limitations, enabling timely delivery of personalized clinical interventions. Tailored strategies are recommended based on individual patient characteristics and needs, encompassing culture-sensitive communication skills training, psychosocial support, and financial assistance. Concurrently, establishing an effective end-of-life communication model led by palliative care specialist nurses, collaborating with clinical psychologists and physicians, is proposed. This model would involve regular simulated family conferences focusing on shared decision-making regarding disease information, emotional management, and advance care planning, thereby enhancing communication quality through comprehensive intervention protocols. Such multifaceted approaches aim to holistically support families of advanced cancer patients, improve communication dynamics, and elevate overall family communication competence.\u003c/p\u003e"},{"header":"6 | Limitations","content":"\u003cp\u003eNotably, this study employed a cross-sectional design with samples drawn from two tertiary hospitals in Anhui Province, China, imposing certain limitations concerning temporal scope and population representativeness. Future research necessitates multicenter, large-sample longitudinal studies to track the dynamic trajectory of family communication quality over time. Additionally, as the current analysis relied solely on separate surveys administered to cancer patients and their primary family caregivers using the Cancer Family Communication Assessment Tool (CCAT-P), it may underestimate intra-family communication congruence. Subsequent studies incorporating dual-subject data collection are recommended to refine the analytical framework elucidating influencing factors. This enhanced understanding will provide a robust evidence base for developing targeted interventions to improve family communication and, ultimately, enhance the quality of life for families navigating advanced cancer.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e7 | Data availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e8 | Author contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRuirui Ma Contributed to this manuscript Corresponding author:\u0026nbsp;R-RM was responsible for the study design, data compilation, and analysis and completed the draft manuscript. X-LF, \u0026nbsp; and X-BT participated in the data collection and coordination of the study. Z-Bl, WZand TC were responsible for the quality control and manuscript review. All the authors have read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e9 | Funding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by a grant (No. 2021kcszsfkc433) from the Fund Project of Nursing Laboratory Science Provincial Curriculum Civics Demonstration Course, the Anhui Education Department. \u0026nbsp;and（KY22040046）2022 Provincial Department of Education Key Projects in Natural Science.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e10 | Acknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to express their sincere gratitude to all participants involved in this study. We also thank the staff at Wannan Medical University Affiliated Yi ji shan Hospital for their support and assistance throughout the research process.We would also like to acknowledge Editage (www.editage.cn) for English language editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e11 | Conffict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential confflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e12 | Consent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have provided their consent for publication of this manuscript. Additionally, informed consent was obtained from all participants involved in the study, allowing for the publication of results and findings. We affirm that all ethical guidelines were followed, and the confidentiality of participant data has been preserved throughout the research process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e13 | Ethics declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis was a retrospective study, and patient information was hidden prior to the study. Approval was obtained from the Ethics Review Committee of Wannan Medical College and Shan Hospital (2024) Ethics Research No. (91). The manuscript has been provided.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e14 | Clinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eClinical trial number: not applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBray F, Laversanne M, Sung H. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. 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Curr Oncol. 2022;29(11):8967\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Advanced cancer, patients, Caregiver, Family communication","lastPublishedDoi":"10.21203/rs.3.rs-7433559/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7433559/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo investigate the current status of family communication among advanced cancer patients and explore its influencing factors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDesign\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA cross-sectional study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA cross-sectional study was conducted in Anhui Province, China. Using the General Information Questionnaire, the Cancer Communication Assessment Tool for Patients（CCAT-P）、the Cancer Communication Assessment Tool for Families (CCAT-F), the Family APGAR index, (APGAR),the Fear of Progression Questionnaire-Short Form (FoP-Q-SF) and the Social Isolation Assessment Questionnaire for Cancer Patients (SIAQ-CF), SPSS 27.0 was applied to analyze the data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn total, 400 participants completed the survey. Their levels of family communication were moderate or lower. their mean CCAT-P total score was 59.18 ± 20.12 among the advanced cancer patients and CCAT-F total score was 58.23±18.32 among the caregivers, respectively. The family communication level was closely related to six factors regression analysis revealed that Education level, Monthly income, APGAR, FoP-Q-SF, FoP-Q-SF/C, SIAQ-CF, CBS-CP were the primary influencing factors for family communication in advanced-stage cancer patients (\u003cem\u003eP \u003c/em\u003e\u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFamilies of advanced-stage cancer patients exhibit suboptimal communication levels characterized by poor communication. Clinicians should prioritize interventions for households demonstrating family dysfunction, psychological dysregulation related to fear of disease progression, elevated social isolation among patients, low educational attainment, and limited average monthly household income. Tailored clinical interventions are recommended to enhance positive family communication dynamics and thereby improve quality of life for these late-stage cancer patient families.\u003c/p\u003e","manuscriptTitle":"Family Communication Status and Influencing Factors Among Advanced Cancer Patients: A Cross- Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-29 17:16:36","doi":"10.21203/rs.3.rs-7433559/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7cb5d808-8af4-4597-a44a-b82b80abc2f4","owner":[],"postedDate":"September 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-17T05:54:39+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-29 17:16:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7433559","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7433559","identity":"rs-7433559","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}