Supportive Care Needs of Parents Caring for Children with Leukemia: a latent class analysis

Supportive Care Needs of Parents Caring for Children with Leukemia: a latent class analysis | 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 Supportive Care Needs of Parents Caring for Children with Leukemia: a latent class analysis Jingting WANG, Zhuting ZHENG, Xuanyi BI, Wen Zhang, Yingwen WANG, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4568591/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 08 Dec, 2024 Read the published version in Supportive Care in Cancer → Version 1 posted 10 You are reading this latest preprint version Abstract Background: Parents’ supportive care needs directly affect their quality of life and the quality of care for their children diagnosed with leukemia. Objectives: To identify supportive care needs of Chinese parents in the unobserved subgroups who care for children with leukemia and to examine the associations of the latent class membership with individual characteristics. Methods : A multicenter cross-sectional survey study was conducted. A total of 221 parents who had children with leukemia were surveyed in China with the Chinese version of the Supportive Care Needs Survey for Caregivers of Children with Pediatric Cancer (SCNS-C-Ped-C). Latent class analysis (LCA) was applied to identify latent classes of parents according to supportive care needs. Binary logistic regression model was used to identify the association between individual characteristics and the latent class membership. Results : LCA results suggested a 2-class solution: Class 1-“high supportive care needs” class (n=150, 67.9%), and Class 2-“low supportive care needs” class (n=71, 32.1%). Parents with children at early stage of treatment, being married, with lower household income, locating in the same city with the treatment hospital, having lower disease cognitive ability and higher person-centered care skills, and with lower balancing caregiving needs and one’s own needs were more likely to be in the “high supportive care” class. Conclusion : There existed two distinct classes of parents caring for children with leukemia on the basis of supportive care needs. The class membership was significantly associated with children’s treatment duration, parents’ marital status, family income, distance to the hospital, daily caregiving time, and parents’ caregiving ability. Implications for Practice: These findings may be helpful in the development of personalized supportive care interventions for parents of children with leukemia. children with leukemia parents supportive care needs latent class analysis Figures Figure 1 Background Cancer stands as one of the primary causes of childhood mortality, with leukemia being the most prevalent type. Among very young children (aged 0–4 years), leukemia accounted for 36.1% of all cancers, as compared with 15.4% in adolescents during 2001–2010 [ 1 ]. The estimated world-standardized incidence rate of leukemia from 2001 to 2010 was 46.4 per million person-years in children (aged 0–14 years) and 28.5 per million person-years in adolescents (aged 15–19 years) [ 2 ]. In China, the estimated age-standardized childhood cancer incidence rate is 87.1 per million, with leukemia being the most prevalent cancer (35.6 per million) [ 3 ]. China shoulders a significant portion of the global burden of childhood cancer [ 4 ]. With advancements in treatment over the past decade, the survival rate of childhood leukemia continues to increase, yet substantial international variation occurs in age-standardized 5-year net survival from acute lymphoblastic leukemia (ALL) in children, ranging from 50% to more than 90% [ 1 ]. Chemotherapy is the primary treatment for leukemia, thanks to the ongoing advancements in the discovery of novel, more targeted chemotherapy agents. However, the long-term effects of anticancer chemotherapy remain an area of concern for children with leukemia and their parents. As the primary caregivers, parents of children with leukemia play an active role in ensuring that their children’s basic needs are met throughout the diagnosis and treatment [ 5 ]. However, during the challenging and lengthy process of caring for their children with leukemia, parents themselves tend to encounter psychological distress, physiological discomfort, and economic pressure. Consequently, most parents seek assistance to address their supportive care needs [ 6 ]. Supportive care refers to care provided to patients with cancer and to their families, in order to cope with the disease and its treatment [ 7 ]. Previous studies have demonstrated that caregivers of children with pediatric cancer reported a variety of unmet needs, including informational, psychological, occupational, and social needs [ 8 , 9 ]. Moreover, caring for children with pediatric cancer can be challenging, owning to the high medical expenses, caregiving costs, and changes in caregivers’ employment status after the diagnosis of the children’s cancer [ 10 ]. Thus, parents of children with leukemia urgently need supportive care intervention. The initial step in providing precise, targeted, and appropriate support to parents of children with leukemia is to recognize parents’ supportive care needs. However, although the significance of assessing parents’ supportive care needs is extensively recognized, in China or even around the world, only a few qualitative studies have been conducted to explore the needs or experiences of parents with children suffering from leukemia [ 11 , 12 ], possibly due to the lack of appropriate tools for assessing the needs of caregivers taking care of children with pediatric cancer. Our research team revised the Supportive Care Needs Survey for Partners and Caregivers of Cancer Patients (SCNS-P&C) and evaluated the psychometric properties of the Chinese Version of the Supportive Care Needs Survey for Caregivers of Children with Pediatric Cancer (SCNS-C-Ped-C) for caregivers of children with pediatric cancer [ 13 ]. SCNS-C-Ped-C, the reliability and validity of which was demonstrated in the evaluation, was determined to be suitable, in Chinese clinical and research settings, to assess the multi-dimensional supportive care needs for caregivers of children with pediatric cancer and was therefore used in this study to explore the supportive care needs of parents caring for children with leukemia. Moreover, the likelihood of significant individual variation in supportive care needs can create heterogeneous groups [ 14 ]. Latent class models, statistical tools for constructing typologies based on observed variables, prove particularly beneficial in identifying subgroups within large, heterogeneous populations [ 15 ]. Owing to the population heterogeneity, latent class analysis (LCA) is an appropriate method to classify parents according to their supportive care needs. After the responses were analyzed to explicit test questions, LCA determines the optimal number of latent classes of parents and the prevalence of each class [ 16 ]. The identification of latent classes of parents regarding supportive care needs is followed by the essential identification of the associated characteristics of the latent class membership. The Supportive Care Framework for Cancer Care developed by Margaret Fitch [ 17 ] proposed that supportive care needs were influenced by the socioeconomic status, social support, coping resources, and personality. Studies have indicated that the demographic information of children and their parents and the diagnosis and treatment information of the children were associated with parents’ supportive care needs [ 18 ]. Moreover, studies have shown that the caregiving abilities of parents with children diagnosed with leukemia were closely related to their supportive care needs [ 19 , 20 ]. Therefore, these influencing factors including children’s clinical information, parents and children’s socio-demographic information, parents’ caregiving ability, self-efficacy, coping mode, and social support need to be considered as factors associated with the latent class membership. To the best of our knowledge, no existing studies have used the SCNS-C-Ped-C to investigate the supportive care needs among parents of children with leukemia in China, nor has any study analyzed the heterogeneity among parents. Therefore, in the present study, the SCNS-C-Ped-C was used to assess the supportive care needs of Chinese parents with children diagnosed with leukemia; LCA was utilized to identify unobserved latent classes of parents based on their supportive care needs and to explore the characteristics associated with membership in each latent class. The findings of this study will be helpful for understanding the differences in parents’ supportive care needs and for tailoring the interventions accordingly to the subgroups with various supportive care needs. Methods 2.1 Design A multicenter cross-sectional survey study was conducted. The study was prepared and reported according to the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) checklists. 2.2 Sample recruitment Our study included 221 parents, whose children were diagnosed with leukemia and were recruited from three children's hospitals in Shanghai, Jiangsu, and Chongqing, China. The eligibility criteria for parents and children were as follows: (1) the child met the diagnostic criteria for leukemia [ 21 ], (2) the child was under treatment and under 15 years old, (3) the child had no other serious or chronic diseases, (4) the parent could communicate fluently in Mandarin, (5) the parent was primarily responsible for the child's daily caregiving, and (6) the parent volunteered to participate in the survey. 2.3 Data collection Data collection took place in the selected three children’s hospitals between May 2019 and April 2020. The researchers explained the research aims to the parents, and only after signed consent forms were obtained, the printed questionnaires within sealed envelopes were provided to the parents. Similarly, the completed questionnaires were collected on the same day by researchers after parents had finished filling them out. The consent form guaranteed anonymous and voluntary participation, as well as the right to withdraw from the study. 2.4 Instruments 2.4.1 Socio-demographic and clinical characteristics The socio-demographic and clinical characteristics concerning caregivers and their children with leukemia were collected with the use of a self-designed questionnaire. The information included (1) parents’ gender, age, education, marital status, employment status, average monthly household income, residency area, whether the hospital and the residency area located in the same city, type of medical payment, daily caregiving time, and the number of co-caregivers; (2) children’s gender, age, whether the child was the single child, and treatment duration. 2.4.2 SCNS-C-Ped-C Parents’ supportive care needs were measured by the SCNS-C-Ped-C, a reliable and valid tool designed to evaluate the multidimensional supportive care needs of caregivers with children diagnosed with pediatric cancer. This scale had been previously validated in family caregivers of hematologic malignancies in China[ 13 ]. The SCNS-C-Ped-C consisted of 44 items across six domains: health care and information needs (13 items), daily care and communication needs (17 items), psychological and spiritual needs (7 items), medical service needs (2 items), economic needs (2 items), and emotional needs (3 items). Responses were rated on a 5-point Likert response scale (1 = not applicable, 2 = satisfied, 3 = low need, 4 = moderate need, and 5 = high need). The score of each domain was the average score of all the items within that domain (the score of the domain ≤ 2: no need, > 2 and ≤ 3: low need, > 3 and ≤ 4: medium need, > 4 and ≤ 5: high need). In this study, the scores of the six domains were recoded as dichotomous indicator of parent's supportive care needs: 0-"no needs" (if item score ≤ 2) vs. 1-"at least some needs" (if item score > 2). The Cronbach’s alpha was 0.968 for the total scale and ranged from 0.603 to 0.952 for the six domains. The split-half reliability coefficient was 0.883 for the total scale and ranged from 0.659 to 0.931 for the six domains. In the present study, the Cronbach’s alpha was 0.965 for the total scale and ranged from 0.642 to 0.952 for the 6 domains, a result that indicated satisfactory internal consistency. 2.4.3 Hematologic Malignancies’ Family Caregiver Skills Scale (HMFCGSS) Parents’ caregiving ability was measured based on their last week’s experience, with the use of the HMFCGSS that was previously validated in hematologic malignancies’ family caregivers in China (Cronbach’s α = 0.920) [ 22 ]. HMFCGSS consists of 6 domains with a total of 23 items: disease cognitive ability with 3 items, general approaches to caregiving with 3 items, person-centered care skills with 5 items, emotional management ability with 4 items, appraising supportive resources with 3 items, and balancing caregiving needs and one’s own needs with 5 items. Each of the 23 items was measured on a 5-point Likert scale ranging from not difficult (1) to very difficult (5). The higher the scale, the lower the parents’ caregiving ability. 2.4.4 General Self-efficacy Scale (GSES) Parents’ self-efficacy was measured by the 10-item GSES[ 23 ]. The scale was scored on a 4-point scale ranging from not at all true (1) to exactly true (4). Individuals with higher scores perceive a high level of self-efficacy. The Chinese version of the GSES has demonstrated good reliability (Cronbach’s α = 0.87) [ 23 ]. 2.4.5 Medical Coping Modes Questionnaire (MCMQ) Parents’ coping modes were measured by MCMQ [ 24 ]. The MCMQ consisted of confrontation (8 items), avoidance (7 items), and resignation (5 items) domains. All the items were rated by the 4-point scale. The dimension with the highest cumulative score indicated the particular coping strategy the participant likely to use. The Chinese version of the MCMQ has demonstrated good reliability (Cronbach’s α = 0.69, 0.60, 0.76) [ 24 ]. 2.4.6 Perceived Social Support Scale (PSSS) Parents’ social support was measured by the 12-item PSSS [ 25 ]. All the items were rated by the 7-point scale ranging from never (1) to every day (7). A lower score indicates poorer social support. The Chinese version of the PSSS has demonstrated good reliability (Cronbach’s α = 0.88) [ 25 ]. 2.5 Ethical considerations Ethical review approval from the Naval Medical University (NO.HJEC-2018-YF-001) was obtained. The participants were informed of the aim of this study prior to the survey. No procedures were performed until all the participants had signed the informed consent forms. 2.6 Data analysis The 6 dichotomous supportive care needs indicators were used for LCA [ 26 ]. To conduct the LCA, we used 200 sets of random start values, along with 50 initial stage iterations, to ensure that the model estimates were not based on local maxima of the likelihood function. The LCA analysis was started with a single-class solution, and then models with increased number of classes were estimated and compared. Model fit statistics and indices, including the Akaike information criterion (AIC), Bayesian information criterion (BIC), adjusted Bayesian information criterion (aBIC), bootstrapped likelihood ratio test (BLRT), Lo-Mendell-Rubin likelihood ratio(LMR LR) test, Lo-Mendell-Rubin adjusted(aLMR LR) test, and entropy score, were examined. Lower values on AIC, BIC, and aBIC indicate better model fit; significant p-values on the BLRT, LMR, and aLMR indicate that the k class model was more preferable than the k-1 class model [ 26 ]. The entropy statistics measure the quality of class classification, with values ranging from 0 to 1 and a value closer to 1 indicating better classification. For a LCA model with entropy ≥ 0.80, the latent class membership estimated from the model can be saved as "observed" categorical variables for further analysis [ 27 ]. Results 3.1 Socio-demographic characteristics A total of 221 parents of children with leukemia, who completed the questionnaires, were eligible for this survey. The socio-demographic characteristics of parents and children are described in Table 1 . Table 1 Sample characteristics (n = 221) Variables Categories n % Children with leukemia Gender Boy 121 54.8 Girl 100 45.2 Age (years old) < 3 69 31.2 3–6 81 36.7 7 or more 71 32.1 Single child Yes 94 42.5 No 127 57.5 Treatment duration 1–3 months 161 72.8 4–8 months 26 11.8 9 months or more 34 15.4 Parents Gender Male 61 27.6 Female 160 72.4 Age ≤ 30 68 30.8 31–40 129 58.3 > 40 24 10.9 Education High school or below 101 45.8 Junior college 60 27.1 Bachelor's degree or above 60 27.1 Marital status Married 194 87.8 Unmarried (divorced, widowed, or separated) 27 12.2 Employment status Full-time 82 37.1 Part-time 16 7.2 Not work 123 55.7 Average monthly household income 2000-5000CNY ( $ 285–713) 115 52.0 5001-8000CNY ( $ 713–1411) 48 21.7 Over 8000CNY (over $ 1411) 58 26.3 Residency area City 109 49.3 Country 112 50.7 Hospital and the residency area located in the same city Yes 60 27.1 No 161 72.9 Type of medical payment Self-pay 65 29.4 Medical health insurance 55 24.9 Rural cooperative health care insurance 101 46.7 Daily caregiving time 18h 120 54.3 Number of co-caregivers 3 or more 11 5.0 2 113 51.1 1 73 33.0 0 24 10.9 3.2 Latent class analysis Mode fit statistics are shown in Table 2 . The 2-class solution is considered to be the best model. The single-class model had the largest AIC, BIC, and aBIC, as compared with all other models. In addition, the likelihood ratio (LR) tests of the 2-class model were all statistically significant (LMR P < 0.0001, aLMR P < 0.0001, and BLRT P < 0.0001), indicating population heterogeneity rather than homogeneity. Compared with the 2-class and 3-class models, the 3-class model had smaller information criterion indices (AIC, BIC, and aBIC), but the LR tests of 3-class model were not all statistically significant (LMR P = 0.1688, aLMR P = 0.1745, and BLRT P < 0.0001). Therefore, considering model fit, model parsimony, and clinical interpretability of the results, we selected the 2-class model. Figure 1 displays the results of the 2-class solution. The entropy value of 0.813 indicates good quality of class classification. The probabilities of endorsing “high need” in Class 1 (n = 150, 67.9%) are consistently high across six domains. Therefore, this class was labeled as “high supportive care needs” class. The Class 2 (n = 71, 32.1%) was labeled as “low supportive care needs” class based on the item response probabilities in the class. Table 2 Model fit comparisons and latent class prevalence by model (n = 221) 1-class model 2-class model 3-class model AIC 1474.210 1268.830 1239.045 BIC 1494.599 1313.007 1307.008 aBIC 1475.584 1271.809 1243.628 Entropy n/a 0.813 0.756 LMR n/a < 0.0001 0.1688 aLMR n/a < 0.0001 0.1745 BLRT n/a < 0.0001 < 0.0001 Relative class size n/a 0.679/0.321 0.534/0.348/0.118 Best-fitting model in bold AIC : Akaike information criterion BIC : Bayesian information criterion aBIC : adjusted Bayesian information criterion LMR : Lo-Mendell-Rubin likelihood ratio test aLMR : Lo-Mendell-Rubin adjusted likelihood ratio test BLRT : bootstrapped likelihood ratio test 3.4 Analysis of supportive care needs by latent class Table 3 shows the mean scores of the six supportive care needs domains according to latent classes. In Class 1 (the “high supportive care needs” class), only the mean score of emotional needs was nearly 3 (3.14 ± 1.23), whereas the mean scores of the other five domains were nearly 4 or higher than 4 (from 3.94 to 4.62), indicating that the parents had relatively high needs across all domains of supportive care. In Class 2 (the “low supportive care needs” class), the mean score of Emotional needs was lower than 2 (1.90 ± 0.56), and the mean scores of the domains of daily care and communication needs, psychological and spiritual needs, and medical service needs were lower than 3 (ranging from 2.41 to 2.52). Only the mean scores of the domains of healthcare and informational needs and economic needs were higher than 3 (ranging from 3.40 to 3.41), indicating that the parents had more supportive care needs of healthcare and information aspect and economic aspect. Table 3 The scores of each scale and domains (n = 221) “high supportive care needs” class (‾ x ± sd ) n = 150 “low supportive care needs” class (‾ x ± sd ) n = 71 Supportive care needs 4.24 ± 0.50 2.75 ± 0.50 Healthcare and informational needs 4.62 ± 0.48 3.40 ± 0.93 Daily care and communication needs 4.24 ± 0.63 2.48 ± 0.49 Psychological and spiritual needs 3.94 ± 0.84 2.41 ± 0.79 Medical service needs 3.99 ± 1.24 2.52 ± 1.07 Economic needs 4.60 ± 1.44 3.41 ± 1.30 Emotional needs 3.14 ± 1.23 1.90 ± 0.56 3.5 The binary logistic regression model Selected results of the binary logistic regression model are shown in Table 4 . Parents whose children had shorter treatment duration were more likely to be classified in the “high supportive care needs” class than in the “low supportive care needs” class (OR = 4.319, 95%CI 1.334, 13.979). Parents who were married, had low average monthly household income, commonly visited the hospital located in the same city with residency area, and spent more than 18h on daily caregiving were more likely to be classified in the “high supportive care needs” class than in the “low supportive care needs” class. The corresponding adjusted ORs were as follows: OR = 5.927 (95%CI 1.752, 20.047) for married parents; OR = 7.768 (95%CI 2.092, 28.847) for parents with average monthly household income of 2000-5000CNY ( $ 285–713); OR = 3.406 (95%CI 1.226, 9.460) for parents whose residency area was located in the same city as the hospital; and OR = 0.330 (95%CI 0.109–0.996) for parents spending daily caregiving time of 12-18h. Parents with low disease cognitive ability (with higher scale) (OR = 2.486, 95%CI 1.327, 4.657), high person-centered care skills (with lower scale) (OR = 0.253, 95%CI 0.100, 0.640), and low balancing caregiving needs and one’s own needs (with higher scale) (OR = 2.276, 95%CI 1.154, 4.490) were more likely to be classified in the “high supportive care needs” class than in the “low supportive care needs” class. Table 4 Selected results of the binary logistic regression model (n = 221) Variables β S.E. Wald P OR 95%CI Treatment duration of the child 7.584 0.023 1–3 months 1.463 0.599 5.958 0.015 4.319 1.334–13.979 4–8 months 0.415 0.766 .293 0.588 1.514 0.337–6.794 9 months or more - - - - - - Marital status of parents Married 1.779 0.622 8.190 0.004 5.927 1.752–20.047 Unmarried (divorced, widowed, or separated) - - - - - - Average monthly Household income 9.397 0.009 2000-5000CNY ( $ 285–713) 2.050 0.669 9.377 0.002 7.768 2.092–28.847 5001-8000CNY ( $ 713–1411) 1.123 0.614 3.347 0.067 3.073 0.923–10.232 Over 8000CNY (over $ 1411) - - - - - - Hospital and the residency area located in the same city Yes 1.226 0.521 5.529 0.019 3.406 1.226–9.460 No - - - - - - Daily caregiving time 4.137 .126 18h - - - - - - Disease cognitive ability 0.911 0.320 8.082 0.004 2.486 1.327–4.657 Person-centered care skills -1.373 0.473 8.427 0.004 0.253 0.100–0.640 Balancing caregiving Needs and one’s own needs 0.822 0.347 5.629 0.018 2.276 1.154–4.490 Constant -9.674 2.789 12.032 0.001 0.000 Discussion 4.1 The latent classes of Chinese parents with children diagnosed with leukemia on the basis of supportive care needs To the best of our knowledge, this is the first study that used the LCA to identify unobserved subgroups of Chinese parents whose children were diagnosed with leukemia in accordance with supportive care needs. Parents in this study were classified into 2 distinct priori unknown classes based on supportive care needs measured by SCNS-C-Ped-C: Class 1-“high supportive care needs” class; Class 2-“low supportive care needs” class. Totally, 67.9% (n = 150) of the parents were classified in the “high supportive care needs” class. The parents in Class 1 had a medium level of emotional needs and high levels of the other five domains. Class 2 accounted for 32.1% (n = 71) of the sample. The parents in Class 2 had medium levels of healthcare and informational needs and economic needs; low levels of daily care and communication needs, psychological and spiritual needs, and medical service needs; and no emotional needs. For parents in the “high supportive care needs” class, caring for children with leukemia was exceptionally challenging and in urgent need of support. 4.2 Supportive care needs of parents in two latent classes As shown in Table 3 , parents in both classes had higher levels of “healthcare and informational needs” and “economic needs”, as compared with other domains of supportive care needs. This result indicated that parents had higher levels of healthcare and informational needs and economic needs. Although leukemia is the most prevalent childhood cancer, the vast majority of parents lack both sufficient understanding of the disease and the knowledge regarding the treatment and care [ 28 ]. Furthermore, with the progression of the disease and the advancement of the treatment, parents developed new healthcare and informational needs. Therefore, it is essential to understand the development patterns of healthcare and informational needs among parents with different characteristics and to continuously provide them with the necessary knowledge related to healthcare. The economic needs of parents in both groups were high. The expenses for the treatment of children with leukemia usually impose a heavy economic burden on patients’ families [ 29 ]. The treatment for leukemia encompasses a variety of approaches such as chemotherapy, radiotherapy, and bone marrow transplantation [ 30 ]. These treatments often span extended period, requiring close monitoring and adjustments based on the treatment progress [ 31 ]. The treatment process may involve multiple hospitalizations, repeated medication treatments, and laboratory tests, all of which directly increase the medical expenses [ 29 ]. Additionally, there are indirect expenses such as transportation to and from the hospital, accommodation, and food expenses [ 32 ]. Moreover, the treatment process may affect the work and daily lives of the parents, requiring additional expenses to cope with these changes [ 33 ]. The high medical costs impose substantial financial pressure on the families of children with leukemia, sometimes compelling them to borrow funds or seek social support [ 33 ]. Concurrently, some governments and non-profit organizations provide certain financial assistance and support to help families meet the financial challenges. However, this information is probably unavailable to the parents, or the parents have an unclear understanding of the conditions for fund application. For example, these parents may lack knowledge about the process and the required materials for application. Therefore, it is crucial to provide information regarding the financial assistance and support to the parents. The mean score of emotional needs domain was the lowest in both classes, a finding indicating that parents had low level of emotional needs. The emotional needs domain in the SCNS-C-Ped-C had three items: problems with sex life, emotional support for self, and emotional support for loved ones [ 13 ]. During the painful stage when children were diagnosed with leukemia or undergoing treatment, parents’ attention was mostly focused on their children, with less concern for their own and their partners’ emotional needs [ 34 ]. Moreover, influenced by traditional Chinese culture, parents adopt an implicit attitude towards their own emotions and feelings, resulting in limited perception and self-expression of their emotions, and seldom seek emotional support and assistance from others[ 35 ]. Additionally, their skills in providing emotional support to others were relatively inadequate. Furthermore, Chinese couples may seldom disclose issues or concerns regarding their sex life to outsiders, even when researchers assure confidentiality of the data before the investigation. Therefore, it is essential to encourage parents to honestly confront their own emotional needs and to work together with their partners to address and resolve the emotional issues. 4.3 Association between socio-demographic and clinical characteristics and latent class membership 4.3.1 Children’s treatment duration Parents with children having a shorter treatment duration had higher likelihood of being in the “high supportive care” class than in the “low supportive care” class. In this study, 161 (72.8%) children were at the early stage of treatment (1–3 months after the diagnosis). Parents of children newly diagnosed with leukemia were suffering from a tremendous blow and undergoing a painful process, leading to higher psychological and spiritual needs. Those parents needed to select or advocate for better medical services for their children, resulting in a higher level of medical service need. During the initial diagnosis and treatment of their children, parents needed to participate in many clinical decisions related to their children's treatment [ 28 ]. Due to their lack of understanding of the disease, they often found themselves in a state of confusion and needed more healthcare and informational support. Moreover, parents improved their caregiving ability through communication with doctors and caregiving practices [ 28 ]. Thus, those of children with shorter treatment duration had more daily care and communication needs. The treatment costs of leukemia are high, especially during the initial diagnosis and early treatment stages when timely medical expense reimbursement is unavailable [ 36 ]. Families of children with leukemia bear a heavy financial burden, resulting in high economic needs. During the early stages of diagnosis and treatment, parents often focused all their attention on their children [ 37 ]. Although they might experience emotional distress, they had little time to attend to their own emotional needs, resulting in the data of moderate emotional needs. 4.3.2 Marital status Married parents were unexpectedly more likely to be in the “high supportive care” class. Studies indicated that a married parent had more access to social support, particularly from the partner [ 38 ]. In addition, married parents usually have their partners primarily responsible for earning money, which enables them to receive more financial support and consequently experience less financial burden [ 39 ]. Previous research findings indicated that the supportive care needs of married parents should be relatively lower than those of unmarried parents, and those findings are contrary to the findings of this study. In this study, there were 194 married parents (87.8%), 155 (79.9%) of which were taking care of children at the early stage of treatment (1–3 months after the diagnosis). The results of this study indicated that parents with children undergoing a shorter treatment duration had higher likelihood of being in the “high supportive care” class than in the “low supportive care” class. Therefore, sample bias may be the reason why married parents were more likely to be in the “high supportive care” class. Conversely, throughout the journey of diagnosis and treatment for their children, parents need to make multiple clinical decisions. In the context of traditional Chinese culture, family members from both the paternal and maternal sides of married parents typically pay attention to the diagnosis and treatment of the child and, to some extent, participate in treatment decision making. The involvement of the Chinese-style extended family in clinical decisions added complexity, which may result in parents' need for various forms of support, such as informational, emotional, or psychological support. 4.3.3 Average monthly household income Lower income had a significant effect on the likelihood of being in the “high supportive care” class. The economic burden on parents of children with hematological malignancies is substantially heavier than that on parents of children with any other cancer [ 40 ]. Parents confronted with a high medical cost for their children’s disease treatment and caregiving expenses, and changes in employment status following a child's cancer diagnosis may reduce their financial stability [ 10 ]. Many parents could not work because of their children’s disease and lost a good portion of their family income. Further, despite their high total expenditure on treatment, most parents received no financial help from any sources, and some parents were even forced to sell some of their property to support their income [ 41 , 42 ]. Moreover, children with leukemia have a higher rate of unplanned hospitalizations or clinical visits [ 43 ]. In order to reduce the inconvenience of commuting between home and the hospital, many families rent accommodation near the treatment hospital, which also increased their financial burden. 4.3.4 Distance from hospital and residency area In China, high-level clinical resources for the treatment of childhood leukemia are mainly concentrated in several tertiary pediatric hospitals [ 44 ]. In this study, most families (161, 72.9%) with children diagnosed with leukemia need to commute across cities between their residency area and the treatment hospital. Compared with the families whose original residency area was in the same city as that of the hospital, parents living far from the hospital were more likely to be in the “low supportive care” class than in the “high supportive care” class. This result was unexpected because it was commonly believed that living far from the hospital would lead to increased commuting burden and reduced social support [ 45 ]. However, with the advancement of information and communication networks in China, parents of children with leukemia can obtain some social support through the Internet [ 6 ]. Moreover, transportation in China has become more convenient. Therefore, the impact of distance on parents’ access to social support and on the burden of commuting has diminished. Families who live far from the hospital typically have one or both parents consistently involved throughout the entire course of their child’s treatment. They gradually become familiar with the illness, treatment procedures, laboratory tests, and daily care. They also adapt to the life of accompanying their child for treatment in another city. Consequently, their daily care and communication needs, medical service needs, psychological and spiritual needs, and emotional needs are relatively lower. However, accompanying the child for treatment away from their home often requires the parents to temporarily suspend or resign from their original jobs, leading to their relatively high economic burden [ 5 ]. Additionally, as the child’s treatment progresses, parents need to acquire more new medical knowledge, thus resulting in relatively higher healthcare and informational needs. Meanwhile, for parents whose residency area is in the same city as that of the treatment hospital, they generally have more co-caregivers. In this study, of the 60 parents whose residency area is in the same city as that of the treatment hospital, 28 (46.7%) parents had two or more co-caregivers. Additionally, 18 (30%) of these parents spent less than 12 hours on daily care for their sick children. These parents may be in a situation where they need to balance work and caregiving for their children with leukemia, leading to higher supportive care needs during this process. Considering the bias of sample, out of the 161 parents living far from the treatment hospital, 118 (73.3%) parents were taking care of children at the early stage of treatment (1–3 months after the diagnosis). The sample bias may be the reason why parents whose original residency areas were in the same city as those of the hospital were more likely to be in the “high supportive care” class. Therefore, further study including more parents of children in different stages of treatment is urgently needed. 4.3.5 Daily caregiving time Compared with the parents with daily caregiving time of more than 18h, parents with daily caregiving time of 12–18 hours were more likely to be classified in the “low supportive care needs” class than in the “high supportive care needs” class. Parents with daily caregiving time of more than 18 hours may have heavy caregiving burden, which would frequently lead to sleep deprivation and feeling of fatigue and exhaustion [ 5 ]. Moreover, parents with daily caregiving time of more than 18 hours often experienced a significant disruption in their previous lifestyle. They were unable to engage in work, social activities, or outings freely, as they had to accompany their children for treatment and manage their daily care needs throughout the day [ 33 ]. The substantial caregiving burden placed upon them resulted in their supportive care need in different aspects. Since parents who provided daily caregiving for 12–18 hours were familiar with their child's treatment and daily caregiving, they had a high level of caregiving ability and could provide a higher standard of care for their children. As a result, they had some time for rest, which was beneficial for their physical and mental well-being, and thereby their need for supportive care was relatively low. In our study, more than half (54.3%) of the parents took care of their children for more than 18 hours every day. Therefore, healthcare providers should focus on those parents who spend almost the entire day accompanying their children in the hospital and actively provide them with supportive care. 4.4 Association between parents’ caregiving ability and latent class membership 4.4.1 Disease cognitive ability Parents with low disease cognitive ability were more likely to be classified in the “high supportive care needs” class than in the “low supportive care needs” class. Disease cognitive ability includes the assessment of the children’s condition, the observation of changes in the children’s condition, learning information on disease treatment and caring for the children, and contacting with the professional healthcare providers [ 22 ]. Parents with low disease cognitive ability had more difficulty in assessing and observing the changes of their children’s condition. They could not fully grasp the information and knowledge related to leukemia treatment, nor could they have a good understanding of many key points in caring for their children with leukemia. Therefore, they might fail to effectively implement high quality of caregiving, resulting in the failure to detect the changes of children’s disease in a timely manner or leading to more suffering or delayed diagnosis and treatment. Thereby, the parents with lower disease cognitive ability had more supportive care needs. Furthermore, communication between these parents and healthcare providers is often inefficient, as they were unable to accurately identify issues that arise during care; moreover, they found it difficult to grasp the caregiving guidance provided by healthcare providers all at once [ 6 , 46 ]. For parents with low disease cognitive ability, information should be provided in a more accessible and understandable manner, such as graphic or video materials, so they can study repeatedly to improve their disease cognitive ability and thereby reduce their healthcare and informational needs and daily care and communication needs. 4.4.2 Person-centered care skills Parents with high person-centered care skills were more likely to be classified in the “high supportive care needs” class than in the “low supportive care needs” class. These parents can better perceive the person-centered care needs of their children. Such perceived needs require more effort in caregiving from those parents, who typically have a certain level of understanding of their children's disease and care, are willing to actively learn and improve their caregiving abilities. They strive to meet their children's care needs to the best of their abilities. Generally, children receiving care from such parents also experience higher quality of care. However, providing meticulous and responsible care for their children with leukemia may to some extent result in higher physical strain for these parents and can even lead to caregiving burden and psychological pressure occasionally, thus resulting in higher supportive caregiving needs [ 19 , 20 ]. Therefore, the parents with high person-centered care skills should be taken into account. After ensuring that the care needs of the children are met, we should guide parents to focus on their own needs, encourage them to relax appropriately, and fulfill their own supportive care needs, because maintaining a good physical and mental state is good for both themselves and for their children. 4.4.3 Balancing caregiving needs and one’s own needs Parents with low balancing caregiving needs and one’s own needs ability were more likely to be classified in the “high supportive care needs” class than in the “low supportive care needs” class. When parents have difficulty in balancing caregiving needs and their own needs, they need more support to meet both the caregiving needs of the children and their own personal needs. Therefore, their level of supportive care needs tends to be high. During the initial stages of leukemia treatment for the children, parents typically prioritize their efforts on caring for their children and strive to meet the children’s caregiving needs. They temporarily neglect their own needs, leading to the imbalance between the children's caregiving needs and the parents' personal own needs [ 47 ]. Parents with a high ability to balance caregiving needs and their own needs tend to allocate time and energy reasonably. When caring for their children, they can also pay attention to their own needs and avoid prolonged neglect of their personal needs. Conversely, parents with a low ability to balance caregiving needs and their own needs primarily focus on caring for their children, leading to prolonged unmet personal needs for themselves. Consequently, they experience higher levels of supportive care needs. Moreover, the prolonged unmet supportive care needs may result in physiological and psychological discomfort for the parents, increasing their supportive care needs furthermore [ 9 ]. Therefore, healthcare providers should not only fully understand the mindset of parents prioritizing their children’s needs over their own but also remind parents to take care of their own needs, utilize available social support when appropriate, and balance caring for the children and self-care. It is important to make parents aware that only by taking good care of their own needs and maintaining good physical and mental health can they take better care for their children. 4.5 Clinical Implementation Exploring the latent classes of supportive care needs of Chinese parents of children with leukemia as well as the characteristics of parents and their children in the latent classes could offer valuable insights for the healthcare professionals and enable the identification of parents who are more likely to have high supportive care needs. Consequently, early and precise supportive care interventions could be provided to the targeted parents, resulting in the improvement of the physical and mental health of the parents, along with the improvement of quality of care, disease prognosis, and quality of life of the children. Moreover, the results of this study also reminded us that parents in the “low supportive care needs” may not have low needs in all the aspects of supportive care. They are likely to have relatively high supportive care needs in health care and information and in economic aspect; therefore, targeted support is needed. Additionally, parents’ supportive care needs may gradually change over time along with their children’s treatment progress. Therefore, it is strongly encouraged to monitor and track the development of parents’ supportive care needs. This proactive approach will ensure that appropriate support could be consistently provided to meet the changing needs of parents throughout the course of their children’s treatment. 4.6 Limitations There are some limitations in the study. First, the data were collected exclusively from three major cities in China—Shanghai, Suzhou, and Chongqing—and solely from three prominent children’s hospitals, without information from community clinical settings. Second, 72.8% of the participants were parents caring for children at the early stage of treatment (1–3 months after the diagnosis), which may lead to bias in the study sample. Consequently, the findings may not fully represent the supportive care needs of all the parents. Moreover, the parents’ supportive care needs may change throughout their children’s disease treatment journey after the diagnosis. Given the cross-sectional design of the present study, speculating the trajectory of parents’ supportive care needs development was impossible. A longitudinal study would be necessary to explore the developmental patterns of parents’ supportive care needs in the future. Conclusion Two distinct latent classes of Chinese parents of children with leukemia were identified based on supportive care needs It was the first such study utilizing LCA in China. The class membership was significantly associated with children’s treatment duration, parents’ marital status, family income, distance to the hospital, daily caregiving time, and parents’ caregiving ability. Our findings provided valuable insights for healthcare providers to better understand the classes of supportive care needs among parents of children with leukemia, enabling healthcare providers to develop tailored and appropriate supportive care interventions and to deliver targeted supportive intervention to those parents in need. Declarations Competing Interests The authors have declared that there is no conflict of interest. Ethics approval Ethical review approval from the Naval Medical University (NO.HJEC-2018-YF-001) was obtained. Consent to participate Informed consent was obtained from all participants included in the study. Consent to publish The authors affirm that human research participants provided informed consent for publication of the tables. Funding This study was supported by the National Natural Science Foundation of China (Project No.72374204 and No.71904195). Author Contribution All authors contributed to the study conception and design. Material preparation, and data collection were performed by Jingting Wang, Yingwen Wang, Huifang Wu, Qi Yang, Linyu Ma. Data analysis was performed by Zhuting Zheng, Xuanyi Bi, and Wen Zhang. The first draft of the manuscript was written by Jingting Wang and all authors commented on previous versions of the manuscript. Zhaohui Geng, and Changrong Yuan revised the manuscript. All authors read and approved the final manuscript. References Ssenyonga N, Stiller C, Nakata K, Shalkow J, Redmond S, Bulliard JL, Girardi F, Fowler C, Marcos-Gragera R, Bonaventure A, Saint-Jacques N, Minicozzi P, De P, Rodríguez-Barranco M, Larønningen S, Di Carlo V, Mägi M, Valkov M, Seppä K, Wyn Huws D, Coleman MP, Allemani C (2022) Worldwide trends in population-based survival for children, adolescents, and young adults diagnosed with leukaemia, by subtype, during 2000-14 (CONCORD-3): analysis of individual data from 258 cancer registries in 61 countries. Lancet Child Adolesc Health 6: 409–431 Steliarova-Foucher E, Colombet M, Ries LAG, Moreno F, Dolya A, Bray F, Hesseling P, Shin HY, Stiller CA (2017) International incidence of childhood cancer, 2001-10: a population-based registry study. Lancet Oncol 18: 719–731 Zheng R, Peng X, Zeng H, Zhang S, Chen T, Wang H, Chen W (2015) Incidence, mortality and survival of childhood cancer in China during 2000–2010 period: A population-based study. Cancer Lett 363: 176–180 Cheung YT, Zhang H, Cai J, Au-Doung LWP, Yang LS, Yan C, Zhou F, Chen X, Guan X, Pui CH, Hudson MM, Li CK (2021) Identifying Priorities for Harmonizing Guidelines for the Long-Term Surveillance of Childhood Cancer Survivors in the Chinese Children Cancer Group (CCCG). JCO Glob Oncol 7: 261–276 Wang J, Shen N, Zhang X, Shen M, Xie A, Howell D, Yuan C (2017) Care burden and its predictive factors in parents of newly diagnosed children with acute lymphoblastic leukemia in academic hospitals in China. Support Care Cancer 25: 3703–3713 Wang J, Howell D, Shen N, Geng Z, Wu F, Shen M, Zhang X, Xie A, Wang L, Yuan C (2018) mHealth Supportive Care Intervention for Parents of Children With Acute Lymphoblastic Leukemia: Quasi-Experimental Pre- and Postdesign Study. JMIR Mhealth Uhealth 6: e195 Cho YR, Yoo YS (2020) Factors influencing supportive care needs of multiple myeloma patients treated with chemotherapy. Support Care Cancer 28: 1783–1791 Lyu QY, Wong FKY, You LM, Zhou XZ (2019) Unmet Family Needs Concerning Healthcare Services in the Setting of Childhood Hospitalization for Cancer Treatment in Mainland China: A Qualitative Study. J Pediatr Nurs 44: e66-e71 Aziza YDA, Wang ST, Huang MC (2019) Unmet supportive care needs and psychological distress among parents of children with cancer in Indonesia. Psychooncology 28: 92–98 Tsimicalis A, Stevens B, Ungar WJ, Castro A, Greenberg M, Barr R (2020) Shifting Priorities for the Survival of My Child: Managing Expenses, Increasing Debt, and Tapping Into Available Resources to Maintain the Financial Stability of the Family. Cancer Nurs 43: 147–157 He L, Wu H, Li M, Deng X (2022) A qualitative meta-synthesis of the caregiving experiences of adult children providing care for cancer patients in China: Implications for multidisciplinary healthcare teams. Health Soc Care Community 30: e3829-e3842 Yamaji N, Nagamatsu Y, Kobayashi K, Hasegawa D, Yuza Y, Ota E (2022) Information needs of children with leukemia and their parents' perspectives of their information needs: a qualitative study. BMC Pediatr 22: 414 Wang J, Bi X, Zhang S, Wang Y, Wu H, Yang Q, Ma L, Yuan C (2023) Psychometric evaluation of the Chinese version of the supportive care needs survey for caregivers of children with Paediatric cancer (SCNS-C-Ped-C). Nurs Open 10: 4196–4204 Dong B, Zhang J, Wang F, Xie C, Qi Y, Lin L, Tian L (2023) Supportive care needs of patients with colorectal cancer undergoing anticancer therapy: A latent class analysis. Asia Pac J Oncol Nurs 10: 100216 Tein JY, Coxe S, Cham H (2013) Statistical Power to Detect the Correct Number of Classes in Latent Profile Analysis. Struct Equ Modeling 20: 640–657 Miranda VPN, Dos Santos Amorim PR, Bastos RR, Souza VGB, de Faria ER, do Carmo Castro Franceschini S, Priore SE (2019) Evaluation of lifestyle of female adolescents through latent class analysis approach. BMC Public Health 19: 184 Fitch MI (2008) Supportive care framework. Can Oncol Nurs J 18: 6–24 Kerr LM, Harrison MB, Medves J, Tranmer J (2004) Supportive care needs of parents of children with cancer: transition from diagnosis to treatment. Oncol Nurs Forum 31: E116-126 Wang J, Bi X, Wang J, Gu Y, Zheng X, Wang Y, Wu H, Yang Q, Ma L, Liu F, Yuan C (2022) Chinese parents' caregiving ability for children with haematological malignancies: A latent class analysis. Nurs Open 9: 2073–2083 Wu HF, Bi XY, Li J, Wang JT (2020) Analysis on care ability and its influencing factors for parents of children with leukemia. Mil Nurs 37: 18–22 Shen T, Zhao YQ (2018) Diagnostic and therapeutic criteria of hematologic diseases, 4th Edition. Science Press, Beijing Qian SJ (2016) The adaptation of hematologic malignancies family caregiver skills scale. Dissertation, Soochow University Wang CK, Hu ZF, Liu Y (2001) Evidences for reliability and validity of the Chinese version of general selfefficacy scale. Chin J Appl Psychol: 37–40 Shen XH, Jiang QJ (2000) Report on application of Chinese version of MCMQ in 701 patients. Chin J Behav Med Brain Sci: 22–24 Huang L, Jiang QJ, Ren WH (1996) Coping style, social support,psychosomatic symptoms in patients with cancer. Chin Ment Health J 10: 160–161 Wang J, Wang X (2020) Structural Equation Modeling: Applications Using Mplus, 2nd Edition. John Wiley, New York Clark SL (2010) Mixture Modeling with Behavioral Data. Dissertation, University of California Wollney EN, Bylund CL, Kastrinos AL, Campbell-Salome G, Sae-Hau M, Weiss ES, Fisher CL (2023) Understanding parents uncertainty sources and management strategies while caring for a child diagnosed with a hematologic cancer. PEC Innov 3: 100198 Yucel E, Zhang S, Panjabi S (2021) Health-Related and Economic Burden Among Family Caregivers of Patients with Acute Myeloid Leukemia or Hematological Malignancies. Adv Ther 38: 5002–5024 Board PDQPTE (2002) Childhood Acute Lymphoblastic Leukemia Treatment (PDQ®): Health Professional VersionPDQ Cancer Information Summaries. National Cancer Institute (US), Bethesda (MD) Aldiss S, Hollis R, Phillips B, Ball-Gamble A, Brownsdon A, Chisholm J, Crowther S, Dommett R, Gower J, Hall NJ, Hartley H, Hatton J, Henry L, Langton L, Maddock K, Malik S, McEvoy K, Morgan JE, Morris H, Parke S, Picton S, Reed-Berendt R, Saunders D, Stewart A, Tarplee-Morris W, Walsh A, Watkins A, Weller D, Gibson F (2023) Research priorities for children's cancer: a James Lind Alliance Priority Setting Partnership in the UK. BMJ Open 13: e077387 Rahman SA, Variyath S, Al-Yateem N, Al Marzouqi A, Subu MA (2023) Economic and Social Burden of Childhood Cancer in Bangladesh. Asian Pac J Cancer Prev 24: 69–74 Limburg H, Shaw AK, McBride ML (2008) Impact of childhood cancer on parental employment and sources of income: a Canadian pilot study. Pediatr Blood Cancer 51: 93–98 Chodidjah S, Kongvattananon P, Liaw JJ (2022) "Changed our lives": Psychosocial issues experienced by families of early adolescents with leukemia. Eur J Oncol Nurs 56: 102077 Ao MQ, Xia L, Wang XQ, Fang S, Yang BX, Liu Q, Chen J, Zhou SC, Li XY, Sun T, Lu B, Bao A, Luo D, Ruan J (2023) Help-Seeking Intentions for Depression from Mental Health Professionals Among Community-Dwelling Persons in Central China. Adm Policy Ment Health 50: 901–911 Lau S, Lu X, Balsamo L, Devidas M, Winick N, Hunger SP, Carroll W, Stork L, Maloney K, Kadan-Lottick N (2014) Family life events in the first year of acute lymphoblastic leukemia therapy: a children's oncology group report. Pediatr Blood Cancer 61: 2277–2284 Huang Y, Chen M, Zhang Y, Chen X, Zhang L, Dong C (2023) Finding family resilience in adversity: A grounded theory of families with children diagnosed with leukaemia. J Clin Nurs 32: 5160–5172 Arab M, Bernstein C, Haghshenas A, Ranjbar H (2020) Factors associated with caregiver burden for mothers of children undergoing Acute Lymphocytic Leukemia (ALL) treatment. Palliat Support Care 18: 405–412 Patistea E, Makrodimitri P, Panteli V (2000) Greek parents' reactions, difficulties and resources in childhood leukaemia at the time of diagnosis. Eur J Cancer Care (Engl) 9: 86–96 Pagano E, Baldi I, Mosso ML, di Montezemolo LC, Fagioli F, Pastore G, Merletti F (2014) The economic burden of caregiving on families of children and adolescents with cancer: a population-based assessment. Pediatr Blood Cancer 61: 1088–1093 Ma Y, Dai Q (2019) Real experiences of parents of children with leukemia during the illness: a qualitative study. J Nurses Train 34: 2174–2177 Wei YQ, Yang X, Wang RR, Yang T, Liu YS, Zhang CM, Liu YH (2021) The real experiences and needs of caregivers of acute leukemia children: a meta-synthesis of qualitative studies. J Nurses Train 36: 1441–1447 + 1452 Hoenk K, Torno L, Feaster W, Taraman S, Chang A, Weiss M, Pugh K, Anderson B, Ehwerhemuepha L (2021) Multicenter study of risk factors of unplanned 30-day readmissions in pediatric oncology. Cancer Rep (Hoboken) 4: e1343 Iida M, Liu K, Huang XJ, Huang H, Kuwatsuka Y, Moon JH, Lee JW, Lakshmi KM, Dodds A, Wilcox L, Ko BS, Hamidieh AA, Behfar M, Ho KW, Bunworasate U, Ho A, Farzana T, Sim J, Dung PC, Akter M, Ratnayake W, Bravo MR, Gyi AA, Santosa D, Poudyal BS, Batshkh K, Srivastava A, Okamoto S, Atsuta Y (2023) Report on hematopoietic cell transplantations performed in 2018/2019 focusing on the trends of selection of stem cell sources in the Asia-Pacific region: APBMT Activity Survey. Blood Cell Ther 6: 114–123 Ghatak N, Trehan A, Bansal D (2016) Financial burden of therapy in families with a child with acute lymphoblastic leukemia: report from north India. Support Care Cancer 24: 103–108 Wang J, Yao N, Shen M, Zhang X, Wang Y, Liu Y, Geng Z, Yuan C (2016) Supporting Caregivers of Children With Acute Lymphoblastic Leukemia via a Smartphone App: A Pilot Study of Usability and Effectiveness. Comput Inform Nurs 34: 520–527 Wang YY, Wang JT, Yu SY, Zhou F, Yuan CR (2016) Parents’ needs of early diagnosed children with acute lymphoblastic leukemia: a qualitative study. Mil Nurs 33: 6–10 Additional Declarations No competing interests reported. Supplementary Files Table1.docx Table2.docx Table3.docx Table4.docx Cite Share Download PDF Status: Published Journal Publication published 08 Dec, 2024 Read the published version in Supportive Care in Cancer → Version 1 posted Editorial decision: Revision requested 01 Oct, 2024 Reviews received at journal 23 Sep, 2024 Reviewers agreed at journal 03 Sep, 2024 Reviews received at journal 13 Aug, 2024 Reviewers agreed at journal 30 Jul, 2024 Reviewers agreed at journal 28 Jul, 2024 Reviewers invited by journal 23 Jul, 2024 Editor assigned by journal 23 Jul, 2024 Submission checks completed at journal 14 Jun, 2024 First submitted to journal 12 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4568591","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":339815098,"identity":"0328dcee-338d-4d6c-88e9-8925c7ffcf68","order_by":0,"name":"Jingting WANG","email":"","orcid":"","institution":"The Naval Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jingting","middleName":"","lastName":"WANG","suffix":""},{"id":339815099,"identity":"0b908690-0c34-4a6d-816d-001f7b37f7e1","order_by":1,"name":"Zhuting ZHENG","email":"","orcid":"","institution":"Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Zhuting","middleName":"","lastName":"ZHENG","suffix":""},{"id":339815100,"identity":"1d37dce3-9527-4c3a-9384-b6dff019b6b8","order_by":2,"name":"Xuanyi BI","email":"","orcid":"","institution":"The Naval Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xuanyi","middleName":"","lastName":"BI","suffix":""},{"id":339815101,"identity":"9dfc22ea-2cff-4bc8-8d86-c8a23a654e43","order_by":3,"name":"Wen Zhang","email":"","orcid":"","institution":"Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Wen","middleName":"","lastName":"Zhang","suffix":""},{"id":339815102,"identity":"e000b211-7273-414b-b3aa-d36c4c5e0083","order_by":4,"name":"Yingwen WANG","email":"","orcid":"","institution":"Children’s Hospital of Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Yingwen","middleName":"","lastName":"WANG","suffix":""},{"id":339815103,"identity":"365a47e9-1987-4d5f-bd88-5905c457cd99","order_by":5,"name":"Huifang WU","email":"","orcid":"","institution":"Children’s Hospital of Soochow University","correspondingAuthor":false,"prefix":"","firstName":"Huifang","middleName":"","lastName":"WU","suffix":""},{"id":339815104,"identity":"63c6945f-a552-496d-b6f8-03798783b479","order_by":6,"name":"Qi YANG","email":"","orcid":"","institution":"Children’s Hospital of Soochow University","correspondingAuthor":false,"prefix":"","firstName":"Qi","middleName":"","lastName":"YANG","suffix":""},{"id":339815105,"identity":"f8f0bcc7-bc95-4ccd-8bf2-e6c44cb79ffc","order_by":7,"name":"Linyu MA","email":"","orcid":"","institution":"Children’s Hospital of Chongqing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Linyu","middleName":"","lastName":"MA","suffix":""},{"id":339815106,"identity":"7ce5a669-df9f-4d2a-b752-0f62fefc3889","order_by":8,"name":"Zhaohui Geng","email":"","orcid":"","institution":"Shanghai University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Zhaohui","middleName":"","lastName":"Geng","suffix":""},{"id":339815107,"identity":"07823722-3cb0-4047-b482-30208b2c08b5","order_by":9,"name":"Changrong YUAN","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAwUlEQVRIiWNgGAWjYPACG34GhgQQg5loLWmSDaRqOUyCFoMbyc8e/NxzXsLgOJDBUGGd2MB+9gABLWnmhj3PbksYnHlmbsBwJj2xgScvgYCWBDNphgO360AMCca2w4kNEjwGBLSkfwNqOScBYkgw/iNKSw7IlgMSIIYEYwMRWiTPvCmT7DmQLAFiSCQcSzdu48nBr4XvePo2iR8H7CTAjA811rL97Gfwa1E4gMxLAGI2vOqBQL6BkIpRMApGwSgYBQBQZUdh9r+j/AAAAABJRU5ErkJggg==","orcid":"","institution":"Fudan University","correspondingAuthor":true,"prefix":"","firstName":"Changrong","middleName":"","lastName":"YUAN","suffix":""}],"badges":[],"createdAt":"2024-06-12 08:16:03","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4568591/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4568591/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00520-024-09020-1","type":"published","date":"2024-12-08T15:57:25+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":63285271,"identity":"8caf184f-e10a-4f46-8376-6925fe7ad139","added_by":"auto","created_at":"2024-08-26 13:38:09","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":65984,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eClass prevalence and patterns of item-response probability by latent class\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-4568591/v1/ec14bad1e296c525752a41e3.png"},{"id":70964671,"identity":"eb16a29a-7789-48ac-8f33-8b9374d19dc9","added_by":"auto","created_at":"2024-12-09 16:13:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1194985,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4568591/v1/521b69cf-d1cd-4a62-8f0f-332be9365709.pdf"},{"id":63288000,"identity":"aa7e3454-f509-4e51-b098-79de762c36f5","added_by":"auto","created_at":"2024-08-26 13:54:09","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":23609,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.docx","url":"https://assets-eu.researchsquare.com/files/rs-4568591/v1/52cda784b8aa66eb37eb49cf.docx"},{"id":63285270,"identity":"eb9e8a83-1e13-4229-946c-f86cdfb24cf1","added_by":"auto","created_at":"2024-08-26 13:38:09","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":20793,"visible":true,"origin":"","legend":"","description":"","filename":"Table2.docx","url":"https://assets-eu.researchsquare.com/files/rs-4568591/v1/6b22725acd64333a78de4c4c.docx"},{"id":63285273,"identity":"89cc9e3b-fe82-436f-9c81-278ea5503351","added_by":"auto","created_at":"2024-08-26 13:38:09","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":20300,"visible":true,"origin":"","legend":"","description":"","filename":"Table3.docx","url":"https://assets-eu.researchsquare.com/files/rs-4568591/v1/9a152519a883da662067afa5.docx"},{"id":63285274,"identity":"c5227c74-2c9b-4c89-a3b9-b23276d2a3ee","added_by":"auto","created_at":"2024-08-26 13:38:09","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":23537,"visible":true,"origin":"","legend":"","description":"","filename":"Table4.docx","url":"https://assets-eu.researchsquare.com/files/rs-4568591/v1/4140ffc01d16b53e27a9aa9a.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Supportive Care Needs of Parents Caring for Children with Leukemia: a latent class analysis","fulltext":[{"header":"Background","content":"\u003cp\u003eCancer stands as one of the primary causes of childhood mortality, with leukemia being the most prevalent type. Among very young children (aged 0\u0026ndash;4 years), leukemia accounted for 36.1% of all cancers, as compared with 15.4% in adolescents during 2001\u0026ndash;2010 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The estimated world-standardized incidence rate of leukemia from 2001 to 2010 was 46.4 per million person-years in children (aged 0\u0026ndash;14 years) and 28.5 per million person-years in adolescents (aged 15\u0026ndash;19 years) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In China, the estimated age-standardized childhood cancer incidence rate is 87.1 per million, with leukemia being the most prevalent cancer (35.6 per million) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. China shoulders a significant portion of the global burden of childhood cancer [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. With advancements in treatment over the past decade, the survival rate of childhood leukemia continues to increase, yet substantial international variation occurs in age-standardized 5-year net survival from acute lymphoblastic leukemia (ALL) in children, ranging from 50% to more than 90% [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eChemotherapy is the primary treatment for leukemia, thanks to the ongoing advancements in the discovery of novel, more targeted chemotherapy agents. However, the long-term effects of anticancer chemotherapy remain an area of concern for children with leukemia and their parents. As the primary caregivers, parents of children with leukemia play an active role in ensuring that their children\u0026rsquo;s basic needs are met throughout the diagnosis and treatment [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, during the challenging and lengthy process of caring for their children with leukemia, parents themselves tend to encounter psychological distress, physiological discomfort, and economic pressure. Consequently, most parents seek assistance to address their supportive care needs [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSupportive care refers to care provided to patients with cancer and to their families, in order to cope with the disease and its treatment [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Previous studies have demonstrated that caregivers of children with pediatric cancer reported a variety of unmet needs, including informational, psychological, occupational, and social needs [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Moreover, caring for children with pediatric cancer can be challenging, owning to the high medical expenses, caregiving costs, and changes in caregivers\u0026rsquo; employment status after the diagnosis of the children\u0026rsquo;s cancer [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Thus, parents of children with leukemia urgently need supportive care intervention.\u003c/p\u003e \u003cp\u003eThe initial step in providing precise, targeted, and appropriate support to parents of children with leukemia is to recognize parents\u0026rsquo; supportive care needs. However, although the significance of assessing parents\u0026rsquo; supportive care needs is extensively recognized, in China or even around the world, only a few qualitative studies have been conducted to explore the needs or experiences of parents with children suffering from leukemia [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], possibly due to the lack of appropriate tools for assessing the needs of caregivers taking care of children with pediatric cancer.\u003c/p\u003e \u003cp\u003eOur research team revised the Supportive Care Needs Survey for Partners and Caregivers of Cancer Patients (SCNS-P\u0026amp;C) and evaluated the psychometric properties of the Chinese Version of the Supportive Care Needs Survey for Caregivers of Children with Pediatric Cancer (SCNS-C-Ped-C) for caregivers of children with pediatric cancer [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. SCNS-C-Ped-C, the reliability and validity of which was demonstrated in the evaluation, was determined to be suitable, in Chinese clinical and research settings, to assess the multi-dimensional supportive care needs for caregivers of children with pediatric cancer and was therefore used in this study to explore the supportive care needs of parents caring for children with leukemia.\u003c/p\u003e \u003cp\u003eMoreover, the likelihood of significant individual variation in supportive care needs can create heterogeneous groups [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Latent class models, statistical tools for constructing typologies based on observed variables, prove particularly beneficial in identifying subgroups within large, heterogeneous populations [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Owing to the population heterogeneity, latent class analysis (LCA) is an appropriate method to classify parents according to their supportive care needs. After the responses were analyzed to explicit test questions, LCA determines the optimal number of latent classes of parents and the prevalence of each class [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe identification of latent classes of parents regarding supportive care needs is followed by the essential identification of the associated characteristics of the latent class membership. The Supportive Care Framework for Cancer Care developed by Margaret Fitch [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] proposed that supportive care needs were influenced by the socioeconomic status, social support, coping resources, and personality. Studies have indicated that the demographic information of children and their parents and the diagnosis and treatment information of the children were associated with parents\u0026rsquo; supportive care needs [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Moreover, studies have shown that the caregiving abilities of parents with children diagnosed with leukemia were closely related to their supportive care needs [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Therefore, these influencing factors including children\u0026rsquo;s clinical information, parents and children\u0026rsquo;s socio-demographic information, parents\u0026rsquo; caregiving ability, self-efficacy, coping mode, and social support need to be considered as factors associated with the latent class membership.\u003c/p\u003e \u003cp\u003eTo the best of our knowledge, no existing studies have used the SCNS-C-Ped-C to investigate the supportive care needs among parents of children with leukemia in China, nor has any study analyzed the heterogeneity among parents. Therefore, in the present study, the SCNS-C-Ped-C was used to assess the supportive care needs of Chinese parents with children diagnosed with leukemia; LCA was utilized to identify unobserved latent classes of parents based on their supportive care needs and to explore the characteristics associated with membership in each latent class. The findings of this study will be helpful for understanding the differences in parents\u0026rsquo; supportive care needs and for tailoring the interventions accordingly to the subgroups with various supportive care needs.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Design\u003c/h2\u003e \u003cp\u003eA multicenter cross-sectional survey study was conducted. The study was prepared and reported according to the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) checklists.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Sample recruitment\u003c/h2\u003e \u003cp\u003eOur study included 221 parents, whose children were diagnosed with leukemia and were recruited from three children's hospitals in Shanghai, Jiangsu, and Chongqing, China. The eligibility criteria for parents and children were as follows: (1) the child met the diagnostic criteria for leukemia [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], (2) the child was under treatment and under 15 years old, (3) the child had no other serious or chronic diseases, (4) the parent could communicate fluently in Mandarin, (5) the parent was primarily responsible for the child's daily caregiving, and (6) the parent volunteered to participate in the survey.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Data collection\u003c/h2\u003e \u003cp\u003eData collection took place in the selected three children’s hospitals between May 2019 and April 2020. The researchers explained the research aims to the parents, and only after signed consent forms were obtained, the printed questionnaires within sealed envelopes were provided to the parents. Similarly, the completed questionnaires were collected on the same day by researchers after parents had finished filling them out. The consent form guaranteed anonymous and voluntary participation, as well as the right to withdraw from the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Instruments\u003c/h2\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.4.1 Socio-demographic and clinical characteristics\u003c/h2\u003e \u003cp\u003eThe socio-demographic and clinical characteristics concerning caregivers and their children with leukemia were collected with the use of a self-designed questionnaire. The information included (1) parents’ gender, age, education, marital status, employment status, average monthly household income, residency area, whether the hospital and the residency area located in the same city, type of medical payment, daily caregiving time, and the number of co-caregivers; (2) children’s gender, age, whether the child was the single child, and treatment duration.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.4.2 SCNS-C-Ped-C\u003c/h2\u003e \u003cp\u003e Parents’ supportive care needs were measured by the SCNS-C-Ped-C, a reliable and valid tool designed to evaluate the multidimensional supportive care needs of caregivers with children diagnosed with pediatric cancer. This scale had been previously validated in family caregivers of hematologic malignancies in China[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The SCNS-C-Ped-C consisted of 44 items across six domains: health care and information needs (13 items), daily care and communication needs (17 items), psychological and spiritual needs (7 items), medical service needs (2 items), economic needs (2 items), and emotional needs (3 items). Responses were rated on a 5-point Likert response scale (1 = not applicable, 2 = satisfied, 3 = low need, 4 = moderate need, and 5 = high need). The score of each domain was the average score of all the items within that domain (the score of the domain ≤ 2: no need, \u0026gt; 2 and ≤ 3: low need, \u0026gt; 3 and ≤ 4: medium need, \u0026gt; 4 and ≤ 5: high need). In this study, the scores of the six domains were recoded as dichotomous indicator of parent's supportive care needs: 0-\"no needs\" (if item score ≤ 2) vs. 1-\"at least some needs\" (if item score \u0026gt; 2).\u003c/p\u003e \u003cp\u003eThe Cronbach’s alpha was 0.968 for the total scale and ranged from 0.603 to 0.952 for the six domains. The split-half reliability coefficient was 0.883 for the total scale and ranged from 0.659 to 0.931 for the six domains. In the present study, the Cronbach’s alpha was 0.965 for the total scale and ranged from 0.642 to 0.952 for the 6 domains, a result that indicated satisfactory internal consistency.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.4.3 Hematologic Malignancies’ Family Caregiver Skills Scale (HMFCGSS)\u003c/h2\u003e \u003cp\u003eParents’ caregiving ability was measured based on their last week’s experience, with the use of the HMFCGSS that was previously validated in hematologic malignancies’ family caregivers in China (Cronbach’s α = 0.920) [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. HMFCGSS consists of 6 domains with a total of 23 items: disease cognitive ability with 3 items, general approaches to caregiving with 3 items, person-centered care skills with 5 items, emotional management ability with 4 items, appraising supportive resources with 3 items, and balancing caregiving needs and one’s own needs with 5 items. Each of the 23 items was measured on a 5-point Likert scale ranging from not difficult (1) to very difficult (5). The higher the scale, the lower the parents’ caregiving ability.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e2.4.4 General Self-efficacy Scale (GSES)\u003c/h2\u003e \u003cp\u003eParents’ self-efficacy was measured by the 10-item GSES[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The scale was scored on a 4-point scale ranging from not at all true (1) to exactly true (4). Individuals with higher scores perceive a high level of self-efficacy. The Chinese version of the GSES has demonstrated good reliability (Cronbach’s α = 0.87) [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e2.4.5 Medical Coping Modes Questionnaire (MCMQ)\u003c/h2\u003e \u003cp\u003eParents’ coping modes were measured by MCMQ [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The MCMQ consisted of confrontation (8 items), avoidance (7 items), and resignation (5 items) domains. All the items were rated by the 4-point scale. The dimension with the highest cumulative score indicated the particular coping strategy the participant likely to use. The Chinese version of the MCMQ has demonstrated good reliability (Cronbach’s α = 0.69, 0.60, 0.76) [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e2.4.6 Perceived Social Support Scale (PSSS)\u003c/h2\u003e \u003cp\u003eParents’ social support was measured by the 12-item PSSS [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. All the items were rated by the 7-point scale ranging from never (1) to every day (7). A lower score indicates poorer social support. The Chinese version of the PSSS has demonstrated good reliability (Cronbach’s α = 0.88) [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Ethical considerations\u003c/h2\u003e \u003cp\u003e Ethical review approval from the Naval Medical University (NO.HJEC-2018-YF-001) was obtained. The participants were informed of the aim of this study prior to the survey. No procedures were performed until all the participants had signed the informed consent forms.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e2.6 Data analysis\u003c/h2\u003e \u003cp\u003eThe 6 dichotomous supportive care needs indicators were used for LCA [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. To conduct the LCA, we used 200 sets of random start values, along with 50 initial stage iterations, to ensure that the model estimates were not based on local maxima of the likelihood function. The LCA analysis was started with a single-class solution, and then models with increased number of classes were estimated and compared. Model fit statistics and indices, including the Akaike information criterion (AIC), Bayesian information criterion (BIC), adjusted Bayesian information criterion (aBIC), bootstrapped likelihood ratio test (BLRT), Lo-Mendell-Rubin likelihood ratio(LMR LR) test, Lo-Mendell-Rubin adjusted(aLMR LR) test, and entropy score, were examined. Lower values on AIC, BIC, and aBIC indicate better model fit; significant p-values on the BLRT, LMR, and aLMR indicate that the k class model was more preferable than the k-1 class model [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. The entropy statistics measure the quality of class classification, with values ranging from 0 to 1 and a value closer to 1 indicating better classification. For a LCA model with entropy ≥ 0.80, the latent class membership estimated from the model can be saved as \"observed\" categorical variables for further analysis [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section3\"\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003cdiv id=\"Sec29\" class=\"Section3\"\u003e \u003c/div\u003e \u003c/div\u003e\n\n \u003cdiv id=\"Sec32\" class=\"Section2\"\u003e \u003cdiv id=\"Sec33\" class=\"Section3\"\u003e \u003c/div\u003e \u003cdiv id=\"Sec34\" class=\"Section3\"\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003ch2\u003e3.1 Socio-demographic characteristics\u003c/h2\u003e\u003cp\u003eA total of 221 parents of children with leukemia, who completed the questionnaires, were eligible for this survey. The socio-demographic characteristics of parents and children are described in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\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\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\u003eSample characteristics (n = 221)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\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\u003eCategories\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChildren with leukemia\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBoy\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e121\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54.8\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGirl\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45.2\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAge (years old)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt; 3\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.2\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3–6\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.7\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 or more\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32.1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSingle child\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.5\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e127\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57.5\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eTreatment duration\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1–3 months\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e161\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e72.8\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4–8 months\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.8\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 months or more\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParents\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.6\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e160\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e72.4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e≤ 30\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.8\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31–40\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e129\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58.3\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt; 40\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.9\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh school or below\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45.8\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJunior college\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBachelor's degree or above\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e194\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e87.8\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnmarried (divorced, widowed, or separated)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.2\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eEmployment status\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFull-time\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37.1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePart-time\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.2\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot work\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55.7\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAverage monthly household income\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2000-5000CNY (\u003cspan\u003e$\u003c/span\u003e285–713)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e115\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52.0\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5001-8000CNY (\u003cspan\u003e$\u003c/span\u003e713–1411)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.7\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOver 8000CNY (over \u003cspan\u003e$\u003c/span\u003e1411)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.3\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eResidency area\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCity\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e109\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49.3\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCountry\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50.7\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHospital and the residency area located in the same city\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e161\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e72.9\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eType of medical payment\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelf-pay\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedical health insurance\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.9\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural cooperative health care insurance\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46.7\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eDaily caregiving time\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt; 12h\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.3\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12-18h\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt; 18h\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e120\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54.3\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eNumber of co-caregivers\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 or more\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.0\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e113\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51.1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.0\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.9\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003ch2\u003e3.2 Latent class analysis\u003c/h2\u003e\u003cp\u003eMode fit statistics are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The 2-class solution is considered to be the best model. The single-class model had the largest AIC, BIC, and aBIC, as compared with all other models. In addition, the likelihood ratio (LR) tests of the 2-class model were all statistically significant (LMR \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.0001, aLMR \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.0001, and BLRT \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.0001), indicating population heterogeneity rather than homogeneity. Compared with the 2-class and 3-class models, the 3-class model had smaller information criterion indices (AIC, BIC, and aBIC), but the LR tests of 3-class model were not all statistically significant (LMR \u003cem\u003eP\u003c/em\u003e = 0.1688, aLMR \u003cem\u003eP\u003c/em\u003e = 0.1745, and BLRT \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.0001). Therefore, considering model fit, model parsimony, and clinical interpretability of the results, we selected the 2-class model.\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e displays the results of the 2-class solution. The entropy value of 0.813 indicates good quality of class classification. The probabilities of endorsing “high need” in Class 1 (n = 150, 67.9%) are consistently high across six domains. Therefore, this class was labeled as “high supportive care needs” class. The Class 2 (n = 71, 32.1%) was labeled as “low supportive care needs” class based on the item response probabilities in the class.\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\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\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\u003eModel fit comparisons and latent class prevalence by model (n = 221)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1-class model\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2-class model\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3-class model\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAIC\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1474.210\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1268.830\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1239.045\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBIC\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1494.599\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1313.007\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1307.008\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eaBIC\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1475.584\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1271.809\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1243.628\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEntropy\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en/a\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.813\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.756\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLMR\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en/a\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt; 0.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.1688\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eaLMR\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en/a\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt; 0.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.1745\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBLRT\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en/a\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt; 0.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt; 0.0001\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRelative class size\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en/a\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.679/0.321\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.534/0.348/0.118\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eBest-fitting model in bold\u003c/p\u003e \u003cp\u003e\u003cem\u003eAIC\u003c/em\u003e: Akaike information criterion\u003c/p\u003e \u003cp\u003e\u003cem\u003eBIC\u003c/em\u003e: Bayesian information criterion\u003c/p\u003e \u003cp\u003e\u003cem\u003eaBIC\u003c/em\u003e: adjusted Bayesian information criterion\u003c/p\u003e \u003cp\u003e\u003cem\u003eLMR\u003c/em\u003e: Lo-Mendell-Rubin likelihood ratio test\u003c/p\u003e \u003cp\u003e\u003cem\u003eaLMR\u003c/em\u003e: Lo-Mendell-Rubin adjusted likelihood ratio test\u003c/p\u003e \u003cp\u003e\u003cem\u003eBLRT\u003c/em\u003e: bootstrapped likelihood ratio test\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003ch2\u003e3.4 Analysis of supportive care needs by latent class\u003c/h2\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the mean scores of the six supportive care needs domains according to latent classes. In Class 1 (the “high supportive care needs” class), only the mean score of emotional needs was nearly 3 (3.14 ± 1.23), whereas the mean scores of the other five domains were nearly 4 or higher than 4 (from 3.94 to 4.62), indicating that the parents had relatively high needs across all domains of supportive care. In Class 2 (the “low supportive care needs” class), the mean score of Emotional needs was lower than 2 (1.90 ± 0.56), and the mean scores of the domains of daily care and communication needs, psychological and spiritual needs, and medical service needs were lower than 3 (ranging from 2.41 to 2.52). Only the mean scores of the domains of healthcare and informational needs and economic needs were higher than 3 (ranging from 3.40 to 3.41), indicating that the parents had more supportive care needs of healthcare and information aspect and economic aspect.\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\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\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\u003eThe scores of each scale and domains (n = 221)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e“high supportive care needs” class (‾\u003cem\u003ex\u003c/em\u003e ± \u003cem\u003esd\u003c/em\u003e) n = 150\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e“low supportive care needs” class (‾\u003cem\u003ex\u003c/em\u003e ± \u003cem\u003esd\u003c/em\u003e)\u003c/p\u003e \u003cp\u003en = 71\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\u003eSupportive care needs\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.24 ± 0.50\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.75 ± 0.50\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealthcare and informational needs\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.62 ± 0.48\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.40 ± 0.93\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDaily care and communication needs\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.24 ± 0.63\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.48 ± 0.49\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychological and spiritual needs\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.94 ± 0.84\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.41 ± 0.79\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedical service needs\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.99 ± 1.24\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.52 ± 1.07\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEconomic needs\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.60 ± 1.44\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.41 ± 1.30\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmotional needs\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.14 ± 1.23\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.90 ± 0.56\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003ch2\u003e3.5 The binary logistic regression model\u003c/h2\u003e\u003cp\u003eSelected results of the binary logistic regression model are shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. Parents whose children had shorter treatment duration were more likely to be classified in the “high supportive care needs” class than in the “low supportive care needs” class (OR = 4.319, 95%CI 1.334, 13.979). Parents who were married, had low average monthly household income, commonly visited the hospital located in the same city with residency area, and spent more than 18h on daily caregiving were more likely to be classified in the “high supportive care needs” class than in the “low supportive care needs” class. The corresponding adjusted ORs were as follows: OR = 5.927 (95%CI 1.752, 20.047) for married parents; OR = 7.768 (95%CI 2.092, 28.847) for parents with average monthly household income of 2000-5000CNY (\u003cspan\u003e$\u003c/span\u003e285–713); OR = 3.406 (95%CI 1.226, 9.460) for parents whose residency area was located in the same city as the hospital; and OR = 0.330 (95%CI 0.109–0.996) for parents spending daily caregiving time of 12-18h. Parents with low disease cognitive ability (with higher scale) (OR = 2.486, 95%CI 1.327, 4.657), high person-centered care skills (with lower scale) (OR = 0.253, 95%CI 0.100, 0.640), and low balancing caregiving needs and one’s own needs (with higher scale) (OR = 2.276, 95%CI 1.154, 4.490) were more likely to be classified in the “high supportive care needs” class than in the “low supportive care needs” class.\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\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\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\u003eSelected results of the binary logistic regression model (n = 221)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\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\u003e\u003cem\u003eβ\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eS.E.\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eWald\u003c/em\u003e\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\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eOR\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003e95%CI\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\u003eTreatment duration of the child\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 \u003cp\u003e7.584\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1–3 months\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.463\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.599\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.958\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.319\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.334–13.979\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4–8 months\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.415\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.766\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.293\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.588\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.514\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.337–6.794\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9 months or more\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\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\u003eMarital status of parents\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\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\u003e1.779\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.622\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.190\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.927\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.752–20.047\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnmarried (divorced, widowed, or separated)\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\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\u003eAverage monthly Household income\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 \u003cp\u003e9.397\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2000-5000CNY (\u003cspan\u003e$\u003c/span\u003e285–713)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.050\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.669\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.377\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.768\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.092–28.847\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5001-8000CNY (\u003cspan\u003e$\u003c/span\u003e713–1411)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.123\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.614\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.347\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.067\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.073\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.923–10.232\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOver 8000CNY (over \u003cspan\u003e$\u003c/span\u003e1411)\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\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\u003eHospital and the residency area located in the same city\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\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\u003e1.226\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.521\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.529\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.406\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.226–9.460\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\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\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\u003eDaily caregiving time\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 \u003cp\u003e4.137\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.126\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt; 12 h\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.091\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.483\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.851\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.913\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.354–2.354\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12-18h\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.109\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.564\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.868\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.049\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.330\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.109–0.996\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt; 18h\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\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\u003eDisease cognitive ability\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.911\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.320\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.082\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.486\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.327–4.657\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePerson-centered care skills\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.373\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.473\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.427\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.253\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.100–0.640\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBalancing caregiving Needs and one’s own needs\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.822\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.347\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.629\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.276\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.154–4.490\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstant\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-9.674\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.789\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.032\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e \u003cb\u003e4.1 The latent classes of Chinese parents with children diagnosed with leukemia on the basis of supportive care needs\u003c/b\u003e \u003c/p\u003e\u003cp\u003eTo the best of our knowledge, this is the first study that used the LCA to identify unobserved subgroups of Chinese parents whose children were diagnosed with leukemia in accordance with supportive care needs. Parents in this study were classified into 2 distinct priori unknown classes based on supportive care needs measured by SCNS-C-Ped-C: Class 1-“high supportive care needs” class; Class 2-“low supportive care needs” class. Totally, 67.9% (n = 150) of the parents were classified in the “high supportive care needs” class. The parents in Class 1 had a medium level of emotional needs and high levels of the other five domains. Class 2 accounted for 32.1% (n = 71) of the sample. The parents in Class 2 had medium levels of healthcare and informational needs and economic needs; low levels of daily care and communication needs, psychological and spiritual needs, and medical service needs; and no emotional needs. For parents in the “high supportive care needs” class, caring for children with leukemia was exceptionally challenging and in urgent need of support.\u003c/p\u003e\u003ch2\u003e4.2 Supportive care needs of parents in two latent classes\u003c/h2\u003e\u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, parents in both classes had higher levels of “healthcare and informational needs” and “economic needs”, as compared with other domains of supportive care needs. This result indicated that parents had higher levels of healthcare and informational needs and economic needs. Although leukemia is the most prevalent childhood cancer, the vast majority of parents lack both sufficient understanding of the disease and the knowledge regarding the treatment and care [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Furthermore, with the progression of the disease and the advancement of the treatment, parents developed new healthcare and informational needs. Therefore, it is essential to understand the development patterns of healthcare and informational needs among parents with different characteristics and to continuously provide them with the necessary knowledge related to healthcare.\u003c/p\u003e\u003cp\u003e The economic needs of parents in both groups were high. The expenses for the treatment of children with leukemia usually impose a heavy economic burden on patients’ families [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. The treatment for leukemia encompasses a variety of approaches such as chemotherapy, radiotherapy, and bone marrow transplantation [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. These treatments often span extended period, requiring close monitoring and adjustments based on the treatment progress [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. The treatment process may involve multiple hospitalizations, repeated medication treatments, and laboratory tests, all of which directly increase the medical expenses [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Additionally, there are indirect expenses such as transportation to and from the hospital, accommodation, and food expenses [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Moreover, the treatment process may affect the work and daily lives of the parents, requiring additional expenses to cope with these changes [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. The high medical costs impose substantial financial pressure on the families of children with leukemia, sometimes compelling them to borrow funds or seek social support [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Concurrently, some governments and non-profit organizations provide certain financial assistance and support to help families meet the financial challenges. However, this information is probably unavailable to the parents, or the parents have an unclear understanding of the conditions for fund application. For example, these parents may lack knowledge about the process and the required materials for application. Therefore, it is crucial to provide information regarding the financial assistance and support to the parents.\u003c/p\u003e\u003cp\u003e The mean score of emotional needs domain was the lowest in both classes, a finding indicating that parents had low level of emotional needs. The emotional needs domain in the SCNS-C-Ped-C had three items: problems with sex life, emotional support for self, and emotional support for loved ones [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. During the painful stage when children were diagnosed with leukemia or undergoing treatment, parents’ attention was mostly focused on their children, with less concern for their own and their partners’ emotional needs [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Moreover, influenced by traditional Chinese culture, parents adopt an implicit attitude towards their own emotions and feelings, resulting in limited perception and self-expression of their emotions, and seldom seek emotional support and assistance from others[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Additionally, their skills in providing emotional support to others were relatively inadequate. Furthermore, Chinese couples may seldom disclose issues or concerns regarding their sex life to outsiders, even when researchers assure confidentiality of the data before the investigation. Therefore, it is essential to encourage parents to honestly confront their own emotional needs and to work together with their partners to address and resolve the emotional issues.\u003c/p\u003e\u003ch2\u003e4.3 Association between socio-demographic and clinical characteristics and latent class membership\u003c/h2\u003e\u003ch2\u003e4.3.1 Children’s treatment duration\u003c/h2\u003e\u003cp\u003eParents with children having a shorter treatment duration had higher likelihood of being in the “high supportive care” class than in the “low supportive care” class. In this study, 161 (72.8%) children were at the early stage of treatment (1–3 months after the diagnosis). Parents of children newly diagnosed with leukemia were suffering from a tremendous blow and undergoing a painful process, leading to higher psychological and spiritual needs. Those parents needed to select or advocate for better medical services for their children, resulting in a higher level of medical service need. During the initial diagnosis and treatment of their children, parents needed to participate in many clinical decisions related to their children's treatment [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Due to their lack of understanding of the disease, they often found themselves in a state of confusion and needed more healthcare and informational support. Moreover, parents improved their caregiving ability through communication with doctors and caregiving practices [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Thus, those of children with shorter treatment duration had more daily care and communication needs. The treatment costs of leukemia are high, especially during the initial diagnosis and early treatment stages when timely medical expense reimbursement is unavailable [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Families of children with leukemia bear a heavy financial burden, resulting in high economic needs. During the early stages of diagnosis and treatment, parents often focused all their attention on their children [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Although they might experience emotional distress, they had little time to attend to their own emotional needs, resulting in the data of moderate emotional needs.\u003c/p\u003e\u003ch2\u003e4.3.2 Marital status\u003c/h2\u003e\u003cp\u003eMarried parents were unexpectedly more likely to be in the “high supportive care” class. Studies indicated that a married parent had more access to social support, particularly from the partner [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. In addition, married parents usually have their partners primarily responsible for earning money, which enables them to receive more financial support and consequently experience less financial burden [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Previous research findings indicated that the supportive care needs of married parents should be relatively lower than those of unmarried parents, and those findings are contrary to the findings of this study. In this study, there were 194 married parents (87.8%), 155 (79.9%) of which were taking care of children at the early stage of treatment (1–3 months after the diagnosis). The results of this study indicated that parents with children undergoing a shorter treatment duration had higher likelihood of being in the “high supportive care” class than in the “low supportive care” class. Therefore, sample bias may be the reason why married parents were more likely to be in the “high supportive care” class.\u003c/p\u003e\u003cp\u003e Conversely, throughout the journey of diagnosis and treatment for their children, parents need to make multiple clinical decisions. In the context of traditional Chinese culture, family members from both the paternal and maternal sides of married parents typically pay attention to the diagnosis and treatment of the child and, to some extent, participate in treatment decision making. The involvement of the Chinese-style extended family in clinical decisions added complexity, which may result in parents' need for various forms of support, such as informational, emotional, or psychological support.\u003c/p\u003e\u003ch2\u003e4.3.3 Average monthly household income\u003c/h2\u003e\u003cp\u003eLower income had a significant effect on the likelihood of being in the “high supportive care” class. The economic burden on parents of children with hematological malignancies is substantially heavier than that on parents of children with any other cancer [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Parents confronted with a high medical cost for their children’s disease treatment and caregiving expenses, and changes in employment status following a child's cancer diagnosis may reduce their financial stability [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Many parents could not work because of their children’s disease and lost a good portion of their family income. Further, despite their high total expenditure on treatment, most parents received no financial help from any sources, and some parents were even forced to sell some of their property to support their income [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Moreover, children with leukemia have a higher rate of unplanned hospitalizations or clinical visits [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. In order to reduce the inconvenience of commuting between home and the hospital, many families rent accommodation near the treatment hospital, which also increased their financial burden.\u003c/p\u003e\u003ch2\u003e4.3.4 Distance from hospital and residency area\u003c/h2\u003e\u003cp\u003eIn China, high-level clinical resources for the treatment of childhood leukemia are mainly concentrated in several tertiary pediatric hospitals [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. In this study, most families (161, 72.9%) with children diagnosed with leukemia need to commute across cities between their residency area and the treatment hospital. Compared with the families whose original residency area was in the same city as that of the hospital, parents living far from the hospital were more likely to be in the “low supportive care” class than in the “high supportive care” class. This result was unexpected because it was commonly believed that living far from the hospital would lead to increased commuting burden and reduced social support [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. However, with the advancement of information and communication networks in China, parents of children with leukemia can obtain some social support through the Internet [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Moreover, transportation in China has become more convenient. Therefore, the impact of distance on parents’ access to social support and on the burden of commuting has diminished.\u003c/p\u003e\u003cp\u003eFamilies who live far from the hospital typically have one or both parents consistently involved throughout the entire course of their child’s treatment. They gradually become familiar with the illness, treatment procedures, laboratory tests, and daily care. They also adapt to the life of accompanying their child for treatment in another city. Consequently, their daily care and communication needs, medical service needs, psychological and spiritual needs, and emotional needs are relatively lower. However, accompanying the child for treatment away from their home often requires the parents to temporarily suspend or resign from their original jobs, leading to their relatively high economic burden [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Additionally, as the child’s treatment progresses, parents need to acquire more new medical knowledge, thus resulting in relatively higher healthcare and informational needs.\u003c/p\u003e\u003cp\u003eMeanwhile, for parents whose residency area is in the same city as that of the treatment hospital, they generally have more co-caregivers. In this study, of the 60 parents whose residency area is in the same city as that of the treatment hospital, 28 (46.7%) parents had two or more co-caregivers. Additionally, 18 (30%) of these parents spent less than 12 hours on daily care for their sick children. These parents may be in a situation where they need to balance work and caregiving for their children with leukemia, leading to higher supportive care needs during this process.\u003c/p\u003e\u003cp\u003e Considering the bias of sample, out of the 161 parents living far from the treatment hospital, 118 (73.3%) parents were taking care of children at the early stage of treatment (1–3 months after the diagnosis). The sample bias may be the reason why parents whose original residency areas were in the same city as those of the hospital were more likely to be in the “high supportive care” class. Therefore, further study including more parents of children in different stages of treatment is urgently needed.\u003c/p\u003e\u003ch2\u003e4.3.5 Daily caregiving time\u003c/h2\u003e\u003cp\u003eCompared with the parents with daily caregiving time of more than 18h, parents with daily caregiving time of 12–18 hours were more likely to be classified in the “low supportive care needs” class than in the “high supportive care needs” class. Parents with daily caregiving time of more than 18 hours may have heavy caregiving burden, which would frequently lead to sleep deprivation and feeling of fatigue and exhaustion [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Moreover, parents with daily caregiving time of more than 18 hours often experienced a significant disruption in their previous lifestyle. They were unable to engage in work, social activities, or outings freely, as they had to accompany their children for treatment and manage their daily care needs throughout the day [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. The substantial caregiving burden placed upon them resulted in their supportive care need in different aspects. Since parents who provided daily caregiving for 12–18 hours were familiar with their child's treatment and daily caregiving, they had a high level of caregiving ability and could provide a higher standard of care for their children. As a result, they had some time for rest, which was beneficial for their physical and mental well-being, and thereby their need for supportive care was relatively low. In our study, more than half (54.3%) of the parents took care of their children for more than 18 hours every day. Therefore, healthcare providers should focus on those parents who spend almost the entire day accompanying their children in the hospital and actively provide them with supportive care.\u003c/p\u003e\u003ch2\u003e4.4 Association between parents’ caregiving ability and latent class membership\u003c/h2\u003e\u003ch2\u003e4.4.1 Disease cognitive ability\u003c/h2\u003e\u003cp\u003eParents with low disease cognitive ability were more likely to be classified in the “high supportive care needs” class than in the “low supportive care needs” class. Disease cognitive ability includes the assessment of the children’s condition, the observation of changes in the children’s condition, learning information on disease treatment and caring for the children, and contacting with the professional healthcare providers [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Parents with low disease cognitive ability had more difficulty in assessing and observing the changes of their children’s condition. They could not fully grasp the information and knowledge related to leukemia treatment, nor could they have a good understanding of many key points in caring for their children with leukemia. Therefore, they might fail to effectively implement high quality of caregiving, resulting in the failure to detect the changes of children’s disease in a timely manner or leading to more suffering or delayed diagnosis and treatment. Thereby, the parents with lower disease cognitive ability had more supportive care needs. Furthermore, communication between these parents and healthcare providers is often inefficient, as they were unable to accurately identify issues that arise during care; moreover, they found it difficult to grasp the caregiving guidance provided by healthcare providers all at once [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFor parents with low disease cognitive ability, information should be provided in a more accessible and understandable manner, such as graphic or video materials, so they can study repeatedly to improve their disease cognitive ability and thereby reduce their healthcare and informational needs and daily care and communication needs.\u003c/p\u003e\u003ch3\u003e4.4.2 Person-centered care skills\u003c/h3\u003e\u003cp\u003e Parents with high person-centered care skills were more likely to be classified in the “high supportive care needs” class than in the “low supportive care needs” class. These parents can better perceive the person-centered care needs of their children. Such perceived needs require more effort in caregiving from those parents, who typically have a certain level of understanding of their children's disease and care, are willing to actively learn and improve their caregiving abilities. They strive to meet their children's care needs to the best of their abilities. Generally, children receiving care from such parents also experience higher quality of care. However, providing meticulous and responsible care for their children with leukemia may to some extent result in higher physical strain for these parents and can even lead to caregiving burden and psychological pressure occasionally, thus resulting in higher supportive caregiving needs [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e Therefore, the parents with high person-centered care skills should be taken into account. After ensuring that the care needs of the children are met, we should guide parents to focus on their own needs, encourage them to relax appropriately, and fulfill their own supportive care needs, because maintaining a good physical and mental state is good for both themselves and for their children.\u003c/p\u003e\u003ch2\u003e4.4.3 Balancing caregiving needs and one’s own needs\u003c/h2\u003e\u003cp\u003e Parents with low balancing caregiving needs and one’s own needs ability were more likely to be classified in the “high supportive care needs” class than in the “low supportive care needs” class. When parents have difficulty in balancing caregiving needs and their own needs, they need more support to meet both the caregiving needs of the children and their own personal needs. Therefore, their level of supportive care needs tends to be high.\u003c/p\u003e\u003cp\u003eDuring the initial stages of leukemia treatment for the children, parents typically prioritize their efforts on caring for their children and strive to meet the children’s caregiving needs. They temporarily neglect their own needs, leading to the imbalance between the children's caregiving needs and the parents' personal own needs [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. Parents with a high ability to balance caregiving needs and their own needs tend to allocate time and energy reasonably. When caring for their children, they can also pay attention to their own needs and avoid prolonged neglect of their personal needs. Conversely, parents with a low ability to balance caregiving needs and their own needs primarily focus on caring for their children, leading to prolonged unmet personal needs for themselves. Consequently, they experience higher levels of supportive care needs. Moreover, the prolonged unmet supportive care needs may result in physiological and psychological discomfort for the parents, increasing their supportive care needs furthermore [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e Therefore, healthcare providers should not only fully understand the mindset of parents prioritizing their children’s needs over their own but also remind parents to take care of their own needs, utilize available social support when appropriate, and balance caring for the children and self-care. It is important to make parents aware that only by taking good care of their own needs and maintaining good physical and mental health can they take better care for their children.\u003c/p\u003e\u003ch2\u003e4.5 Clinical Implementation\u003c/h2\u003e\u003cp\u003eExploring the latent classes of supportive care needs of Chinese parents of children with leukemia as well as the characteristics of parents and their children in the latent classes could offer valuable insights for the healthcare professionals and enable the identification of parents who are more likely to have high supportive care needs. Consequently, early and precise supportive care interventions could be provided to the targeted parents, resulting in the improvement of the physical and mental health of the parents, along with the improvement of quality of care, disease prognosis, and quality of life of the children. Moreover, the results of this study also reminded us that parents in the “low supportive care needs” may not have low needs in all the aspects of supportive care. They are likely to have relatively high supportive care needs in health care and information and in economic aspect; therefore, targeted support is needed. Additionally, parents’ supportive care needs may gradually change over time along with their children’s treatment progress. Therefore, it is strongly encouraged to monitor and track the development of parents’ supportive care needs. This proactive approach will ensure that appropriate support could be consistently provided to meet the changing needs of parents throughout the course of their children’s treatment.\u003c/p\u003e\u003ch2\u003e4.6 Limitations\u003c/h2\u003e\u003cp\u003eThere are some limitations in the study. First, the data were collected exclusively from three major cities in China—Shanghai, Suzhou, and Chongqing—and solely from three prominent children’s hospitals, without information from community clinical settings. Second, 72.8% of the participants were parents caring for children at the early stage of treatment (1–3 months after the diagnosis), which may lead to bias in the study sample. Consequently, the findings may not fully represent the supportive care needs of all the parents. Moreover, the parents’ supportive care needs may change throughout their children’s disease treatment journey after the diagnosis. Given the cross-sectional design of the present study, speculating the trajectory of parents’ supportive care needs development was impossible. A longitudinal study would be necessary to explore the developmental patterns of parents’ supportive care needs in the future.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003e Two distinct latent classes of Chinese parents of children with leukemia were identified based on supportive care needs It was the first such study utilizing LCA in China. The class membership was significantly associated with children’s treatment duration, parents’ marital status, family income, distance to the hospital, daily caregiving time, and parents’ caregiving ability. Our findings provided valuable insights for healthcare providers to better understand the classes of supportive care needs among parents of children with leukemia, enabling healthcare providers to develop tailored and appropriate supportive care interventions and to deliver targeted supportive intervention to those parents in need.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eCompeting Interests\u003c/h2\u003e \u003cp\u003eThe authors have declared that there is no conflict of interest.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eEthics approval\u003c/h2\u003e \u003cp\u003eEthical review approval from the Naval Medical University (NO.HJEC-2018-YF-001) was obtained.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent to participate\u003c/strong\u003e \u003cp\u003e Informed consent was obtained from all participants included in the study.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent to publish\u003c/strong\u003e \u003cp\u003e The authors affirm that human research participants provided informed consent for publication of the tables.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis study was supported by the National Natural Science Foundation of China (Project No.72374204 and No.71904195).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors contributed to the study conception and design. Material preparation, and data collection were performed by Jingting Wang, Yingwen Wang, Huifang Wu, Qi Yang, Linyu Ma. Data analysis was performed by Zhuting Zheng, Xuanyi Bi, and Wen Zhang. The first draft of the manuscript was written by Jingting Wang and all authors commented on previous versions of the manuscript. Zhaohui Geng, and Changrong Yuan revised the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSsenyonga N, Stiller C, Nakata K, Shalkow J, Redmond S, Bulliard JL, Girardi F, Fowler C, Marcos-Gragera R, Bonaventure A, Saint-Jacques N, Minicozzi P, De P, Rodr\u0026iacute;guez-Barranco M, Lar\u0026oslash;nningen S, Di Carlo V, M\u0026auml;gi M, Valkov M, Sepp\u0026auml; K, Wyn Huws D, Coleman MP, Allemani C (2022) Worldwide trends in population-based survival for children, adolescents, and young adults diagnosed with leukaemia, by subtype, during 2000-14 (CONCORD-3): analysis of individual data from 258 cancer registries in 61 countries. Lancet Child Adolesc Health 6: 409\u0026ndash;431\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSteliarova-Foucher E, Colombet M, Ries LAG, Moreno F, Dolya A, Bray F, Hesseling P, Shin HY, Stiller CA (2017) International incidence of childhood cancer, 2001-10: a population-based registry study. Lancet Oncol 18: 719\u0026ndash;731\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZheng R, Peng X, Zeng H, Zhang S, Chen T, Wang H, Chen W (2015) Incidence, mortality and survival of childhood cancer in China during 2000\u0026ndash;2010 period: A population-based study. Cancer Lett 363: 176\u0026ndash;180\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCheung YT, Zhang H, Cai J, Au-Doung LWP, Yang LS, Yan C, Zhou F, Chen X, Guan X, Pui CH, Hudson MM, Li CK (2021) Identifying Priorities for Harmonizing Guidelines for the Long-Term Surveillance of Childhood Cancer Survivors in the Chinese Children Cancer Group (CCCG). JCO Glob Oncol 7: 261\u0026ndash;276\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang J, Shen N, Zhang X, Shen M, Xie A, Howell D, Yuan C (2017) Care burden and its predictive factors in parents of newly diagnosed children with acute lymphoblastic leukemia in academic hospitals in China. Support Care Cancer 25: 3703\u0026ndash;3713\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang J, Howell D, Shen N, Geng Z, Wu F, Shen M, Zhang X, Xie A, Wang L, Yuan C (2018) mHealth Supportive Care Intervention for Parents of Children With Acute Lymphoblastic Leukemia: Quasi-Experimental Pre- and Postdesign Study. JMIR Mhealth Uhealth 6: e195\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCho YR, Yoo YS (2020) Factors influencing supportive care needs of multiple myeloma patients treated with chemotherapy. Support Care Cancer 28: 1783\u0026ndash;1791\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLyu QY, Wong FKY, You LM, Zhou XZ (2019) Unmet Family Needs Concerning Healthcare Services in the Setting of Childhood Hospitalization for Cancer Treatment in Mainland China: A Qualitative Study. J Pediatr Nurs 44: e66-e71\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAziza YDA, Wang ST, Huang MC (2019) Unmet supportive care needs and psychological distress among parents of children with cancer in Indonesia. Psychooncology 28: 92\u0026ndash;98\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTsimicalis A, Stevens B, Ungar WJ, Castro A, Greenberg M, Barr R (2020) Shifting Priorities for the Survival of My Child: Managing Expenses, Increasing Debt, and Tapping Into Available Resources to Maintain the Financial Stability of the Family. Cancer Nurs 43: 147\u0026ndash;157\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHe L, Wu H, Li M, Deng X (2022) A qualitative meta-synthesis of the caregiving experiences of adult children providing care for cancer patients in China: Implications for multidisciplinary healthcare teams. Health Soc Care Community 30: e3829-e3842\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYamaji N, Nagamatsu Y, Kobayashi K, Hasegawa D, Yuza Y, Ota E (2022) Information needs of children with leukemia and their parents' perspectives of their information needs: a qualitative study. BMC Pediatr 22: 414\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang J, Bi X, Zhang S, Wang Y, Wu H, Yang Q, Ma L, Yuan C (2023) Psychometric evaluation of the Chinese version of the supportive care needs survey for caregivers of children with Paediatric cancer (SCNS-C-Ped-C). Nurs Open 10: 4196\u0026ndash;4204\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDong B, Zhang J, Wang F, Xie C, Qi Y, Lin L, Tian L (2023) Supportive care needs of patients with colorectal cancer undergoing anticancer therapy: A latent class analysis. Asia Pac J Oncol Nurs 10: 100216\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTein JY, Coxe S, Cham H (2013) Statistical Power to Detect the Correct Number of Classes in Latent Profile Analysis. Struct Equ Modeling 20: 640\u0026ndash;657\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMiranda VPN, Dos Santos Amorim PR, Bastos RR, Souza VGB, de Faria ER, do Carmo Castro Franceschini S, Priore SE (2019) Evaluation of lifestyle of female adolescents through latent class analysis approach. BMC Public Health 19: 184\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFitch MI (2008) Supportive care framework. Can Oncol Nurs J 18: 6\u0026ndash;24\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKerr LM, Harrison MB, Medves J, Tranmer J (2004) Supportive care needs of parents of children with cancer: transition from diagnosis to treatment. Oncol Nurs Forum 31: E116-126\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang J, Bi X, Wang J, Gu Y, Zheng X, Wang Y, Wu H, Yang Q, Ma L, Liu F, Yuan C (2022) Chinese parents' caregiving ability for children with haematological malignancies: A latent class analysis. Nurs Open 9: 2073\u0026ndash;2083\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu HF, Bi XY, Li J, Wang JT (2020) Analysis on care ability and its influencing factors for parents of children with leukemia. Mil Nurs 37: 18\u0026ndash;22\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShen T, Zhao YQ (2018) Diagnostic and therapeutic criteria of hematologic diseases, 4th Edition. Science Press, Beijing\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQian SJ (2016) The adaptation of hematologic malignancies family caregiver skills scale. Dissertation, Soochow University\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang CK, Hu ZF, Liu Y (2001) Evidences for reliability and validity of the Chinese version of general selfefficacy scale. Chin J Appl Psychol: 37\u0026ndash;40\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShen XH, Jiang QJ (2000) Report on application of Chinese version of MCMQ in 701 patients. Chin J Behav Med Brain Sci: 22\u0026ndash;24\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuang L, Jiang QJ, Ren WH (1996) Coping style, social support,psychosomatic symptoms in patients with cancer. Chin Ment Health J 10: 160\u0026ndash;161\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang J, Wang X (2020) Structural Equation Modeling: Applications Using Mplus, 2nd Edition. John Wiley, New York\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClark SL (2010) Mixture Modeling with Behavioral Data. Dissertation, University of California\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWollney EN, Bylund CL, Kastrinos AL, Campbell-Salome G, Sae-Hau M, Weiss ES, Fisher CL (2023) Understanding parents uncertainty sources and management strategies while caring for a child diagnosed with a hematologic cancer. PEC Innov 3: 100198\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYucel E, Zhang S, Panjabi S (2021) Health-Related and Economic Burden Among Family Caregivers of Patients with Acute Myeloid Leukemia or Hematological Malignancies. Adv Ther 38: 5002\u0026ndash;5024\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoard PDQPTE (2002) Childhood Acute Lymphoblastic Leukemia Treatment (PDQ\u0026reg;): Health Professional VersionPDQ Cancer Information Summaries. National Cancer Institute (US), Bethesda (MD)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAldiss S, Hollis R, Phillips B, Ball-Gamble A, Brownsdon A, Chisholm J, Crowther S, Dommett R, Gower J, Hall NJ, Hartley H, Hatton J, Henry L, Langton L, Maddock K, Malik S, McEvoy K, Morgan JE, Morris H, Parke S, Picton S, Reed-Berendt R, Saunders D, Stewart A, Tarplee-Morris W, Walsh A, Watkins A, Weller D, Gibson F (2023) Research priorities for children's cancer: a James Lind Alliance Priority Setting Partnership in the UK. BMJ Open 13: e077387\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRahman SA, Variyath S, Al-Yateem N, Al Marzouqi A, Subu MA (2023) Economic and Social Burden of Childhood Cancer in Bangladesh. Asian Pac J Cancer Prev 24: 69\u0026ndash;74\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLimburg H, Shaw AK, McBride ML (2008) Impact of childhood cancer on parental employment and sources of income: a Canadian pilot study. Pediatr Blood Cancer 51: 93\u0026ndash;98\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChodidjah S, Kongvattananon P, Liaw JJ (2022) \"Changed our lives\": Psychosocial issues experienced by families of early adolescents with leukemia. Eur J Oncol Nurs 56: 102077\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAo MQ, Xia L, Wang XQ, Fang S, Yang BX, Liu Q, Chen J, Zhou SC, Li XY, Sun T, Lu B, Bao A, Luo D, Ruan J (2023) Help-Seeking Intentions for Depression from Mental Health Professionals Among Community-Dwelling Persons in Central China. Adm Policy Ment Health 50: 901\u0026ndash;911\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLau S, Lu X, Balsamo L, Devidas M, Winick N, Hunger SP, Carroll W, Stork L, Maloney K, Kadan-Lottick N (2014) Family life events in the first year of acute lymphoblastic leukemia therapy: a children's oncology group report. Pediatr Blood Cancer 61: 2277\u0026ndash;2284\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuang Y, Chen M, Zhang Y, Chen X, Zhang L, Dong C (2023) Finding family resilience in adversity: A grounded theory of families with children diagnosed with leukaemia. J Clin Nurs 32: 5160\u0026ndash;5172\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArab M, Bernstein C, Haghshenas A, Ranjbar H (2020) Factors associated with caregiver burden for mothers of children undergoing Acute Lymphocytic Leukemia (ALL) treatment. Palliat Support Care 18: 405\u0026ndash;412\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePatistea E, Makrodimitri P, Panteli V (2000) Greek parents' reactions, difficulties and resources in childhood leukaemia at the time of diagnosis. Eur J Cancer Care (Engl) 9: 86\u0026ndash;96\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePagano E, Baldi I, Mosso ML, di Montezemolo LC, Fagioli F, Pastore G, Merletti F (2014) The economic burden of caregiving on families of children and adolescents with cancer: a population-based assessment. Pediatr Blood Cancer 61: 1088\u0026ndash;1093\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMa Y, Dai Q (2019) Real experiences of parents of children with leukemia during the illness: a qualitative study. J Nurses Train 34: 2174\u0026ndash;2177\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWei YQ, Yang X, Wang RR, Yang T, Liu YS, Zhang CM, Liu YH (2021) The real experiences and needs of caregivers of acute leukemia children: a meta-synthesis of qualitative studies. J Nurses Train 36: 1441\u0026ndash;1447\u0026thinsp;+\u0026thinsp;1452\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHoenk K, Torno L, Feaster W, Taraman S, Chang A, Weiss M, Pugh K, Anderson B, Ehwerhemuepha L (2021) Multicenter study of risk factors of unplanned 30-day readmissions in pediatric oncology. Cancer Rep (Hoboken) 4: e1343\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIida M, Liu K, Huang XJ, Huang H, Kuwatsuka Y, Moon JH, Lee JW, Lakshmi KM, Dodds A, Wilcox L, Ko BS, Hamidieh AA, Behfar M, Ho KW, Bunworasate U, Ho A, Farzana T, Sim J, Dung PC, Akter M, Ratnayake W, Bravo MR, Gyi AA, Santosa D, Poudyal BS, Batshkh K, Srivastava A, Okamoto S, Atsuta Y (2023) Report on hematopoietic cell transplantations performed in 2018/2019 focusing on the trends of selection of stem cell sources in the Asia-Pacific region: APBMT Activity Survey. Blood Cell Ther 6: 114\u0026ndash;123\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGhatak N, Trehan A, Bansal D (2016) Financial burden of therapy in families with a child with acute lymphoblastic leukemia: report from north India. Support Care Cancer 24: 103\u0026ndash;108\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang J, Yao N, Shen M, Zhang X, Wang Y, Liu Y, Geng Z, Yuan C (2016) Supporting Caregivers of Children With Acute Lymphoblastic Leukemia via a Smartphone App: A Pilot Study of Usability and Effectiveness. Comput Inform Nurs 34: 520\u0026ndash;527\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang YY, Wang JT, Yu SY, Zhou F, Yuan CR (2016) Parents\u0026rsquo; needs of early diagnosed children with acute lymphoblastic leukemia: a qualitative study. Mil Nurs 33: 6\u0026ndash;10\u003c/span\u003e\u003c/li\u003e \u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"children with leukemia, parents, supportive care needs, latent class analysis","lastPublishedDoi":"10.21203/rs.3.rs-4568591/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4568591/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eParents’ supportive care needs directly affect their quality of life and the quality of care for their children diagnosed with leukemia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives:\u003c/strong\u003e To identify supportive care needs of Chinese parents in the unobserved subgroups who care for children with leukemia and to examine the associations of the latent class membership with individual characteristics.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: A multicenter cross-sectional survey study was conducted. A total of 221 parents who had children with leukemia were surveyed in China with the Chinese version of the Supportive Care Needs Survey for Caregivers of Children with Pediatric Cancer (SCNS-C-Ped-C). Latent class analysis (LCA) was applied to identify latent classes of parents according to supportive care needs. Binary logistic regression model was used to identify the association between individual characteristics and the latent class membership.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: LCA results suggested a 2-class solution: Class 1-“high supportive care needs” class (n=150, 67.9%), and Class 2-“low supportive care needs” class (n=71, 32.1%). Parents with children at early stage of treatment, being married, with lower household income, locating in the same city with the treatment hospital, having lower disease cognitive ability and higher person-centered care skills, and with lower balancing caregiving needs and one’s own needs were more likely to be in the “high supportive care” class.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: There existed two distinct classes of parents caring for children with leukemia on the basis of supportive care needs. The class membership was significantly associated with children’s treatment duration, parents’ marital status, family income, distance to the hospital, daily caregiving time, and parents’ caregiving ability.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImplications for Practice: \u003c/strong\u003eThese findings may be helpful in the development of personalized supportive care interventions for parents of children with leukemia.\u003c/p\u003e","manuscriptTitle":"Supportive Care Needs of Parents Caring for Children with Leukemia: a latent class analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-26 13:38:04","doi":"10.21203/rs.3.rs-4568591/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-10-01T12:24:44+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-23T18:35:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"96359713337874207652302528233792303948","date":"2024-09-03T15:48:20+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-13T15:41:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"51884980001441681728977260745256956169","date":"2024-07-30T16:53:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"152666334291247168513116581447897939158","date":"2024-07-28T23:25:44+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-07-24T02:54:48+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-07-23T20:09:27+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-14T07:29:55+00:00","index":"","fulltext":""},{"type":"submitted","content":"Supportive Care in Cancer","date":"2024-06-12T08:14:43+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"8b0f7393-26ff-43d8-9158-2cfeee640e9a","owner":[],"postedDate":"August 26th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-12-09T16:01:31+00:00","versionOfRecord":{"articleIdentity":"rs-4568591","link":"https://doi.org/10.1007/s00520-024-09020-1","journal":{"identity":"supportive-care-in-cancer","isVorOnly":false,"title":"Supportive Care in Cancer"},"publishedOn":"2024-12-08 15:57:25","publishedOnDateReadable":"December 8th, 2024"},"versionCreatedAt":"2024-08-26 13:38:04","video":"","vorDoi":"10.1007/s00520-024-09020-1","vorDoiUrl":"https://doi.org/10.1007/s00520-024-09020-1","workflowStages":[]},"version":"v1","identity":"rs-4568591","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4568591","identity":"rs-4568591","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}