Hardiness in Family Caregivers During Caring From Pearsons With Breast Cancer: A cross-sectional study

Hardiness in Family Caregivers During Caring From Pearsons With Breast Cancer: A cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Hardiness in Family Caregivers During Caring From Pearsons With Breast Cancer: A cross-sectional study Xin Sun, Lili Xu, Zixia Kuang, Liping Liu, Zhangjie Shi, Jigang Sun, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2353014/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Aim Currently, there is a shortage of literature on Family hardiness among breast cancer caregivers. More specifically, the relationship between preparedness for caregiving and intimate relationship experiences has not been explored. This study was designed to describe the experiences of family Caregivers' hardiness and analysis the influences by evaluating the relationships between Family hardiness,intimate relationship experiences, and preparedness for caregiving. Methods From March to July, 2022, we surveyed 140 caregivers of breast cancer patients who were admitted in two IIIA-grade hospitals in Hunan Province, and reviewed their medical records. The Family Hardiness Index, Caregiver Preparedness Scale, and Experiences in Close Relationships Inventory were used, and chi-square and multiple logistic regression analyses were performed. Results The mean Family Hardiness Index score of caregivers was 58.11 (SD = 5.67). Multiple linear regression analysis indicated that family hardiness is affected by educational background, occupation, and knowledge of the patient’s disease. This study found that preparedness for caregiving was able to positively predict family hardiness(β = 0.265, P < 0.001), whereas intimate relationship experiences negatively predicted family hardiness (β = −0.078, P < 0.001). Conclusion Breast cancer patients’ primary caregivers had moderate levels of family hardiness, suggesting that nurses should focus on the disease itself, while also evaluating the level of family hardiness of the main caregivers. Through disease knowledge guidance and psychological counseling, caregivers can improve their readiness, reduce attachment anxiety and attachment avoidance, provide patients with a good family environment, and promote their recovery from disease. breast cancer family hardiness intimate relationship experiences preparedness for caregiving 1. Introduction Breast cancer is a malignant tumor with a high global incidence that seriously threatens women’s lives and health. For example, according to the 2018 China Cancer Center report, the number of breast cancer cases and deaths in the country accounted for 11.2% and 9.2%, respectively, of the worldwide total, with an increasing year-on-year trend [ 1 ]. With the rapid development of technologies for diagnosis and treatment, the five-year relative survival rate of breast cancer patients has reached about 73%. However, postoperative patients still face a series of problems that necessitate a long-term rehabilitation process: body image change, sexual dysfunction, social role change, cancer recurrence and metastasis, and anxiety and fear [ 2 ]. Family caregivers, also known as informal caregivers, can include a spouse or partner, as well as children, friends, relatives, and neighbors [ 3 ]. When patients with severe disease advance toward death, the goal of treatment is no longer cure [ 4 ]. Thus, caregivers and patients must face the complexities of life-threatening diseases—and even the death of the patient—and caregivers often report that they are not fully prepared for their role in these circumstances [ 5 ]. Thus, poor adaptation to the role of caregiver, lack of sufficient psychological preparation and confidence, as well as anxiety, depression, tension, and other negative emotions, can all cause impaired physical and mental health of family caregivers. In addition, they can lead to inadequate care measures, which might accelerate the deterioration of the patient’s condition, and damage the quality of life of patient and caregivers alike. Primarily, family caregivers take responsibility for patient care during breast cancer recovery, and they therefore have a crucial role to play. However, studies have shown that the family caregivers of cancer patients experience multiple psychological, physical, and social stresses in the process of caring for the patient [ 6 ]. According to the theory of family hardiness put forward by McCubbin [ 7 ], if the family can fully exercise its characteristics in the face of pressure or crisis, and make good use of its protective qualities, then it can successfully and smoothly navigate through the crisis and reach a better level of adaptation. Family hardiness refers to the ability of the family to maintain a balanced and stable state throughout its overall efforts in the face of pressure or crisis. Domestic researchers have summarized various internal and external factors that promote hardiness of the families of cancer patients, but most of them are qualitatively oriented, so it is difficult to identify which factors can lead to specific and effective protective outcomes. Preparedness for caregiving was proposed by the American scholar Archbold[ 8 ]. It refers to the caregiver’s perceived readiness for the multifaceted tasks and requirements of their caregiving role, which include the provision of physical care and emotional support, and coping with care-associated stress. Previous research [ 8 ] has shown that caregiver readiness does not depend on the duration or intensity of care. Nevertheless, it has become an important outcome indicator in caregiver research, and has emerged as an international research hotspot. The purpose of this study was to explore the effects of family members on breast cancer patients of various familial factors, such as family hardiness, intimate relationship experiences; preparedness for caregiving.Thus, the main factors in determining family hardiness were investigated, in order to guide family interventions for patients with breast cancer. 2. Methods 2.1. Study design and subjects From March to July 2022, breast cancer patients receiving surgery in two IIIA-grade hospitals in Hunan Province were selected by convenience sampling. Primary family caregivers of at least 18 years of age, and who were willing to participate in the study, were also included via a self-reported questionnaire.For respondents who were illiterate or unable to read the questionnaire, a researcher read the questions out loud and recorded the responses. Participants who were unable to communicate or respond to questionnaires due to physical or mental illness (e.g.delirium or dementia) were excluded. All study subjects signed the informed consent form and submitted it to the ethics committee for approval. 2.2. Study procedure and variables Various sociodemographic data were recorded, including gender, marital status, relationship with the patient, understanding of the patient’s disease, course of the disease, and closeness with the patient, among others. The Family Hardiness Index 20 [ 10 ] consists of 20 items assessing caregiver perception, regarding: (1) how collaborative the family members are in the face of hardship, with questions such as, “we get stronger when we encounter big problems” (eight items, commitment); (2) the family’s tendency to deal with stressful situations, with questions including, “my family is boring because we repeat the same activities” (to be coded reversely, six items, challenge); and (3) the sense of control the family perceives collectively, with questions such as, “most of the inconveniences are due to misfortune” (six items, control). Respondents provided their ratings using a four-point scale, from 0 (“not at all”) to 3 (“very much so”). A higher score implies a hardier family environment. Cronbach’s alpha was 0.8232 for the original scale, and 0.85 for the current study [ 11 ]. The Caregiver Preparedness Scale 15 (CPS) is an instrument for evaluating the preparedness of caregivers who assist patients with chronic conditions [ 12 ]. It contains eight items and uses a five-point Likert scale for responses ranging from 0 (“not at all prepared”) to 4 (“very well prepared”). Thus, the components of the CPS investigate the extent to which a caregiver feels prepared to take care of both the physical and emotional needs of a patient, with a higher score meaning higher preparedness. The validity and reliability of the CPS have been demonstrated for caregivers of patients with heart failure, showing suitable goodness-of-fit indices in confirmatory factor analysis (e.g., comparative fit index, 0.97; root mean square error of approximation, 0.065) and supportive reliability (Cronbach’s alpha = 0.91) [ 13 ]. The Experiences in Close Relationships Inventory contained 36 entries in total[ 14 ].These included attachment anxiety (fear of being rejected; free and abandoned) and attachment avoidance (dislike dependence on others; do not like to be close to others). Each item was graded from 1 (strongly disagree) to 7 (strongly disagree). In this study, the overall Cronbach’s alpha was 0.78, and for the two dimensions, the values of the same coefficient were 0.88 and 0.81, respectively. 2.3. Statistical analyses All data were analyzed using the SPSS 22.0 software. General data are expressed in terms of frequency and percentage. The scores for family hardiness, intimate relationship experiences, and caregiver readiness are presented as mean values with standard deviations. To compare family hardiness scores among breast cancer patients with different characteristics, t-test or ANOVA analyses were used. To evaluate family hardiness associations with intimacy and caregiver readiness, Pearson correlation analysis was performed. Finally, multiple linear regression analysis was applied to investigate the factors influencing family hardiness. All tests were two-tailed, and P < 0.05 was taken as the significance threshold. 3. Results 3.1. General characteristics of the study subjects As shown in Table 1 , 79 (56.4%) of the study subjects were male. Twenty-five people (17.9%) were without a partner. Eighty-nine people (63.5%) were educated to at least high school level, and 17 persons (12.1%) were unemployed,et al. 3.2. Status scores for each variable of the study subjects The results for status scores are presented in Table 2 . For the study subjects, the mean family hardiness score was 58.11 (SD = 5.67); the mean attachment avoidance score was 55.49(SD = 14.5); the mean attachment anxiety score was 66.18 (SD = 16.4); and the mean caregiver readiness score was 22.31 (SD = 5.69). 3.3. Correlation of family hardiness, intimate relationship experiences, and preparedness for caregiving As can be seen in Table 3 , family hardiness was negatively correlated with attachment anxiety (r = − 0.461). A negative correlation was also found with attachment avoidance (r = − 0.318), although a positive correlation was observed with caregiver readiness (r = 0.369).In all three cases, P < 0.05. 3.4. Multiple linear regression analysis of the subjects’ family hardiness The results of this analysis are displayed in Table 4 . The following variables were included in the regression model, and explained 33.4% of the variance of the overall sample: caregiver literacy, caregiver occupation, caregiver knowledge of patient disease, caregiver attachment anxiety, attachment avoidance score, and caregiver readiness score. 4. Discussion In this study, we explored the current landscape of family hardiness for breast cancer patients and investigated its influencing factors. The results revealed moderate family hardiness, with the main contributing factors being caregiver literacy, caregiver occupation, caregiver knowledge of patient disease. Family hardiness was positively predicted by caregiver readiness, but negatively predicted by intimate relationship experiences. First,family hardiness is a characteristic and an attribute of a family. It describes how family members use their internal resources to adapt to a stressful environment and survive a crisis, protecting the family unit [ 15 ]. In this research, we used the Family Hardiness Index 20, which is a reliable and valid method [ 16 , 17 ] for evaluating the internal advantages of family members. The adaptability assessment items in this survey included responsibility, control, and challenge aspects. As such, family hardiness can evaluate the ability of the main caregivers of breast cancer patients to assume responsibility (responsibility assumption), respond to challenges (actively meet challenges), and take control of the situation (control of negative events), in the face of such stressful circumstances. In this study, the family hardiness score of breast cancer patient caregivers was 58.11 (SD = 5.67), which is consistent with the findings of Wang [ 18 ]. As expressed by crisis theory, negative life events can hinder fulfillment of the basic needs of family members, and can change family hardiness. If the family cannot face the harm brought by a negative event, it will appear imbalanced or disharmonious, resulting in family crisis or even collapse. When a family member is suffering from cancer, the whole family is impacted in various ways, leading to varying degrees of family crisis and seriously affecting the harmony of the whole family. This explains why the family hardiness score of cancer patients in this study was low, suggesting that nursing staff should pay attention to family hardiness when communicating with breast cancer patients and their families. This will enable each family to return to balance and harmony as soon as possible. The main caregiver’s degree represents the level of education, which to a certain extent reflects the cultural environment of the whole family, and thus reflects the family’s ability to cope when faced with crisis events. A higher level of education indicates more mature and adaptable caregivers compared with lower education, independent access to disease-related knowledge, and more effective communication with the patient [ 19 ]. From their own point of view, highly educated caregivers can take responsibility and actively respond to negative events, so as to maintain a stable family state, control the development of the situation, and thereby improve the hardiness of the family. From the perspective of family members, highly educated caregivers can better maintain the stability of the family environment, deal with family conflicts and contradictions in a timely manner, and pay attention to the circumstances of patients’ lives. Therefore, when faced with crisis events, highly educated caregivers can better utilize their internal family resources to adapt to and deal with the stressful situation. The extent to which caregivers know about the patient’s illness determines the level of stress on the family members, which laterally affects family hardiness. Due to the particularities of the disease, breast cancer patients may have a heavy psychological burden and emotional excitement, often accompanied by negative psychological experience [ 20 ]. Patients’ families with a greater understanding of the disease will have sufficient psychological preparation and a high degree of coordination with treatment, resulting in relatively less psychological pressure on both the patient and the main caregiver. However, families who lack understanding of the patient’s disease state will tend to overestimate or underestimate their condition, which has a certain impact on treatment effectiveness. At the same time, primary caregivers need to actively cooperate with adjuvant treatments, which places higher demands on them in terms of their hardiness and cognitive ability relating to the disease. This influences the psychological state and domestic environment of family members. Thus, the lower the level of caregivers’ knowledge of the patient’s disease, the lower the family hardiness will be. In addition, care readiness (preparedness for caregiving) refers to the state of readiness to provide the necessary care to the patient, and is the evaluation indicator [ 21 ] used to predict the strain of the caregiving role. As the main support for and helper of the patient’s physical and mental needs, the caregiver’s own health may also be negatively affected after a long period of care. Furthermore, the physical and mental health of the caregiver will directly impact the effectiveness of the patient’s rehabilitation. We used the Caregiver Preparedness Scale, another methodology that has been proven reliable and valid, to assess the caregiver readiness of individuals supporting breast cancer patients. This scale has been validated for caregivers, and it is commonly used when researching this population. We also used the Experiences in Close Relationships Inventory, another validated approach [ 22 ], to assess the status of family intimacy [ 23 ]. This is currently the most commonly used scale when assessing adult attachment, and it is also the most widely employed scale in research relating to caregiver attachment. When it is applied to family caregivers of cancer patients, some researchers consider that since cancer patients face life-threatening situations—and their caregivers genuinely worry about losing each other—this scale does not accurately reflect the caregiver’s attachment. However, the Cronbach’s alpha coefficients for the attachment anxiety and attachment avoidance subscales in the revised questionnaire were 0.88 and 0.86, respectively. For the families of breast cancer patients, the main caregiver is the creator and maintainer of the family environment, and their psychological status is directly affected by caregiver readiness, as well as the level of intimate relationship experiences. If the primary caregivers suffer psychological problems themselves, they will be unable to maintain the original family environment, leading to uncoordinated family relations and tension in the family environment, thereby affecting the patient’s physical and mental progress [ 24 ]. Existing literature [ 25 ] shows that family stress felt by the main caregivers of breast cancer patients comes mostly from the family economic situation and the stress generated by the caring role. In the face of sudden crisis situations, family members with high levels of caregiver preparedness and intimacy have stronger coping skills, and can therefore have a positive impact on family hardiness. This study found that caregiver readiness positively predicted family hardiness, whereas intimate relationship experiences negatively predicted it. Caregiver readiness measures caregivers’ level of preparedness for their upcoming responsibilities. The strength of the main caregivers’ abilities will have obvious impacts on treatment compliance and effectiveness. If the main caregiver is not prepared to deal with problems and emergencies in the process of taking care of the patient, it may lead them to experience inner anxiety and other emotions that will affect the tenacity of the family. Individuals with attachment anxiety are extremely sensitive in the face of setbacks or threats. They tend to overactivate their own emotional regulation strategies and their desire for excessive attention and support [ 26 ], but patients may ignore the psychological state of their caregivers due to their illness. This follows the findings of previous studies [ 27 ], and suggests that health care workers should strengthen their assessment of the attachment types of cancer patients’ caregivers, and guide them in adopting positive self-emotional regulation strategies. Meanwhile, targeted health education is also needed to promote caregiver readiness and improve the level of family hardiness among cancer caregivers. In summary, in clinical nursing work, it is possible to provide the main caregivers of breast cancer patients with corresponding disease knowledge guidance and psychological counseling. This will improve the level of family hardiness, facilitate a good home environment, and promote disease rehabilitation of the patient. However, the sample size in this study is relatively limited, and sample collection should therefore be expanded in the future to test the reliability of the present results. Table 1 General characteristics of the study subjects (N = 140). Variable N (%) Family hardiness score ( ̄x ± SD) T/F P Sex −1.900 0.060 Male 79 (56.4) 57.32 ± 5.44 Female 60 (42.9) 59.15 ± 5.88 Marital status 2.305 0.023 With partner 115 (82.1) 57.60 ± 5.52 Without partner 25 (17.9) 60.44 ± 5.85 Education level 5.062 0.002 Primary school and below 7 (5.0) 53.43 ± 1.90 Junior high school or junior college 44 (31.4) 56.57 ± 5.40 High school or junior college 45 (32.1) 58.31 ± 5.45 Bachelor’s degree or above 44 (31.4) 60.18 ± 5.78 Profession 3.894 0.003 Unemployed 17 (12.1) 58.59 ± 4.68 Peasant 32 (22.9) 56.31 ± 6.16 Factory hand 9 (6.4) 55.33 ± 7.21 Office worker 47 (33.6) 60.55 ± 5.52 Individuality 27 (19.3) 57.67 ± 4.05 Self-employed 8 (5.7) 54.50 ± 4.31 Domicile 1.961 0.052 Town 76 (54.3) 58.96 ± 5.59 Village 64 (45.7) 57.09 ± 5.63 Per capita monthly family income (RMB) 4.013 0.004 10,000 18 (12.9) 61.67 ± 6.88 Relationship to patient 5.599 0.005 Offspring 57 (40.7) 59.32 ± 5.41 Spouse 64 (45.7) 56.44 ± 5.10 Other blood relative 19 (13.6) 60.11 ± 6.88 Self-perceived physical condition 3.805 0.025 worse 6 (4.3) 57.00 ± 7.77 fair 71 (50.7) 56.93 ± 5.07 good 63 (45.0) 59.54 ± 5.86 Caregiving experience 0.715 0.017 Yes 59 (42.1) 59.44 ± 5.79 No 81 (57.9) 57.14 ± 5.41 Others who need to care for 1.066 0.288 Yes 56 (40.0) 57.48 ± 6.16 No 84 (60.0) 58.52 ± 5.32 Knowledge of the patient’s disease 6.539 0.002 Incomprehension 20 (14.3) 54.35 ± 4.88 A little 94 (67.1) 58.36 ± 5.31 Very familiar 26 (18.6) 60.08 ± 6.34 Course of disease (months) 0.051 0.985 ≤ 6 101 (72.1) 58.18 ± 5.35 7–12 23 (16.4) 57.92 ± 6.13 13–24 7 (5.0) 57.43 ± 8.18 ≥ 24 9 (6.4) 58.33 ± 6.82 Caring time per day (hours) 0.150 0.861 4–8 61 (43.6) 58.21 ± 5.12 8–12 39 (27.9) 57.69 ± 6.16 ≥ 12 40 (28.6) 58.35 ± 6.09 Number of caregiving days per month 3.017 0.052 7–14 64 (45.7) 59.28 ± 5.89 15–30 18 (12.9) 58.17 ± 5.23 30 58 (41.4) 56.79 ± 5.35 Number of families to help care for 0.681 0.565 0 51 (36.4) 57.65 ± 5.23 1 47 (33.6) 57.79 ± 6.18 2 32 (22.9) 58.69 ± 5.74 ≥ 3 10 (7.1) 60.10 ± 5.30 Intimacy with the patient 4.890 0.009 Commonly 8 (5.7) 52.75 ± 4.95 More intimate 37 (26.4) 57.41 ± 6.53 Very close 95 (67.9) 58.83 ± 5.12 Medical expenses payment method 2.277 0.106 At own expense 31 (22.1) 56.29 ± 6.00 Hospitalization insurance 54 (38.6) 58.96 ± 5.28 Cooperative medical care 55 (39.3) 58.29 ± 5.72 Table 2 Family hardiness, and family adaptability, hardiness, and preparedness scores, for caregivers of breast cancer patients (N = 140). Variable Theoretical range of score Range of actual score Score ( ̄x ± SD) Family tenacity 20–80 44–76 58.11 ± 5.67 Responsibility 9–36 14–36 27.06 ± 3.46 Control 6–24 10–23 16.71 ± 2.54 Challenge 5–20 11–19 14.34 ± 1.48 Intimate relationship experiences 36–252 49–184 121.7 ± 25.01 Attachment avoidance 18–126 19–100 55.49 ± 14.50 Attachment anxiety 18–126 29–110 66.18 ± 16.40 Caregiver readiness 0–32 0–32 22.31 ± 5.69 Table 3 Correlation analysis (Pearson r) of family hardiness and parental stress among caregivers of patients with breast cancer. Variable Family hardiness Responsibility Control Challenge Total Intimate relationship experiences Attachment avoidance −0.400** −0.247** −0.406** −0.461** Attachment anxiety −0.092 −0.432** −0.261** −0.318** Total −0.292** −0.428** −0.407** −0.476** Caregiver readiness 0.368** 0.106 0.369** 0.369** ** (e.g., P < 0.01). Table 4 Multiple regression analysis of family hardiness of breast cancer patients’ caregivers. a Variable b Sb b’ t P (Constant) 57.399 3.763 – 15.254 0.000 Total score of the intimate relationship experiences scale −0.078 0.017 −0.345 −4.535 0.000 Total caregiver readiness score 0.265 0.072 0.266 3.689 0.000 Educational background 1.221 0.484 0.196 2.524 0.013 Occupation −0.630 0.288 −0.164 −2.188 0.030 Knowledge of the patient’s disease 1.445 0.714 0.146 2.023 0.045 a R 2 = 0.334, F = 14.968. Declarations Ethics approval Approval for the study was obtained from the Ethics Committee of Changsha Medical University. All the participants consented for participation in this study. Funding This work was supported by the Academics Working Station, Changsha Medical University, Changsha,410219,P.R.China. Data sharing statement All relevant data that support the findings of this study are available on request from Miss.Lili XU( [email protected] ). Author statement Xin Sun,Lili Xu,Donghua Wang designed research;Zixia Kuang,Liping Liu,Zhangjie Shi, Jigang Sun collected the data;Xin Sun analyzed the data and drafted the manuscript; Lili Xu,Zixia Kuang revised the manuscript.Donghua Wang had primary responsibility for final content. All authors read and approved the final manuscript. Declaration of Competing Interest The authors declare that they have no conflict of interest. Acknowledgements The authors thank the participants for their supports during the study. References Zeng H,Zheng R,Guo Y,et al.Cancer survival in China,2003-2005:a population-based study[J].International Journal of Cancer,2015,136(8):1921-1930. LU ZQ,TANG LC.Status and prospect of rehabilitation therapy for breast cancer patients[J].Shanghai Nursin,2017,17(6):5-9. Rafiei H,Vanaki Z,Mohammadi E,et al.The Role of Family Caregivers in Pressure Injury Prevention Guidelines:A Scoping Review[J].Home Healthc Now.2021,39(5):253-260. 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Saimaldaher ZH,Wazqar DY.Relationships between caregiving stress,mental health and physical health in family caregivers of adult patients with cancer:implications for nursing practice[J]. Scand J Caring Sci.2020,34(4):889-898. Hart J,Shaver PR,Goldenberg JL.Attachment,self-esteem,worldviews, and terror management: evidence for a tripartite security system[J].J Pers Soc Psychol.2005,88(6):999-1013. Rodin G,Walsh A,Zimmermann C,et a1.The contribution of attachment security and social support to depressive symptoms in patients with metastatic cancer[J].Psychooncology.2007,16(12):1080-1091． Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies 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-2353014","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":158435135,"identity":"37eabaab-bdb3-4968-978c-5d0d8fa0129d","order_by":0,"name":"Xin Sun","email":"","orcid":"","institution":"Changsha medical university","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xin","middleName":"","lastName":"Sun","suffix":""},{"id":158435140,"identity":"c4e7163e-bc45-48c7-b968-2ae5215f354e","order_by":1,"name":"Lili Xu","email":"","orcid":"","institution":"Changsha medical university","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Lili","middleName":"","lastName":"Xu","suffix":""},{"id":158435141,"identity":"1db2e6b3-6a72-424d-b951-2f4c8f746ce7","order_by":2,"name":"Zixia Kuang","email":"","orcid":"","institution":"Changsha medical university","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Zixia","middleName":"","lastName":"Kuang","suffix":""},{"id":158435145,"identity":"ba4c4c94-c839-4c97-88c9-1f5322b00470","order_by":3,"name":"Liping Liu","email":"","orcid":"","institution":"Changsha medical university","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Liping","middleName":"","lastName":"Liu","suffix":""},{"id":158435150,"identity":"f4f75b14-3465-4159-8cd0-f4b64075dff3","order_by":4,"name":"Zhangjie Shi","email":"","orcid":"","institution":"Changsha medical university","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Zhangjie","middleName":"","lastName":"Shi","suffix":""},{"id":158435154,"identity":"c98bd971-3011-436e-bee8-bba44149fbd6","order_by":5,"name":"Jigang Sun","email":"","orcid":"","institution":"Changsha medical university","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jigang","middleName":"","lastName":"Sun","suffix":""},{"id":158435158,"identity":"373e909e-1230-489b-95ed-20f0b4af3fb5","order_by":6,"name":"Donghua Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzUlEQVRIiWNgGAWjYLAC3gYQyXzgwIcfpGlhSzw4s4c0LTzGhznYiFBtcPzs4Rdvd9jZ687I+XCYgYdBnl/sAAEtZ/LSLOeeSU7cdiN3w+ECCwbDmbMT8GsxO5BjZszbdiDBDKRlBg9DgsFtQlrOvwFrsTe7kfPgMA8bMVpu5Bg/Bmph3HYjh4E4LfY33pgxzm0D+uXMMwNgIEsQ9otkf47xh7dtdvZmx5Mff/jww0aeX5qAFiBgk0DiSOBUhgyYPxClbBSMglEwCkYuAAC4M0wR/i6CnwAAAABJRU5ErkJggg==","orcid":"","institution":"Changsha medical university","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Donghua","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2022-12-07 08:44:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2353014/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2353014/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":32817090,"identity":"dcb90bab-438e-40c9-ad5b-ee171b6b409a","added_by":"auto","created_at":"2023-02-13 01:29:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":473976,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2353014/v1/52b3676b-067b-4981-a7a5-76ddff720a43.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Hardiness in Family Caregivers During Caring From Pearsons With Breast Cancer: A cross-sectional study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eBreast cancer is a malignant tumor with a high global incidence that seriously threatens women\u0026rsquo;s lives and health. For example, according to the 2018 China Cancer Center report, the number of breast cancer cases and deaths in the country accounted for 11.2% and 9.2%, respectively, of the worldwide total, with an increasing year-on-year trend [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. With the rapid development of technologies for diagnosis and treatment, the five-year relative survival rate of breast cancer patients has reached about 73%. However, postoperative patients still face a series of problems that necessitate a long-term rehabilitation process: body image change, sexual dysfunction, social role change, cancer recurrence and metastasis, and anxiety and fear [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFamily caregivers, also known as informal caregivers, can include a spouse or partner, as well as children, friends, relatives, and neighbors [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. When patients with severe disease advance toward death, the goal of treatment is no longer cure [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Thus, caregivers and patients must face the complexities of life-threatening diseases\u0026mdash;and even the death of the patient\u0026mdash;and caregivers often report that they are not fully prepared for their role in these circumstances [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Thus, poor adaptation to the role of caregiver, lack of sufficient psychological preparation and confidence, as well as anxiety, depression, tension, and other negative emotions, can all cause impaired physical and mental health of family caregivers. In addition, they can lead to inadequate care measures, which might accelerate the deterioration of the patient\u0026rsquo;s condition, and damage the quality of life of patient and caregivers alike.\u003c/p\u003e \u003cp\u003ePrimarily, family caregivers take responsibility for patient care during breast cancer recovery, and they therefore have a crucial role to play. However, studies have shown that the family caregivers of cancer patients experience multiple psychological, physical, and social stresses in the process of caring for the patient [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAccording to the theory of family hardiness put forward by McCubbin [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], if the family can fully exercise its characteristics in the face of pressure or crisis, and make good use of its protective qualities, then it can successfully and smoothly navigate through the crisis and reach a better level of adaptation. Family hardiness refers to the ability of the family to maintain a balanced and stable state throughout its overall efforts in the face of pressure or crisis. Domestic researchers have summarized various internal and external factors that promote hardiness of the families of cancer patients, but most of them are qualitatively oriented, so it is difficult to identify which factors can lead to specific and effective protective outcomes.\u003c/p\u003e \u003cp\u003ePreparedness for caregiving was proposed by the American scholar Archbold[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. It refers to the caregiver\u0026rsquo;s perceived readiness for the multifaceted tasks and requirements of their caregiving role, which include the provision of physical care and emotional support, and coping with care-associated stress. Previous research [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] has shown that caregiver readiness does not depend on the duration or intensity of care. Nevertheless, it has become an important outcome indicator in caregiver research, and has emerged as an international research hotspot.\u003c/p\u003e \u003cp\u003eThe purpose of this study was to explore the effects of family members on breast cancer patients of various familial factors, such as family hardiness, intimate relationship experiences; preparedness for caregiving.Thus, the main factors in determining family hardiness were investigated, in order to guide family interventions for patients with breast cancer.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Study design and subjects\u003c/h2\u003e \u003cp\u003eFrom March to July 2022, breast cancer patients receiving surgery in two IIIA-grade hospitals in Hunan Province were selected by convenience sampling. Primary family caregivers of at least 18 years of age, and who were willing to participate in the study, were also included via a self-reported questionnaire.For respondents who were illiterate or unable to read the questionnaire, a researcher read the questions out loud and recorded the responses. Participants who were unable to communicate or respond to questionnaires due to physical or mental illness (e.g.delirium or dementia) were excluded. All study subjects signed the informed consent form and submitted it to the ethics committee for approval.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Study procedure and variables\u003c/h2\u003e \u003cp\u003eVarious sociodemographic data were recorded, including gender, marital status, relationship with the patient, understanding of the patient\u0026rsquo;s disease, course of the disease, and closeness with the patient, among others.\u003c/p\u003e \u003cp\u003eThe Family Hardiness Index 20 [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] consists of 20 items assessing caregiver perception, regarding: (1) how collaborative the family members are in the face of hardship, with questions such as, \u0026ldquo;we get stronger when we encounter big problems\u0026rdquo; (eight items, commitment); (2) the family\u0026rsquo;s tendency to deal with stressful situations, with questions including, \u0026ldquo;my family is boring because we repeat the same activities\u0026rdquo; (to be coded reversely, six items, challenge); and (3) the sense of control the family perceives collectively, with questions such as, \u0026ldquo;most of the inconveniences are due to misfortune\u0026rdquo; (six items, control). Respondents provided their ratings using a four-point scale, from 0 (\u0026ldquo;not at all\u0026rdquo;) to 3 (\u0026ldquo;very much so\u0026rdquo;). A higher score implies a hardier family environment. Cronbach\u0026rsquo;s alpha was 0.8232 for the original scale, and 0.85 for the current study [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe Caregiver Preparedness Scale 15 (CPS) is an instrument for evaluating the preparedness of caregivers who assist patients with chronic conditions [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. It contains eight items and uses a five-point Likert scale for responses ranging from 0 (\u0026ldquo;not at all prepared\u0026rdquo;) to 4 (\u0026ldquo;very well prepared\u0026rdquo;). Thus, the components of the CPS investigate the extent to which a caregiver feels prepared to take care of both the physical and emotional needs of a patient, with a higher score meaning higher preparedness. The validity and reliability of the CPS have been demonstrated for caregivers of patients with heart failure, showing suitable goodness-of-fit indices in confirmatory factor analysis (e.g., comparative fit index, 0.97; root mean square error of approximation, 0.065) and supportive reliability (Cronbach\u0026rsquo;s alpha\u0026thinsp;=\u0026thinsp;0.91) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe Experiences in Close Relationships Inventory contained 36 entries in total[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].These included attachment anxiety (fear of being rejected; free and abandoned) and attachment avoidance (dislike dependence on others; do not like to be close to others). Each item was graded from 1 (strongly disagree) to 7 (strongly disagree). In this study, the overall Cronbach\u0026rsquo;s alpha was 0.78, and for the two dimensions, the values of the same coefficient were 0.88 and 0.81, respectively.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Statistical analyses\u003c/h2\u003e \u003cp\u003eAll data were analyzed using the SPSS 22.0 software. General data are expressed in terms of frequency and percentage. The scores for family hardiness, intimate relationship experiences, and caregiver readiness are presented as mean values with standard deviations. To compare family hardiness scores among breast cancer patients with different characteristics, t-test or ANOVA analyses were used. To evaluate family hardiness associations with intimacy and caregiver readiness, Pearson correlation analysis was performed. Finally, multiple linear regression analysis was applied to investigate the factors influencing family hardiness. All tests were two-tailed, and \u003cem\u003eP\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.05 was taken as the significance threshold.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e3.1. General characteristics of the study subjects\u003c/h2\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, 79 (56.4%) of the study subjects were male. Twenty-five people (17.9%) were without a partner. Eighty-nine people (63.5%) were educated to at least high school level, and 17 persons (12.1%) were unemployed,et al.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.2. Status scores for each variable of the study subjects\u003c/h2\u003e \u003cp\u003eThe results for status scores are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. For the study subjects, the mean family hardiness score was 58.11 (SD\u0026thinsp;=\u0026thinsp;5.67); the mean attachment avoidance score was 55.49(SD\u0026thinsp;=\u0026thinsp;14.5); the mean attachment anxiety score was 66.18 (SD\u0026thinsp;=\u0026thinsp;16.4); and the mean caregiver readiness score was 22.31 (SD\u0026thinsp;=\u0026thinsp;5.69).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.3. Correlation of family hardiness, intimate relationship experiences, and preparedness for caregiving\u003c/h2\u003e \u003cp\u003eAs can be seen in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, family hardiness was negatively correlated with attachment anxiety (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.461). A negative correlation was also found with attachment avoidance (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.318), although a positive correlation was observed with caregiver readiness (r\u0026thinsp;=\u0026thinsp;0.369).In all three cases, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.4. Multiple linear regression analysis of the subjects\u0026rsquo; family hardiness\u003c/h2\u003e \u003cp\u003eThe results of this analysis are displayed in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. The following variables were included in the regression model, and explained 33.4% of the variance of the overall sample: caregiver literacy, caregiver occupation, caregiver knowledge of patient disease, caregiver attachment anxiety, attachment avoidance score, and caregiver readiness score.\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eIn this study, we explored the current landscape of family hardiness for breast cancer patients and investigated its influencing factors. The results revealed moderate family hardiness, with the main contributing factors being caregiver literacy, caregiver occupation, caregiver knowledge of patient disease. Family hardiness was positively predicted by caregiver readiness, but negatively predicted by intimate relationship experiences.\u003c/p\u003e \u003cp\u003eFirst,family hardiness is a characteristic and an attribute of a family. It describes how family members use their internal resources to adapt to a stressful environment and survive a crisis, protecting the family unit [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In this research, we used the Family Hardiness Index 20, which is a reliable and valid method [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] for evaluating the internal advantages of family members. The adaptability assessment items in this survey included responsibility, control, and challenge aspects. As such, family hardiness can evaluate the ability of the main caregivers of breast cancer patients to assume responsibility (responsibility assumption), respond to challenges (actively meet challenges), and take control of the situation (control of negative events), in the face of such stressful circumstances.\u003c/p\u003e \u003cp\u003eIn this study, the family hardiness score of breast cancer patient caregivers was 58.11 (SD\u0026thinsp;=\u0026thinsp;5.67), which is consistent with the findings of Wang [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. As expressed by crisis theory, negative life events can hinder fulfillment of the basic needs of family members, and can change family hardiness. If the family cannot face the harm brought by a negative event, it will appear imbalanced or disharmonious, resulting in family crisis or even collapse. When a family member is suffering from cancer, the whole family is impacted in various ways, leading to varying degrees of family crisis and seriously affecting the harmony of the whole family. This explains why the family hardiness score of cancer patients in this study was low, suggesting that nursing staff should pay attention to family hardiness when communicating with breast cancer patients and their families. This will enable each family to return to balance and harmony as soon as possible.\u003c/p\u003e \u003cp\u003eThe main caregiver\u0026rsquo;s degree represents the level of education, which to a certain extent reflects the cultural environment of the whole family, and thus reflects the family\u0026rsquo;s ability to cope when faced with crisis events. A higher level of education indicates more mature and adaptable caregivers compared with lower education, independent access to disease-related knowledge, and more effective communication with the patient [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. From their own point of view, highly educated caregivers can take responsibility and actively respond to negative events, so as to maintain a stable family state, control the development of the situation, and thereby improve the hardiness of the family. From the perspective of family members, highly educated caregivers can better maintain the stability of the family environment, deal with family conflicts and contradictions in a timely manner, and pay attention to the circumstances of patients\u0026rsquo; lives. Therefore, when faced with crisis events, highly educated caregivers can better utilize their internal family resources to adapt to and deal with the stressful situation.\u003c/p\u003e \u003cp\u003eThe extent to which caregivers know about the patient\u0026rsquo;s illness determines the level of stress on the family members, which laterally affects family hardiness. Due to the particularities of the disease, breast cancer patients may have a heavy psychological burden and emotional excitement, often accompanied by negative psychological experience [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Patients\u0026rsquo; families with a greater understanding of the disease will have sufficient psychological preparation and a high degree of coordination with treatment, resulting in relatively less psychological pressure on both the patient and the main caregiver. However, families who lack understanding of the patient\u0026rsquo;s disease state will tend to overestimate or underestimate their condition, which has a certain impact on treatment effectiveness. At the same time, primary caregivers need to actively cooperate with adjuvant treatments, which places higher demands on them in terms of their hardiness and cognitive ability relating to the disease. This influences the psychological state and domestic environment of family members. Thus, the lower the level of caregivers\u0026rsquo; knowledge of the patient\u0026rsquo;s disease, the lower the family hardiness will be.\u003c/p\u003e \u003cp\u003eIn addition, care readiness (preparedness for caregiving) refers to the state of readiness to provide the necessary care to the patient, and is the evaluation indicator [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] used to predict the strain of the caregiving role. As the main support for and helper of the patient\u0026rsquo;s physical and mental needs, the caregiver\u0026rsquo;s own health may also be negatively affected after a long period of care. Furthermore, the physical and mental health of the caregiver will directly impact the effectiveness of the patient\u0026rsquo;s rehabilitation. We used the Caregiver Preparedness Scale, another methodology that has been proven reliable and valid, to assess the caregiver readiness of individuals supporting breast cancer patients. This scale has been validated for caregivers, and it is commonly used when researching this population.\u003c/p\u003e \u003cp\u003eWe also used the Experiences in Close Relationships Inventory, another validated approach [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], to assess the status of family intimacy [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. This is currently the most commonly used scale when assessing adult attachment, and it is also the most widely employed scale in research relating to caregiver attachment. When it is applied to family caregivers of cancer patients, some researchers consider that since cancer patients face life-threatening situations\u0026mdash;and their caregivers genuinely worry about losing each other\u0026mdash;this scale does not accurately reflect the caregiver\u0026rsquo;s attachment. However, the Cronbach\u0026rsquo;s alpha coefficients for the attachment anxiety and attachment avoidance subscales in the revised questionnaire were 0.88 and 0.86, respectively.\u003c/p\u003e \u003cp\u003eFor the families of breast cancer patients, the main caregiver is the creator and maintainer of the family environment, and their psychological status is directly affected by caregiver readiness, as well as the level of intimate relationship experiences. If the primary caregivers suffer psychological problems themselves, they will be unable to maintain the original family environment, leading to uncoordinated family relations and tension in the family environment, thereby affecting the patient\u0026rsquo;s physical and mental progress [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Existing literature [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] shows that family stress felt by the main caregivers of breast cancer patients comes mostly from the family economic situation and the stress generated by the caring role. In the face of sudden crisis situations, family members with high levels of caregiver preparedness and intimacy have stronger coping skills, and can therefore have a positive impact on family hardiness.\u003c/p\u003e \u003cp\u003eThis study found that caregiver readiness positively predicted family hardiness, whereas intimate relationship experiences negatively predicted it. Caregiver readiness measures caregivers\u0026rsquo; level of preparedness for their upcoming responsibilities. The strength of the main caregivers\u0026rsquo; abilities will have obvious impacts on treatment compliance and effectiveness. If the main caregiver is not prepared to deal with problems and emergencies in the process of taking care of the patient, it may lead them to experience inner anxiety and other emotions that will affect the tenacity of the family. Individuals with attachment anxiety are extremely sensitive in the face of setbacks or threats. They tend to overactivate their own emotional regulation strategies and their desire for excessive attention and support [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], but patients may ignore the psychological state of their caregivers due to their illness. This follows the findings of previous studies [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], and suggests that health care workers should strengthen their assessment of the attachment types of cancer patients\u0026rsquo; caregivers, and guide them in adopting positive self-emotional regulation strategies. Meanwhile, targeted health education is also needed to promote caregiver readiness and improve the level of family hardiness among cancer caregivers.\u003c/p\u003e \u003cp\u003eIn summary, in clinical nursing work, it is possible to provide the main caregivers of breast cancer patients with corresponding disease knowledge guidance and psychological counseling. This will improve the level of family hardiness, facilitate a good home environment, and promote disease rehabilitation of the patient. However, the sample size in this study is relatively limited, and sample collection should therefore be expanded in the future to test the reliability of the present results.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGeneral characteristics of the study subjects (N\u0026thinsp;=\u0026thinsp;140).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFamily hardiness score (\u003cem\u003ēx\u003c/em\u003e\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eT/F\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 \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\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=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;1.900\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.060\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e79 (56.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e57.32\u0026thinsp;\u0026plusmn;\u0026thinsp;5.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e60 (42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e59.15\u0026thinsp;\u0026plusmn;\u0026thinsp;5.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.305\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWith partner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e115 (82.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e57.60\u0026thinsp;\u0026plusmn;\u0026thinsp;5.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWithout partner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25 (17.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e60.44\u0026thinsp;\u0026plusmn;\u0026thinsp;5.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.062\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary school and below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7 (5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e53.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJunior high school or junior college\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44 (31.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e56.57\u0026thinsp;\u0026plusmn;\u0026thinsp;5.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh school or junior college\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45 (32.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e58.31\u0026thinsp;\u0026plusmn;\u0026thinsp;5.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBachelor\u0026rsquo;s degree or above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44 (31.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e60.18\u0026thinsp;\u0026plusmn;\u0026thinsp;5.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProfession\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=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.894\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17 (12.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e58.59\u0026thinsp;\u0026plusmn;\u0026thinsp;4.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeasant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32 (22.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e56.31\u0026thinsp;\u0026plusmn;\u0026thinsp;6.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactory hand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 (6.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e55.33\u0026thinsp;\u0026plusmn;\u0026thinsp;7.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOffice worker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e47 (33.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e60.55\u0026thinsp;\u0026plusmn;\u0026thinsp;5.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndividuality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27 (19.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e57.67\u0026thinsp;\u0026plusmn;\u0026thinsp;4.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8 (5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e54.50\u0026thinsp;\u0026plusmn;\u0026thinsp;4.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDomicile\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=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.961\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.052\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e76 (54.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e58.96\u0026thinsp;\u0026plusmn;\u0026thinsp;5.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVillage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e64 (45.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e57.09\u0026thinsp;\u0026plusmn;\u0026thinsp;5.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePer capita monthly family income (RMB)\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=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14 (10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e56.14\u0026thinsp;\u0026plusmn;\u0026thinsp;4.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1,000\u0026ndash;2,999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24 (17.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e56.17\u0026thinsp;\u0026plusmn;\u0026thinsp;5.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3,000\u0026ndash;4,999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52 (37.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e57.37\u0026thinsp;\u0026plusmn;\u0026thinsp;5.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5,000\u0026ndash;10,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32 (22.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e59.63\u0026thinsp;\u0026plusmn;\u0026thinsp;4.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;10,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18 (12.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e61.67\u0026thinsp;\u0026plusmn;\u0026thinsp;6.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRelationship to patient\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=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.599\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOffspring\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e57 (40.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e59.32\u0026thinsp;\u0026plusmn;\u0026thinsp;5.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpouse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e64 (45.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e56.44\u0026thinsp;\u0026plusmn;\u0026thinsp;5.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther blood relative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19 (13.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e60.11\u0026thinsp;\u0026plusmn;\u0026thinsp;6.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSelf-perceived physical condition\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=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.805\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eworse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e57.00\u0026thinsp;\u0026plusmn;\u0026thinsp;7.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003efair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e71 (50.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e56.93\u0026thinsp;\u0026plusmn;\u0026thinsp;5.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003egood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e63 (45.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e59.54\u0026thinsp;\u0026plusmn;\u0026thinsp;5.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCaregiving experience\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=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.715\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59 (42.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e59.44\u0026thinsp;\u0026plusmn;\u0026thinsp;5.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e81 (57.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e57.14\u0026thinsp;\u0026plusmn;\u0026thinsp;5.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOthers who need to care for\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=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.288\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e56 (40.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e57.48\u0026thinsp;\u0026plusmn;\u0026thinsp;6.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e84 (60.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e58.52\u0026thinsp;\u0026plusmn;\u0026thinsp;5.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eKnowledge of the patient\u0026rsquo;s disease\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=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.539\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncomprehension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20 (14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e54.35\u0026thinsp;\u0026plusmn;\u0026thinsp;4.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA little\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e94 (67.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e58.36\u0026thinsp;\u0026plusmn;\u0026thinsp;5.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery familiar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26 (18.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e60.08\u0026thinsp;\u0026plusmn;\u0026thinsp;6.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCourse of disease (months)\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=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.051\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.985\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e101 (72.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e58.18\u0026thinsp;\u0026plusmn;\u0026thinsp;5.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u0026ndash;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23 (16.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e57.92\u0026thinsp;\u0026plusmn;\u0026thinsp;6.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7 (5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e57.43\u0026thinsp;\u0026plusmn;\u0026thinsp;8.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 (6.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e58.33\u0026thinsp;\u0026plusmn;\u0026thinsp;6.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCaring time per day (hours)\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=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.861\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u0026ndash;8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e61 (43.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e58.21\u0026thinsp;\u0026plusmn;\u0026thinsp;5.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u0026ndash;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e39 (27.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e57.69\u0026thinsp;\u0026plusmn;\u0026thinsp;6.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40 (28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e58.35\u0026thinsp;\u0026plusmn;\u0026thinsp;6.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of caregiving days per month\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=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.052\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u0026ndash;14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e64 (45.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e59.28\u0026thinsp;\u0026plusmn;\u0026thinsp;5.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18 (12.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e58.17\u0026thinsp;\u0026plusmn;\u0026thinsp;5.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e58 (41.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e56.79\u0026thinsp;\u0026plusmn;\u0026thinsp;5.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of families to help care for\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=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.681\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.565\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51 (36.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e57.65\u0026thinsp;\u0026plusmn;\u0026thinsp;5.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e47 (33.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e57.79\u0026thinsp;\u0026plusmn;\u0026thinsp;6.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32 (22.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e58.69\u0026thinsp;\u0026plusmn;\u0026thinsp;5.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e60.10\u0026thinsp;\u0026plusmn;\u0026thinsp;5.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIntimacy with the patient\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=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.890\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommonly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8 (5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e52.75\u0026thinsp;\u0026plusmn;\u0026thinsp;4.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore intimate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37 (26.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e57.41\u0026thinsp;\u0026plusmn;\u0026thinsp;6.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery close\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e95 (67.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e58.83\u0026thinsp;\u0026plusmn;\u0026thinsp;5.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMedical expenses payment method\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=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.277\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.106\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAt own expense\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31 (22.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e56.29\u0026thinsp;\u0026plusmn;\u0026thinsp;6.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospitalization insurance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e54 (38.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e58.96\u0026thinsp;\u0026plusmn;\u0026thinsp;5.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCooperative medical care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e55 (39.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e58.29\u0026thinsp;\u0026plusmn;\u0026thinsp;5.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFamily hardiness, and family adaptability, hardiness, and preparedness scores, for caregivers of breast cancer patients (N\u0026thinsp;=\u0026thinsp;140).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\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=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTheoretical range of score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRange of actual score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eScore (\u003cem\u003ēx\u003c/em\u003e\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily tenacity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u0026ndash;80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44\u0026ndash;76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e58.11\u0026thinsp;\u0026plusmn;\u0026thinsp;5.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResponsibility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u0026ndash;36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u0026ndash;36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e27.06\u0026thinsp;\u0026plusmn;\u0026thinsp;3.46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u0026ndash;23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e16.71\u0026thinsp;\u0026plusmn;\u0026thinsp;2.54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChallenge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u0026ndash;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e14.34\u0026thinsp;\u0026plusmn;\u0026thinsp;1.48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntimate relationship experiences\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36\u0026ndash;252\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49\u0026ndash;184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e121.7\u0026thinsp;\u0026plusmn;\u0026thinsp;25.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAttachment avoidance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026ndash;126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u0026ndash;100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e55.49\u0026thinsp;\u0026plusmn;\u0026thinsp;14.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAttachment anxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026ndash;126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29\u0026ndash;110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e66.18\u0026thinsp;\u0026plusmn;\u0026thinsp;16.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCaregiver readiness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u0026ndash;32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u0026ndash;32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e22.31\u0026thinsp;\u0026plusmn;\u0026thinsp;5.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation analysis (Pearson r) of family hardiness and parental stress among caregivers of patients with breast cancer.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eFamily hardiness\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResponsibility\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChallenge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntimate relationship experiences\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 \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAttachment avoidance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;0.400**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;0.247**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.406**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;0.461**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAttachment anxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;0.092\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;0.432**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.261**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;0.318**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;0.292**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;0.428**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.407**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;0.476**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCaregiver readiness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.368**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.369**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.369**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e** (e.g., \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultiple regression analysis of family hardiness of breast cancer patients\u0026rsquo; caregivers.\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" 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=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eb\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eSb\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eb\u0026rsquo;\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(Constant)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e57.399\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.763\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ndash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e15.254\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal score of the intimate relationship experiences scale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;0.078\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.345\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;4.535\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal caregiver readiness score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.265\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.072\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.266\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.689\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducational background\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.221\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.484\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.524\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccupation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;0.630\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.288\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.164\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;2.188\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.030\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge of the patient\u0026rsquo;s disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.445\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.714\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.045\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csup\u003ea\u003c/sup\u003eR\u003csup\u003e2\u003c/sup\u003e = 0.334, F\u0026thinsp;=\u0026thinsp;14.968.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eApproval for the study was obtained from the Ethics Committee of Changsha Medical University. All the participants consented for participation in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Academics Working Station, Changsha Medical University, Changsha,410219,P.R.China.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData sharing statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll relevant data that support the findings of this study are available on request from Miss.Lili XU([email protected]).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXin Sun,Lili Xu,Donghua Wang designed research;Zixia Kuang,Liping Liu,Zhangjie Shi, Jigang Sun collected the data;Xin Sun analyzed the data and drafted the manuscript; Lili Xu,Zixia Kuang revised the manuscript.Donghua Wang had primary responsibility for final content. All authors read and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of Competing Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank the participants for their supports during the study.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eZeng H,Zheng R,Guo Y,et al.Cancer survival in China,2003-2005:a population-based study[J].International Journal of Cancer,2015,136(8):1921-1930.\u003c/li\u003e\n\u003cli\u003eLU ZQ,TANG LC.Status and prospect of rehabilitation therapy for breast cancer patients[J].Shanghai Nursin,2017,17(6):5-9.\u003c/li\u003e\n\u003cli\u003eRafiei H,Vanaki Z,Mohammadi E,et al.The Role of Family Caregivers in Pressure Injury Prevention Guidelines:A Scoping Review[J].Home Healthc Now.2021,39(5):253-260.\u003c/li\u003e\n\u003cli\u003eZimmermann C,Swami N,Krzyzanowska M,et al.Perceptions of palliative care among patients with advanced cancer and their caregivers[J].CMAJ.2016,188(10):E217-E227.\u003c/li\u003e\n\u003cli\u003eJohansen S,Cvancarova M,Ruland C.The Effect of Cancer Patients\u0026apos; and Their Family Caregivers\u0026apos; Physical and Emotional Symptoms on Caregiver Burden[J].Cancer Nurs.2018,41(2):91-99.\u003c/li\u003e\n\u003cli\u003eJing LW,Liu H,Liu Y,et al.Advance in sexual dysfunction for patients with breast cancer(review)[J].Chinese Journal of Rehabilitation Theory and Practice,2020,26(4),458-462.\u003c/li\u003e\n\u003cli\u003eMcCubbin HI,McCubhin MA.Typologies of resilient families:Emerging roles of social class and ethnicity[J]Fam Relat,1988,37(3):247\u0026mdash;254.\u003c/li\u003e\n\u003cli\u003eArchbold PG Stewart BJ,Greenlick M R,et al .Mutuality and preparedness a predictors of caregiver role strain[J].Res Nurs H ealth ,1990 13(6):375-384.\u003c/li\u003e\n\u003cli\u003eLi Y,Wang K,Yin Y,et al.Relationships between family resilience,breast cancer survivors\u0026apos; individual resilience,and caregiver burden:A cross-sectional study[J].Int J Nurs Stud.2018 88:79-84.\u003c/li\u003e\n\u003cli\u003eMcCubbin M,McCubbin H,Thompson A.Family Hardiness Index (FHI).In:McCubbin HI, Thompson,AI,eds.Family Assessment Inventories for Research and Practice.2nd ed.Madison: University of Wisconsin System; 1986:124\u0026ndash;130\u003c/li\u003e\n\u003cli\u003eMcCubbin HI, Thompson EA, Thompson AI,et al.The sense of coherence:an historical and future perspective[J]. Isr J Med Sci.1996,32(3-4):170\u0026ndash;178.\u003c/li\u003e\n\u003cli\u003eArchbold PG,Stewart BJ,Greenlick MR, et al.Mutuality and preparedness as predictors of caregiver role strain[J].Res Nurs Health.1990,13(6):375\u0026ndash;384.\u003c/li\u003e\n\u003cli\u003ePetruzzo A,Paturzo M,Buck HG,et al.Psychometric evaluation of the Caregiver Preparedness Scale in caregivers of adultswith heart failure[J].Res Nurs Health.2017,40(5):470\u0026ndash;478.\u003c/li\u003e\n\u003cli\u003eLi Tonggui, Jiateng HS. Measurement of adult attachment:Intimate Relationship Experience Scale (ECR), Chinese edition [J].Psychological Journal,2006,38 (3):399- -406.\u003c/li\u003e\n\u003cli\u003eXu Yuying, Liu Guihua, Li Guokai, et al. Study on family resilience and influencing factors of caregivers of children with autism spectrum disorder[J].Journal of Nursing,2017,32 (7): 65-68.\u003c/li\u003e\n\u003cli\u003eOlson DH (1986) Circumplex model VIII:validation studies and FACES III.Fam Process 25(3):337\u0026ndash;351.\u003c/li\u003e\n\u003cli\u003eYoun BB,Lee HR,Kwak KW, Oh MK, Lim JH, Lee KR (1990) A study on reliability and validity of FACES III. J Korean Acad Fam Med 11(10):8\u0026ndash;17.\u003c/li\u003e\n\u003cli\u003eWang Wenhui,Jiang Zhe,Yang Zhi,et al.Research on family adaptability and family resilience and social support in cancer patients [J].Journal of Nursing Management,2016,16(4):232-234.\u003c/li\u003e\n\u003cli\u003eJacobsen PB,Breitbart W.Psychosocial Aspects of Palliative Care[J].Cancer Control.1996 3(3):214-222. \u003c/li\u003e\n\u003cli\u003eChen YP,Chen YH.Investigation on the psychological condition of children and their parents with tic disorders[J].Chin J Women Child Heal,2014,5(6):11-14. \u003c/li\u003e\n\u003cli\u003eHenrikson A ,Arestedt K.Exploring factors and care-giver outcomes associated with feelings of preparedness for caregiving in family caregivers in palliative care:A correlational, cross-sectional study [J]. Palliat M ed,2013,27(7).639-646.\u003c/li\u003e\n\u003cli\u003eHart J,Shaver PR,Goldenberg JL.Attachment, self-stcem,world-views and trror management: evidence for a tripartite secunity system [J],J Pers Soc Psychol,2005. 88(6):999-1013.\u003c/li\u003e\n\u003cli\u003eLi Tonggui,Kato.Measurement of adult attachment:Intimate Relationship Experience Scale (ECR),Chinese version[J].Psychological Journal,2006,38(3):399-406.\u003c/li\u003e\n\u003cli\u003eRib\u0026eacute; JM,Salamero M,P\u0026eacute;rez-Testor C,et al.Quality of life in family caregivers of schizophrenia patients in Spain:caregiver characteristics,caregiving burden, family functioning,and social and professional support[J].Int J Psychiatry Clin Pract.2018,22(1):25-33. \u003c/li\u003e\n\u003cli\u003eSaimaldaher ZH,Wazqar DY.Relationships between caregiving stress,mental health and physical health in family caregivers of adult patients with cancer:implications for nursing practice[J]. Scand J Caring Sci.2020,34(4):889-898.\u003c/li\u003e\n\u003cli\u003eHart J,Shaver PR,Goldenberg JL.Attachment,self-esteem,worldviews, and terror management: evidence for a tripartite security system[J].J Pers Soc Psychol.2005,88(6):999-1013.\u003c/li\u003e\n\u003cli\u003eRodin G,Walsh A,Zimmermann C,et a1.The contribution of attachment security and social support to depressive symptoms in patients with metastatic cancer[J].Psychooncology.2007,16(12):1080-1091． \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"breast cancer, family hardiness, intimate relationship experiences, preparedness for caregiving","lastPublishedDoi":"10.21203/rs.3.rs-2353014/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2353014/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eAim\u003c/h2\u003e \u003cp\u003eCurrently, there is a shortage of literature on Family hardiness among breast cancer caregivers. More specifically, the relationship between preparedness for caregiving and intimate relationship experiences has not been explored. This study was designed to describe the experiences of family Caregivers' hardiness and analysis the influences by evaluating the relationships between Family hardiness,intimate relationship experiences, and preparedness for caregiving.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e From March to July, 2022, we surveyed 140 caregivers of breast cancer patients who were admitted in two IIIA-grade hospitals in Hunan Province, and reviewed their medical records. The Family Hardiness Index, Caregiver Preparedness Scale, and Experiences in Close Relationships Inventory were used, and chi-square and multiple logistic regression analyses were performed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe mean Family Hardiness Index score of caregivers was 58.11 (SD\u0026thinsp;=\u0026thinsp;5.67). Multiple linear regression analysis indicated that family hardiness is affected by educational background, occupation, and knowledge of the patient\u0026rsquo;s disease. This study found that preparedness for caregiving was able to positively predict family hardiness(β\u0026thinsp;=\u0026thinsp;0.265, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), whereas intimate relationship experiences negatively predicted family hardiness (β = \u0026minus;0.078, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eBreast cancer patients\u0026rsquo; primary caregivers had moderate levels of family hardiness, suggesting that nurses should focus on the disease itself, while also evaluating the level of family hardiness of the main caregivers. Through disease knowledge guidance and psychological counseling, caregivers can improve their readiness, reduce attachment anxiety and attachment avoidance, provide patients with a good family environment, and promote their recovery from disease.\u003c/p\u003e","manuscriptTitle":"Hardiness in Family Caregivers During Caring From Pearsons With Breast Cancer: A cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-12-12 14:45:36","doi":"10.21203/rs.3.rs-2353014/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b349e68a-0fa7-4307-9a40-fa13bb2074e7","owner":[],"postedDate":"December 12th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-02-13T01:29:18+00:00","versionOfRecord":[],"versionCreatedAt":"2022-12-12 14:45:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2353014","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2353014","identity":"rs-2353014","version":["v1"]},"buildId":"GqpaHPwrfC8PjnIFayRh5","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}