The association between resilience and palliative care problems and needs in cancer patients: A cross-sectional study

doi:10.21203/rs.3.rs-4685564/v1

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Research Article

The association between resilience and palliative care problems and needs in cancer patients: A cross-sectional study

https://doi.org/10.21203/rs.3.rs-4685564/v1

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Objective

Analyze the association of resilience on palliative care problems and needs in cancer patients.

Methods

An analytical cross-sectional study design was employed, demographic information was collected using a general data questionnaire. resilience levels were measured using the Connor-Davidson Resilience Scale (CD-RISC10), while participants' levels of problems, needs, and quality of life were assessed using the Palliative Care Problems and Needs Questionnaire-Short Version (PNPC-SV).

Results

Residential area, high resilience, liver cancer, breast cancer, endometrial cancer, and ovarian cancer were influencing factors for palliative care problems (p < 0.05); Residential area, high resilience, liver cancer, breast cancer, cervical cancer, endometrial cancer, and ovarian cancer were influencing factors for palliative care needs (p < 0.05).

Conclusions

Patients with high resilience are less likely to experience palliative care problems or needs compared to those with low resilience. Cancer patients living in rural areas, as well as those diagnosed with liver cancer, breast cancer, endometrial cancer, and ovarian cancer, may encounter greater challenges and requirements regarding palliative care.

Palliative care

Resilience

End-of-Life care

Influencing factors

Cancer is the leading cause of deaths in China and developed countries (Cao et al., 2021) (Bray et al., 2021). Most cancers remain uncured despite better early diagnosis and treatment methods. As a result, professional care turned its focus to optimizing quality of life through palliative care because the patients experience physical, emotional, social, financial, and other problems (Osse et al., 2005). The cancer patients experience problems because of the effects of prolonged ailment and its treatments.

The core of palliative care is to improve the quality of life of terminally ill patients by controlling pain, relieving other uncomfortable symptoms, and dealing with the psychological, social and spiritual problems of patients and their families (Yin et al., 2017) (Radbruch et al., 2020). Thus, the effect of palliative care depends on whether it meets the problems and needs of the cancer patients in terms of psychological, physical, spirit, social, financial and other aspects. Palliative problems are physical, emotional, and social challenges that patients with terminally ill face whereas palliative needs are the requirements for support and care in addressing the problems. The relationship between problems and needs of palliative care is a positive one however other research on problems experienced by patients with cancer and their needs for palliative care found that patients experiencing problems was not synonymous with patients having unmet needs for professional care (Osse et al., 2005). Thus, the effect of palliative care depends on whether it meets the problems and needs of the cancer patients in terms of psychological, physical, spirit, social, financial and other aspects. Patients with unsolved problems and unmet needs experience poor health status and quality of life in cancer patients (Wang et al., 2019). Moreover, the complexity and changing disease trajectory of cancer and consequences may result in fluctuating care needs in patients with advanced cancer (Driessen et al., 2023). Evidence has shown that pattern of needs of palliative care in cancer patient can also be influenced by sociodemographic factors such as age, sex, marital status, income level; and clinical factors such as location of cancer, stage of disease, and tumor size (Okediji et al., 2017). It is clear that cancer patients experience a wide range of unmet supportive needs, for which solutions need to be devised in order to improve the supportive care services for these patients and their overall quality of life.

By definition, resilience is the ability to adapt and cope with adversity and stress (Sisto et al., 2019). It plays a crucial role in how individuals facing palliative problems and needs respond to their situation. It is essential that individuals facing terminal illnesses maintain a sense of hope and optimism during this critical stage of their lives. resilience can serve as a valuable form of intervention for these patients, offering support and promoting a positive outlook. It is the ability for a person to maintain their physical and psychological well-being in the face of adversity. This is also a very practical goal for cancer patients (Salsman & Rosenberg, 2024)

A resilient person has the ability to effectively utilize their internal and external resources to resolve their issues and proactively respond to the demands of their circumstances. resilience is characterized by adaptability, mental clarity, increased social support, and satisfaction with life. It also involves accepting and adjusting to challenging situations or changes in order to achieve the best possible outcome. Resilience is not a fixed trait, but rather a complex set of behaviors and thoughts that can vary depending on the situation and over time. Almost anyone can learn and develop resilience, which can help individuals cope with illness or difficult events while also enhancing their quality of life and ability to carry on with their normal activities.

In the context of palliative care, resilience is crucial for cancer patients to maintain some quality of life even in the face of impending death (Lau et al., 2021; Zanatta et al., 2020). Numerous external factors can impact an individual's psychological fortitude. Educational attainment, financial standing, age, gender, and cultural convictions all possess the potential to exert influence. Concerning individuals grappling with cancer, Lim (2007) pursued an investigation exploring the repercussions of education and financial status on the resilience of patients. The findings revealed that individuals with limited education or lower financial means displayed a greater likelihood of experiencing diminished resilience. This can be attributed to the heightened prevalence of depression and anxiety within this particular demographic (Kavčič et al., 2021; Zager Kocjan et al., 2021).

According to a study conducted in China, that assessed the resilience of women after breast cancer surgery, they found out that resilience offers psychological mechanisms to cope with problems experienced by cancer patients during the life time of the condition (Huang et al., 2019). In other ways, higher levels of resilience can positively impact a patient's ability to manage problems and needs of palliative associated with cancer. Other studies have shown that resilience affects lower levels of emotional stress, better adjustment and better quality of life in people with cancer (Martinac, 2021).

1.Background

Cancer patients have diverse palliative care needs that require a comprehensive care approach. Different cancer types and stages have distinct symptom patterns, treatment goals, and care needs. For example, pancreatic cancer is notorious for the low survival rate and high symptom burden. The main problems and needs of pancreatic cancer patients in China include poor physical health, multiple physical symptoms such as pain and digestive problems, and psychological distress. (Yang et al.2021) (Zhu et al., 2021) (Lee et al.2021) (Cai et al.2021) On the other hand, studies have shown that breast cancer patients might also have psychological symptoms such as depression and anxiety, in addition to physical symptoms. The most common cancer in men in China is lung cancer and liver cancer, while in women it is lung cancer and gastric cancer. (Yang et al., 2020) (Cao et al., 2020) (Juanjuan et al.2020) (Levesque et al.2020) (So et al.2021). This is in agreement with the global cancer statistics. It is worth noting that the cancer profile in China is different from that in Western countries, reflected by the significant higher incidence of liver cancer and lower incidence of colorectal and breast cancer.

2.Palliative care

A nationwide survey that involved 10,856 service providers, both hospitals and hospices, revealed that less than 20% of the hospitals and hospices have palliative care services. In addition, the majority of the services are available in eastern China and in urban areas. Patients living in rural and remote places and in central and western China have very limited access to services (Ling et al., 2020) (Chung et al., 2021) (Zhu et al.2021) (Li et al.2023) (Xie et al., 2020) (Cheng et al.2021) (Chen et al.2022). This geographical variation in service provision has also been recognized by the Chinese government. In the "Health China 2020" planning outline, it is stated that the government will promote the development of palliative care services, making efforts to eliminate regional disparities in service provision and reduce the burden of the disease and health care costs for the patients who need palliative care

The development of palliative care is related to the rise of the modern hospice movement, which was established in 1967 by Dame Cicely Saunders. Palliative care was first introduced into Mainland China in the early 1990s and has recently shown considerable development. There is increasing international evidence that patients with cancer do not access palliative care early enough in the course of their disease, and most Chinese cancer patients still suffer from much unmet need for palliative care (Wang et al., 2021). Understanding the palliative care needs in cancer patients, in terms of the disease symptoms, can provide good evidence in policy making, in the provision of care, and in the development of palliative care education programs for the healthcare professionals in China. Last but not least, the palliative care provision is in consistence with the recommendation by Chinese National Health and Family Planning Commission and WHO. According to the WHO, palliative care is an approach that improves the quality of life for patients and their families facing the problems associated with life-threatening illness, and the health commission in China has also proposed that palliative care should be accessible to all appropriate patients. In consideration of the rapid development of palliative care service in China, it is crucial to have more studies to take a close look at the palliative care needs for cancer patients and to fill up the gaps in research by providing much-needed quantitative results (Wang et al., 2021)

3.Significance of the study

Palliative care has emerged as a necessary and integral part of care for cancer patients, and it increasingly receives attention and significance both in China and globally. However, most studies about palliative care in cancer patients are conducted in Europe and North America, and the knowledge of the research, the experience of practice, or the development of policy in China may be limited. Although a few studies about palliative care for cancer patients in China were published, nearly all of them focused on the principle, the philosophy, or the current situation of palliative care, and few studies focused on understanding on relationship of palliative care problems and needs, resilience and other associated factors among cancer patients.

Overall, the importance of understanding problems and needs of palliative through the lens of resilience is to improve person’s quality of life. Nevertheless, understanding problems and needs of palliative care and influencing factors is complex and multifaceted, and it can vary from person to person. Assessing the problems and needs and resilience of palliative care is therefore important step in developing tailored palliative care services. The outcome of the study would inform the development of tailored palliative care interventions in the hospitals and clinics.

4.Aim of the study

The study was conducted with the primary aim to analyze the association of resilience and palliative care problems and needs including other factors in cancer patients.

5.Research question:

The question we attempted to answer in this study is: How resilience acts as determinants of problems and needs in palliative care in cancer patients?

1 Participants

The inclusion criteria for patients were as follows: 1) confirmed cases of single malignant tumors by histopathology or cytology; 2) more than 18 years of age; 3), clear language expression, normal cognition, able to complete the questionnaire independently; 4) patients who gave informed consent and participated voluntarily.

The exclusion criteria for patients were as follows: Not able to complete questionnaire for any reasons and current or previous history of serious mental illness, organic brain lesions.

2 Sample size

A total of 1220 patients were interviewed in this study. 26 patients refused to participate in the study and 62 patients’ questionnaires were invalid. The final sample size was therefore 1132 patients, representing 92.8% response rate.

3 Instruments

Based on literature (Martinac, 2021) socio-demographic questionnaire was designed and used to obtain data on patients such as: age, gender, ethnicity, religion, occupation, education, residential area. marital status, chronic history and diagnosis of cancer.

Questionnaire was the primary method of this study by convenience sampling, and the measurement tools included Connor-Davidson Resilience Scale (CD-RISC10) and Problems and Needs in Palliative Care questionnaire-short version (PNPC-sv).

The study used the Chinese version of Connor-Davidson Resilience Scale-10 (CD-RISC-10) scale with 10 statements. Each item is scored on a five-point Likert scale ranged from 0 to 4, the score 0 represents low resilient statement and a score of 4 suggest that the resilient statement is high. At the end the total scores are calculated by getting the sum of all the 10 items. The total scores range from 0 to 40. The higher the scores the greater level of resilience whilst the lower scores indicate less resilience (Boškailo et al., 2021). The Chinese version of the CD-RISC-10, which is reliable, valid and easy to use, is suitable for clinical setting. (Ye et al., 2017).

The Problems and Needs in Palliative Care questionnaire-short version (PNPC-sv) has 33 items. The Chinese version was translated by Wang et al and has 33 items and covers eight dimensions of problems and palliative care needs of advanced cancer patients including activities of daily life (ADL) (3 items), physical (9 items), autonomy (4 items), social (5 items), psycho- logical (5 items), spiritual (4 items), financial (2 items) and informational (1 item) issues (Wang et al., 2019). The scale assesses patients’ problems and to which extent they want care support to address their problems (needs-for-care) separately. In each item, the patients were asked two questions: (1) “Do you experience the item to be a problem?”, which belongs to the problem part with the answer of “yes”, “somewhat”, and “no”; and (2) “Do you need (extra) professional attention for the item?”, which belongs to the need-for-care part with the answer of “yes, more”, “as much as now” and “no”. Higher scores indicate more problems and stronger care needs. Chinese version of the PNPC-sv is a valid, reliable and user-friendly instrument for measuring problems and palliative care needs of patients with advanced cancer (Wang et al., 2019).

4 Reliability and validity of the instruments

The study confirmed the reliability and validity of Chinese version of Connor-Davidson Resilience Scale-10 (CD-RISC-10) by using the validation results of Ye et al study (Ye et al., 2017). The study used the Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) with a sample size of 500 parents. The results showed that the Chinese version of CD-RISC-10 which was used in this study has good psychometric properties and retains its single dimension in the original English version, which can explain 49.602% of the total variance and had Cronbach of 0.909.

Wang et al. undertook a study to validate the PNPC-sv questionnaire with the participation of 174 patients. Through expert and patient evaluations, they established the questionnaire's high content and face validity. Remarkably, it achieved an outstanding Content Validity Index (CVI) of 1.0, and patients gave it a notably positive rating for usefulness. The fit indexes indicated satisfactory model fit. The Cronbach values for problem part was 0.933 and need part was 0.945. The high’s alpha values demonstrated strong internal consistency. The study concluded that the Mandarin Chinese version of PNPC-sv is a valid, reliable, and user-friendly tool for assessing problems and palliative care needs in advanced cancer patients. However, further research with larger sample sizes is warranted to delve deeper into its psychometric properties (Wang et al., 2019).

5 Statistical analysis

The data was analyzed by the statistical Package for the Social Sciences (SPSS) software for windows, version 26.0 (IBM, Armonk, New York, USA). Socio-demographic variables such as age, gender, ethnicity, religion, occupation, education, residential area. marital status, chronic history and diagnosis of cancer were described by counts and percentage.

6 Grouping process

Patients were grouped into more problems or less problems and more needs or less needs groups. The basis for grouping was using median: since there is no recommended cut-off value for the two scales. In addition, since the data is non-normal distribution, the median was appropriate for grouping the two group to ensure that there is sufficient sample in each group.

The total scores of palliative care problems and needs in all 9 dimensions were compared between the higher and lower resilience groups using the Mann-Whitney Test because problems and needs scores do not follow a normal distribution.

The study used logistic regression method because our studies used categorical variables. For logistic regression; the depended variables were the problems of palliative care and needs of palliative care while the independent variables were resilience demographic variables, residential area, chronic history, and diagnoses. Uni-variate logistic regression was performed with the confidence interval of 95% to measuring the association between outcome and all dependent variables. All meaningful variables were included in the calculation of Multivariate logistic regression test. The Hosmer and Lemeshow Test was used to test the model fit of multivariate logistic regression (p > 0.05).

1 Socio-demographic characteristics

Among the 1132 participants present in the study, age>50, female, han, have no religion, junior high school and below, married, rural, no chronic history, bowel cancer is the most common (Table 1).

Table 1 Descriptive analysis

Variables	N(%)	More problems	Less problems	More needs	Less needs
Age
≤50	445(39.3)	212	233	222	223
＞50	687(60.7)	437	340	341	346
Gender
Male	455(40.2)	217	238	221	234
Female	677(59.8)	342	335	342	335
Nationality
Han	888(78.4)	432	456	436	452
Minority	244(21.6)	127	117	127	117
Religion
No	1041(92)	518	523	520	521
Yes	91(8)	41	50	43	48
Occupation
Employed	566(50)	258	308	265	301
Unemployed	566(50)	301	265	298	268
Education
Junior high school and below	697(61.6)	364	333	376	321
High school and above	435(38.4)	195	240	187	248
Marital status
Unmarried	35(3.1)	544	553	15	20
Married	1097(96.7)	15	20	548	549
Residential area
Rural	638(56.4)	359	279	367	271
City	494(43.6)	200	294	196	298
Chronic history
No	790(69.8)	382	408	383	407
Yes	342(30.2)	177	165	180	162
Diagnosis
Lung cancer	267(23.6)	128	139	126	141
Bowel cancer	289(25.5)	125	164	118	171
Liver cancer	114(10.1)	72	42	71	43
Bteast cancer	103(9.1)	36	67	33	70
Cervical cancer	165(14.6)	87	78	96	69
Endometrial cancer	50(4.4)	35	15	33	17
Ovarian cancer	63(5.6)	40	23	43	20
Other	81(7.2)	36	45	43	38

2 Clinical and psychological factors

The study results indicate that the resilience scores of our sample had a median of 25[21, 30], Problems of palliative care median of 17[11, 27] and Needs of palliative care median of 17[9, 29] (Table 2 ).

Table 2 Median of key variables

Variables	M(IQR)
Resilience	25[21, 30]
Problems of palliative care	17[11, 27]
Needs of palliative care	17[9, 29]

For Problems part, ADL, Physical, Autonomy, Social, Psychological, Spiritual, Financial, Global Problem Score, the median for the high resilience group is consistently lower than that for the low resilience group (P<0.001).In all dimensions of the needs section, the medians of all dimensions for the high resilience group is consistently lower than that for the low resilience group (P<0.001).

Table 2 Difference between High resilience and Low resilience groups

Dimensions	High resilience （N=635）	Low resilience （N=497）	z	P
Dimensions	M(IQR)	M(IQR)	z	P
Problem part
ADL*	0[0,3]	1[0,3]	-3.667	＜0.001
Physical	4[2,8]	6[3,9]	-5.538	＜0.001
Autonomy	0[0,4]	1[0,4]	-4.076	＜0.001
Social	0[0,2]	1[0,4]	-5.432	＜0.001
Psychological	3[0,5]	5[2,6]	-5.855	＜0.001
Spiritual	1[0,3]	2[0,4]	-7.565	＜0.001
Financial	2[2,4]	4[2,4]	-2.447	0.014
Information	1[0,2]	1[0,2]	-1.805	0.071
Global Problem Score	15[9,24]	21[13,30]	-7.262	＜0.001
Need part
ADL	0[0,3]	1[0,3]	-4.505	＜0.001
Physical	4[1,9]	6[2.5,9]	-5.83	＜0.001
Autonomy	0[0,4]	1[0,4]	-4.312	＜0.001
Social	0[0,2]	1[0,5]	-6.262	＜0.001
Psychological	3[0,5]	5[1,6]	-6.508	＜0.001
Spiritual	1[0,4]	2[0,4]	-6.221	＜0.001
Financial	2[1,4]	4[2,4]	-5.211	＜0.001
Information	1[0,2]	1[0,2]	-2.355	0.019
Global Need Score	14[7,26]	21[13,32]	-7.62	＜0.001

ADL* means Activity of Daily Life

3 Uni-variate logistic regression

The results show that for Problems part; unemployed, high school and above, residing in city, high resilient, lung cancer, liver cancer, breast cancer, endometrial and ovarian cancer have statistically significant associations with the problems of palliative care (P <0.05) (Table 3).

For Needs part; unemployed, residing in city, high resilient, liver cancer, breast cancer, endometrial and ovarian have statistically significant associations with the needs of palliative care (P <0.05) (Table 4)

Table 3 Uni-variate logistic regression - Problem of palliative care

Variables	B	S.E.	Wald	P	OR	95% C.I
Variables	B	S.E.	Wald	P	OR	Lower	Upper
Age=＞50	0.115	0.122	0.889	0.346	1.122	0.883	1.424
gender=female	0.113	0.121	0.868	0.351	1.120	0.883	1.420
Nationality=minority	0.136	0.145	0.885	0.347	1.146	0.863	1.521
Religion=no	0.189	0.220	0.739	0.390	1.208	0.785	1.858
Occupation=unemployed	0.305	0.119	6.522	0.011	1.356	1.073	1.713
Education=High school and above	-0.297	0.123	5.849	0.016	0.743	0.584	0.945
Marital status=Married	0.271	0.347	0.612	0.434	1.312	0.665	2.589
Residential area=City	-0.637	0.122	27.503	0.000	0.529	0.417	0.671
Chronic history=no	-0.136	0.130	1.103	0.294	0.873	0.677	1.125
Resilience=high	-0.823	0.122	45.255	0.000	0.439	0.345	0.558
Diagnosis (=lung cancer)			35.688	0.001
diagnosis=bowel cancer	-0.189	0.171	1.229	0.268	0.828	0.592	1.156
diagnosis=liver cancer	0.621	0.230	7.327	0.007	1.862	1.187	2.919
diagnosis=breast cancer	-0.539	0.240	5.029	0.025	0.583	0.364	0.934
diagnosis=cervical cancer	0.192	0.198	0.934	0.334	1.211	0.821	1.787
diagnosis=endometrial cancer	0.930	0.332	7.841	0.005	2.534	1.322	4.857
diagnosis=ovarian cancer	0.636	0.289	4.843	0.028	1.889	1.072	3.327
diagnosis=other	-0.141	0.255	0.305	0.581	0.869	0.527	1.432

Table 4 Uni-variate logistic regression - Needs of palliative care

Variables	B	S.E.	Wald	P	OR	95% C.I
Variables	B	S.E.	Wald	P	OR	Lower	Upper
Age=＞50	-0.010	0.122	0.007	0.934	0.990	0.780	1.257
gender=female	0.078	0.121	0.412	0.521	1.081	0.852	1.371
Nationality=minority	0.118	0.145	0.666	0.414	1.125	0.847	1.494
Religion=no	0.108	0.219	0.244	0.622	1.114	0.725	1.711
Occupation=unemployed	0.233	0.119	3.844	0.050	1.263	1.000	1.595
Education=High school and above	-0.440	0.123	12.802	0.000	0.644	0.506	0.819
Marital status=Married	0.286	0.347	0.679	0.410	1.331	0.674	2.627
Residential area=City	-0.722	0.122	35.072	0.000	0.486	0.382	0.617
Chronic history=no	-0.166	0.130	1.643	0.200	0.847	0.657	1.092
Resilience=high	-0.887	0.123	52.166	0.000	0.412	0.324	0.524
diagnosis(Ref: lung cancer)			47.452	0.000
diagnosis=bowel cancer	-0.259	0.171	2.277	0.131	0.772	0.552	1.080
diagnosis=liver cancer	0.614	0.229	7.198	0.007	1.848	1.180	2.894
diagnosis=breast cancer	-0.640	0.244	6.860	0.009	0.528	0.327	0.851
diagnosis=cervical cancer	0.443	0.200	4.908	0.027	1.557	1.052	2.303
diagnosis=endometrial cancer	0.776	0.323	5.778	0.016	2.172	1.154	4.089
diagnosis=ovarian cancer	0.878	0.297	8.731	0.003	2.406	1.344	4.307
diagnosis=other	0.236	0.254	0.863	0.353	1.266	0.769	2.084

4 Multivariate logistic regression

The goodness-of-fit was tested by Hosmer and Lemeshow. The p-value associated with the test was 0.213 for problems of palliative care model and 0.714 for needs of palliative care model.

The results from Table 5 reveals that residential area, high resilience, liver cancer, breast cancer, endometrial cancer, ovarian cancer are the influencing factors of palliative care problems (P <0.05).

In terms of needs of palliative care, Table 6 reveals residential area, high resilience, liver cancer, breast cancer, cervical cancer, endometrial cancer, ovarian cancer are the influencing factors of palliative care needs(P <0.05).

Table 5 Multivariate Influencing factors of Problem of palliative care

Variables	B	S.E.	Wald	P	OR	95% C.I
Variables	B	S.E.	Wald	P	OR	Lower	Upper
Occupation=unemployment	0.069	0.144	0.227	0.634	1.071	0.807	1.422
Education=High school and above	0.177	0.155	1.301	0.254	1.193	0.881	1.616
residential area=City	-0.526	0.154	11.604	0.001	0.591	0.436	0.8
Resilience=high	-0.772	0.129	35.885	0.001	0.462	0.359	0.595
Diagnosis=liver cancer	0.45	0.214	4.45	0.035	1.569	1.032	2.384
Diagnosis=breast cancer	-0.625	0.226	7.66	0.006	0.535	0.344	0.833
Diagnosis=endometrial cancer	1.014	0.325	9.724	0.002	2.756	1.457	5.213
Diagnosis=Ovarian cancer	0.581	0.279	4.341	0.037	1.788	1.035	3.088
Constant	0.472	0.156	9.139	0.003	1.603

Table 6 Multivariate Influencing factors of Needs of palliative care

Variables	B	S.E.	Wald	P	OR	95% C.I
Variables	B	S.E.	Wald	P	OR	Lower	Upper
Education=High school and above	0.029	0.151	0.038	0.846	1.030	0.766	1.384
residential area=City	-0.560	0.148	14.332	0.000	0.571	0.427	0.763
Resilience=high	-0.874	0.131	44.306	0.000	0.417	0.323	0.540
diagnosis=liver cancer	0.484	0.217	4.970	0.026	1.623	1.060	2.485
diagnosis=breast cancer	-0.683	0.234	8.526	0.004	0.505	0.319	0.799
diagnosis=cervical cancer	0.661	0.184	12.896	0.000	1.937	1.350	2.778
diagnosis=endometrial cancer	0.937	0.321	8.545	0.003	2.552	1.362	4.784
diagnosis=ovarian cancer	0.889	0.292	9.264	0.002	2.432	1.372	4.310
Constant	0.541	0.121	19.978	0.000	1.717

This study showed that Patients with different levels of resilience have different palliative care problems and needs. In both problems and needs parts, there were significant differences between the high and low resilient groups for each dimension, as indicated by the p-values (p<0.005). Resilience is a complex psychological factor that refers to an individual's ability to adapt and bounce back from adversity or significant stress. In the context of cancer palliative care, where patients are often facing terminal illness or end-of-life issues, resilience can play a crucial role in how patients cope with their condition and the challenges they encounter. Assessing the levels of resilience of each cancer patient can help to determine the appropriate palliative care problems and needs (Abdelhadi, 2023). This result signifies that importance of considering resilience as an important factor in palliative care needs and problem assessment. By assessing patients' resilience levels and understanding how these relate to their palliative care needs, healthcare providers can tailor interventions to address specific challenges and enhance patients' overall well-being and quality of life. This personalized approach can help optimize the effectiveness of palliative care and support patients in coping with the complex emotional, physical, and existential issues they may face.

According to our findings resilience influences the problems and needs of palliative. The patients with high resilience are less likely to experience problems of palliative care or need palliative care compared to those with low resilience. As discussed earlier, resilience plays a crucial role in how patients cope with their illness and the challenges associated with palliative care. Patients with higher levels of resilience may be better equipped to navigate the physical, emotional, and existential aspects of their illness, leading to fewer palliative care problems and need for care support and thereby improved quality of life. Conversely, patients with lower resilience levels may be more vulnerable to experiencing distress, symptom burden, and difficulty in coping with their condition. Consistent with the results of this study, Lau et al found that there is positive association between resilience and needs for care (Lau et al., 2021). Other studies indicate that a higher level of resilience has a positive effect on faster recovery from cancer and that resilience is positively associated with the physical, mental and spiritual functioning of cancer patients (Martinac, 2021) (Boškailo et al., 2021) (Boškailo et al., 2021). Other evidence from psychological research establishes the fact that cancer affects a patient not only just physiologically but also psychosocially (Gowda et al., 2019). Psychological distress is highly prevalent among cancer survivors and significantly impacts their health. Assessing patients' resilience levels can therefore help healthcare providers identify those who may benefit from additional support and interventions to enhance their coping abilities and mitigate palliative care problems.

Secondly, our findings suggest that residential area and diagnoses (liver cancer, breast cancer, endometrial cancer, ovarian cancer) are the additional influencing factors of palliative care problems. On the other hand, residential area, diagnoses (liver cancer, breast cancer, cervical cancer, endometrial cancer, ovarian cancer) are the other influencing factors of palliative care needs. The patients with the liver, breast and gynecological tumor conditions such as ovarian, cervical and endometrial cancers experience most problems of palliative care and require care support.

This research has two limitations. Firstly, due to the self-reported nature of survey, bias in inevitable. Lastly, selecting participants from one clinical setting (hospital) might limit the generalizability of the findings.

This study suggests that Patients with different levels of resilience have different palliative care problems and needs. In both problems and needs parts, there were significant differences between the high and low resilient groups for each dimension, as indicated by the p-values (p<0.005). The patients with high resilience are less likely to experience problems of palliative care or need palliative care compared to those with low resilience. Conversely, patients with lower resilience levels may be more vulnerable to experiencing distress, symptom burden, and difficulty in coping with their condition. The study has provided evidence that patients with different levels of resilience have different palliative care problems and needs. Therefore, assessing patients' resilience levels can help to determine the appropriate care interventions for each patient The Cancer patients in rural areas are likely to experience more problems and needs of palliative care than those living in the city. The authority should make the palliative care and hospice services more available in the rural areas in order to increase access. For both palliative care problems and needs, different types of cancer diagnoses have varying influences, hence understanding the different cancer diagnoses allows healthcare providers to tailor interventions to address specific challenges related to patients' unique circumstances and optimize symptom management, psychosocial support, and quality of life.

Declaration of competing interest:

The authors declare no conflict of interest.

Funding

This work was funded by grants from one Yunnan Applied Basic Research Projects- Kunming Medical University Union Foundation (Grant Number 202101AY070001-178), and one Scientific Research Fund of Education Department of Yunnan Province (Grant Number 2022J0177), and one Yunnan Provincial Education Planning Project (Grant Number AC22015 ).

Ethics approval

Ethical approval was obtained from the Institutional Review Committee of Yunnan Cancer Hospital (ky2021133). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Author Contribution

Sylvia Njunga Malema: Write drafts, revisions, and final versions.Nan Shen: Data collection, data curation, data analysis.Qianrong Yang: Conceptualization, MethodologyHailiang Ran: Guide data analysisQiuyan He: Data collectionYongpei Hu: Data collectionLirong Guo: Data collectionYing Zhang: SupervisionJiao Yang: Conceptualization, Writing- Reviewing and Editing

Data Availability

The manuscript’s data are available from the corresponding author.

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The association between resilience and palliative care problems and needs in cancer patients: A cross-sectional study

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Abstract

Introduction

1.Background

Materials and Methods

1 Participants

2 Sample size

3 Instruments

4 Reliability and validity of the instruments

5 Statistical analysis

6 Grouping process

Results

1 Socio-demographic characteristics

2 Clinical and psychological factors

3 Uni-variate logistic regression

4 Multivariate logistic regression

Discussion

Conclusion

Declarations

Declaration of competing interest:

Funding

Author Contribution

Data Availability

References

Additional Declarations

Status:

Version 1