Resilience in family caregivers of patients diagnosed with advanced cancer – unravelling the process of bouncing back from difficult experiences, a hermeneutic review

Despite the risk for developing mental disorders, most of advanced cancer patients’ family caregivers undergo a resilient process throughout the caregiving period. Research on resilience in caregivers of advanced cancer patients is scarce and further hindered by the lack of a univocal definition and a theoretical framework. To provide clarity on the concept of resilience by proposing an integrative view that can support health care professionals and researchers in conducting and interpreting research on resilience. The review process was inspired by the hermeneutic methodology: a cyclic review process, consisting of repeated searching and analysing until data saturation is reached and focussed on achieving a deeper understanding of ill-defined concepts. The definitions from eighteen reviews on resilience and the theoretical frameworks from eight concept analyses were analysed. The composing elements of resilience were listed and compared. The American Psychological Association’s definition of resilience and Bonanno’s theoretical framework are suggested to guide further research on resilience. Moreover, four knowledge gaps were uncovered: (1) How do resilience resources interact? (2) What are the key predictors for a resilient trajectory? (3) How do the resilient trajectories evolve across the caregiving period? And (4) how does the patient’s nearing death influence the caregiver’s resilience? To address flaws in conceptualisation and the resulting gaps in knowledge, we suggest a definition and a theoretical framework that are suited to allow heterogeneity in the field, but enables the development of sound interventions, as well as facilitate the interpretation of intervention effectiveness.

尽管存在罹患精神障碍的风险，绝大多数晚期癌症患者的家庭照护者在整个照护周期中均会经历韧性（resilience）历程。目前针对晚期癌症患者照护者韧性的相关研究较为匮乏，且由于缺乏统一的定义与理论框架，相关研究的推进进一步受阻。本研究旨在明确韧性的概念，提出整合性视角，以协助医疗保健专业人员与研究人员开展并解读韧性相关研究。本综述的研究过程借鉴诠释学方法（hermeneutic methodology）：采用循环式综述流程，即反复开展文献检索与分析直至达成数据饱和，核心目标为深化对界定模糊概念的理解。本研究对18篇韧性相关综述的定义，以及8项概念分析的理论框架进行了分析，并梳理对比了韧性的构成要素。本研究建议采用美国心理学会（American Psychological Association）对韧性的定义，以及博南诺（Bonanno）的理论框架，以指导后续的韧性相关研究。此外，本研究还揭示了4项知识空白：（1）韧性资源之间如何产生交互作用？（2）韧性轨迹的关键预测因子是什么？（3）韧性轨迹在整个照护周期中如何演变？（4）患者临近死亡如何影响照护者的韧性？为弥补概念界定的缺陷及由此产生的知识空白，本研究提出了适配该领域异质性的定义与理论框架，既可为严谨的干预措施开发提供支撑，也有助于解读干预措施的有效性。