The coping experiences in patients with hepatocellular carcinoma and their spouses following postoperative recurrence: A dyadic qualitative study

“” [Spouse 5].”

“27 This approach enables researchers to delve into the processes and perspectives of the individuals involved.”

“33 Additionally, cultural norms rooted in Confucian philosophy instill a deep sense of duty to care for loved ones, emphasizing mutual support during dif fi culty times.”

“9,10 Evidence con fi rms that such coping efforts not only strengthen marital bonds but also enhance the couple's quality of life.”

“Spouse, even without direct communication, were acutely aware of these fears, creating a shared emotional landscape for both partners, which exempli fi es the APIM.”

“30 In this study, which focuses on patients with recurrent HCC and their spouses, informed the design of interview questions by emphasizing the interconnectedness of partners' experiences and behaviors within the context of coping with recurrent HCC.”

“24 This relationship model encourages understated expressions of love between couples, characterized by silent care, acts of devotion, and emotional resilience.”

“9,10 Evidence con fi rms that such coping efforts not only strengthen marital bonds but also enhance the couple's quality of life.”

“28 The model posits that a subject's dependent variable is in fl uenced not only by their own actor effects but also by speci fi c partner effects.”

“20 These complex dynamics underscore the need to further investigate how couples navigate HCC through dyadic coping strategies within the APIM framework, and how these strategies in fl uence their health outcomes.”

“19 This heightened risk could stem from the mutual in fl uence and interaction of negative psychological experiences between patients and their spouses, which may erode intimacy, marital quality, and overall well-being.”

“Meanwhile, the patients believed they “ fully understood ” their health conditions [Patient 11].”

“18 However, while both partners experience psychological trauma during the cancer journey, studies suggest that spouses may be more vulnerable to psychological disorders than the patients themselves.”

“36 However, in the Chinese cultural context, the marital bond is uniquely reinforced by traditional roles, where marriage is integral to family support systems.”

“23 These cultural practices are deeplyrootedinConfucianphilosophies,whichemphasizeloyalty,mutual support,andsharedresponsibilitieswithinmarriage,fosteringthedynamic of “ husband's loyalty and wife's obedience".”

“8 This collective approach, known as dyadic coping, refers to the mutual support partners provide to each other, encompassing shared concerns, coping mechanisms, and the maintenance of intimacy.”

“This practice re fl ects cultural values surrounding a ‘ good death ’ 47 and the desire to ‘ return to one's roots ’ , 48 illustrating the shared anxiety and pragmatic coping strategies between partners.”

“7,43 This tendency was especially evident among patients with a family history of HCC, who often doubted treatments ef fi cacy and developed negative attitudes toward re-treatment.”

“26 Given these cultural practices, the application of the APIM framework — focusing on emotional regulation, social support, and shared adaptation — may offer valuable insights into how Chinese patients and their spouses cope with HCC recurrence, and this warrants further exploration.”

“46 While patients' struggles with fears of recurrence not only burden on their spouses emotionally but also leave their spouses feeling helpless, especially when faced with imminent decisions like purchasing burial plots.”

“14 – 17 This evidence suggests that the APIM could be valuable for understanding dyadic coping in other cancer types and stages, including during the recurrence of HCC. International evidence supports the psychological and physical health bene fi ts of patients and their spouses coping with HCC…”

“21 Consequently, many cancer patients — especially those critically ill or experiencing recurrence — are excluded from conversations about their diagnosis and disease progression.”

“11,12 However, dyadic coping practices can vary depending on cultural contexts, socioeconomic factors, and the stages of the cancer journey.”

“29 This highlights the signi fi cant interpersonal interactions between dyadic individuals in intimate relationships, where one person's emotional cognition or behavior can signi fi cantly impact their partner.”

“44 In a cultural context where recurrence is perceived as a progression toward death, 45 these feelings of sorrow and despair added emotional burdens to their partners.”

“These fi ndings align with prior research 42 suggesting that couples bene fi t from psychological adaptability, dynamically responding to health changes while modifying their behaviors to manage disease risk.”

“40 This fi nding also exempli fi es the APIM.”

“Given China's high Hepatitis B Virus prevalence and the correspondingly high incidence of HCC compared to Western countries, 2 these health behaviors could signi fi cantly inform public health initiatives and support preventive efforts, particularly for those with a hereditary predisposition.”

“14 – 17 This evidence suggests that the APIM could be valuable for understanding dyadic coping in other cancer types and stages, including during the recurrence of HCC. International evidence supports the psychological and physical health bene fi ts of patients and their spouses coping with HCC…”

“51,52 Patients' re fl ections on the fi nancial burden of ongoing treatment highlight how their decision-making is deeply inter-twined with their spouses' emotional and fi nancial concerns.”

“35 Furthermore, the selective sharing of information by spouses underscores their prioritization of their partners' emotional well-being.”

“7,43 This tendency was especially evident among patients with a family history of HCC, who often doubted treatments ef fi cacy and developed negative attitudes toward re-treatment.”

“By selectively sharing information, the spouses intended to maintain their loved one's focus on recovery rather than on fear and uncertainty or as a way to “ protect ” them “ from emotional distress ” [Spouse 6].”

“4,5,23 There were also several studies exploring the experiences of cancer patients and spousal caregivers.”

“61 In contrast, the Western literature emphasizes the benefits of open communication within families and between patients and health care providers for emotional well-being and informed decision-making.”

“Consistent with Yue et al. [25], couples improve disease management efficacy by engaging in positive health behaviors.”

“This predominant worry likely stems from anxiety surrounding their spouse's illness, especially after witnessing other family members succumb to HBV-related HCC. 9 In some cases, spouses had children who tested positive for HBV, heightening fears about health risks to their children and extended family, and the possib…”

“Spouses are often the primary informal caregivers and play a central role in treatment decision-making, symptom monitoring, daily care and emotional support [7].”