Cognitive appraisal, negative coping, and family resilience among acute leukemia patients and their primary family caregivers: an actor-partner interdependence mediation model of quality of life

Objectives This study used a dyadic approach to examine the association between cognitive appraisal and quality of life (QoL), and to test whether negative coping and family resilience mediate this association in dyads of acute leukemia (AL) patients and their primary family caregivers. Methods Three hundred and eight AL patient-caregiver dyads were recruited from five hospitals in China. QoL was measured using the Functional Assessment of Cancer Therapy-Leukemia (FACT-Leu) for patients and the 12-Item Short-Form Health Survey (SF-12) for primary family caregivers. Cognitive appraisal, negative coping, and family resilience were assessed using the Cognitive Appraisal of Health Scale (CAHS), the Trait Coping Style Questionnaire (TCSQ), and the Family Hardiness Index (FHI), respectively. The Actor-Partner Interdependence Mediation Model (APIMeM) was performed in R to examine direct and indirect effects. Results Patients’ QoL was significantly correlated with their own positive coping ( r = 0.523, p < 0.01), family resilience ( r = 0.489, p < 0.01), and negative coping ( r = −0.466, p < 0.01), and with caregivers’ QoL ( r = 0.237, p < 0.01), family resilience ( r = 0.436, p < 0.01), and negative coping ( r = −0.234, p < 0.01). In the APIMeM, negative coping fully mediated the association between patients’ threat appraisal and their QoL, whereas caregivers’ threat appraisal was directly associated with poorer QoL. Family resilience from either dyad member predicted better patient QoL. Actor effects predominated, with patients’ threat appraisal predicting caregivers’ negative coping as a cross-dyad pathway. Conclusion Acute leukemia patients and their primary family caregivers demonstrate divergent stress-coping pathways. For patients, mitigating maladaptive coping such as avoidance and resignation may protect QoL, whereas caregivers may benefit from interventions directly targeting threat perception and emotional burden. Family resilience shows a distinct pattern. It exerts protective effects on patient QoL but not on caregiver QoL, pointing to the need for tailored dyadic psychosocial care.