Family Function and Medication Safety Behaviors in Older Adults with Cancer: A Serial Mediation Analysis

Medication safety behaviors are critical for preventing medication-related harm in older adults with cancer, given polypharmacy, complex antitumor regimens, and age-related physiological changes. Guided by the Capability-Opportunity-Motivation-Behavior (COM-B) model, the primary objective of this study was to examine the association between family function and medication safety behaviors among older adults with cancer. The secondary objective was to explore the potential individual and serial mediating roles of medication beliefs and medication literacy in this association.

A cross-sectional survey was conducted in two tertiary cancer hospitals in Jiangsu Province, China, from June 2024 to April 2025. Of 260 hospitalized patients aged 60 years or older recruited by convenience sampling, 251 provided valid questionnaires. Participants completed measures of family function, medication beliefs, medication literacy, and medication safety behaviors. Pearson correlation analysis examined bivariate associations. The serial mediation model was tested using PROCESS version 4.0 Model 6 with 5000 bootstrap samples.

The mean (SD) medication safety behavior score was 31.85 (5.75). Family function, medication beliefs, medication literacy, and medication safety behaviors were positively correlated (all P < 0.01). In the serial mediation model, the coefficient for the direct pathway between family function and medication safety behaviors was 1.084 (95% CI: 0.778-1.389). The combined indirect estimate was 0.525 (95% CI: 0.348-0.733), accounting for 32.63% of the total association. Statistically significant indirect associations were observed through medication beliefs alone, medication literacy alone, and the hypothesized serial pathway involving medication beliefs and medication literacy.

In this cross-sectional study, better family function was associated with safer medication behaviors, with model-based indirect associations through medication beliefs, medication literacy, and their hypothesized serial pathway. These findings highlight the potential value of considering family function, medication beliefs, and medication literacy together when developing and testing medication-safety support for older adults with cancer.