APIM-guided dyadic nursing after colorectal cancer surgery: a propensity score-matched cohort study

Recovery after colorectal cancer surgery is influenced not only by patient symptoms but also by caregiver capacity, psychological distress, self-efficacy, and dyadic coping. However, real-world evidence on Actor-Partner Interdependence Model (APIM)-guided dyadic nursing in routine postoperative care remains limited.

To examine the association between documented exposure to APIM-guided dyadic nursing and 6-month postoperative outcomes among colorectal cancer patient-caregiver dyads, and to explore potential actor-partner pathways.

This propensity score-matched retrospective cohort study reviewed postoperative colorectal cancer patient-caregiver dyads identified from electronic medical records, nursing documentation, and structured follow-up records. A total of 292 dyads were screened, and 252 dyads were retained after eligibility assessment and 1:1 propensity score matching, including 126 dyads exposed to APIM-guided dyadic nursing and 126 dyads receiving usual postoperative nursing. Outcomes were assessed at baseline/discharge and at 1, 3, and 6 months after discharge. Linear mixed-effects models estimated adjusted longitudinal associations. APIM-based generalized estimating equations and exploratory structural equation modeling were used to examine actor-partner associations and possible indirect pathways.

Compared with usual postoperative nursing, APIM-guided dyadic nursing exposure was associated with more favorable changes in patient colorectal cancer-specific quality of life, psychological distress, bowel dysfunction, self-efficacy, and dyadic coping. Caregivers in the APIM-guided nursing group also showed lower burden and distress, together with better quality of life and caregiving preparedness. Exploratory APIM analyses suggested stronger and more consistent actor associations than partner associations, with self-efficacy and distress emerging as key dyadic factors. Possible indirect pathways through patient self-efficacy, caregiver self-efficacy, and shared dyadic coping were also observed.

In this propensity score-matched retrospective cohort study, APIM-guided dyadic nursing was associated with better postoperative patient and caregiver outcomes. These findings should be interpreted as adjusted associations rather than definitive causal evidence. Prospective multicenter randomized trials are needed to confirm effectiveness and implementation feasibility.