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Background: Spouses' ability to care for survivors can be particularly challenging because patients and spouses are interdependent and mutually influence one another. Family functioning such as family cohesion and communication may play a primary role in improving the health-related quality of life (HRQOL) of couples, given that cancer can influence family dynamics., Objective: The aims of this study were to investigate the mediating effect of family communication on the relationship between family cohesion and HRQOL and examine the moderating effect of sex on this relationship among cancer survivor-spouse dyads., Methods: A total of 91 cancer survivors with a diagnosis of breast, colorectal, or prostate cancer and their spouses were recruited from the University Hospital Registry in Cleveland, Ohio. The dyadic data were analyzed using structural equation modeling with the actor-partner interdependence mediation model., Results: Findings demonstrated that the spouses' own perceived family communication mediated the associations between their own family cohesion and physical HRQOL and between the survivors' family cohesion and physical HRQOL. The spouse actor effects between family communication and HRQOL significantly differed by sex., Conclusions: Enhancing family cohesion and communication within the family can improve the spouses' HRQOL. Findings regarding sex differences serve as a rationale for gender-based approaches to improving HRQOL in survivorship care in the family context., Implications for Practice: Couple- and/or family-based interventions should be designed to enhance family cohesion and improve family communication skills for effective adjustments within couples and families. Supportive care within the family context can be promoted to address the diverse challenges of survivorship care.

Objective: Access to nutritious foods is key to achieving health promotion goals. While there is evidence that nutritious food access is complex, measures assessing multiple domains of access, including spatial-temporal, economic, social, service delivery and personal, are lacking. The current study evaluates psychometric properties of scales designed to measure perceptions of multiple domains of nutritious food access among low-income populations., Design: A cross-sectional survey was conducted in 2015. Eighty-one items were selected or developed to represent five domains of nutritious food access for food shopping overall and specific to shopping at farmers' markets. Evaluation of the items included exploratory factor analysis within each domain and internal consistency reliability for each of the sub-scales., Setting: Data were collected in seventeen urban neighbourhoods in Greater Cleveland, Ohio, USA that have high levels of poverty. All participants had access to at least one farmers' market within 1·6 km (1 mile) of their home to standardize spatial access to nutritious foods., Subjects: Adults (n 304) receiving Supplemental Nutrition Assistance Program benefits., Results: Each domain included multiple sub-domains: spatial-temporal (four), service delivery (two), economic (two), social (three) and personal (three), for a total of fourteen subdomains. The internal consistency reliability for one of the sub-domains was outstanding (>0·90), seven were excellent (0·80-0·89), five were very good (0·70-0·79) and one scale had poor reliability (0·58)., Conclusions: Multiple sub-domains of nutritious food access can be assessed using short measures that have been tested for internal consistency. These measures are suitable for assessing the complex phenomena of nutritious food access among low-income populations.

Purpose/objectives: To investigate the relationships among life stress, family functioning, family coping, reliance on formal and informal resources, and decisional conflict in cancer survivors. 
., Design: Cross-sectional.
., Setting: Participants were recruited from the California Cancer Surveillance Program, hospital registries, and community agencies in southern California and Cleveland, Ohio. 
., Sample: 243 European American, African American, Chinese American, and Korean American cancer survivors diagnosed with breast, colorectal, or prostate cancer.
., Methods: The merged data from an ethnically diverse cohort of cancer survivors participating in the two survey studies were used. Standardized measures were used to identify family context variables and decisional conflict. 
., Main Research Variables: Life stress, family functioning, family coping, reliance on formal and informal resources, and decisional conflict.
., Findings: Structural equation modeling demonstrated that life stress was significantly associated with decisional conflict. Family functioning significantly mediated the impact of life stress on decisional conflict through family coping. Reliance on formal and informal resources moderated the relationships among the study variables. 
., Conclusions: The role of the family context, which includes family functioning and coping, on decisional conflict is important in the adjustment process to make high-quality decisions in cancer survivorship care. 
., Implications for Nursing: Findings present nursing practice and research implications that highlight the need for efforts to encourage and support family involvement in the decision-making process and to enhance cancer survivors' adjustment process.

Purpose: This study aimed to examine the actor and partner effects of coping and resilience characteristics on psychological distress in cancer survivors and their spouses and to examine the mediating role of resilience characteristics in the relationship between coping and psychological distress., Methods: A total of 91 breast, colorectal, and prostate cancer survivor-spouse dyads were recruited from the University Hospital Registry in Cleveland, Ohio. Standardized questionnaires that assessed psychological distress, reframing and acquiring social support coping, and resilience characteristics were used., Results: The actor-partner interdependence mediation model demonstrated that the resilience of the survivors and spouses was a strong predictor of their personal psychological distress. Survivors' and spouses' own resilience mediated the association between their reframing coping and psychological distress. However, only the survivor model confirmed the mediating effect of resilience characteristics in the relationship between social support coping and psychological distress. In addition, spouse psychological distress was influenced by survivor resilience, indicating a spouse-partner effect in the relationship between resilience characteristics and psychological distress., Conclusions: Our findings provide insight into the relationships between coping, resilience characteristics, and psychological distress at the individual and dyadic levels. Enhancing cancer survivors' and their spouses' positive thoughts and available external resources can improve resilience and, in turn, reduce their psychological distress of couples coping with cancer.