Together but Overcrowded: A Dyadic Analysis of Predicaments in Family Resilience Development in Families of Adolescents With Leukaemia.
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AIM: To examine predicaments in the development of family resilience among families of adolescents with leukaemia from the perspectives of adolescents and their caregivers. DESIGN: Qualitative descriptive interview study. METHODS: Purposive sampling was used to recruit 20 adolescent-caregiver dyads from a tertiary hospital in Fujian Province, China. Data were collected between November and December 2025 through semi-structured individual interviews with adolescents diagnosed with leukaemia and their primary caregivers. Guided by Walsh's family resilience framework, data were analysed using thematic analysis incorporating an adapted framework method, which incorporated a dyadic analytic approach to examine shared and divergent perspectives. RESULTS: An overarching theme, 'Together but Overcrowded', was identified, which describes a contradictory state of family life shaped by leukaemia. Three specific predicaments in family resilience development were identified, including 'We Can Only See the Present: Long-term Planning Put on Hold', 'The Family Became a Small World: Separating the Internal from the External' and 'I Can, but You Cannot: Power Asymmetry'. In coping with illness, families developed an initial adaptive state, but long-term planning was put on hold, family boundaries became more closed and adolescent-caregiver power differences became more evident. CONCLUSION: The findings highlight the predicaments experienced and their specific manifestations by families of adolescents with leukaemia during the development of family resilience. These insights underscore the importance of addressing adolescents' developmental needs and family relationships when considering future efforts to support family resilience. IMPLICATIONS FOR NURSING PRACTICE: This study highlights the value of dyadic assessment of patients and caregivers in paediatric oncology nursing. The findings revealed predicaments in family resilience development and different needs between adolescents and caregivers within the Chinese cultural context. The study suggests developing family-centred support to address illness disclosure for adolescents and emotional support for caregivers. Such support may help families respond to barriers to family resilience development. IMPACT: Families of adolescents with leukaemia face unique predicaments that differ from those of families at other stages of the family life cycle, suggesting the urgent need for nursing support for adolescents' role development and family adaptation. REPORTING METHOD: The study adheres to the COREQ guidelines. PATIENT OR PUBLIC CONTRIBUTION: This study did not include patient or public involvement in its design, conduct or reporting.